Issue link: https://beckershealthcare.uberflip.com/i/1058489
14 PATIENT EXPERIENCE Rush hospital nurse: Why providers should revisit how they discuss death with patients By Megan Knowles P roviders oen struggle to have open end-of-life discus- sions with critically ill patients, prompting a need for hospital leaders to reevaluate how nurses discuss death and dying, a nurse argued in an op-ed for e Hill. Here are six insights from the op-ed, written by Colleen Chierici, BSN, RN, a nurse at Rush Oak Park (Ill.) Hospital: 1. Ms. Chierici recalled when her mother was critically ill, she listened to an oncologist discuss the 30 percent chance her mother would respond to chemotherapy, but never said her mother was dying. "Would my family have chosen a different path for my mother, if there had been a more explicit conversation? Resoundingly, yes," Ms. Chierici wrote. "If my mother's healthcare providers would have had a deliberate discussion about her impending death, my family would never have chosen chemotherapy and instead chose to initiate hospice care." 2. Nurses have a duty to advocate for patients, Ms. Chierici said. "Advocating can take many forms, but most oen, it is helping pa- tients navigate the complexities of the healthcare system as well as explaining the meaning of test results, procedures and diagnoses." 3. But nurses across the globe, including Ms. Chierici, oen struggle to have explicit conversations about dying with their patients, she said. A study published in the International Journal of Nursing Studies surveyed acute care and critical care nurses to evaluate how they approach end-of-life discussions and found nurses' own knowledge and participation rates are low when it comes to end-of-life care. 4. On the other side of this issue is patients who may not be making a well-informed decision since they do not understand they are dying, Ms. Chierici said. "When the focus is shied from 'fighting to live' to 'death is imminent,' other care decisions can be made by these patients. ey can choose hospice care." 5. For nurses who struggle to have difficult discussions about death with patients and their families, Ms. Chierici recom- mended reviewing the End-of-Life Nursing Education Con- sortium project — a national education initiative for educating nurses on better end-of-life care that includes coursework on effective communication. 6. Hospital leaders may need to reevaluate how nurses are trained to have conversations about death and dying, Ms. Chierici concluded. "Have those who are experts at these discussions share their wisdom and teach nurses how to have these conversations in an empathetic and impactful way so that patients can receive the comfort and dignity of hospice care in a timely manner," she wrote. "If we can make these changes in our communication with patients and their families, perhaps one day we will all know when it is our time to die." n Viewpoint: How to turn '10 minutes into 20' with a patient By Mackenzie Bean F aced with "ever-shrinking time slots" for appointments, physicians must learn how to make the most out of the time they do have for face-to-face encounters with pa- tients, Suneel Dhand, MD, an internal medicine physician and author, wrote in an op-ed for Medpage Today. Dr. Dhand shared the following verbal and nonverbal tech- niques physicians can use to communicate effectively and still provide a positive patient experience in a short amount of time. Patients can pick up on a physician who is "visibly on edge and showing signs of being rushed," Dr. Dhand wrote. He said physicians should pay close attention to their facial expression, posture and hand gestures to ensure they are not giving off this impression. Physicians can also use various verbal techniques to trans- form "10 minutes into 20," according to Dr. Dhand. These strategies include offering patients uninterrupted talking time, using open-ended questions, practicing active listening and allocating time for a care summary at the end of the visit. "It's simply about seeking to give our patients the best pos- sible human experience within the constraints of our very fragmented and complex healthcare system," Dr. Dhand concluded. "The rewards for any doctor, both for your patients and your own job satisfaction, are immense." n Medical scribes linked to better patient experience, physician workflow By Megan Knowles T he use of medical scribes to track physician-patient en- counters in real time for primary care visits was linked to significant reductions in EHR documentation time and improvements in physician productivity and job satisfac- tion, a study published in JAMA Internal Medicine found. Eighteen primary care physicians were randomly assigned to start the first three-month period with or without scribes and then had alternated exposure to scribes every three months for one year. The physicians completed a survey at the end of each study period. The researchers also surveyed patients of participating primary care physicians after scribed clinic visits. Compared with periods that were not scribed, scribed pe- riods were linked to less after-hours EHR documentation by physicians. The study found scribed periods were also linked to a higher likelihood that a physician would report spending more than 75 percent of the visit interacting with the patient. "Our results support the use of medical scribes as one strategy for improving physician workflow and visit quality in primary care," the researchers wrote. n