Vital Views

Dr. Henna Lee 0:20
Hi. Welcome to another episode of vital views. A UNLV scrim nursing Podcast. I'm Dr Hyun Huang Hanna Lee, Interim Associate Dean for Research and associate professor at the scrim nursing today, I'm very honored to be joined by Dr Lisa Hansen, the May e Rowlinson Distinguished Professor at Oregon Health and Science University, OHSU scrum nursing. Dr Hansen's nursing career began in Denmark before she pursued her BSN MS and PhD in the United States, followed by a postdoctoral fellowship at the University of Washington. She is a renowned expert in palliative and end of life care, with research focusing on liver disease, symptom management, caregiver burden and treatment decision making. Through interdisciplinary collaboration, she strives to enhance quality of life for patients and families. Her work has been supported by NIH, National Institutes of Health, Robert Wood Johnson Foundation, American Cancer Society and other prominent organizations. Dr Hansen is also our guest speaker for 2025 Juha lecture taking place on March 10, 2025 Welcome Dr Hansen, thank you for joining us today.

Dr. Lissi Hansen 1:49
Thank you so much for having me. This is really an honor and a privilege to be here today, and I'm all excited. Thank

Dr. Henna Lee 1:56
you so much. I'd like to start with your background in nursing given New York from Denmark, what initially inspired you to become a nurse?

Dr. Lissi Hansen 2:07
So after I had complete, completed something called gym nation, which prepares you for going to the university, I thought about becoming a nurse, and went to a nursing school and talked to them, and they said I needed some practical experience before I could get into the program, and I was fortunate to get to work in a nursing home, but it was very different than any nursing home that there. It was very different than any nursing home that probably exists today. There was only 20 residents, and they were there for various reasons, from dementia to psychiatric illnesses to alcohol abuse. And that's where I met my first death. And I enjoyed, not the death it was, I can still remember it, but I enjoyed the interaction with the residents and more. So I really enjoyed that I could do things physically, like walk and bathe and do things with my hands, but at the same time, I needed to think that I needed to have knowledge, and that really was the beginning to getting into the nursing program in Denmark, which I then did and and became a nurse in Denmark. And at that time, a nurse in Denmark was a nurse. There was only one type of nurses, and it was a three and year and seven month program.

Dr. Henna Lee 3:40
I see, wow, I think I see that it's quite a tense experience as a new really, I think still new nursing maybe students back then, yeah, but you kind of experienced a very in depth experience that not many nurses even experienced as a independent practice. That's amazing. So your research, I guess I think how you studied your palliative and end of life focus in your research, but your research in palliative and end of life care has had a significant impact in both you know, nationally and internationally. What led you to focus on this critical area of healthcare?

Dr. Lissi Hansen 4:25
I have had a lot of losses in my life, but that's not really it. What really triggered me was that I had worked in intensive care units in Denmark, and then we my husband got to work and we had a chance to get to the or the Boston area, and it was a tough decision, because I didn't have a work permission, and I couldn't work for a couple of years. So when I got a work permission, I started in the intensive care unit. At the Framingham Union Hospital. And today I'm, like, really struck by jumping into the ICU, and I actually ran around for the students who are out there with a little black book with little abbreviations in to explain the English language. And also I had a spell check, or I'm terrible at spelling, and working in the intensive care unit, I was very taken by the aggressiveness that was implemented, even for elderly people coming intubations, cardiovascular, you know, surgeries and I it really took me by surprise, and I remember several of them, but there was an elderly lady coming in, and she had a little dog at home, and the her physician knew that she didn't want to be in the ICU, but that was too late. So she was there for about 48 hours, and she should definitely have been home in the nursing home with her, her little dog, was my opinion. So it really intrigued me. There was treatments like the swan ganz catheter, which was a counter indication in Denmark for people who had a heart attack. In the case, we were perforating the heart with the catheter. But almost everybody bother, in my opinion, as well, Swan can GaNS catheter and and that really intrigued me to learn more. But I also knew that if I needed to make a change, then I needed a PhD. And fortunate, a lot of my colleagues at that time thought more education and thought masters and advanced practice positions and went back to school. So when we got transferred, my husband got transferred to the state of Washington, I decided that that might be the time for me to really do something about making these changes. Another thing that was different for me was also that I felt that the physicians was put at a higher pedestal than nurses, and I was used to we were more equal than I experienced. And that was very interesting for me too. So I knew I needed that extra education to be able to get the funding. That's

