Defining Your Conflict Management Style

Wit, Wisdom, and Hard Work Make a Model Medical Director of the Year

Is There a Role for Herpes Zoster Vaccine in Chronic Pain Management?

PurposeThis paper aims to reveal the effects of birth order in decision-making style, conflict handling style and propensity for participative decision-making. The intention is to open the perspective of birth order research in organizational studies, as an important individual difference of managers.Design/methodology/approachA survey was conducted with 230 managers from different industries in Kosovo. Self-report measures were used for decision-making style, conflict handling style and participatory decision-making constructs.FindingsResults indicate that only children are more avoidant and spontaneous decision-makers. Firstborns are rational in decision-making and prefer problem-solving in conflict handling. Middleborns are intuitive decision-makers and use compromising in conflict handling. Lastborns make decisions rationally and use both compromising and problem-solving in conflicting situations. In addition, lastborns appeared to have a more positive attitude toward participative decision-making, followed by middleborns, firstborns and only children.Research limitations/implicationsBirth order affects managers’ behaviors in decision-making and conflict situations. Relationship dynamics in sibships are reflected in organizational settings, affecting how people behave in decision-making and conflict handling.Originality/valueTo the best of the authors’ knowledge, this is the first study to attest how birth order influences the ways managers make decisions, handle conflicts and involve others in decision-making. As birth order cannot be changed, such knowledge is critical.

Background: To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude, and practice about palliative care. Lack of knowledge about palliative care, negative attitudes towards it, as well as gaps in evidence-based practice among nurses, are some of the most common obstacles to quality palliative care. Methods: To collect data, a cross-sectional questionnaire was administered to 565 nurses working in primary health care organisations in Astana, Kazakhstan. Data collection was completed from January 2022 to March 2023. The questionnaire contained demographic and professional characteristic questions, the Palliative Care Quiz for Nurses (PCQN), the Frommelt Attitudes Towards Care of the Dying (FATCOD), and the Evidence-based Practice Questionnaire (EBPQ). Descriptive statistics, independent t-tests, and one-way ANOVAs were used for analysis. Results: The sample size was 565 nurses. Nurses’ palliative care knowledge level was low (mean score: 9.06±2.93). The largest number of the correct answers on the PCQN questionnaire was received in the category "Management and control of pain and other symptoms" (49.95%). The majority of nurses (93%) have a neutral or negative attitude towards caring for dying patients (mean score: 94.50±12.41). Only 6.7% of respondents had a positive attitude. The obtained score (4.39 ± 1.05) on the EBPQ scale indicates an average level of competence in evidence-based practice. Age, work experience, educational level, attendance at palliative care training, and good competencies in evidence-based practice are statistically significant factors that affect knowledge of palliative care. The aspect of knowledge/skills in EBP is the most significant (β=0.122; p=0.005). Conclusions: An insufficient level of nurses' knowledge about palliative care and a neutral or negative attitude towards caring for dying patients was revealed. Health care providers are encouraged to expand palliative care-related training programs, which together can improve the quality of palliative care nursing services for patients. The results also indicate that much attention, and resources should be directed to improving the level of knowledge of nurses in the field of evidence-based practice, because this aspect significantly affects the level of knowledge on palliative care. Implications for research, policy, and practice: Further research is needed to identify the factors contributing to nurses' inadequate knowledge of palliative care, including gaps in training and cultural or systemic barriers. Policymakers should develop national frameworks for palliative care training and certification, while healthcare institutions should regularly assess and enhance nurses' knowledge through continuous professional development. What is already known about the topic Most nurses do not receive training in palliative care. The benefits of using evidence-based medicine in palliative care are described. The most common barriers to providing quality palliative care have been described many times. What this paper adds Primary care nurses have insufficient knowledge of palliative care. Primary care nurses have a negative or neutral attitude towards palliative care. The use of evidence-based medicine by nurses contributes to the formation of a high level of knowledge about palliative care and a positive attitude towards it.

