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PALO ALTO VA IS LEARNING LAB FOR END-OF-LIFE AND

PALLIATIVE CARE -- "As we see an increasing number of older

and chronically ill patients, all nurses will benefit by having some

understanding and basic skill sets in palliative care medicine."

Story here... http://include.nurse.com/apps/
pbcs.dll/article?AID=/20080630/CA02/106300015

Story below:

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VA Palo Alto Serves as Learning Lab for End-of-Life and Palliative Care

Susan Meyers

As the elderly population fills more hospital beds, many healthcare institutions are struggling with the challenges of end-of-life care.

To arm hospitals with the support they need, seven hospitals nationwide are serving as learning labs and hosting free site visits through the Hospital-Based Palliative Care Consortium. The consortium, which was established by the Hospital & Healthsystem Association of Pennsylvania and is managed by the Health Research & Educational Trust, is funded by a grant from the Agency for Healthcare Research and Quality.

“This is an opportunity for hospitals to send their palliative care teams to us so we can tailor the educational experience to their needs, answer their questions, and help them work through any programmatic issues they may be having in establishing their own programs,” says Michelle Gabriel, RN, MS, ACHPN, palliative care clinical nurse specialist at Veterans Affairs (VA) Palo Alto Health Care System in Palo Alto, Calif., one of the selected learning labs.

Spreading the knowledge

Palliative care refers to alleviating pain and other symptoms to relieve suffering and ensure the best possible quality of life for patients who are chronically ill or facing the end of life. Palliative care focuses on meeting all the needs identified by the patient and family, including physical, emotional, and social needs. While palliative care and hospice overlap in their patient-centered philosophies, they are different in that palliative care is offered based on need, regardless of how long a patient may have to live, whereas hospice care is targeted to people with a limited prognosis.

The consortium's program involves three phases. During the first phase, a host hospital receives materials that will help its planning committee prepare for the site visit. The participating hospital teams also complete surveys to gauge the visiting hospital's strengths and weaknesses. Phase two involves the site visit to the host hospital to see firsthand how a well-functioning palliative care program operates. During the last phase, visiting hospitals are given feedback as they implement their own programs.

Meeting a growing need

Palliative care programs more than doubled between 2000 and 2006, from 632 to 1,299 programs, according to a Center to Advance Palliative Care analysis of data from the American Hospital Association's 2006 “Annual Survey of Hospitals.”

Dealing with end-of-life issues requires specialized skill sets that include pain and symptom management, and communication skills that include how to talk about grief and bereavement, Gabriel says. There is also a focus on understanding the natural history and complications of chronic diseases.

“Most nurses today will be exposed to patients who are chronically ill or are dying,” Gabriel says. “However, many are not fully prepared for these situations, so instead of discussing end-of-life issues, they may completely avoid communication with the patient and family.”

Other learning opportunities

Linda Blum, APRN-BC, MS, GNP-BC, nurse practitioner for palliative care services at California Pacific Medical Center in San Francisco, completed a one-year fellowship at the Palo Alto VA in 2003-04. She says the training was invaluable.

“My training taught me how to work as a colleague alongside physicians … how to provide consultations … a better understanding of the basis and pathophysiology of diseases and how to communicate this to other nurses, physicians, and families,” she says.

The Palo Alto VA offers interdisciplinary palliative care fellowships to a variety of healthcare workers, including nurses, social workers, psychologists, and chaplains, based on preceptor availability.

Many hospitals like the Palo Alto VA also provide palliative care training and education to their nurses through the End-of-Life Nursing Education Consortium (ELNEC) project, a national education initiative that provides a standardized curriculum to train nursing students and practicing nurses.

Gabriel, who hosts 3 two-day ELNEC seminars at the VA annually, says the training is needed because most nurses receive little palliative care training in their core curricula. “Palliative care issues bisect many areas of the hospital, and most nurses are not prepared to deal with these issues,” she says. “As we see an increasing number of older and chronically ill patients, all nurses will benefit by having some understanding and basic skill sets in palliative care medicine.”

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posted by Larry Scott
Founder and Editor
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