If you have a serious illness, should you get palliative care?

caregivers

Yes. Palliative care provides an additional level of support while still providing curative treatment. Hospice care, on the other hand, also provides support but focuses on pain management and a good quality end-of-life care. Coming from NYU, I’m aware of the NICHE program (Nurses Improving Care for Healthsystem Elders). One thing it does is provide caregiver resources especially useful while you or your loved one is at the hospital. Here is their guide for helping you determine if you need palliative care.

1. Do you have one or more serious illnesses?

Such as: • Cancer • Congestive heart failure (CHF) • Kidney failure • Liver failure • Neurological diseases (e.g., ALS, Parkinson’s) • Dementia • Chronic obstructive pulmonary disease (COPD), emphysema, lung disease

Yes___ No___

2. Do you have symptoms that make it difficult to be as active as you would like to be, or impact your quality of life?

These symptoms might include: • Pain or discomfort • Shortness of breath • Fatigue • Anxiety • Depression • Lack of appetite • Nausea • Constipation

Yes___ No___

3. Have you, or someone close to you, experienced the following:

• Difficult side effects from treatment • Eating problems due to a serious illness • Frequent emergency room visits • Three or more admissions to the hospital within 12 months, and with the same symptoms

Yes___ No___

4. Do you, or someone close to you, need help with:

• Knowing what to expect • Knowing what programs and resources are available • Making medical decisions about treatment choices/options • Matching your goals and values to your medical care • Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, surgery, etc.)

Yes___ No___

5. Do you, or someone close to you, need help with:

• Coping with the stress of a serious illness • Emotional support • Spiritual or religious support • Talking with your family about your illness and what is important to you

Yes___ No___

If you answered yes to more than one of the questions, palliative care is something you or your loved one may need. If you feel you may benefit from palliative care, please talk to your healthcare provider today.


Update from April 24, 2014
To spread awareness about COPD and raise money for the COPD Foundation, you can write your story and Healthline will donate $10. The top 5 stories will receive a $75 American Express card.

Education Day 2: Communication and Delegation

Today was our second “Education” Day. The first Education Day that happened one month ago covered medication errors and IV insertion. Today, we talked about communication, delegation and the electronic health record.

Communication among the nurses, patients, doctors, and ancillary staff are crucial for good patient outcomes. We communicate to convey  messages to other people. What do you think is the most important part about communication? Take a guess first!

  • Words
  • Body Language (facial expressions, hand gestures)
  • Paralinguistic (the tone; the way that the words are said)

*

*

*

It’s body language, which accounts of 55%. Words account for 7% and paralinguistic accounts for 38%. Body language shows your attitude and shows how you feel.

There are different ways to give and receive information. Even though we spend 7-12 years of our education on learning how to write and read, we spend less than 1-2 years of formal education on how to speak and listen. This is almost counterintuitive, considering that over half of our communication depends on LISTENING to each other.

We broke out into 4 groups and discussed about traits of good listeners vs bad listeners.

Good Listeners:

  • Eye contact
  • Gives feedback
  • Not rushed

Bad Listeners:

  • Interrupts
  • Has a reply or rebuttal before letting the other person finish speaking

Etc, etc, it can go on and on. To show that we care,

  1. Look at the patient in the eye (not at the WOW all the time; let the patient know you’ll ask a series of questions on the WOW so they know you’re not purposely trying to not give eye contact)
  2. Sit down next to the patient to show that you’re not rushed
  3. When they are concerned about something, ask them for more details (especially regarding pain!)

*************

As for delegation, it is something that new nurses struggle with. The most important takeaway messages I got was:

  • Be specific
    • Example: Take that patient for a walk vs
    • Take that patient for a walk for 80 feet. 1 assist with a walker and oxygen is needed at all times. It’s the first time the patient is getting up so take a pulse ox before and after he goes for the walk. When that’s completed, please tell me what happened.
  • Vital signs and I/O
    • “Please tell me any abnormal vital signs that you see. And for these specific patients (congestive heart failure, post-open heart patients, renal), please document intake and output.”
  • Change priorities as needed
    • Some ancillary staff may think that cleaning equipment or doing the bedtime bundle or whatever it is that they are doing is more important than a patient’s change in condition. Sometimes when you say, “please go do a fingerstick stat” or a “EKG stat” or something else that’s more urgent (such as compromised patient safety aka a patient getting out of bed without supervision especially if they want to use the bathroom or go for a walk but forget or don’t want to call you!), the PCA takes their time to do what you asked them to do.
    • It may help to say: “That isn’t important right now. Right now, it’s more important for you to take a set of vitals on this patient.”
  • If there is an isolated problem (they don’t know or just forgot), it is important to address it right away in private (never in front of the patient!!). Sandwich a compliment, criticism, and compliment. If it is a continuous problem (due to attitude or laziness), then still address it but also bring it up to management.
  • Give feedback. Everyone is valued and needed on the unit. Using their name and saying thanks goes a long way.