Kimberly D. Acquaviva

Screening, Diagnosis, and Treatment of Depression in Patients with End-Stage Renal Disease

Depression is common in patients with end-stage renal disease and has been linked to increased mortality. Screening for depression in the general medical population remains controversial; however, given the high prevalence of depression and its significant impact on morbidity and mortality, a strong case for depression screening in patients with end-stage renal disease can be made. Several studies have been performed to validate the more common depression screening measures in patients with chronic kidney disease. The Beck Depression Inventory, the Hamilton Rating Scale for Depression, the Nine-Question Patient Health Questionnaire, and the Center for Epidemiologic Studies Depression Scale are some of the measures that have been used to screen for depression in patients with end-stage renal disease. Data suggest a higher Beck Depression Inventory cutoff score, of >14 to 16, will have increased positive predictive value at diagnosing depression in patients with end-stage renal disease. There are limited data on the treatment of depression in this patient population. Pharmacotherapy, including selective serotonin reuptake inhibitors, can be used if deemed clinically indicated, and no active contraindication exists. There are even fewer data to support the role of cognitive behavioral therapy, social support group interventions, and electroconvulsive therapy for treatment of depression in patients with chronic kidney disease. Larger randomized, controlled clinical trials aimed at the treatment of depression in patients with end-stage renal disease are desperately needed.

Validation of the Caregiving at Life’s End questionnaire

The researchers in this study developed and validated a questionnaire to measure the needs of end-of-life (EOL) caregivers. The model is used to facilitate meaningful and supportive experiences for both the patient and caregiver. The questionnaire was developed using existing scales of meaning, self-acceptance, burden, and gain as well as new scales of caregiver comfort, importance of caregiving tasks, and caregiver closure. The sample included 34 current and 17 bereaved caregivers affiliated with The Hospice Institute of the Florida Suncoast. The scales performed well in terms of concurrent validity, internal consistency, and reliability.

Perspective: are we teaching racial profiling? The dangers of subjective determinations of race and ethnicity in case presentations.

Physicians make subjective visual assessments concerning the race and/or ethnicity of their patients and document these assessments in patient histories every day. Medical students learn this practice through textbooks and the example set by their educators. Although physicians may believe that they are helping their patients, the practice of using visual clues concerning race and/or ethnicity to determine whether a patient is at risk of certain diseases lacks scientific rigor and may put the patient at significant risk of receiving substandard medical care. The authors argue that if the patients race or ethnicity is of critical importance, the data should be collected through more objective, scientifically rigorous means, such as genetic testing. In this article, the authors call for the widespread transformation of the way medical schools teach tomorrows physicians about the role of race and ethnicity in taking medical histories, and they challenge physicians to change their current practices.

State recognition of same-sex relationships and preparations for end of life among lesbian and gay boomers

The authors compared 793 nonheterosexual baby boomers on their relationship status (single or in a civil union) and the state in which they lived (did or did not recognize same-sex civil unions). Analyses revealed patterns attributable to participants’ relationship status, state recognition, and the combination of these variables. Findings showed that state recognition of same-sex unions has an impact not only on nonheterosexual individuals’ current quality of life but also on their future plans and emotional responses to those plans. A lack of legal recognition requires nonheterosexuals to take greater action to ensure that their end-of-life wishes will be carried out, and may lead to their having increased fears about late life.

Medical Student Perceptions of Self-Paced, Web-Based Electives: A Descriptive Study

Abstract A first-of-its-kind course at The George Washington University was taught entirely online using a self-paced, modular, case-based multispecialty format. Data on student perceptions of the course were obtained through a Web-based survey administered to students who had completed the course. Close-ended questions were analyzed using basic descriptive statistics in order to determine frequency of responses, whereas open-ended questions were analyzed thematically. Students reported having a favorable experience with the self-paced online course, with flexibility being the major benefit reported by respondents. Students in this asynchronous course perceived the two greatest challenges in online learning to be (1) decreased opportunity for social interaction and (2) technological barriers.

Using algorithmic practice maps to teach emergency preparedness skills to nurses

In 2004, The George Washington University received funding from the U.S. Department of Homeland Security to develop a web-based emergency preparedness course for nurses. The purpose of the course was to provide training that would be accessible regardless of work setting or location. In designing the course, the development team used algorithmic decision making as a conceptual framework to transcend the linear, didactic focus of traditional online preparedness training to provide learners with a learning experience crafted around the decision-making process. This article describes the design of the algorithmic practice maps underlying this course and provides a replicable structure for those interested in developing similar offerings for nurses.

Patient and Family Education and Advocacy

1. Explain how to assess knowledge of patient care and teach patient-care skills. 2. Explain how to assess knowledge and teach patients and caregivers about end-stage disease progression. 3. Explain how to assess knowledge and teach patients and caregivers about pain and symptom management. 4. Explain how to assess knowledge and teach patients and caregivers about medication management. 5. Explain how to assess knowledge and teach patients and caregivers about disposal of supplies. 6. Explain how to assess knowledge and teach patients and caregivers about the signs and symptoms of imminent death.

Psychosocial and Spiritual Issues

1. Describe psychosocial assessment, supportive techniques, and your role as an interdisciplinary/interprofessional team member in using them. 2. Describe emotional distress and strategies for assessing it. 3. List the developmental tasks involved in life completion and life closure. 4. Define despair, hope, and meaning in the context of chronic and life-limiting illness. 5. Describe a spiritual/existential assessment and your role as an interdisciplinary/interprofessional team member in conducting one. 6. Describe common experiences of distress around spiritual/ existential issues for patients and families facing chronic and life-limiting conditions.

Shared Decision Making and Family Dynamics

1. Describe how you can facilitate shared decision making among the patients and families you serve. 2. Explain the ethical imperative for shared decision making. 3. Describe the process of coordinating and facilitating a family meeting focused on shared decision making. 4. Explain the role of shared decision making in palliative sedation. 5. Describe how shared decision making may be made more challenging by family dynamics for LGBTQ individuals.

LGBTQ Inclusion: A Call to Action for Nurses.

International Journal of Palliative Nursing 2017, Vol 23, No 5