ORLANDO, FL — The Society House of Delegates (HoD) passed several significant resolutions and white papers at its recent meeting. “It was an incredibly productive and interesting meeting. We made tremendous progress on several key issues within a limited time frame,” said 2015–2016 HoD Chair Milta Little, DO, CMD. “The issues addressed — and the items passed — highlight the amount of public policy work that is being done and what additional work the Society is being asked to do. There is a big push on public policy efforts, and that will be a key part of HoD efforts in the year ahead,” said Dr. Little. Among the policy-related resolutions: •%Ensuring Appropriate Risk Adjustment Prior to Implementation of Value-Based Purchasing (B16): This directs the Society to work with stakeholder organizations and federal agencies to require the Centers for Medicare & Medicaid Services to clearly define risk stratification indices and develop a cost-to-risk algorithm. This algorithm is to be based on previous utilization data and will incorporate unique patient characteristics including age and frailty.•%Reimbursing Physician Practices for Administrative Costs of VBP Programs (C16): This directs the Society to work with the American Medical Association and other interested parties to seek legislative action modifying the CMS value-based purchasing regulations to ensure that all eligible professionals who participate in the VBP programs receive appropriate compensation on their Medicare charges for the attributed population and for added administrative costs.•%Support for the End of the Meaningful Use Program by CMS (I16): This calls for the Society to seek legislative and regulatory action to remove PA/LTC patient encounters from the Meaningful Use program. This would include any future iterations of Meaningful Use under the Merit-Based Incentive Payment System, until such time that interoperable certified technology is widely available in these settings. It also directs the Society to work with appropriate stakeholders to incentivize health information technology systems that support the interoperability, continuity of care, and care coordination specific to PA/LTC residents. The HoD also passed two resolutions about establishing specialty of post-acute and long-term care medicine that call for the Society to work with CMS to seek full recognition of PA/LTC medicine as a medical specialty and engage American Board of Medical Specialties to prepare for this recognition. The HoD also passed three white papers on the following topics: •%Capacity for Sexual Consent in Dementia in Long-Term Care (A16)•%Dementia Care in Transitions (M16)•%Post-Acute and Long-Term Care Population Served (N16) Suzanne Gillespie, MD, RD, CMD, 2016–2017 HoD chair, noted that the topics addressed “reflect the diversity of our membership and the issues that affect and interest us all.” She was impressed by the level of knowledge demonstrated by House delegates and the “robust dialogue that took place on the various topics.” For details about the white papers and resolutions passed by the HoD, go to http://www.paltc.org/papers?type=All&topic=All. Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for the Society and other organizations.

Best Practices for Increasing Compassion Resiliency and Moral Wellness in Post-Acute and Long-Term Care Settings

Successful conflict resolution is vital for effective teamwork and is critical for safe patient care in the operating room. Being able to appreciate the differences in training backgrounds, individual knowledge and opinions, and task interdependency necessitates skilled conflict management styles when addressing various clinical and professional scenarios. The goal of this study was to assess conflict styles in anesthesiology residents via self- and counterpart assessment during participation in simulated conflict scenarios. Twenty-two first-year anesthesiology residents (first postgraduate year) participated in this study, which aimed to assess and summarize conflict management styles by 3 separate metrics. One metric was self-assessment with the Thomas-Kilmann Conflict Mode Instrument (TKI), summarized as percentile scores (0%-99%) for 5 conflict styles: collaborating, competing, accommodating, avoiding, and compromising. Participants also completed self- and counterpart ratings after interactions in a simulated conflict scenario using the Dutch Test for Conflict Handling (DUTCH), with scores ranging from 5 to 25 points for each of 5 conflict styles: yielding, compromising, forcing, problem solving, and avoiding. Higher TKI and DUTCH scores would indicate a higher preference for a given conflict style. Sign tests were used to compare self- and counterpart ratings on the DUTCH scores, and Spearman correlations were used to assess associations between TKI and DUTCH scores. On the TKI, the anesthesiology residents had the highest median percentile scores (with first quartile [Q1] and third quartile [Q3]) in compromising (67th, Q1-Q3 = 27-87) and accommodating (69th, Q1-Q3 = 30-94) styles, and the lowest scores for competing (32nd, Q1-Q3 = 10-57). After each conflict scenario, residents and their counterparts on the DUTCH reported higher median scores for compromising (self: 16, Q1-Q3 = 14-16; counterpart: 16, Q1-Q3 = 15-16) and problem solving (self: 17, Q1-Q3 = 16-18; counterpart: 16, Q1-Q3 = 16-17), and lower scores for forcing (self: 13, Q1-Q3 = 10-15; counterpart: 13, Q1-Q3 = 13-15) and avoiding (self: 14, Q1-Q3 = 10-16; counterpart: 14.5, Q1-Q3 = 11-16). There were no significant differences (P > .05) between self- and counterpart ratings on the DUTCH. Overall, the correlations between TKI and DUTCH scores were not statistically significant (P > .05). Findings from our study demonstrate that our cohort of first postgraduate year anesthesiology residents predominantly take a more cooperative and problem-solving approach to handling conflict. By understanding one's dominant conflict management style through this type of analysis and appreciating the value of other styles, one may become better equipped to manage different conflicts as needed depending on the situations.

