If this has already been asked, I apologize. I could not find a thorough post. Any recommendations/advice/comments (good or bad) would be really appreciated!
Does anyone have any advice on an ICU clinical rotation? Or advice on working as a PA in ICU/critical care? Any recommendation on books/resources to use as a student on rotation? Any current or previous ICU/critical care PA: is it difficult to find a job in ICU/critical care? Is a fellowship recommended or required?
In this day of selivering bad news, I thought that this article that I saved from last year would be a great refresher. Food is food regardless of the source.
The Rules for Delivering Bad News to Patients
August 27, 2019
The Watercooler: Career Advice
The Bookbag: Education
The Rounds: Clinical Considerations
I've talked to some colleagues recently who've been a little down about their roles as nurse practitioners. Working in family practice, they have found themselves in the position of delivering bad or upsetting news to their patients. Cancer diagnoses were fortunately made rather than missed, but letting a patient know they've got a serious, life-altering illness or condition is tough, not to mention, this is not something most of us as NPs learn to do in school.
Have you ever found yourself in the position of delivering difficult news to patients? How did you feel? Having such conversations as nurse practitioners can make us anxious or awkward. Some of us approach these discussions emotionally while others appear detached and robotic in their delivery of the news. Delivering bad news is an unavoidable part of our jobs as nurse practitioners but that doesn't mean we get used to it. Fortunately, however, conducting serious conversations is a skill that can be learned and there are many guidelines out there to help healthcare providers hone this skill set.
Rule #1: Know what constitutes bad news
Sometimes I share information with a patient that I perceive as not a big deal. Then, the patient starts to freak out. Or cry. Or to have some other sort of emotional reaction that I didn't anticipate. Bad news doesn't have to be a terminal diagnosis. It can be related to anything surrounding a diagnosis such as timing, personal or professional consequences. Breaking a metatarsal and wearing a boot, for example, may not be too bad in the grand scheme of things, but breaking your foot the day before your wedding is pretty disappointing.
Rule #2: Full disclosure is best
In the past, healthcare providers operated on a more guarded front. In the 1800's, for example, the American Medical Association even encouraged physicians to avoid sharing news that discouraged patients. Today, however, studies (not to mention ethics!) show that most patients prefer full disclosure. It's our duty as nurse practitioners to share up-front, honest information rather than sugar coat our delivery with excessive optimism, withhold details, or give false hope. Share news with the patient directly rather than directing it toward family members. Honest, trustworthy information is empowering!
Rule #3: Prepare yourself
Anticipate the conversation you're about to have with your patient. You may even wish to practice your delivery with a colleague. Prepare yourself to feely badly as you share the news. And, don't forget that silence is OK. Avoid the temptation to fill gaps in your conversation rather let the patient process and take the time to formulate questions.
Rule #4: Frame the conversation
Framing the news you're about to share is essential. Your patient may or may not be expecting to hear something difficult. And, the way you set up your conversation has an impact on the patient's reaction. Using the word "serious" (ex. "I have some serious news to share...") is better than using the word "bad". "Serious" creates a more constructive framework that inspires action and empowerment as opposed to the word "bad" which indicates the situation is helpless. Even if you're delivering a terminal diagnosis, your patient can choose how to react and what steps they wish to take in response.
Rule #5: Think SPIKES
There are a few well-known methods for delivering serious news to patients, my favorite of which is the SPIKES method. This algorithm lays out considerations for nurse practitioners and other healthcare providers in these situations. Here's the SPIKES protocol:
Setup - Think through the conversation you're about to have, anticipating questions the patient might ask beforehand. Prepare for an emotional reaction. Gather any necessary resources that might be helpful for the patient.
Perception - Gauge the patient's understanding and perspective on the news you have shared. This is best accomplished by asking questions like "What did you take away from what I just shared with you?" or "What are your expectations of treatment?". This way you know you are both on the same page as far as understanding the medical outlook, next steps and goals.
