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Alex 01:27 We’re delighted to welcome back Tim F a rrell, who’s a geriatrician, associate chief for Age Friendly care at the University of Utah and chair of the American Geriatric Society Ethics Committee. All right, and finally we have Yael Zweig, who is a geriatricnurse practitioner at NYU. Thanks for having me.
This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. I’m going to turn to you Lauren.
Alex: We are delighted to welcome to the GeriPal podcast, Susan Hickman, who is professor at the Indiana University schools of nursing and medicine, and is director of the IU Center for Aging Research at the Regenstrief Institute. I have done a lot of work on POLST and nursing homes and I’ve seen POLST forms. Who are they?
Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
And that helped them focus on that instead of, say, the blood pressure, the vasopressors or the ventilator settings that day. And then they had to be receiving 48 hours of continuous mechanical ventilation at a minimum and be an adult. Eric: And how did you do that? There were nine disease categories. Eric: Okay.
For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursing homes. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl’s GeriPal post on appropriate use of POLST Enjoy!
In the US, geriatrics “grew up” as an academic profession with a heavy research base. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. . You’re not hiring a bunch of social workers or nurses or docs to do it. Kate: Yeah, the nursing homes.
I’d be willing to take some time on a mechanical ventilation machine to live longer.” And so the idea that patients are walking around with these on their shoulder like, “Hey, I got the mechanical ventilation preference, just want to make sure.” ” Because I’m like, “Yeah, to what end?
Their oxygenation, while important, whether or not we can take them off the ventilator, probably has nothing to do with the big picture, oh, and they’re dying of metastatic pancreatic cancer. I think we use VitalTalk and we use SPIKES and NURSE and the REMAP. It may not be the big, big problem if you take a big step back.
And that’s not so much an instrumental value argument because once they’ve been in the trial, unlike with your docs and nurses, it’s not to try to get them to be in future trials or something so much as it is to recognize that past contribution, so I think that’s another example. Emily: Yeah.
Today we talk with Fayron Epps and Karen Moss, two nurse researchers who are focused on improving the experience of Black/African American caregivers of persons living with dementia. Why are nurse researchers in particular critical to the study of these issues? You both are nurse leaders who are doing this unique work out there.
Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
And yet, when the reality of breathing difficulties, BIPAP, the talks of tracheostomy and ventilators set in, what had seemed so clear on that piece of paper, no longer seemed so clear. And a lot of that work and effort has now been shifted onto a family who’s having to be doctors and nurses around the clock. Alex: Yeah.
Nurses don’t always find the exact specialty that fuels their passion when they start out on a nursing path. Career opportunities and connections brought her to work as a poison control nurse, and Reid realized she found her place. Here, she shares some of her story about being a poison control nurse with Minority Nurse.
Alex 00:54 And Jasmine Santoyo-Olsson, who’s a social behavioral scientist and a fellow in the T32 Research Fellowship at the UCSF Division of Geriatrics. A lot has changed, but what motivated the study was a recognition that most advanced care planning interventional research had been undertaken in nursing homes.
So legally dead in California, family moved to New Jersey, where she was kind of alive despite having a death certificate for another four years, and then died four years later after being actually home on a ventilator for a while, too, we talked more about that with the Bob Truog podcast. So I was called out by the nurses.
“Imagine that you are the medical director of a large (>150 bed) nursing home. The other physicians who previously saw patients in the nursing home are no longer coming to your facility because you have COVID positive patients. You’re short on nurses and nurse aids so now you have to help deliver meals.”.
We really tried to be very broad and were receiving mechanical ventilation for at least 48 hours continuously. And I would actually start putting things like nudges on this issue, nudges on mechanical ventilation, decisions for liberation, for example. Pretty much every organ system. It had to really think through. Thank you everyone!
We did the Geriatric 5M approach to telemedicine with Lauren Mo. And then of course the pandemic hit and then everyone had to do telemedicine, whether it was inpatient, outpatient, you were at a skilled nursing facility and so forth. Brooke: I feel like you’re getting better year after year, so good. Alex: Hope so.
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