The value of alleviating suffering and dignifying death in war and humanitarian crises

In clinical practice, pharmacists are continually required to improve their knowledge and expertise; however, the postgraduate education system for professional development cannot be confidently stated to be well established. The establishment of a systematic and multifaceted educational curriculum should be useful to improve home care and pharmacists' contribution; therefore, we developed a curriculum in collaboration with the university faculty of pharmaceutical sciences, department of pharmacy in hospital, and the Fukuoka Pharmaceutical Association. Class topics were extracted from the "Kanwa-Iryou-Yakugaku", edited by the Japanese Society for Pharmaceutical Palliative Care and Sciences. The items are necessary to perform palliative care as a pharmacist. A class schedule of 6 days (24 classes in total) was formulated. Questionnaires on comprehension degree before and after each class were provided to the participants. Comprehension was assessed on a scale of 1 to 10, where "I do not understand at all" was 1 and "I understand enough" was 10. The average recovery rates of questionnaires from each class were 92.6 % and 88.9 % before and after class, respectively. The average number of participants who completely answered the questionnaire before and after class was 45.6; therefore, these data were analyzed. Comprehension degree on each topic had significantly increased after attendance of all classes (p < 0.01). The comprehension degree of participants of the medical science of palliative care did greatly improve. Consequently, it is clear that the standard education model constructed was meaningful for the professional development of pharmacists in palliative care medicine.

The role of palliative care in pediatric critical care medicine is described, with a focus on communication practices, complex chronic medical disease, end-of-life care, and moral resiliency. Palliative care medicine has an increasing presence in pediatric critical care medicine. The model for delivering quality palliative care from a primary to consultative role is evolving, as increasing numbers of patients and families benefit from this additional layer of care and advocacy. Palliative care medicine is complementary care at all levels and focuses on collaborating with families and patients by understanding values, contextualizing the traumatic nature of their experiences, and communication through shared decision-making. Enhancing and strengthening palliative care skills of pediatric intensive care unit (PICU) clinicians will provide one possible mechanism for addressing moral distress. Palliative care is an essential component of comprehensive care for our patients and families facing critical and life-threatening illness of any severity or prognosis. It augments and complements intensive care treatments, and it is based on need, not prognosis or outcome.

When I call, state chapter leaders wonder if they really want to answer their phones. “Yes, it’s Mary Evans calling, asking that you please do your utmost to join me in not only evangelizing about the Foundation for Post-Acute and Long-Term Care Medicine’s Futures Program, but also that you raise money and send a check.” They usually answer, I think, because our chapter leaders understand that we are all working to recruit the next generation of medical directors and that Futures is a gateway to achieving that. Some forthrightly say, “Yes, Mary, I am doing this because I would like to see more facilities have qualified directors — and, truth be told, I’d like to retire someday, and I want to have a successor who is skilled and also shares our values.” Since 2001, the Foundation has funded the attendance of over 1,000 practitioners to the Futures Program — 67 enthusiastic practitioners joined us in 2018 alone. Being a medical director is among the most satisfying and challenging positions in medicine today. And the range of required knowledge keeps expanding as the demographics and both the post-acute and long-term care aspects of facilities change. Hence, the purpose of this column: If you are a member of a state chapter of AMDA — The Society for Post-Acute and Long-Term Care Medicine, please contribute to your chapter’s efforts to fund one or more Futures candidates. If you are a chapter leader, please budget for Futures — and send a check ASAP. FUTURES IS NOT A FRILL! It’s a strategic imperative! Prospects for our work in PA/LTC rest on the shoulders of those who succeed us. We need more capable, well-trained, enthusiastic, and dedicated talent to provide informed care for the millions of patients who are knocking at our doors. And we need them to become leaders in our fight for quality, specialized care. Financially, it’s quite simple. Based on the needs of the individual, we provide free training and transportation costs. A single sponsorship is $3,000, and we also offer two spots for $5,000. How about sending four to six trainees? In the last few years, we have also had practices funding their own trainees so that physicians are ready to step in when the contributors retire. This is really an act of leadership, caring, and great philanthropy. Instead of waiting for my call, I’d like to ask each member of the Society to contribute to Futures, to contribute to their chapter initiatives for Futures, or to consider sponsoring their own trainee. You can also e-mail me at [email protected], contact Chris Ewing at the Foundation office at [email protected] or (410) 992-3134, or donate online at http://paltcfoundation.org/index.php/support-us/online-donations. Dr. Evans is chair of the Foundation for PA/LTC Medicine’s State Chapter Campaign.

