Jewish Home Lifecare 11th Annual Geriatric Palliative Care
Conference, November 12, 2013

Mary Ersek, PhD, RN, FAAN
Philad...
Describe the growing need for integrating
palliative care into nursing homes.
Describe the role of nursing in palliative c...
Between 1.5–1.8 million people live in US
nursing homes (NHs) Kaye et al, Health Affairs, 2010
By 2050, more than 3 millio...
Over half are totally dependent or need extensive
assistance with bathing, dressing, toileting, and
transferring
67% of nu...
Nursing Assistants
Licensed nursing staff (RNs and LPNs)
Medication and Treatment nurses
Unit manager
Care manager
MDS Coo...
Identifying and documenting goals of care
Facilitating completion of advance directives
Assessing and managing symptoms
Fa...
1. Hospice
2. External palliative care teams
3. Internal palliative care teams/units
Education
Knowledge
Attitudes

Policies: development and implementation
Teams
Role modeling
Quality improvement – monitori...
License nursing staff, certified nursing
assistants, activities director, etc.
Self-assessment
Supervisor assessment
Knowl...
Internal Teams
Principles of palliative care
Hospice 101
Pain and symptom
management
Communication with residents
and fami...
EOL/Palliative Educational Resource Center
(EPERC), www.eperc.mcw.edu/EPERC
Advancing Excellence,
www.nhqualitycampaign.or...
“No complaints of pain”
“That’s the way she always is…”
“Of course she’s in pain…she’s 92, what do you
expect?”
Policies and procedures: Symptom assessment
& management
Policies and procedures: Advanced directives,
assessing capacity
...
Demonstrates knowledge of pain assessment
techniques
Re-evaluates pain following pain medications and
nondrug pain interve...
Quality improvement team
Training team
Pain management team
Goals of care team
Transitions team
Ask about a residents’
comfort level
Report a resident’s
concerns to the nurse
Advocate for a resident
Communicate respect...
RN/LPN
Nurse
practitioner

Nursing
assistants

DON/Admin

RESIDENTS
Physician

Non-nursing
staff
Family
Structure
Process
Outcome
Structure:
Policies - symptom assessment & management, advance
directives
Protocols for managing acute conditions to avoid...
MDS:
Symptoms: Pain, dyspnea; Depressive symptoms (PHQ-9)
Feeding tubes
Hospice
Quality indicators
Percent of Residents wh...
Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders
Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders
Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders
Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders
Upcoming SlideShare
Loading in …5
×

Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders

517 views

Published on

2014 Jewish Home Lifecare Palliative Care Conference, It's Not the Place, It's the Practice

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
517
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
8
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Mary Ersek-Nursing Home-Based Palliative Care: Empowering Nurses as IDT Team Leaders

  1. 1. Jewish Home Lifecare 11th Annual Geriatric Palliative Care Conference, November 12, 2013 Mary Ersek, PhD, RN, FAAN Philadelphia VAMC University of Pennsylvania School of Nursing ersekm@nursing.upenn.edu
  2. 2. Describe the growing need for integrating palliative care into nursing homes. Describe the role of nursing in palliative care. Describe strategies to prepare nursing staff for delivering palliative care and in leading palliative care practices.
  3. 3. Between 1.5–1.8 million people live in US nursing homes (NHs) Kaye et al, Health Affairs, 2010 By 2050, more than 3 million people are expected to spend time in a NH Kaye et al, 2010 28% of persons ≥ 65 years died in a NH in 2007 CDC NCHS, 2010 Nearly 70% of persons with advanced dementia die in a NH Mitchell et al, JAGS, 2005
  4. 4. Over half are totally dependent or need extensive assistance with bathing, dressing, toileting, and transferring 67% of nursing home residents are female 64.8% have moderate to severe cognitive impairment 78.9% are non-Hispanic White 15.3% reported moderate to severe pain (last 5 days) 35.6% incontinent of bowel and/or bladder 25.5% received antipsychotic medication (last 7 days) Average length of stay ≈ 2 years Nursing Home Data Compendium, 2012 Edition
  5. 5. Nursing Assistants Licensed nursing staff (RNs and LPNs) Medication and Treatment nurses Unit manager Care manager MDS Coordinator Staff educator Quality Improvement Director Assistant Director of Nursing Director of Nursing/Clinical Services Nurse Practitioners
  6. 6. Identifying and documenting goals of care Facilitating completion of advance directives Assessing and managing symptoms Facilitating life closure Offer grief and bereavement support Decreasing burdensome transitions Maximizing human dignity
  7. 7. 1. Hospice 2. External palliative care teams 3. Internal palliative care teams/units
  8. 8. Education Knowledge Attitudes Policies: development and implementation Teams Role modeling Quality improvement – monitoring progress
  9. 9. License nursing staff, certified nursing assistants, activities director, etc. Self-assessment Supervisor assessment Knowledge assessment
  10. 10. Internal Teams Principles of palliative care Hospice 101 Pain and symptom management Communication with residents and families Goals of care/Advance directives/POLST Ethical issues Cultural and spiritual issues Loss, grief and bereavement Care for imminently dying Quality improvement External Teams (including hospice) Nursing home history Nursing home culture Work teams and organization Staff as family Central role of CNAs Family involvement Nursing home regulations Nursing home trends Dementia care Geriatrics Respect for NH work and staff
  11. 11. EOL/Palliative Educational Resource Center (EPERC), www.eperc.mcw.edu/EPERC Advancing Excellence, www.nhqualitycampaign.org Geriatric Pain, www.geriatricpain.org Prepare for Your Care, www.prepareforyourcare.org
  12. 12. “No complaints of pain” “That’s the way she always is…” “Of course she’s in pain…she’s 92, what do you expect?”
  13. 13. Policies and procedures: Symptom assessment & management Policies and procedures: Advanced directives, assessing capacity Policies and procedures: Management of acute conditions
  14. 14. Demonstrates knowledge of pain assessment techniques Re-evaluates pain following pain medications and nondrug pain intervention Advocates for residents experiencing pain Role models best practices for pain assessment Consistently observes and reports to the nurse residents’ reports of pain and/or pain-related behaviors Solicits all team members’ evaluations of residents’ pain.
  15. 15. Quality improvement team Training team Pain management team Goals of care team Transitions team
  16. 16. Ask about a residents’ comfort level Report a resident’s concerns to the nurse Advocate for a resident Communicate respectfully Keep families informed
  17. 17. RN/LPN Nurse practitioner Nursing assistants DON/Admin RESIDENTS Physician Non-nursing staff Family
  18. 18. Structure Process Outcome
  19. 19. Structure: Policies - symptom assessment & management, advance directives Protocols for managing acute conditions to avoid hospitalizations Process: Documentation of pain management plan and f/u Documentation of AD Outcomes: Resident symptoms (chart/MDS) Care matches preferences Bereaved Family Perceptions of Care at EOL Hospitalizations, ER visits Staff satisfaction, staff turnover
  20. 20. MDS: Symptoms: Pain, dyspnea; Depressive symptoms (PHQ-9) Feeding tubes Hospice Quality indicators Percent of Residents who Self-Report Moderate to Severe Pain (Short and Long Stay) Percent of Residents Who Have Depressive Symptoms (Long Stay) F-tag 309 – Pain and End-of-life Care

×