Nursing Care at the End of Life

by Susan E. Lowey, associate professor at The College at Brockport Nursing Care at the End of Life: What Every Clinician Should Know should be an essential component of basic educational preparation for the professional registered nurse student. Recent studies show that only one in four nurses feel confident in caring for dying patients and their families and less than 2% of overall content in nursing textbooks is related to end-of-life care, despite the tremendous growth in palliative and end-of-life care programs across the country. The purpose of this textbook is to provide an indepth look at death and dying in this country, including the vital role of the nurse in assisting patients and families along the journey towards the end of life. There is an emphasis throughout the book on the simple, yet understated value of effective interpersonal communication between the patient and clinician. The text provides a basic foundation of understanding death and dying, including a brief historical examination of some main conceptual models associated with how patients cope with impending loss. An overview of illness trajectories and models of care, such as hospice and palliative care are discussed. Lastly, the latest evidence-based approaches for pain and symptom management, ethical concerns, cultural considerations, care at the time of death, and grief/bereavement are examined. The goal of this text is to foster the necessary skills for nurses to provide compassionate care to individuals who are nearing the end of life and their families. Every chapter contains a “What You Should Know” section which highlights and reinforces foundational concepts.https://digitalcommons.brockport.edu/bookshelf/1426/thumbnail.jp

Is Social Licence A Licence To Stall?

The School of Public Policy at the University of Calgary organized a one-day symposium on Oct. 8, 2014 in Calgary, as part of the School’s TransCanada Corporation Energy Policy and Regulatory Frameworks Program. The symposium was titled “Is Social License a License to Stall?” Held at the Hotel Arts, the event attracted a full-capacity audience of about 110 people, including representatives from industry, government and environmental non-government organizations. The symposium included four moderated panel sessions and a keynote speaker at lunch. The School of Public Policy set the framework for discussion at the Calgary symposium with the following description: Canada’s regulators act in the public interest to review energy and infrastructure project applications. Regulators are guided by procedural fairness and follow a transparent application, review and hearing process with data filings and sworn testimony. But that’s changing. “Social license” is a relatively new term, which some interests are using to create a different standard for the approval of projects — especially energy projects. According to social license advocates, projects must meet often ill-defined requirements set up by non-governmental organizations, local residents or other interests — a new hurdle for project approval, but without the rigour and rule of law of a regulator. Is social license a meaningful addition to the regulatory process, or is it being used as a constantly moving goal-post designed to slow down regulatory processes, delay project implementation, frustrate energy infrastructure expansion and even enrich those advocates who promote it as a new model? This paper summarises the discussion and the themes that emerged throughout the day. Most notably, panellists concluded that “social licence” is a real and significant issue that presents both an opportunity and a problem, not only for regulators but for all parties involved in the regulatory process

Taking Reasonable Doubt Seriously

In recent years, we have discovered a spate of factually innocent people who have been convicted. In this article, Professor Loewy contends that the failure of juries to take reasonable doubt seriously contributes to this phenomenon. Professor Loewy via an illustrative fictitious case explains that juries might be reluctant to give the defendant the benefit of a reasonable doubt because of their concern about putting dangerous criminals back on the street. He then asks whether we really want juries to take reasonable doubt seriously. Concluding that we do, he examines how we can do that. Loewy concludes that the best way to that is with a jury instruction that sharply distinguishes proof beyond a reasonable doubt from clear and convincing evidence. Only if the jury really understands that dichotomy is it likely to understand that it cannot convict merely on clear and convincing evidence. The article suggests an instruction that would accomplish this purpose. The author concludes that while this instruction is not constitutionally mandated, it is constitutionally permissible and should be adopted

Nursing Care at the End of Life: What Every Clinician Should Know

Nursing Care at the End of Life: What Every Clinician Should Know should be an essential component of basic educational preparation for the professional registered nurse student. Recent studies show that only one in four nurses feel confident in caring for dying patients and their families and less than 2% of overall content in nursing textbooks is related to end-of-life care, despite the tremendous growth in palliative and end-of-life care programs across the country. The purpose of this textbook is to provide an indepth look at death and dying in this country, including the vital role of the nurse in assisting patients and families along the journey towards the end of life. There is an emphasis throughout the book on the simple, yet understated value of effective interpersonal communication between the patient and clinician. The text provides a basic foundation of understanding death and dying, including a brief historical examination of some main conceptual models associated with how patients cope with impending loss. An overview of illness trajectories and models of care, such as hospice and palliative care are discussed. Lastly, the latest evidence-based approaches for pain and symptom management, ethical concerns, cultural considerations, care at the time of death, and grief/bereavement are examined. The goal of this text is to foster the necessary skills for nurses to provide compassionate care to individuals who are nearing the end of life and their families. Every chapter contains a “What You Should Know” section which highlights and reinforces foundational concepts.https://knightscholar.geneseo.edu/oer-ost/1011/thumbnail.jp

