Description
Palliative care is at the heart of all nursing. As Advanced Practice Nurses you will have to be able to use your advanced skills to provide comfort to those at the end of their life journey. While answering these questions please demonstrate in-depth comprehension of the readings, provided examples/explanations and documented responses.
1. Read the National Consensus Project Report: Practice Guidelines for Quality Practice. The report can be accessed on line (you can download a free copy):
https://www.nationalcoalitionhpc.org/ncp/
A. Select a domain & analyze it’s guidelines & criteria.
B. How will the domain influence your practice?
2. Discuss the similarities & differences between hospice & palliative care.
A. How will the differences affect your practice as an APN?
B. Give at least one specific example.
3. Provide an example from your nursing practice and outline a plan to manage your patients pain and promote comfort. (I am currently a pain management nurse at an outpatient practice)
Powerpoint from: Matzo, M. & Sherman, D.W. (2018).Palliative Care Nursing:Quality Care to the End of Life (5th ed.).
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POWERPOINTS TO ACCOMPANY
Chapter 1
Palliative Care Nursing
Copyright Springer Publishing Company. All Rights Reserved.
From: Palliative Care Nursing
ISBN: 9780826135575
1
© Springer Publishing Company, LLC.
Introduction
• Hospice and palliative care reflects a philosophy of care that is
implemented across the life span and diverse health settings
• Goals of hospice and palliative care nursing:
• Promote and improve the patient’s quality of life
• Relieve suffering during the illness, through the patient’s death, and the
family’s bereavement period
• Focuses on:
• Prevention and relief of suffering
• Management of pain and other symptoms
• Emotional, spiritual, and practical needs of patients and family
• Builds upon hospice care
• Provided in a variety of settings
2
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Introduction (cont.)
• Preparation in hospice and palliative care:
• RNs prepared as generalist or advanced practitioners
• Licensed practical nurses (LPNs) prepared with different levels of
complexity
• Nursing assistants (NAs) have no specific licensure requirements
• Hospice and Palliative Nurses Association (HPNA):
• Nursing assistants (NAs) have no specific licensure requirements
3
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Evolutionary Perspective
• Studies/documents that contributed to the development of
hospice and palliative care:
• Study to Understand Prognoses and Preferences for Outcomes and Risks
of Treatment (SUPPORT)
• Approaching Death: Improving Care at the End of Life
• Improving Palliative Care for Cancer
• National Quality Forum:
• National Framework and Preferred Practices for Palliative and Hospice Care
Quality
• Identified domains of quality palliative care:
• Structure
• Physical
• Psychological and psychiatric
4
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Evolutionary Perspective (cont.)
• Identified domains of quality palliative care: (cont.)
• Social
• Spiritual, religious, and existential
• Cultural
• Imminently dying patient
• Ethical and legal
5
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Educational Preparation
• HPNA documented the scope, standards, and competencies
for RNs, LPNs, and NAs
• Certification examinations have been developed for all levels
of specialization
6
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HPNA Scope, Standards, and Competencies
• Define the body of knowledge
• Standards of practice:
• Basic level of care to provide all hospice and palliative care patients and
families
• Standards of performance:
• Describes activities related to quality of care, performance appraisal,
education, collegiality, ethics, collaboration, participation in research, and
resource utilization
• Identifies the responsibilities for which palliative and hospice care nurses
are accountable
• Remains stable over time
• Criteria updated to reflect changes in technology and clinical practice
7
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HPNA Scope, Standards, and Competencies (cont.)
• Standards of practice:
• Adhere to the nursing process
• Development and maintenance of the nurse–patient and family relationship
• Plan of care:
• Fundamental practice focus for hospice and palliative care
• Standards apply to both generalist and advanced practitioners
• Standards of professional performance:
• Describe professional role behaviors
• Must be self-directed
• Purposeful in seeking knowledge and skills to demonstrate competency
8
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HPNA Scope, Standards, and Competencies (cont.)
• Standards of professional performance: (cont.)
• Professionalism enhanced by:
• Membership in professional organizations
• Certification in the specialty
• Continuing education
• Competencies:
• Represent the “quantifiable knowledge, attitudes, and skills that
practitioners demonstrate in the performance of safe, consistent,
compassionate, state-of-the-art, evidence-based end-of-life care, which
conforms to the patients’ and their families’ wishes”
• Includes:
• Clinical judgment
• Advocacy and ethics
• Professionalism
• Collaboration
9
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HPNA Scope, Standards, and Competencies (cont.)
• Includes: (cont.)
