HPNA/Boston January Meeting

The Interdisciplinary Group and 

Collaborative Leadership Strategies

This interactive session will explore the dynamics of the hospice Interdisciplinary Group ( IDG). Attendees will participate in identifying characteristics of a high-performing IDG. Typical issues - differing perspectives, role sharing, negotiation, care planning, time management, etc, will be illustrated through role play followed by group discussion of new approaches to old problems.

Facilitated by JoAnne Nowak, MD and Luis Pacini, RN

Date: Thursday - January 30, 2014

Time: 5:30 networking and refreshments; program begins at 6:00

Place: Newton Wellesley Hospital - Room Bowls 1

Cost: No cost for chapter members, $10 non-members, fee waived for students

The next HPNA Boston meeting

Date: Wednesday, September 25
Time: 5:30PM registration and complementary food/beverages, 6:00PM program start
Topic: "Medical Marijuana - the newest green state is seeing red."
Place: Hospice of the Good Shepherd, 90 Wells Ave. Newton MA
Cost: Free for HPNA Boston members; $10 non-members; fee waived for student nurses

This program has been approved for 1.5 contact hours.


View Larger Map

Thanks to Pelham Community Pharmacy for their generous support of this meeting.

Smoke 'em if ya got 'em.

Celebrate nurses day/week/month

"...nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet — all at the least expense of vital power to the patient."

Our (sort of) weekly laugh at/with death

Choosing the path

Two Paths Through Pines

photograph by Mark A. Kawell

I’ve developed several metaphors that have proven helpful when talking to families facing catastrophic injury/illness and the possibility of death, and who need to understand end of life care in a meaningful context.

First, let's stop using the awful expression “withdrawing care.” None of us would feel comfortable taking something away from a loved one, especially when that something is literally keeping our loved one alive.

I use the term “redirecting care,” to emphasize our conscious decision to focus on a specific set of objectives – most notably comfort, dignity, and family closeness. This idea also makes better sense when considered in the context of what I describe to families as the three basic paths guiding care in the acute setting.

Curing – The first path focuses on curing the patient’s underlying illness or injury. I use antibiotic therapy and surgery as examples. Often, the patient’s own history includes one or more initial treatments directed at curing, so this is pretty straightforward for most people to understand.

When a patient’s condition is dire, it also helps the family see that the path to a cure may be highly uncertain at best, or even unrealistic, no matter how desperately they may hope otherwise.

Support for Healing – The second path emphasizes actions that support the patient’s own ability to heal. I point to interventions like the nutrition from high calorie/high protein tube feedings, and intubation with mechanical ventilation, as ways that we help a patient get better. I also point out that these measures are generally only needed for a limited time, even if that temporary period extends for weeks.

When a patient hasn’t improved or recovered despite our actions, the family usually finds it easier to understand that the possibility for healing has become more remote.

Comfort and Dignity – The third path is entirely devoted to keeping the patient comfortable in whatever way is required - controling pain, easing air hunger, and calming agitation; and to maintaining the patient’s identity as a person with friends and family who love them.

I also emphasize and identify ways that the family can join in providing this comfort and insuring this dignity.

Families are more at ease when they’re confident we’ll help keep their loved one comfortable, and when they know they’ll all be treated with respect and not left alone.

I’ve found that these three concepts of care support more meaningful discussions with families to determine the most appropriate goals of care. We’re less likely to get into misunderstandings and struggles, and more likely to focus on what we all agree is most important.

- - - - -

Captain Obvious comes right back

"My job is obviously never done."

I was researching back issues of the HPNA journal for an upcoming class on assessing and managing pain when our friend Captain Obvious stuck out his size-13 black boot and tripped me right in front of an article by Ann Marie Dose and colleagues, "The Experience of Transition From Hospital to Home Hospice - Unexpected Disruption."

As Captain Obvious pointed out earlier, while we may take much for granted in the course of our work, our patients and families are experiencing each element of the hospice admission and care for the first time, most often with little preparation, understanding, or context; and always with some degree of emotional stress. Our routine is their disruption.

The authors note:

"Many patients hospitalized at end of life report ‘‘going home’’ as the most important task remaining to achieve. In order to meet this meaningful goal, patients in this study were discharged soon after the decision was made to go home with hospice care. 

Although the physical act of traveling home was relatively problem-free for the study participants, family caregivers experienced burden as a result of getting things ready for the patient’s homecoming often on very short notice. (for example) While securing a hospital bed for the home may be of little consequence for healthcare professionals...for patients and family caregivers, the hospital bed took on a larger meaning and added to the overall disruption."

I'm reminded of an old joke that goes something like this - 

Q - What are the two differing points of view with regards to a ham and egg breakfast?

A - The chicken has an interest, but the pig is committed.

to learn more - Dose, Ann Marie PhD, RN, ACNS-BC; Rhudy, Lori M. PhD, RN; Holland, Diane E. PhD, RN; Olson, Marianne E. PhD, RN. The Experience of Transition From Hospital to Home Hospice: Unexpected Disruption. Journal of Hospice & Palliative Nursing: November/December 2011 - Volume 13 - Issue 6 - pp 394-402. 

Meet Captain Obvious

Ya think?

We're happy to introduce a new contributor to the HPNA Boston blog. Captain Obvious will join us on a semi-regular basis to point out things we already know, or should. Because a little review never hurt anybody, right?

In today's installment, Captain Obvious says:

We're hospice professionals. We take our work seriously. We draw on our accumulated knowledge and experience, as well as that of our colleagues, teams, agencies, and professional resources like HPNA. In the course of our practive we've likely encountered just about every possible situation at least once. And when we run into something new, chances are we know exactly who to turn to for help.

We anticipate and prevent problems. We're experts at assessing and addressing pain, delirium, nausea, constipation, dyspnea, depression, anxiety, and more. We can calculate the equianalgesic doses of multiple opioids. We know when to stop a measure that's not working, and have backup plans for just such instances.

We know how essential are our colleagues in chaplaincy, social work, medicine, music therapy, bereavement, and volunteer services.  We help get them through the door when families are reluctant or unsure about meeting them.

We work in settings of abject poverty one moment, and unimaginable wealth the next.

We've sat with patients as they've drawn their last breath, and with their families in the days leading up to, and following, that moment. We've been present for the unique beauty of a peaceful death, as well as the despair of a distressing one.

In the most difficult cases or during the most trying moments, we're in the home for an hour or two out of every 24.

The greatest challenge of our work is teaching those family members, friends, and others in the home all of the hours in a day, to become as expert as we are, but in a much shorter time, with much less preparation, fewer resources, even less context, and often under tremendous emotional pressure.

And they only get to do it once.