scholarly journals P045: Palliative care nurse specialist in the emergency department: a pilot project

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S79
Author(s):  
K. Nichol ◽  
L. Galitzine ◽  
L. Kachuik ◽  
S. Madore ◽  
S. Olivier ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Palliative Care ◽  
Pilot Project ◽  
The United States ◽  
Nurse Specialist ◽  
Care Hospital ◽  
Care Needs ◽  
Care Nurse ◽  
Palliative Care Needs

Background: Patients presenting to the Emergency Department (ED) with unmet palliative care needs are often admitted to hospital and this can be a pivotal point in their subsequent health care journey. Literature from the United States supports the integration of palliative care resources in the ED and to our knowledge, this has yet to be done in a Canadian setting. Aim Statement: To develop, implement, and evaluate a model to support patients presenting to the ED with unmet palliative care needs. Measures & Design: A pilot project was implemented in one campus of the ED at a tertiary care academic center in Ottawa, Ontario. A palliative care nurse specialist was available for consultation with goals to: a) reduce admission to hospital for patients choosing to have a palliative approach to their care; b) increase coordination between ED and community resources; and c) be a resource for ED staff. Referral criteria were developed after systematic review of the literature and in consultation with palliative and emergency medicine experts. Evaluation/Results: Over the course of the study period (9 months), 50 referrals were made. The primary reason for referral was for increased community supports. Patient outcomes: 10 patients were discharged to hospice/palliative care units from the ED, 38 patients were discharged home. Of those discharged home, 66% had no returns to ED within 30 days. Qualitative feedback collected via pre and post survey has been extremely supportive from ED health care practitioners and community palliative care providers. Discussion/Impact: This ongoing project has led to positive, patient centered outcomes and decreased admission to acute care hospital. Ongoing evaluation will include consideration of Ontario Palliative Care Network quality indicators and cost-analysis to determine impact on health care system.

scholarly journals Palliative Care Needs of Advanced Cancer Patients in the Emergency Department (S767)

2018 ◽  
Vol 55 (2) ◽  
pp. 693
Author(s):  
Isabelle Marcelin ◽  
Caroline McNaughton ◽  
Nicole Tang ◽  
Jeffrey Caterino ◽  
Corita Grudzen
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Palliative Care Needs

scholarly journals Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

2015 ◽  
Vol 22 (7) ◽  
pp. 823-837 ◽  
Author(s):  
Naomi George ◽  
Nina Barrett ◽  
Laura McPeake ◽  
Rebecca Goett ◽  
Kelsey Anderson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Screening Tool ◽  
Content Validation ◽  
Care Needs ◽  
Emergency Department Patients ◽  
Palliative Care Needs

“They Shouldn’t Be Coming to the ED, Should They?”: A Descriptive Service Evaluation of Why Patients With Palliative Care Needs Present to the Emergency Department

2017 ◽  
Vol 34 (10) ◽  
pp. 984-990 ◽  
Author(s):  
Emilie Green ◽  
Sarah Ward ◽  
Will Brierley ◽  
Ben Riley ◽  
Henna Sattar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
A Priori ◽  
Service Evaluation ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Needs ◽  
Direct Admission ◽  
Palliative Care Needs ◽  
Single Center Observational Study

Background: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. Methods: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period. Demographic and clinical data were collected from electronic health records. Results: A total of 105 patients made 112 presentations to the ED. The 2 most common presenting complaints were shortness of breath (35%) and pain (28%). Eighty-three percent of presentations required care in the ED according to a priori defined criteria. They either underwent urgent investigation or received immediate interventions that could not be delivered in another setting, were referred by a health-care professional, or were admitted. Conclusions: Findings challenge the misconception that patients known to a palliative care team should be cared for outside the ED. The importance and necessity of the ED for patients in their last years of life has been highlighted, specifically in terms of managing acute, unpredictable crises. Future service provision should not be based solely on a patient’s presenting complaint. Further qualitative research exploring patient perspective is required in order to explore the decision-making process that leads patients with palliative care needs to the ED.

Dying Fit or Not—Physical Activity as Antidote to Death?

2020 ◽  
pp. 003022282091371
Author(s):  
Hanne Bess Boelsbjerg ◽  
Stinne Glasdam
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Palliative Care ◽  
Field Study ◽  
Advanced Cancer ◽  
Health Care Professionals ◽  
Care Needs ◽  
Palliative Care Needs ◽  
Empirical Material

Physical activity has increasingly gained attention within palliative care. This article aims to explore how the idea of physical activity influences patients with advanced cancer and health-care professionals’ interactions. The empirical material was gathered as part of an anthropological field study about palliative care needs among 16 patients with advanced cancer, consisting of observations and interviews with patients, relatives, and professionals. Two of the patient cases were analyzed, inspired by Goffman’s theory, showing how patients and health-care professionals interact in relation to physical activity. The findings show that patients played roles either embracing physical activity or distancing it by postponement. Professionals played expert roles of duty and attachment, stressing the importance of physical activity. Thus, they accepted a minimum of physical activity when patients were close to death. Professionals regarded patients’ absence of physical activity as a lack of desire to live; patients regard it as a way to live.

scholarly journals A novel care guide for personalised palliative care – a national initiative for improved quality of care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dröfn Birgisdóttir ◽  
Anette Duarte ◽  
Anna Dahlman ◽  
Bengt Sallerfors ◽  
Birgit H. Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Care Needs ◽  
Comprehensive Overview ◽  
Pilot Studies ◽  
Early Palliative Care ◽  
The Family ◽  
Palliative Care Needs

Abstract Background Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. Methods The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. Results After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients’ needs and possibilities for ensuring optimal quality of life, the family included. Conclusions Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings – including implementation, patient and family outcomes, and experiences of patient, family and personnel.

scholarly journals Role of the clinical nurse specialist as a non-medical prescriber in managing the palliative care needs of individuals with advanced lung cancer

2021 ◽  
Vol 27 (4) ◽  
pp. 205-212
Author(s):  
Jenny Osborne ◽  
Helen Kerr
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Positive Impact ◽  
Clinical Nurse Specialist ◽  
Advanced Lung Cancer ◽  
Nurse Specialist ◽  
Care Needs ◽  
Clinical Nurse ◽  
Palliative Care Needs

Background: Rapid identification of the palliative care needs of individuals with a diagnosis of advanced lung cancer is crucial to maximise the patient's quality of life by upholding exemplary standards of patient-centred holistic care. The clinical nurse specialist is in an ideal position to contribute to the identification and management of the palliative care needs of individuals with advanced lung cancer through the assessment and timely prescribing of medications to manage distressing symptoms. Aim: This paper reviews and critiques the role of the clinical nurse specialist as an independent non-medical prescriber in the management of palliative symptoms in end-of-life care for patients with advanced lung cancer. Results: Published literature highlights the positive impact the clinical nurse specialist has as a non-medical prescriber in addressing the palliative needs of individuals with lung cancer. However, there are barriers and challenges, and to overcome these, maximising resources and the availability of support is required to ensure the delivery of timely, person-centred care. Conclusion: The clinical nurse specialist as a non-medical prescriber is an evolving role. There are a range of factors that may influence the clinical nurse specialist to confidently and competently undertake this role. These include the perception that there will be an escalation in the workload, concerns about increased accountability and inadequate mentoring for this new role. To incentivise this role, multidisciplinary support is essential in promoting the clinical nurse specialist's confidence for developing this service to individuals with advanced lung cancer.

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