New member benefit

Hospice and Palliative Nurses Association (HPNA) members now have full access to CE credits for free.

Over 40 online courses are immediately available within the HPNA E-Learning site.Additional courses are being developed. HPNA is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation (ANCC).

HPNA members enjoy:
-Online courses with approved CE credit at no cost
-Free CE Tracking
-Unlimited Access to HPNA's most popular courses, including Opioids in Palliative Care, The Picture of Heart Failure, and Pain Management for all Ages.

Visit HPNA to join.

Observing a birthday

Steven Paul 'Steve' Jobs

February 24, 1955 - October 5, 2011

His 2005 commencement address at Stanford. Offered without further comment.

Getting the toboggan

Toboggan return to toboggan tow at base of hill.
Caberfae Winter Sports Area. 1940-1941.
(source)

I sat quietly by his bed as the mid-morning sun shone through the window. The angle of the light transformed the contours of his fresh white sheets into bright flowing hills and deep shaded valleys that mimicked the snowy fields outside.

He was in his late 80’s, and had been slowly declining over the past years. Now, his breathing had settled into the peaceful but irregular pattern of approaching death.

Something had happened since her visit yesterday, when they both sipped coffee and enjoyed his favorite cookies. She informed the eldest son by phone, and he agreed to call his siblings, who lived out of state. “They’ll start arriving in the next few hours. I’ll get the comfort kit set up.”

She reviewed the medication schedule with the private caregiver, 5mg of morphine oral concentrate every four hours, and drew up a small amount of thick pink liquid into each of several syringes. She squirted the first dose gently behind his lower lip, and massaged his gums while reviewing the technique with the caregiver.

That task complete, we sat by the bed without speaking for about ten minutes, until it was time for us to go.

“He loved the snow,” she said when I noted how the distant fields matched the near scene of his bed sheets. “Last week, when I told him about the coming blizzard, he said ‘Let’s get the toboggan ready.’ He just loved the snow.”

Our weekly laugh at/with death.

Photo: Sylvain Gaboury/Film Magic
from New York magazine

Paul Rudnick is a funny guy. He writes regularly for the New Yorker magazine, often contributing to the weekly humor column, 'Shouts and Murmurs,' which is where I generally encounter his work. He's also written several plays and movie screenplays.

I just finished his latest book, I Shudder: And Other Reactions to Life, Death, and New Jersey. I really needed it. It's a quick read, but if you still don't have enough time, this snippet from page 242 provides a worthwhile taste:

Here's what I know about death and grieving: None of it makes any sense, although I will always cherish the words of a woman who spoke at a friend's memorial, and who began her affectionate remarks by saying, "God knows, Ed was cheap." Here's what I know about New Jersey: If you're a citizen, be proud of it. I know a guy from Piscataway who would tell people that he was from the more posh Princeton, which was forty-five minutes away. I always wanted to tell him, Darling, you're still from New Jersey. Who are you kidding?

And here's what I know about love: Don't let go.

originally posted at my personal blog in 2010.

Safety on the road

 
Relative risks of an accident based on activity while driving
(based on data by the National safety Council)

*texting includes dialing, looking up email/phone number, 

or any other cell phone activity with visual distraction > 3 seconds

How dangerous can it be, to be a hospice care provider?

By “dangerous,” I mean hazardous to the health and safety of the hospice nurse, social worker, chaplain, or hospice aide providing care to patients and families in their homes, or at facilities.

According to the National Institute for Occupational Safety and Health (NIOSH), the Bureau of Labor Statistics (BLS) at the U.S. Department of Labor, and others, the answer may surprise you. We work in an industry, specifically the home health care subsector, which poses significant ongoing risks to us for serious illness, injury, and death.

I only recently began to appreciate the scope and severity of these dangers, as I researched the topic to prepare an orientation class at my agency.  Maybe I didn’t already understand the risks because I didn’t listen closely during my own orientation, or perhaps the topic wasn’t presented effectively.

The potential for serious bodily harm, or even death, merits our undivided attention. Let’s look at just one of the dangers we face, namely driving to and from the places we visit and give care.

A study conducted by BLS between 1995 and 2004 reported 154 job-related deaths among home care paraprofessionals - nursing, psychiatric, and home health aides. The majority of these deaths resulted from motor-vehicle accidents.