Taking Reasonable Doubt Seriously

In recent years, we have discovered a spate of factually innocent people who have been convicted. In this article, Professor Loewy contends that the failure of juries to take reasonable doubt seriously contributes to this phenomenon. Professor Loewy via an illustrative fictitious case explains that juries might be reluctant to give the defendant the benefit of a reasonable doubt because of their concern about putting dangerous criminals back on the street. He then asks whether we really want juries to take reasonable doubt seriously. Concluding that we do, he examines how we can do that. Loewy concludes that the best way to that is with a jury instruction that sharply distinguishes proof beyond a reasonable doubt from clear and convincing evidence. Only if the jury really understands that dichotomy is it likely to understand that it cannot convict merely on clear and convincing evidence. The article suggests an instruction that would accomplish this purpose. The author concludes that while this instruction is not constitutionally mandated, it is constitutionally permissible and should be adopted

A Green Process for Niacinamide Production

This project proposes a plant in which niacinamide can be produced with an environmentally green process. Specifically, it takes 2-methyl-1,5-pentanediamine (MPDA) as a starting reactant and converts it to picoline before subsequently converting it to niacinamide and purifying the final product. By following this particular reaction path, the process avoids the more classic method of preparation by which nicotine is oxidized with potassium dichromate, a reaction with considerably more toxic reactants and waste. Along with this more sustainable reaction path, care was taken to ensure the process was as green as possible at each step along the way. The primary global supplier of niacin is Lonza, whose patent provided the base upon which this process was developed. Only preliminary data was furnished by the patent; the majority of the process presented within this portfolio was developed with limited information from the patent reference. The base-case process presented in this project consists of three main sections; Block 100 involves the conversion of MPDA into picoline, Block 200 involves the formation of niacinamide from picoline, and Block 300 involves the separation and purification of the niacinamide into the final marketable product. A final purity of 97.7% by weight was achieved. Rigorous economic analysis was performed on the entirety of the process, yielding an NPV of $4,932,800 after 20 years and an internal rate of return (IRR) of 16.82% after the third year. Although each of these indicate a positive return on investment, as the economic success of this process is highly subject to the market value of both the feedstock MPDA and product niacinamide, further investigation may be necessary before final project approval

Association among age, sex, and geographical region with health care utilization through the Ontario telemedicine network

The Ontario Telemedicine Network (OTN) facilitates virtual health care services across all of Ontario. Founded in 2006, OTN has allowed patients to access specialized care that was once only accessible in urban settings.1 The services that the services that OTN facilitates has impacted the health and quality of life of hundreds of thousands of residents in the province. It has been suggested that telemedicine decreases the patient’s need to travel long distances to receive appropriate health care.2,3 Traveling to medical appointments is time-consuming and poses many safety risks to those residing in Ontario, particularly for northern and rural residents.2,3 Further, it can create issues of inequity (e.g., vehicle ownership), social disruption, and anxiety in the populations who must travel to seek health care. A lack of public transportation is another reason why patients and providers may choose to use telemedicine over in-person services.4,5 The use of telemedicine services in the Ontario population is not well understood. Specifically, it is unknown how telemedicine service utilization varies between men and women, and among various age groups. It is also unknown how utilization rates within these age and sex groups differ by patient geography; and particularly in older adults, where there is growing familiarity and comfort with telemedicine technologies. To fill this knowledge gap, more research is needed to understand how telemedicine can be used to help older adults, especially those with chronic health conditions.6 Thus, my thesis sought to determine what telemedicine services are utilized through OTN. More specifically, administrative billing data from April 2008 to March 2015 were analyzed to determine what age and sex groups are using telemedicine services most frequently and to further investigate these population utilization rates in a rural and urban context. This study is the first to examine the associations among age, sex and utilization of OTN services. The results show which OTN therapies were most sought out by Ontario patients in different age and sex groups and how utilization rates vary by region and rurality. This study also examined whether telemedicine in Ontario is targeting particular demographics (i.e., if a clinical service area is being utilized by a particular age, sex, or regional group). Through dissemination and knowledge translation, this study hopes to inform rural, northern policy and decision-makers on the OTN utilization patterns of men and women in different age groups, and potentially providing justification on how funding resources should be allocated to improve the specialized health care services that are most needed in the community