Disclosures The speaker has no conflicts of interest to disclose. - - PDF document

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 1

The Missing Link: Palliative Mental Health Expertise at End

• f Life, Developing a Model for a

Good Death Mark A. Curtis, PMHCNS‐BC, ACHPN, LMT Hospice of Dayton Innovative Care Solutions Division of Palliative Care October 29, 2015

Disclosures

• The speaker has no conflicts of

interest to disclose.

Objectives

• 1) Recognize the untapped expertise of the Psych

Mental Health Nurse (PMHN) in the delivery of comprehensive end of life care for patients and their families.

• 2) Develop an emotional needs assessment for those

facing end of life situations.

• 3) Design a personal strategy for the provision of

psychiatric and mental health support for individuals and families coping with end of life issues.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 2

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.

Palliative Care Across the Lifespan

• Brief History of Palliative Care
• Physician Dame Cicely Saunders began her

work with the terminally ill in 1948 and eventually went on to create the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London.

• Saunders introduced the idea of specialized

care for the dying to the United States during a 1963 visit with Yale University.

Palliative Care Across the Lifespan

• 1997: The growing end‐of‐life movement focuses

national attention on quality of life at the end of life as well as the need for increased public awareness and physician education.

• 2004: The first edition of the Clinical Practice

Guidelines for Quality Palliative Care was

• released. This was an important development in

the advancement of palliative care because the document offered a map to the future of palliative care.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 3

Palliative Care Across the Lifespan

• National Consensus Project for Quality

Palliative Care (2009). Clinical practice guidelines for quality palliative care, 2nd edition.

• 2014: Institute of Medicine published their

landmark report, Dying in America.

Palliative Care vs. Hospice Care Palliative Care vs. Hospice Care

• “Many of the mechanisms and tools are the

same, but palliative care is about people living well, and hospice care is about people dying well.” Anne M. Ireland, Oncology Nurses Society

• Palliative care throughout the continuum of

illness involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 4

The Common Thread

Life Trajectory #1

Birth College Marriage Retirement Death

Life Trajectory #2

Birth Bipolar Disorder Marriage Divorce Death

The Common Thread

Life Trajectory #3

Birth Job Job Loss Depression Death

Life Trajectory #4

Birth College Terminal Illness Bewilderment Fear Death

Why Psychiatric/Mental Health Nursing in Palliative Care

• 1) Psych/Mental Health Nurses (PMHN) are

experts at assisting clients to deal/cope with fears, anxieties, disappointments, loss.

• 2) PMHN are trained to address all aspects of

the person, not just parts.

• 3) PMHN develop trust with clients who share

intimate details of their lives.

• 4) PMHN assist clients to utilize their strengths

to set realistic goals and maintain hope.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 5

Why Psychiatric/Mental Health Nursing in Palliative Care

• 5) PMHN provide clients support and guidance

with anticipatory grief and loss.

• 6) The best time to discus end of life choices is

not in the hospital when death is imminent.

• 7) PMHN can assist our clients to create their

legacy.

• 8) Through client advocacy PMHN can promote

the ethical principle of autonomy allowing greater control over how one chooses to die.

Emotional End of Life Needs Assessment

• Statement of assisting with lifelong

continuum: “As we work together on (issue) at some point we will be discussing decision making across your lifespan.”

• Ask for permission to discuss.
• Have you ever thought about or discussed end
• f life issues?

Emotional End of Life Needs Assessment

Physical Functional Ability Strength/Fatigue Sleep & Rest Nausea Appetite Pain Psychological Depression Anxiety Enjoyment/Leisure Happiness Fear Social Financial Burden Caregiver Burden Roles & Relationships Appearance Physical/Sexual Function Spiritual Hope Suffering Meaning of Pain Religiosity Transcendence

Quality Of Life

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 6

Emotional End of Life Needs Assessment

• 1) Have you ever thought about how you want

the last part of your life to look before you die?

• 2) What thoughts or concerns do you have

about dying?

• 3) Have you identified anyone to be your

decision maker if you are unable to advocate for yourself?

Emotional End of Life Needs Assessment

• 4) Have you thought about the kind of medical

treatment you would/would not want if you have a terminal illness?

