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

APNA 29th Annual Conference Session 2027: October 29, 2015 The Missing Link: Palliative Mental Health Expertise at End of 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. Curtis 1

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

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

APNA 29th Annual Conference Session 2027: October 29, 2015 The Common Thread Life Trajectory #1 Life Trajectory #2 Birth Birth Bipolar Death College Death Disorder Divorce Marriage Retirement Marriage The Common Thread Life Trajectory #3 Life Trajectory #4 Birth Birth Death Job Death College Terminal Job Bewilderment Depression Illness Loss Fear 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. Curtis 4

APNA 29th Annual Conference Session 2027: October 29, 2015 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 of life issues? Emotional End of Life Needs Assessment Physical Psychological Functional Ability Depression Strength/Fatigue Anxiety Sleep & Rest Enjoyment/Leisure Nausea Happiness Appetite Fear Pain Quality Of Life Social Spiritual Financial Burden Hope Caregiver Burden Suffering Roles & Relationships Meaning of Pain Appearance Religiosity Physical/Sexual Function Transcendence Curtis 5

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

APNA 29th Annual Conference Session 2027: October 29, 2015 So • How do we enhance the chances of having a good death? Personal Strategy for Delivering End of 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 of Life Nursing Education Consortium (ELNEC) Personal Strategy for Delivering End of 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!). Curtis 7

APNA 29th Annual Conference Session 2027: October 29, 2015 Personal Strategy for Delivering End of 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 • of life. Personal Strategy for Delivering End of 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 of 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. Curtis 8

APNA 29th Annual Conference Session 2027: October 29, 2015 Personal Strategy for Delivering End of 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. Curtis 9