Palliative care nursing requires sophisticated professional skills including the ability to engage in complex clinical reasoning and decision-making. This advanced program builds on a nurses working knowledge of palliative care by focusing on more complex care issues.
It examines principles underpinning care and offers guidance/debate on ethical dilemmas and advanced clinical directives. The program involves practical skill building sessions, including:
Nursing assessment and the development of complex care plans.
How to deal with medical emergencies in palliative care.
Advanced pharmacological issues.
There is a strong emphasis on holistic care throughout this program. It is ideal for all nurses who have a good basic understanding of palliative care and are looking to advance their knowledge.
Need for Program
Palliative care is becoming an increasingly sophisticated nursing skill that when applied, can have a very positive effect on the person with a life-limiting disease. Palliative care nursing is very complex and often requires nurses to work to their full scope of practice, combining a broad range of skills including but not limited to: psychosocial, clinical reasoning, advanced pain management and complex pathophysiological decision-making. There is a need for a more advanced palliative care program that enables nurses, who already have a reasonable level of knowledge relating to a palliative approach to care, to further enhance their practice.
Aims and Objectives
The aim of this program is to teach advanced palliative care nursing skills. It is designed for registered nurses and enrolled nurses who wish to understand more about the clinical skills and nursing decision-making required when those in their care have life-limiting diseases and/or troublesome terminal symptom issues. Basic knowledge of common terminal illness symptoms and their palliation management is a recommended foundation for this advanced program.
After attending this program, it is expected that the nurse will be able to:
Have insight into the complex nature of palliative care nursing.
Write a comprehensive care plan for a person in need of palliative care.
Demonstrate three practical applications of complex palliative care decision-making.
Day 1
Day 2
Educators
8:30am - Registration and Refreshments
9:00am - Making the Transition From Curative Treatment to Palliative Care
At what stage should the care model migrate from a focus on cure to one of palliative care?
What is the meaning for nursing practice of the term 'advanced palliative care'?
9:45am - Nursing Assessment of Patients with Complex and Challenging Issues
Discussion of the skills required in taking a nursing history and assessment summary, when there are concurrent problems in the patient's physical, psychological, social and spiritual dimensions
10:30am - Morning Tea & Coffee
11:00am - Converting Complex Assessment Information into Workable Care Plans
Collaboration of the multi-disciplinary team, patient, and family in designing and implementing care plans which alleviate suffering and promote quality of life.
How realistic is this ideal?
What needs to be done to ensure that holistic care guides individualised care plans?
12:00pm - Case Study and Discussion
The nature of complexity is such that a partial resolution may be all that can be achieved.
Presentation of a case study to illustrate this reality in care planning decisions
Time for your questions and comments
12:30pm - Lunch Break & Time to Network
1:30pm - The Legal and Ethical Texture of Palliative Care
A clinical decision or situation may be ethical yet illegal and vice-versa. An examination of the interface between law and ethics.
2:40pm - Advance Care Directives (ACD)
The right to refuse treatment through an ACD, or through families making decisions for patients with severe cognitive difficulties or who are comatose, is poorly understood by many nurses.
What constitutes a valid Medical Power of Attorney document?
At law, what are the facts about this substitute form of decision-making?
What are the main ethical considerations?
3:00pm - Afternoon Tea & Coffee
3:30pm - Sensitive Communication and Psychological Support
Some patients face the end of their life with a strong sense of meaning and there are others who have lost meaning or who experience meaninglessness in their suffering.
Guidelines for communication approaches
How can nurses get in touch with the spiritual dimension of those in their care?
4:15pm - End of Day One of Program
Start of Day Two
9:00am - Using Advanced Nursing Expertise in Symptom Management
This session will be an in-depth examination of the nurse's role in providing evidence-based care to assist the dying person with concurrent symptoms and complications. Examples:
Fungating wounds
Delirium
Intractable and severe pain
Intractable nausea & vomiting
How useful are complementary therapies?
10:30am - Morning Tea & Coffee
11:00am - Medical Emergencies in Palliative Care
How to use advanced nursing skills when there is a crisis or deterioration in the patient's condition.
Examples:
Spinal cord compression
Haemorrhage
Hypercalcaemia
Superior vena cava obstruction
Respiratory obstruction
12:30pm - Lunch Break & Browse the Book Display
1:30pm - Advanced Pharmacological Issues in Palliative Care
This session will examine a range of concerns in the administration of medicines.
Ethical / research issues in palliative care medications
Issues of conversion
Administration issues:
Syringe drivers & drug combinations
Sub-cutaneious administration
Home administration by family members
Smart pumps and the components of best-practice intravenous medication
2:30pm - 'Getting Stuck' with Unresolved Grief
Some patients and families become immersed in grief, loss and existential distress
What can nurses do to assist patients, their family or friends, to deal with complicated grief and bereavement issues?
What is 'pathological grief'?
What happens when grief remains unresolved?
3:00pm - Afternoon Tea & Coffee
3:30pm - Continuation of Grief Session
4:00pm - Palliative Care Nurse Practitioners
Increasing numbers of nurses are undertaking the requirements to become endorsed as nurse practitioners.
Update on the emergence of these practitioners in palliative care services
Conditions of practice and controversies, e.g. the types of medical investigations and medications, which can be ordered by accredited nurse practitioners.
4:15pm - Close of Program and Evaluations
Judy Zollo
After a 12 year high school teaching career, Judy began her nursing career almost 30 years ago. Judy’s background includes 14 years as a lecturer in the School of Nursing and Midwifery at the University of SA, after which she chose to return to clinical practice. Her decision to seek employment at Mary Potter Hospice just over seven years ago was driven by a strong interest in this emerging nursing specialty area, and a commitment to the principles and philosophy of palliative care. After 6 months as a full time clinician at the hospice, she was contracted by Little Company of Mary Health Care to participate in the preparation and delivery of palliative care courses for registered and enrolled nurses. Judy has recently ended her involvement in the LCMHC courses due to an increased commitment to the Ausmed palliative care seminars. She currently combines this commitment with a continuing clinical role in the hospice and casual lecturing in the School of Nursing and Midwifery at Flinders University. She has a strong interest in Evidence Based Practice, and the related notion of Clinical Practice Improvement.