• 5) How do you define quality of life?
• 6) Which do you value more, quality of life or

quantity? Are there any circumstances that would change your mind?

Emotional End of Life Needs Assessment

• 7) What are your greatest fears about dying?
• 8) What are your previous experiences with

death?

• 9) How would you like to be remembered?
• 10) Are there any goals that you would like to

accomplish before you die?

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 7

So

• How do we enhance the chances of having a

good death?

Personal Strategy for Delivering End

• f Life Care
• Preplanning:
• 1) Reflect on your own feelings about death.
• 2) Ask yourself if this is something you want to

add to your practice.

• 3) Educate yourself on end of life resources

(CAPC, HPNA, National Consensus Project, etc.).

• 4) Consider taking a training course such as End
• f Life Nursing Education Consortium (ELNEC)

Personal Strategy for Delivering End

• f Life Care
• 5) ) Familiarize yourself with local resources on

end of life.

• 6) Network with specialists in your area to

develop referral sources.

• 7) Recognize that high level end of life care is a

multidisciplinary team approach which may involve: primary care, specialty care, mental health, social service, pastoral care, (You don’t have to do it all!).

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 8

Personal Strategy for Delivering End

• f Life Care
• The session:
• 1) Create a safe environment.
• 2) Ask for permission to discuss end of life issues.
• 3) Explain why end of life conversations are

important.

• A) To allow for autonomous choice.
• B) To help clarify what is important at end
• f life.

Personal Strategy for Delivering End

• f Life Care
• C) To reduce confusion among treatment

team.

• D) To reduce confusion among family

members.

• E) To reduce unwanted treatment

measures.

• 3) Review client strengths and successes to

foster hope and optimism.

Personal Strategy for Delivering End

• f Life Care
• 4) Use therapeutic presence and active

listening to foster openness. (Palliative nursing is not only “doing for”, but is largely “being with” the individuals we work with).

• 5) Understand that end of life decisions are

individual and personal.

• 6) Are there any cultural or spiritual

considerations?

• 7) Consider inclusion of family members.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 9

Personal Strategy for Delivering End

• f Life Care
• A Final Thought:
• Take Care of Yourself!

References

• 1) American Association of Colleges of Nursing, End of

Life Nursing Education Consortium. One Dupont Circle, NW, Suite 530 Washington, DC 20036.

• 2)Kamal, H, Pietras, C, et al. (2015). Development of

skills for end‐of‐life discussions ‘a lifelong process’. HemOnc today 16‐12, 1,12‐14.

• 3) Bakitas, MA, et.al. J Clin Onc. (2015) Early Versus

Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial, May 1, 1438‐1445.

• 4) Center for the Advancement of Palliative Care

(CAPC), www.capc.org

References

• 5) Chen, Pauline (2007). Final Exam: A Surgeon’s

Reflections on Mortality. Vintage Books, New York, NY.

• 6) Davis, M, Fairman, B George, K, Ireland, A,

(2015). ONS: Successful early integration of palliative care requires multidisciplinary

• approach. HemOnc Today 16‐6, 1, 10‐12.
• 7) Dying In America: Improving Quality and

Honoring Individual Preferences Near the End of Life, Washington, DC: (2015). The National Academies Press.

APNA 29th Annual Conference Session 2027: October 29, 2015 Curtis 10

References

• 8) Egan‐City, K. A., & Labyak, M. J. (2010). Hospice palliative

care for the 21st century: A model for quality end‐of‐life

• care. In B. R. Ferrell, & N. Coyle (Eds.), Oxford textbook of

palliative nursing, 3rd edition (Chapter 2, pp. 13‐52). New York, NY: Oxford University Press.

• 9) Gawande, Atul, (2014). Being Mortal: Medicine and

What Matters in the End. Metropolitan Books/Henry Holt & Company.

• 10) McMutcheon, et al, (2015). “Conversation ready” : A

framework for improving end‐of‐life care. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.

References

• 11) National Consensus Project for Quality

Palliative Care (2009). Clinical practice guidelines for quality palliative care, 2nd edition. http://www.nationalconsensusproject.org

• 12) The Joint Commission. (2015). Quick
• Safety. Issue 15.
• 13) Williams‐Murphy, Monica, Murphy,

Kristian, (2011). It’s OK to Die. MKN, LLC.