Dr. Henna Lee 7:27
That's amazing story. Thank you. I say that you your passion, like, you know, whatever it takes you, you just didn't lose your interest and motivation, and then you finally pursue that. So it's a PhD program at OHSU, yeah. Okay, that's That's amazing. So significant part of your research, I learned that it focuses on caregiver burden and treatment decision making, probably the you know, what you shared from the ICU experience? Maybe that are so related to some of this, how you become more focusing on this type of elements, I see that this caregiver burden and treatment decision making are really deeply intertwined in patient care, especially in that ICU setting or the palliative or in the end of life care. Could you share some key factors that influence or maybe we need to consider when we think about this caregiver burden, treatment, decision making? Maybe I know it's it may be different where the patient or type of disease and where they are at, but maybe some something from your own experience, yeah.

Dr. Lissi Hansen 8:45
So I have worked also in, you know, 10 years in ICUs, and of course, I'm colored by that. But my dissertation work, which is a long time ago, I interviewed family members or caregivers of elderly people in the community who where the families had to make, maybe make a decision not to transfer their loved one or relative to the hospital, or they had to make a decision to not put in a feeding tube or place a feeding tube. I had this idea that that might be just as difficult than some of the research shown in the intensive care units. And it really was striking to me to speak with these caregivers and how how difficult decision that really were for them, and sometimes even the guilt feeling if they had done the right. And I remember I had caregivers called me after the person had died, and they felt kind of awful, because even prior to the decision, they were struggling to make that decision, and if they did the right thing, and the same with the intensive care units, I think we forget the little things that family members. Haven't been exposed to, for instance, in the intensive care unit. For us who work there, or for me working there, I took for granted that most patients develop an infection or high temperature. But that's not a normal thing for families, and I think we forget to inform them about even the little things in the intensive care unit. And that's really what that study I was fortunate to pursue the life sustaining treatment decision making into the intensive care unit, and I chose to do for several reasons, the liver population. First of all, I was very fascinated, always by their pathophysiology for the patient, and also they have been very stigmatized. And there was an assumption that everybody was a drinker, an alcoholic, which is not the case. And then also for the family, some of them have very strained relationships due to potentially substance abuse. And what that study showed is that family members have some time a hard time saying that this is enough, because we have so many things potentially to offer. And what became very clear on my research with liver patient is that chance of getting a liver transplant is huge. It's a huge pressure, also on the families as well as the patients, and when it's a choice between death or life, then any family member would choose life and hope for that liver transplant, and about only 11,000 transplanted each year for for the liver. So I really was taken by families. There were several strategies that they but one family would ask the same question every day, and that was, if their relative in the bed would get on the transplant list, and based on the different responses they got from providers, they would have an idea how their relative who was in the intensive care unit would do so, and following people in the community, it's really difficult, also the potential change in dynamics. And I ended up doing just to get some of that data. I did like 79 home visits, and really saw how stressful it can be. And now you're getting more information, you probably want it, but just things like, we don't think about that. If they have to drive to get to a clinic visit or other visits, if these, for instance, patients with liver disease are on high doses of diuretics, can they even find a restroom on the way and they get maybe laxatives, and what that really does to their abdominal system and gut system at home. And I think we we forget those struggles that caregivers also are faced with managing medications and then the sudden episodes of hepatic encephalopathy, where they are confused, and a lot of families are not prepared for suddenly that confusion. So maybe that was more what you were no

Dr. Henna Lee 13:38
because I think we had a short conversation people. We started this, you know, podcast, learning that Dr Hansen is still teaching undergraduate students for end of life care and palliative care. I'm just thinking my mind like, how lucky they those are to listen your really lived experience with a lot of meaningful elements. It's not you know, something you can learn from textbook or YouTube or actually, this led to my next question. So you talk about home visit, which I never knew you already do that. You know that home visit too. So maybe, how nurses? How can nurses and maybe other health care provider maybe help better or playing more active role in supporting such families in maybe communities and settings. I mean, like, you know, clinical primary care settings, especially this, families and patients, really, they kind of in the process of navigating a very complex decision makings and you know, situation they face,

