nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

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1 Meeting the Palliative Care Needs of Older Hospitalized Patients: Nursing is Doing It! Susan M. Lee, PhD, RN, CNP Senior Nurse Scientist, NICHE Coordinator, Brigham and Women s Hospital, Boston, MA, Palliative Care NP, Hebrew Senior Life, Boston, MA Deborah Marks Conley, MSN, APRN-CNS, GCNS-BC, FNGNA Gerontological Clinical Nurse Specialist; Assistant Professor, and NICHE Program and AgeWISE Director Methodist Hospital in Omaha, NE Objectives The learner will be able to describe a framework for generalist geropalliative care. The learning will be able to describe nurse-led interventions to prepare the nursing workforce for geropalliative care. Palliative Care (WHO) Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

2 Problem: Older Adults Less Likely to Receive Palliative Care Older people have a significant need for palliative care at the end of life yet may not receive it, particularly if their terminal illness is nonmalignant (Harris, Richard, Khanna, 2006). Problems Timing is late Care in silos Uncertain prognosis Focus on physical Complexity Clinicians lack of knowledge Dementia Terminal care rather than longitudinal Specialist care; not well integrated Prognosis less clear in non-malignant disease Less likely to have spiritual, psychosocial needs met Greater comorbidities, drug reactions Inadequate staff training Less likely to be able to communicate symptoms/needs Lynn and Adamson, RAND Health (Used with permission. Lee. 2009) Available online at Curative / life-prolonging therapy Dimmer Switch: Continuum of care Death Disease-Modifying Treatment Palliative Care Hospice Care Bereavement Support Disease Presentation Terminal Phase of Illness nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 2

3 Types of Palliative Care Primary: (Generalist) Basic palliative care delivered by all frontline clinicians Secondary: Specialist palliative care delivered by boardcertified palliative care clinicians, often in interdisciplinary teams Tertiary: Specialized or disease-specific teams; inpatient palliative care units for uncontrolled symptoms; pain specialists Solution: Educate a group of nurses from each unit to provide generalist palliative care Teach content in geriatrics and palliative care Promote culture change Conduct performance improvement projects With the goal of improving care to older adults and their families who are approaching end-of-life 12 - eight day seminars over 6 months Seminars every other week Inspire change 8 To the next place, to new goals of care, or to a peaceful death Ethics, Communication Palliative Care NICHE GRN AgeWISE is described in Lee et al., (2012). AgeWISE: A national pilot. JONA. nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 3

4 AgeWISE at Methodist Hospital Collaborative partnership between Methodist Hospital and Nebraska Methodist College Invitation to Participate in AgeWISE Two cohorts per year (22 per cohort) Inpatient units and departments Paid to attend Eligibility Nurses with at least 18+ months experience Work hours/week Intend to stay at Nebraska Methodist Hospital for at least another 2 years Nurse Managers are key! Select and invite nurses who have demonstrated engagement, leadership and clinical expertise in caring for patients Required to sit for certification (Gerontological or Hospice and Palliative Care) unit specialty within 6 months after AgeWISE Waiting list AgeWISE at Methodist Hospital Seminars/Course/Curriculum Provides: Implementing EBP in gerontological, palliative, and end-of life nursing care Mentorship and coaching novice and expert dyad Reflective practice skill building Assistance to develop portfolio for career advancement Certification preparation for ANCC Gerontological Nurse or Hospice and Palliative Nurse exams Transformative learning paradigm for adult learning nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 4

5 Methodist AgeWISE Curriculum* Crosswalk *Clinical Practice Guidelines for Palliative Care - 8 Domains Physical Aspects *End-of-Life Nursing Education Consortium (ELNEC) Modules Symptom Management Cultural Aspects of Care AgeWISE Retreat 12 Seminars over 6 months (8 hrs each) Healing Therapies Interprofessional Community Faculty Small Group Work - Domains of Practice Nursing Journal Article Review Reflective Practice Journaling AgeWISE Stories with Discussion Community Clinical Experiences Group Field Trips DVDs with Reflection Graduation Celebration *Conley GERO Modules Falls Promoting Function Pain Assessment & Management Skin Integrity Pharmacology Geriatric Syndromes Dementia Delirium Depression Caregiving AgeWISE Resident Engagement Program Outcomes 147 AgeWISE RNs Geropalliative care content incorporated into BSN college curriculum Increased AgeWISE RN certification rates AgeWISE RNs lead Shared Governance Councils and sit on hospital committees Nurse Excellence award winners Daisy award winners Enrolled in MSN and DNP programs Developed cross unit friendships and collaboration Increased inpatient palliative care team consults AgeWISE is the geropalliative care standard of practice at Methodist Patient care assignments AgeWISE model Biannual NICHE-AgeWISE Collaborative regional Gero conference Quarterly AgeWISE Geriatric Education Seminars - AGES nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 5

6 AgeWISE Nurse Outcomes AgeWISE nurses report: Increased knowledge and skills Empowerment Confidence Advocacy skills Unit cohesiveness Professional and personal growth Decreased moral distress They are AgeWISEING their units AgeWISE Nurse Stories AgeWISE by Kim.. A Advocate alignment of care G Geropalliative care E Experience healing W Well-being is our outcome I Inspire, Intervene, Interdisciplinary S Suffer no more E Empowers and enlightens nurses nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 6

7 References Weissman & Meier (2011). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the Center to Advance Palliative Care. Journal of Palliative Medicine, 14(1), 1-8. Harris, Richard, Khanna. Palliative care for the elderly: A need unmet. Geriatric Medicine, July Dainty & Leung. (2008). An evaluation of palliative care in the acute geriatric setting. Ageing. doi: /ageing/afn050. Puchalski, C. (2015). Spirituality in geriatric palliative care. Clin Geriatr Med 31, Brighi, Balducci, Biasco (2014). Cancer in the elderly: Is it time for palliative care in geriatric oncology? Jnl of Geriatr Onc 5, Lee, Coakley, Blakeney, et al. (2012). AgeWISE: A national pilot. JONA, 42 (7/8), Maxwell & Mion. (2015). Geriatric trauma: An opportunity for proactive palliative care. Geriatr Nsg 36, Izumi, Basin, & Baggs. (2016). Intervention to integrate palliative care into transitional care for older adults: Potential challenges identified by clinicians (S798). Jnl Pain Sym Man, 51(2), 462. Kupensky, Hileman, Emerick & Chance. (2015). Palliative medicine consultation reduces length of stay, improves symptom management, and clarifies advance directives in the geriatric trauma population. Jnl of Trauma Nsg, 22(5), Keeble. (2015). Do I have to have cancer to get better care? Improving palliative care provision for frail older people. Intl Jnl Pal Nsg. 21(8), 409. Dempsey, Dowling, Larkin, Murphy. (2015). The unmet palliative care needs of those dying with dementia. Intl Jnl Pal Nsg. 21(3), Parr, Zhang, Nilsson, et al. (2010). The influence of age of the likelihood of receiving end-of-life care consistent with patient treatment preferences. Jnl Pal Med, 13(6), Moir, Roberts, Martz, Perry, Tivis. (2015). Communicating with patients and their families about palliative and end-oflife care: Comfort and educational needs of nurses. Int Jnl of Pal Nsg. 21(3), nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 7