The Integral Role of Nurses on a Hospital-Based Palliative Care Team

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The Integral Role of Nurses on a Hospital-Based
Palliative Care Team

• Speakers
• Judy Lentz, RN, MSN, NHA
• Lyn Ceronsky, MS, APRN, BC
• Patrick J. Coyne, MSN, APRN, BC
• Sandra Muchka, RN, MS, APNP
• Sharol Herr, RN, MSEd, CHPN
• Sponsored by The Center to Advance Palliative
  Care (CAPC)The Hospice and Palliative Nurses
  Association (HPNA)
• www.capc.org
  www.hpna.org

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Presenter Judy Lentz, RN, MSN, NHA Chief
Executive Officer Hospice and Palliative Nurses
Association One Penn Center West . Suite 229
. Pittsburgh, PA 15276-0100 .
412.787.9301 . www.hpna.org
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• Professional Development
• C.E. teleconferences
• Bimonthly professional journal
• Resources and references
• Networking
• Local chapters
• Special interest groups
• Annual conferences
• Recognition
• Annual awards
• Representation
• Public policy
• Board/committee participation

www.hpna.org
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• Unique Nursing Specialty Certifications
• Benefits
• Enhances knowledge and skills
• Validates competency
• Recognizes professional commitment
• Distinguishes the practitioner
• Eligibility
• APN
• RN
• LP/VN
• NA
• Administration
• Twice a year

www.nbchpn.org
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• Awards
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• Professional writing
• Poetry
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• Grants
• Chapter(s)
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• Support for Foundation

www.hpna.org/hpnf_home.asp
All images courtesy of The John A. Hartford
Foundation Institute for Geriatric Nursing, New
York University, Steinhardt School of Education,
Division of Nursing. Photography by James Schuck.
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Presenter Judy Lentz, RN, MSN, NHA Chief
Executive Officer Hospice and Palliative Nurses
Association One Penn Center West . Suite 229
. Pittsburgh, PA 15276-0100 .
412.787.9301 . www.hpna.org
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The Role of the Advanced Practice Nurse in
Palliative Care

• Patrick J. Coyne, MSN, APRN, FAAN Thomas
  Palliative Care Services of
  Massey Cancer Center at
  Virginia Commonwealth University
  Richmond VA.

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The Evolution of the APN in Palliative Care

• Role is extremely varied depending on settings
  
  Requires highly evolved clinical and
  communication skills

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The Signs of the Movement

• ELNEC course for APNs
  Certification exams for APN in
  Palliative Care
  Job postings clearly
  increasing for these roles

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Roles for APNs

• Education
  Staff development
  (not just nurses)
  Orientation
  Continuing education
  In services
  Community forums
  Authoring
  publications

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Roles for APNs (cont)

• Research in palliative care is extremely
  limited, but opportunities exist.
  These can include insuring evidence based
  practice initiating data bases, conducting
  research, developing quality assurance standards
  any many more interventions.
  

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Roles for APNs (cont)

• Management
  Foster and develop appropriate
  clinical guidelines.
  Insuring appropriate
  staff competency Insuring that barriers
  to care in this population are addressed.
  Economic management of
  limited resources.

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Roles for APNs (cont)

• Leadership
  Involves risk taking , advocacy
  and energy. This individual may (probably) will
  be the hub of any palliative care team.
  These activities
  may be extremely varied such as legislative
  action, team development, role development within
  an institution and beyond.

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Roles for APNs (cont)

• Consultation, typically the largest role.
  This
  can occur in a variety of settings. The
  role may include medication management,
  determining and obtaining appropriate information
  and referrals, patient/family support, conducting
  family and team meetings

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APNs as a further Resource

• Cost saving may be realized by institute.
  Compliance with
  mandates (i.e.. JCAHO) Improved pt/family
  satisfaction Improved
  satisfaction of other HCPs

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Issues facing APNs

• Billing issues
  Role not yet embraced by many
  hospices
  Limited numbers of trained APNs presently exist
  in palliative care.
  

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My Role

• ref Coyne, P., J., "Evolution of the Advanced
  Practice Nurse within Palliative Care." Journal
  of Palliative Medicine. Vol. 6 No. 5, 2003,
  pp.767-768.