Research conducted on behalf of the National Association for Home Care and Hospice (NAHC) found that home care and hospice workers in the U.S. drove almost five billion (5,000,000,000) miles in 2006, to provide four hundred and twenty-eight million (428,000,000) visits to nearly 12 million patients.

The NAHC study showed Massachusetts home care and hospice workers drove 77,737,289 miles to conduct 13,182,930 visits that year – an average of 6 miles per visit in this relatively small and densely-populated state.

Take a moment to consider the time and distance associated with your own work-related travel in the course of a normal week. Better yet, consider how you drive during those trips, and what other tasks you try to accomplish behind the wheel – particularly those that involve your cell phone.

Work by the National Safety Council (pdf), and by researchers at the University of Utah (pdf), and the American Automobile Association (pdf), among others, concludes that driving while talking on a cell phone increases the risk of an accident at least four-fold, equivalent to the risk of driving drunk.

The researchers find it makes no difference whether we hold our cell phones while talking and driving, or use a ‘hands-free’ device like a speaker phone or Bluetooth earpiece/microphone (pdf). The problem is one of simple neuroscience – our brains are not wired to do two things at the same time.

Driving a car is a complex cognitive task, no matter how routine is may seem. Conducting a conversation is just as challenging when the rich mix of subtle nonverbal cues we depend on while taking face to face is absent.

The brain can switch between the two tasks, but it can’t do both at the same time. In other words, multitasking is a myth (pdf), at least when it comes to people.

More complex cell phone tasks pose an even greater hazard, and increase accident risk by over twenty times, because looking up a phone number, checking an email, or texting diverts visual attention. Lots can happen in the distance covered in just three seconds at 55 miles per hour.

There were 33,808 deaths attributed to automobile accidents in the U.S. in 2009 (pdf). Sixteen percent of those deaths – 5,474 to be exact – were caused by distracted driving, which includes cell phone use.

The National Safety Council is actively working for laws banning cell phone use while driving. They’ve also established four simple ways to increase driving safety:

1. wear your seat belt
2. drive sober
3. focus on the road
4. drive defensively

We’re on the road because we’re committed to helping our patients and families achieve the optimal outcome of hospice care - a peaceful death.

It’s frightening to contemplate how our actions while driving could instead result in another family’s sudden and traumatic loss. Perhaps even our own.

by Jerry Soucy, RN, BSN, CSS, CHPN
An edited version of this piece appeared in the HPNA Boston Winter 2013 newsletter

A movie for hospice (French, subtitles)

My wife and I go to the movies several times each month. There are several local independent theaters to choose from, including our favorite – the six-screen West Newton Cinema.

I pay close attention to how movies treat end of life, and have never seen aging and death portrayed with such understated power and honesty as in ‘Amour,’ (‘Love’), the French film by Michael Haneke.

This is the story of Anne and Georges, retired music teachers living in Paris. Anne suffers a stroke that leaves her right side paralyzed, and Georges cares for her, mostly alone.

All of the action takes place within their apartment. It’s not possible to know how much time passes as Anne declines, but any hospice professional will recognize the trajectory.

Each scene is filmed simply, and unfolds without hurry. The dialogue is spare. When their daughter Eva, a musician who lives in London, asks Georges what will happen next as Anne continues to fail, he replies, “Things will go on as they have done up until now. They'll go from bad to worse. Things will go on, and then one day it will all be over.”

That notion, “things will go on,” is what makes ‘Amour’ such a powerful and important film for anybody working in hospice. We visit, but then we leave, and when we leave the patients and families have no alternative but to face each moment as it unfolds. We recognize, even if we don’t clearly say, that “one day it will all be over.”

We also briefly watch each of two nurses who join Georges in helping care for Anne. As in the rest of the movie, every aspect of these encounters is completely credible to anyone familiar with the situations depicted – not as would be portrayed in a documentary, but in the more important and deeper sense of artistic truth.

Because, in the end, ‘Amour’ is a work of art, and only art can touch us so deeply.

More (including trailers)…

Amour at Sony Classic Pictures
Amour at Rotten Tomatoes
Amour at Movie Review Intelligence

February presentation/meeting

HPNA/Boston is hosting a presentation on MOLST - “Medical Orders for Life-Sustaining Treatment”

Feb 26 at Newton-Wellesley Hospital Shipley Auditorium, 2nd Floor in the main hospital building. 2014 Washington St Newton, MA

A light dinner will be provided. 5:30-6:00 PM Networking; 6:00 PM MOLST presentation, followed by membership meeting.