There are still medical providers who believe palliative care medicine is limited to care of the dying. It is actually devoted to relief of suffering at every stage of life. Comprehensive management of patients with serious illness, including the relief of their symptoms, impacts their lives and those of their families, significant others, and caregivers, including healthcare providers. The knowledge and skills inherent in this medical specialty enables them all to grow and fosters resilience in their lives. Patient centered care is the best model that incorporates team practice with physicians and other healthcare professionals, and this is a cornerstone of palliative care medicine. Furthermore, PAs are compassionate listeners who provide comprehensive diagnosis and treatment of vulnerable patient populations across the life span and in all healthcare settings. Among medical providers involved in palliative care medicine, PAs are the only group whose accreditation requirements incorporate this knowledge and training. This text represents a new resource for PAs, clinicians, researchers, and educators of the profession to further facilitate its expansion into palliative and serious illness care. PAs are thereby poised to reduce the workforce shortage of healthcare professionals in palliative care medicine.

From Sleeplessness to Slumber: Person-Centered Approach to Insomnia

Post-acute and long-term care facilities, known as skilled nursing facilities (SNFs), are high risk for severe COVID-19 outbreaks, have potential for presymptomatic/asymptomatic transmission, and may have poor outcomes due to severity of disease in older adults.1, 2 Facilities must keep up-to-date with information and adapt to rapidly changing practices. The Project Extension for Community Healthcare Outcomes (ECHO) model has been used extensively in urban and rural settings to provide telementoring to healthcare workers in a variety of topics and has shown promise in sharing best practices with SNF staff via telementoring.3, 4 The ECHO model employs didactic training and case discussion facilitated by academic medical experts at a remote location, connecting to registered trainees virtually through a web-based videoconferencing platform. Considering social distancing efforts to curb the COVID-19 pandemic, telementoring training programs have distinct advantages as a mode of specialized education delivery. Based on the need of SNF administrators, providers, and staff for up-to-date COVID-19 information, we designed an ECHO telementoring series entitled COVID-19 in Skilled Nursing & Long-Term Care Facilities (COVID-19 SNF). This report shares our experience in utilizing ECHO as an educational platform with SNFs throughout the state of Illinois to rapidly respond to evolving changes in the COVID-19 pandemic. Our center is home to ECHO-Chicago, which hosts over 20 unique subject area ECHO series, including Geriatrics for SNFs and Geriatrics for Primary Care. Based on our previous experiences and infrastructure, we were able to roll out a novel six-session series dedicated to COVID-19 in SNFs in coordination with a Health Resources and Services Administration–funded Geriatrics Workforce Enhancement Program. Timeline from series inception to first educational session was 5 weeks. Planning involved two virtual meetings; curriculum development by geriatric medicine fellows, attendings, and Illinois Department of Public Health (IDPH); and recruitment and enrollment of participants by ECHO staff. Given the rapidly evolving nature of COVID-19 in SNFs and input from IDPH, six sessions were held biweekly for 1-hour duration to share timely information. Each session featured a 20-minute didactic, a case discussion, and a question and answer session with our subject matter expert (SME) team. The Zoom videoconferencing platform was used by participants to join remotely at no cost. The multidisciplinary SME team consisted of at least four academic geriatricians, one infectious disease physician, and one nurse educator with experience in nursing home care. The sessions included: (1) Admitting/Isolation; (2) Personal Protective Equipment/Physical Environment; (3) Healthcare Worker Safety; (4) Advance Care Planning/End-of-Life Care; (5) Telemedicine/Communication; and (6) COVID-19 Therapies. Cases presented centered on issues of diagnosis, communication, goals of care, hospice, and treatment/therapies related to COVID-19. Self-selected participants were enrolled through recruitment efforts by SNF leadership and advertising by the IDPH. Data collection was approved by the institutional review board, and consent was waived as all identifiers were removed. Demographics were collected at registration, attendance was tracked, and a postsurvey was sent following