nursing

Module Nine: Palliative Care

Module Objectives:

This module dives deeper into palliative care. There is an emphasis on interdisciplinary collaboration.

Module Objectives:

1) Discuss palliative care in chronic illness situations.

1) Compare and contrast palliative care and hospice care.

2) Analyze potential barriers to palliative care in rural areas.

2) Explore interdisciplinary collaboration in situations of chronic illness.

2) Discuss barriers and facilitators of effective interdisciplinary collaboration.

Assigned readings:

Backman, C., Chartrand, J., Dingwall, O., & Shea, B. (2017). Effectiveness of person- and family-centered care transition interventions: a systematic review protocol. Systematic reviews, 6(1), 158. https://doi.org/10.1186/s13643 - 017 - 0554 - z

Lowey, S.E. (2015). Nursing care at the end of life. Geneseo, NY: Open SUNY Textbooks, Milne Library. https://milneopentextbooks.org/nursing - care - at - the - end - of - life/ (read pages 35 - 43).

Mayer, D. M., & Murphy, R. (2013). Palliative Care at the End of Life: A Rural Family Perspective. In C.A. Winters (Ed.), Rural nursing: Concepts, theory, and practice (pp. 119 - 129). New York: Springer. http://ssuproxy.mnpals.net/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=e680sw w&AN=547705&scope=site

National Coalition for Hospice and Palliative Care. (2018). Clinical Practice Guidelines for Quality Palliative Care (4th ed.) National Consensus Project for Quality Palliative Care. https://www.nationalcoalitionhpc.org/ncp/ . You can download the free PDF file. Read Domain 1 (pages 1 - 12 of the actual guidelines which is pages 23 - 34 of the PDF file)

National Coalition for Hospice and Palliative Care. (2018). Clinical Practice Guidelines for Quality Palliative Care (4th ed.) National Consensus Project for Quality Palliative Care. An abbreviated power point presentation is at

https://www.chcf.org/wpcontent/uploads/2019/11/GenPCToolkitClinicalPracticeGuidelinesQualityPC.p df

Sherman, D.W., Matzo, M., & Metheny, T. (2015). The Interdisciplinary Practice of Palliative Care Nursing. In M. Matzo & D.W. Sherman (Eds.), Palliative care nursing: Quality care to the end of life (4th ed., pp. 3-20). Springer Publishing Company. https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&d b=e680sww&AN=801728&lang=en%2cen&scope=site

Welch, M.L., Hodgson, J.L., Didericksen, K.W. et al. Family-Centered Primary Care for Older Adults with Cognitive Impairment. Contemp Fam Ther 44, 67–87 (2022). https://doi.org/10.1007/s10591 021 - 09617 - 2

Review resources linked into this module.

Key Points

· The objective of palliative care is to alleviate symptoms without curing the medical condition.

· Unique challenges and opportunities are associated with palliative care in rural areas.

· Although the terms 'hospice care' and 'palliative care are sometimes used interchangeably, they are not identical.

· Effective collaboration, coordination, and communication are essential in achieving positive outcomes.

· Hospice care is generally reserved for persons whose life expectancy is less than six months, while palliative care includes the entire continuum of care for someone with a chronic illness.

· Early integration of palliative care can serve to increase quality of life for patients with chronic illness.

· In palliative care, support of patient and family caregivers is a high priority

· Palliative care serves to manage transitions of care

· Palliative care typically results in cost savings

· "Receiving palliative care may or may not mean that patients are near the end of their life" (Larson, p. 527)

· "Patients may receive curative treatments during palliative care, but not during hospice care" (Larson, p. 527)

Assignments:

Graded assignment:

This synthesis and application assignment will span two modules. You will need insights and evidence from both modules nine and ten along with additional evidence from professional resources. Please note the due dates on your course calendar.

Synthesis and Application assignments have two separate components. Please see the information in the Synthesis and Application Assignment folder for a video and more detailed direction. Refer to the grading rubric (Appendix B in your syllabus) for how points can be earned.  Carefully note the criteria for a professional nursing journal as found in the course syllabus. 

Part 1: Choose one of the situations below. Respond to the situation you choose in the discussion forum adhering to the grading rubric in Appendix B.

Part 2:  You will post a substantive addition to one of your peers' post. Your substantive addition must address the topic/situation  other than the topic/ situation addressed in your original synthesis and application post .

Topic One: Collaboration, communication, and effective team functioning

Please view the three videos linked into Module Nine (Team Safety Debrief; Preparing for the Family Meeting; and the Family Meeting). After reviewing those videos:

1. Discuss the impact transparent communication (including non-verbal communication) can have on team functioning.

2. What communication strategies /approaches will be needed to facilitate a safe and coordinated transfer to the home setting in Mr. Abram's situation? What disciplines might be involved to promote optimal care for Mr. Abrams?

3. Describe a situation in which you actually collaborated with professionals from a discipline other than nursing.

- what do you see as some of your strengths in the process of inter-professional collaboration? - what are some areas of improvement related to collaboration that could be further developed in your nursing practice?

4. How do coordination, clear communication, and effective hand-offs impact safety and quality of care?

5. How do coordination, clear communication, and effective hand-offs impact the cost of care?

Topic Two

You are the palliative care nurse. Mrs. Jones has been living with congestive heart failure for some time and has been receiving palliative care in the home setting for about a year. Her activity tolerance has decreased to the point she can only move from one room to the other in in her home with her oxygen at 4 liters. She is able to sleep in her recliner. Increasing ascites has made it difficult for her to eat. She tells you she is 'totally exhausted' almost all the time. She has been in and out of the hospital with exacerbations three times in the last six months. Each time she comes home she says she 'feels worse'.

Today during your home care visit, Mrs. Jones brings up hospice care.

1. How would you explain the difference between palliative care and hospice care?

Mrs. Jones tells you she would like her daughter to hear more about hospice care. The daughter is present at the next home care visit (two weeks later). The daughter becomes upset and makes it very clear that she thinks her mother should "not give up" and rather "keep fighting". Mrs. Jones is in tears and says she doesn't know if she can live like this much longer.

2. What communication strategies / nursing interventions might be helpful at this time?

3. What communication strategies have the potential to make the situation even more difficult?

Although Mrs. Jones wants to pursue hospice care, she wants her daughter on board with the plan. The daughter agrees to 'think about it' and come back in two weeks for the next scheduled visit. At this visit, the daughter says she can agree to no more hospitalizations but wants everything possible done to make her mother's last months as 'good as they can possibly be'. The daughter says she has heard about 'alternative and holistic' types of things and wonders if those are still options.

4. Briefly describe at least three holistic types of interventions and approaches could you share with Mrs. Jones and her daughter that might be helpful at this point?

The daughter tells you that she is thinking about quitting her job to move in and take care of her mother. She asks you if that is a good idea.

5. Briefly outline how you might respond. Be sure to summarize both potential benefits and potential burdens.