Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4 week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

Race-ethnicity and poverty after spinal cord injury

Objective

Our objective was to examine the relationship between race-ethnicity and poverty status after spinal cord injury (SCI).

Study Design

Secondary analysis of existing data.

Setting

A large specialty hospital in the southeastern United States (US).

Methods

Participants were 2,043 adults with traumatic SCI in the US. Poverty status was measured using criteria from the US Census Bureau.

Results

Whereas only 14% of non-Hispanic White participants were below the poverty level, 41.3% of non-Hispanic Blacks were in poverty. Logistic regression with three different models identified several significant predictors of poverty including marital status, years of education, level of education, age, and employment status. Non-Hispanic Blacks had 2.75 greater odds of living in poverty after controlling for other factors, including education and employment.

Conclusions

We may need to consider quality of education and employment to better understand the elevated risk of poverty among non-Hispanic Blacks in the US.

Adapting the Neuman systems model for family nursing

Family nursing is in the early stages of development, and there is often difficulty in translating nursing conceptual frameworks into terms that are less abstract and more readily usable in the family practice arena. Yet the conversion of abstract ideas to concrete descriptions is necessary if nursing theory-based practice is to expand. This article describes the client system known as family within the Neuman systems model. Based on clinical data and the experience of nurses using the Neuman model in practice, a description of the family as client is developed. The five variables of Neuman's model are identified and the terms used in describing the family system are clarified. A rationale for the application is also presented.

The effects of gestational age and pregnancy planning status on obstetrical nurses' perceptions of giving emotional care to women experiencing miscarriage

Obstetrical nurses (N = 292) were surveyed regarding the influence of gestational age and pregnancy planning on nurses' emotional care for women who had experienced miscarriage. Three measures of emotional care were used as the dependent variables: emotional seriousness, priority of care and emotional support. Both gestational age and whether the pregnancy was planned or unplanned had a significant effect on the nurses' perceptions of emotional seriousness and priority of care. Planning status was significant in the nurses' perception of emotional support.