the series collecting open-ended feedback about the program, and self-reported changes in practice and self-efficacy. During the final moments of each session, two polling questions were asked in real time: (1) "Compared to before today's session, I feel ______ in control when it comes to addressing COVID in my professional capacity." and (2) "Please rate the relevance of today's ECHO content to your professional performance (both rated on a 5-point Likert scale)." Ninety-five unique participants representing a broad range of disciplines, including administrators, attorney, nurses, nurse practitioners, and physicians, participated in the entire ECHO series. Attendance ranged from 25 to 47 participants per session. Polling questions conducted showed a majority of respondents (64%–93%) felt more or much more in control when it came to addressing COVID-19 in their professional capacity. Aggregate data across sessions found 69% of respondents felt that the series contained new and relevant information with definite or potential impact on their professional performance (Figure 1). Postsession feedback revealed that participants enjoyed the case studies and the content of the didactics. One participant noted "[I] appreciated hearing from the panel on their experiences and their opinions on new info(sic) and research as it becomes available." When commenting on workplace change, one participant stated, "Yes, we have implemented some of the things we learned and expanded on others. Thank you for putting this together. The nursing homes are being hit so hard by the media right now. It is good to have many resources." While another commented, "I feel better equipped to handle them [COVID patients] as a result of hearing from others who have been caring for them for several weeks already." COVID-19 SNF training via ECHO is a novel way to engage and educate providers during a global pandemic. Our model was well received by participants as an effective mechanism to rapidly deliver up-to-date information. By utilizing videoconferencing technology, we were able to bring together providers across our state during the shelter in place to engage in shared learning with experts. Leveraging of preexisting ECHO infrastructure to rapidly host, organize, and establish a curriculum with SMEs contributed to program success. Although we had fairly consistent attendance for all sessions, response rates to polling questions were variable; additionally, the attendance might have been reduced by competing priorities during the pandemic. Additionally, we found that participants were occasionally hesitant to share their thoughts during the case discussion. This might be because they were reluctant to share what they did not know or to provide details of how the pandemic was affecting their facilities. To address this, we allowed for anonymous submissions of questions before each session. Given the broad range of participants in the series, we also needed to ensure our sessions covered a range of topics that were applicable to learners in different roles. Given the increasing use of ECHO programs, this type of series has potential to be replicated across the world with a format that can easily be adapted for future epidemics. COVID-19 SNF is a novel approach to provide telementoring in response to the COVID-19 pandemic. This series was rapidly developed, was feasible to implement, and overcame limitations of social distancing. Utilizing videoconferencing technology allowed participants to share best practices in response to COVID-19. Adoption and sustainability for other institutions with ECHO programs is feasible, and these programs could easily be offered to participants at institutions without ECHO programs via videoconferencing. Future work is needed to study this model's impact on patient care and clinical outcomes. This publication was made possible in part by Grant U1QHP28728 from the Health Resources and Services Administration, an operating division of the U.S. Department of Health and Human Services, the COVID T1M grant T1MHP39062, UChicago Medicine's Urban Health Initiative, and the United Health Group Foundation. The authors have no competing interests of conflicts to declare. L.J.G., K.T., D.J., K.L., J.W., K.J.B., S.S., S.L., and S.S.: Study concept and design. J.G., K.M., D.J., and K.L.: Acquisition of data. J.G., K.M., D.J., K.L., L.J.G., S.L., and K.T.: Analysis and interpretation of data. L.J.G., K.T., and J.G.: Drafting of the manuscript. L.J.G., K.J.B., J.W., S.S., J.G., K.M., K.L., S.S., D.J., S.L., and K.T.: Critical revision of the manuscript for important intellectual content. The funding sources were not involved in the design, analysis, or reporting of the results.

PA/LTC Goes Around the World in Online Communities