Objective: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. Methods: We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital’s electronic medical records system. Results: Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief. Conclusion: The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.
Background: Mentoring in Palliative Medicine is critical to training, career satisfaction and professional development. Yet, there are no accounts of effective mentoring programs in Palliative Medicine. This gap is attributed to a failure to define mentoring practice and a lack of acknowledgment of mentoring's context-specific, goal-sensitive, mentee-, mentor-and organizational-dependent nature that has hindered effective review of mentoring programs.
Provision of end of life care and coping with the emotional and existential distress engendered by palliative care demands the provision of holistic support and training for palliativists. Mentoring is an effective means of meeting this need; however little is known of mentoring in palliative care and a universally accepted learning theory of mentoring remains lacking in this setting. To advance mentoring practice in palliative care, we review the only two evidenced based mentoring theories based upon narrative reviews of mentoring practice in the key specialties within palliative care teams.Building upon mentoring's mentee, mentor and organizational dependent, goal specific, context sensitive features highlighted in both recent reviews of mentoring this paper proffers a working theory of mentoring. Constructed Krishna's Mentoring Pyramid that underlines the 5 core elements of successful mentoring programs, we propose melding elements of the cognitive apprenticeship model with the adult learning theory using the multi-theories model of adult learning offers an effective starting point for a mentoring theory.More context-specific studies are needed to provide better insight into the validity of this framework in the ongoing pursuit of an interprofessional mentoring theory in Palliative Medicine.
Objective: Key to effective Palliative Care is interdisciplinary collaboration and holistic support of members of the multidisciplinary team. Mentoring is increasingly seen as being a critical facet of this process however; there is a dearth of guidance on establishing such a program within the Palliative Care setting. To fill this gap, this review analyzes mentoring programs in medicine, surgery, nursing and social work in order to identify key elements and common facets of successful mentoring programs that can be used to create a multi-professional mentoring program in Palliative Care.
Methods:A review of systematic review of undergraduate and postgraduate mentoring programs in medicine, surgery, nursing and social work involving senior clinicians and junior doctors and/or medical students.Results: A total of 20 reviews were included. One review was on mentoring in medicine and nursing, 10 in medicine, 4 in surgery and 5 in nursing. There were no reviews of mentoring in social work. Thematic analysis revealed 3 themes, which were definition of mentoring, components of a mentoring approach and elements of the mentoring process Conclusion: Despite its context sensitive, goal specific and mentee-and mentor-dependent features, common features in mentoring in medicine, surgery and nursing lay the foundation for a learning theory of interprofessional mentoring that can guide construct effective mentorship programs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.