Invitation - Encourage the patient to think further about their care going forward. Find out how much information the patient wants about his or her medical condition as well as who he/she would like to be included in decision making such as family members.
Knowledge - This step has to do with how you as a provider deliver information. The best practice is to deliver the headline first, followed by the details. Communicate using language that matches the patient's level of education and medical knowledge. Be direct in your delivery, avoid skirting the main message.
Empathy - Understandably, patients get emotional about serious news. Anticipate such a reaction and display empathy. Naming the patient's emotions can help. Asking "Can you tell me more about what you mean by that?" will also help you determine how the patient feels about the situation.
Summarize and Strategize - Make a plan for the next steps in both treatment and communication with your patient. Express support and encourage the patient to tell friends and family the news to develop a personal support system. Talk about how the patient can act on this news to accomplish his or her treatment and lifestyle goals going forward.
Have you ever delivered bad news to a patient? How did it go?
This course is designed to be a "scan and surf" adventure with the education ending at 2 pm each day so participants have time to enjoy the location. With so much to do in Huntington Beach and the hotel offering a Beach Amenities Program, the SEMPA Ultrasound Course is the perfect balance of education and fun!
The course will provide point-of-care ultrasound training to physician assistants working in emergency medicine. Didactic sessions will focus on concise, useful information, images, and video. Most importantly, participants will have the opportunity to learn the necessary skills through hands-on teaching and practice on models under the guidance of experienced faculty and sonographers.
Upon completion of this program participants should be able to:
List the standard views or “windows” for each of the six primary areas of emergency ultrasound - trauma, aorta, biliary, cardiac, pelvic and procedural applications Accurately interpret point of care ultrasounds Demonstrate the standard views or “windows” for each of the six primary areas of emergency ultrasound - trauma, aorta, biliary, cardiac, pelvic and procedural applications Limited to 50 participants 1:5 faculty to student ratio Hands-on scanning of live models Simulation technology incorporated Lots of practice time Earn CME towards your EM-CAQ Faculty from emergency ultrasound fellowship programs Learn the core applications to emergency ultrasound Meals included Time to enjoy all Huntington Beach has to offer For more information and to register:
I'm curious if anyone has recommendations for a question bank to help learn critical care medicine? I'm a relatively new PA (graduated in May 2018) and have been practicing in critical care for about a year now. I work in a 26 bed mixed ICU at a community hospital. I've been reading the Washington Manual of Critical Care, Marino's ICU Book, and Up-to-Date. I've also done the Critical Care board review course offered by the SCCM. I'd like to find a question bank that I can use to test my critical care knowledge as well as general adult medical knowledge.
I used ROSH review to study for the PANCE and really liked it. I used the app on my phone and was able to answer questions throughout the day and found it easy to answer a few questions here and there without having to dedicate exclusive study time. I'd like to find something with an equivalent ease of use but ROSH doesn't have any questions geared specifically towards CCM. ROSH does have IM and EM question banks consisting of ~ 1000 questions geared towards residents which I've considered as an option. ROSH also has the NCCPA Hospital Medicine CAQ question bank for Hospitalist PAs that I've considered. Additionally, it seems that CHEST SEEK Critical Care Medicine and the SCCM Self-Assessment Multiprofessional Critical Care are used frequently by CCM fellows who are studying for the CCM Boards. I fear that these latter resources may be too dense for my understanding at this point.
So... My hope is that someone out there has some insight into these (and other) question bank resources and can help guide my decision before dropping hundreds of dollars. I appreciate any help or suggestions.
SEMPA Ultrasound Courses
November 8-10, 2019
Huntington Beach, CA
January 27-28, 2020
The SEMPA Ultrasound Courses will provide point-of-care ultrasound training to physician assistants working in emergency medicine. Didactic sessions will focus on concise, useful information, images, and video. Most importantly, participants will have the opportunity to learn the necessary skills through hands-on teaching and practice on live models under the guidance of experienced faculty.
Due to the popularity of this course, we will be offering two courses this winter.
Choose the course that works best for you and register today!