Dr. Lissi Hansen 14:47
I do think from early on, with families or family caregivers, they play a huge role. We sometimes it's kind of hidden. It's before we get. To the end of life decisions that they often navigate the system for the patient, like finding information, figuring out, filling out prescriptions and where to get that, and the diet that patients may be on, and really early on figuring all on the role they're playing as that might change, and also suddenly, then we we may ask them, and we have to figure out who will be the one who will make the decisions. And that may not be the one that's been the primary caregiver. It might be somebody else. And I do think we really can get at least. My experience is asking also family members if there's certain things that's on their mind, what they really might want to talk about, and often that fills up more than than what we may think should be discussed that day. And I know from families or even also patients, that they also know when we tune out and we don't listen to them. And in our latest research, we are including a measure being heard really for figuring out how best to listen to what families and also patients have to say and what's on their mind. And one of the things that I used also when working in the intensive care unit, would be asking just the family member how they saw the patient that day, whether it was similar or different from the day before, and and what they thought was going on with a patient. So I think we need early on to start thinking about what are the some of the decisions they're already making and building on that, because just medication management can be huge, right, right, right, right?

Dr. Henna Lee 16:57
Yeah, I see that again, like, there's a lot of things that we need to think about, although every one of us, like nurses, other healthcare provider, we are working in different settings and working for different type of patient, but I think we can definitely apply what I use you just shared With us, like, especially chronic disease management, and and those who's really again facing really tough decision making for their treatment, and especially including their family members too. So I guess this would be our last question for today. I know you are one of the really big researcher in this area, palliative, palliative and end of life care. But despite all the advancement in this area, what are the some of the biggest gaps and challenges that still need to be addressed at this point, I

Dr. Lissi Hansen 17:52
really think there's a challenge with just implementing palliative care, and there's still a bias against even the word, and a lot of people still think that palliative care and hospice is the same. So it comes down to early, I would say early introducing palliative care, and this afternoon I'm going to touch on this. Physicians have a generalist approach to palliative care, and I really like it in that way, that, for instance, if they think, if you think about my area of expertise, and the people I interact with the professions, gastroenterologists and hepatologists, we can teach also nurses early on. And if you think about nurses versus medicine, so the generalist is for the physicians to get, maybe some education in palliative care, but not be the specialist and certified in palliative care. But also, for instance, if you work as and I'll get to the nurses. If you work as a hepatologist, maybe you feel uncomfortable with bringing bad news, then potentially get some training in that. Or if you feel spirituality is not an area you're comfortable just asking about, even though patients really want it, get extra information there. I do think nursing is lovely in a way. It's more holistic, and I truly believe that we as nurses should be able to basic pain management and figuring out the pain basic spirituality, and figure out where patients are, also on a social level and what caregivers need, and figuring out when it would be a good time to refer, for instance, to a social worker or having a pharmacist come by and really explain the medications. So I think we as nurses, we could start and we talk about starting a diagnosis. It's not the. Diagnosis. For instance, in my work in population, primarily when it's decompa decompensated liver disease, it should be when the diagnosis of cirrhosis is and there, I do believe nurses in particularly can play a huge role in incorporating aspects of palliative care. And I think palliative care, isn't it? What everybody should have like is, shouldn't we all have palliative care? I'm thinking, the person who is in for an operation, shouldn't they have the best communication, the best care? So that's my What should a soapbox is really palliative care should be for everybody Sure.

Dr. Henna Lee 20:41
Yes, thank you so much. Dr Hansen, it's been an absolute pleasure speaking with you. Thank you for sharing your expertise, and you know, a lot of lessons we learned from you today. Thank you so much. You're welcome. Thank you again for having me. Thank you, and thank you to our listeners for tuning in to another episode of fighter views, please stay connected with us to form more Conversations on the ladies in nursing research and practice.

Music 21:22
Foreign