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The Role of Nurses as Administrators in
Palliative Care

• Lyn Ceronsky, MS, APRN
• System Director, Transitions and Life Choices
  Fairview Health Services
• Minneapolis, MN

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Palliative Care ProgramAdministration

• Nursing leadership in program development is
  critical
• Nurses bring knowledge of clinical aspect and
  hospital operations
• Administrative role may be part of a clinical
  role or a specific focus
• Activities are dependent on resources in your
  setting

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Accountabilities

• Lead program development
• Articulate the clinical case
• Develop strategic and business plans
• Design process and tools for inpatient
  team/unit
• Participate in staffing, marketing,
  identification of resources
• Develop systems to support coordination of care

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Accountabilities

• Determine clinical and financial outcomes
• Select indicators
• Design data collection and analysis
• Develop communication process
• Dashboard
• Audience
• Link with local and national benchmarks and
  initiatives

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Accountabilities

• Support clinical staff
• Problem solving
• Self care
• Continuing education
• Support for organizations employees
• Develop grief resources
• Palliative care employee benefit

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Innovation

• Recognize need for expanded services
• Inpatient unit
• Home care and hospice service capacity
• Outpatient clinic

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Promotion of Palliative Care

• Work with philanthropy professionals
• Articulate the need
• Tell stories
• Nursing and interdisciplinary research
• Represent palliative care to community
• Advocate for education for health care
  professionals

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The Role of the Palliative Care Nurse on a
Physician-Led Program

• Sandra Muchka, RN, MS, APNP
• Clinical Nurse Specialist in Palliative Care
• Palliative Care Center
• Medical College of Wisconsin
• Milwaukee, WI

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Nurses Role

• Initial chart review
• Interview with nursing/medical staff
• Initial patient/family interview
• Collaborative case planning with MD
• Coordinate symptom management
• Triage for ancillary services

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Nurses Role (cont)

• Case management
• Psychological support to patient/family
• Provide continuity of care across care sites

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MD Role

• Initial discussion of issues with medical team
• Patient interview and exam
• Communication with primary MD
• Oversight of symptom management
• Leadership for family meetings, when needed

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MD Role (cont)

• Prognostication
• Collaborative case management with PC nurse

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Working as a Team

• PC Team communication/ Daily rounds
• RN-to-MD communication
• MD-to-MD communication

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Education Opportunities inPalliative Care

• A Nursing Perspective
• Sharol Herr, RN, MSEd., CHPN
• Palliative Nurse Clinician Education
  Coordinator
• Mt. Carmel Health System
• Columbus, OH

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Perform EducationalNeeds Assessment
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Establish Education Goals

• Communicate with stakeholders
• Provide resources and education to prepare direct
  care staff as care givers
• Contribute to the organizations quality and
  performance improvement initiatives
• Establish a mechanism to support education of
  students and provide clinical experience

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Routine Processes Tools

• Interdisciplinary team meeting rounds
• Team member roles responsibilities
• Clinical instrument
• Routine orders protocols
• Establishing a palliative plan of care
• On-call response of physician and team
• How to make a referral/consult

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Integrate Evidenced Based Practice

• Core competencies
• Bench marking data
• Algorithms

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Develop EducationTimeline

• Start-up needs
• Ongoing training
• Mentoring and staff development
• Certification
• Integrate initiatives with system education

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Palliative Education

• Resources

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Texts

• Oxford Textbook of Palliative Medicine, 3rd Ed
  2004 Oxford (UK)2004
• Textbook of Palliative Nursing, Oxford 2001
• Principles and Practice of Palliative Care and
  Supportive Oncology 2nd Ed, Lippincott 2002
• End-of-Life Care Clinical Practice Guidelines.
  WB Saunders 2002

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Journals

• J Palliative Medicine (US) Official Journal of
  AAHPM
• J Pain and Symptom Management (US)
• American J of Hospice and Palliative Care (US)
• Palliative and Supportive Care (US)
• J of Pain and Palliative Care Pharmacotherapy (US)

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Web Links

• EPERC (End of Life/Palliative Education Resource
  Center). www.eperc.mcw.edu
• Searchable database of ed. materials, articles,
  books, videos, web links, etc.
• ELNEC (End of Life Nursing Education Consortium).
  www.aacn.nche.edu/elnec
• Comprehensive, national education program to
  improve end-of-life care by nurses.

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Web Links

• Hospice and Palliative Care Nurses Association
  (HPNA)
• www.hpna.org
• City of Hope Pain/Palliative Care Resource
  Center. http//prc.coh.org
• Clearinghouse for palliative care resources for
  individuals and institutions

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Certification Resources

• National Board for Certification of Hospice and
  Palliative Nurses (NBCHPN)
• www.nbchpn.org
• American Academy for Hospice and Palliative
  Medicine (AAHPM)
• www.aahpm.org

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Web Links

• CAPC (Center to Advance Palliative Care) Tools.
• Tools to assist in designing, strengthening,
  maintaining and defending Palliative Care
  programs .

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Train at a Palliative Care Leadership Center

• 2 days of intensive, hands-on training tailored
  to your own institution
• Full year of mentoring
• Train at any one of six Leadership Centers
• An initiative of CAPC and RWJF
• CME credits available
• Nursing Accreditation Pending

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Palliative Care Leadership Center Curriculum

• Module 1 Systems Assessment Mission Alignment
• Module 2 Clinical Models Staffing
• Module 3 Financial Case Sustainability
• Module 4 Measurement
• Module 5 Internal Marketing
• Module 6 Community Partnerships
• Module 7 Palliative Care Education
• Module 8 Program Implementation
• To apply for training, visit www.capc.org