• Systems thinking
• Cultural competence
• Facilitation of learning
• Communication
10
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Certification
• 1994: National Board for the Certification of Hospice Nurses
(NBCHN) offered the first certification exam and the credential
Certified Registered Nurse Hospice (CRNH)
• 2001: National Board for Certification of Hospice and Palliative
Nurses (NBCHPN) began certifying nursing assistants in
hospice and palliative care as Certified Hospice and Palliative
Nursing Assistants (CHPNA)
• 2002: Began the process of developing the exam to Credential
Palliative and Hospice Practical/Vocational Nurse (CHPLN)
• 2004: Began certifying advance practice nurses for the
credential Advanced Certified Hospice and Palliative Nurses
(ACHPN)
• Certification in hospice and palliative care adds value to the
role
11
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Principles of Palliative Care
• Core principles:
• Patient and family constitute the unit of care
• Collaborate through an interprofessional team process
• Implement clinical ethics
• Foundation of palliative care philosophy:
• Constructs of family-centered care
12
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Conceptual Frameworks
• Conceptual model of care:
• Whole-person suffering
• Dimensions: physical, psychological, spiritual, and social
• Suffering affects each domain of the bio–psycho–social–spiritual aspects of
care
• Delivery model of care:
• Umbrella of care
• Provides access to palliative care across all settings
• Interprofessional team:
• Communication and decision making among team members is
collaborative
• Leadership shared and based upon primary patient and family needs and
goals
• The whole is greater than the sum of its parts
• Members of the interprofessional team (see Table 1.1)
13
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POWERPOINTS TO ACCOMPANY
Chapter 2
Palliative Care: Responsive to the Need
for Healthcare Reform in the United States
Copyright Springer Publishing Company. All Rights Reserved.
From: Palliative Care Nursing
ISBN: 9780826135575
1
© Springer Publishing Company, LLC.
Introduction
• Hospice care:
• Originated in the 11th century
• Provided to travelers on religious pilgrimages
• Later associated with care of the sick and dying
• Principles of hospice care:
• Holistic patient- and family-centered care
• Provided by an interprofessional team of practitioners
• Occurs during the last 6 months of life
• Palliative care:
• Addresses care of the mind, body, and spirit
2
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Introduction (cont.)
• Differences between hospice care and palliative care:
• Palliative care begins at the time of diagnosis, continues until the death of
the patient and into the family bereavement period
• Includes curative treatments if appropriate
3
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Moving Palliative Care Into the Mainstream of
Healthcare
• Viewed as a highly structured and organized system of care
• Matches treatments with the values and preferences of the
patient and family
• Promotes positive health outcomes
• Used for patients of various ages with a wide variety of
illnesses
4
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Palliative Care and Healthcare Reform in America
• The Joint Commission:
• Recognizes the value of palliative care with a voluntary process of
accreditation
• Palliative care:
• Positioned to become a universally accepted approach to healthcare
• Impact of Affordable Care Act:
• Hospice eligibility criteria need to be reevaluated
• Cost of palliative home care programs
• Patients’ and families’ quality of life
5
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Value of Palliative Care in the United States
• Palliative care:
• Allows the shift of care from hospital to home
• Reduces the overuse of marginally effective, ineffective, and unnecessary
treatments
• Results in fewer hospital readmissions
• Allows greater continuity of care
• Allows for the development of safe transition plans upon initial discharge
6
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State of Maryland Action Plan for Palliative Care in
Oncology
• Blueprint for Success in Palliative and Hospice Care:
• Endorses the belief that quality and affordable healthcare is important
during any stage of the illness trajectory
• Role of key stakeholders:
• Ensure quality of care and quality of life
• Low cost
• Increase access to cancer and palliative care
• Improve coordination and continuity of care
• Reduce health disparities
• Key stakeholders:
• Patients, families, and communities
• Healthcare professionals and associated staff
• Institutions
• Healthcare policy makers, legislators, and payers
7
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State of Maryland Action Plan for Palliative Care in
Oncology (cont.)
• Blueprint for Success in Palliative and Hospice Care:
• Achieve the 4 As:
• Awareness
• Acknowledgment
• Access
• Action (see Tables 2.1 and 2.2)
• Hallmarks of this program:
• Education
• Competencies
• Goals and strategies
• Budgetary resources
• Identify barriers
• Track data
• Study outcomes
8
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Global Imperative
• Palliative care being considered as a human right in many
countries
• Nearly half of the world’s countries do not have palliative care
• International recommendations for palliative care:
• Importance of shared definitions of palliative care
• Recognize the strengths and weaknesses of different payment systems
• Identify country-specific and international research priorities
• Determine appropriate economic evaluation methods
• Evaluate palliative care costs
• Support interprofessional professional care education and training
programs
• Develop national standards to regulate and determine palliative care
planning and development
9
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Hospice and Palliative Care Nurses as Leaders of
Reform
• Combine knowledge, experience, and commitment to
advancing the specialty and promoting quality palliative and
EOL care
• Standards of care:
• Reflect the values and priorities of palliative care nursing
• Provide a framework with which to evaluate practice
• Foundational tenets:
• Age appropriate
• Culturally sensitive
• Safety
• Education
• Coordination and continuity of care
• Communication
10
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Roles of Advanced Practice Palliative Care Nurses
• Functional roles:
• Develop, implement, and evaluate palliative care services
• Serve as:
• Clinician
• Administrator
• Researcher
• Educator
• Advocate
• Health policy maker
• Public health advocate
• Clinical Practice Guidelines for Quality Palliative Care:
• Guideline domains:
• Structure and processes of care
• Physical aspects of care
• Psychological and psychiatric care
11
© Springer Publishing Company, LLC.
Roles of Advanced Practice Palliative Care Nurses
• Clinical Practice Guidelines for Quality Palliative Care: (cont.)
• Guideline domains:
• Social aspects of care
• Spiritual, religious, and existential aspects of care
• Cultural aspects of care
• Ethical/legal
• Care of the dying
12
© Springer Publishing Company, LLC.
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