Palliative Care

  1. How much of your nursing training was/is devoted to palliative care and symptom control? Please comment on whether you think this was enough.
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  2. 14 Comments

  3. by   adrienurse
    Also, I notice that we don't have a palliative care forum here. Do any of you actually work on a palliative care unit?
  4. by   pebbles
    University of manitoba BN program has a palliative care course included in the mandatory curriculum... I know most other places have it as an optional course. It's in the fourth year, so it's mostly only the "senior" students taking the course.

    Ten weeks, classes three times a week, and clinical two days a week, for half-days. It was definitely enough - just enough to get a sense of what this specialty is all about, without overdoing it. This is the rotation where it finally hit home to me what nursing is all about.... I'm so glad I got to take that course. Now I think about "palliation" issues in many of my patients - even those that don't quite have the "terminal" label attached to them yet.

    Oh - adrienurse, I see you are from Winterpeg too!
    hello!
  5. by   adrienurse
    I graduated from the U of M. Half of the reason why I'm asking is because the profs used to claim their program was unique. I draw on my palliative care teachings almost every day.
  6. by   Kayzee
    No palliative care training. I just learned from experiences. i feel it should have been offered.
  7. by   Cascadians
    Some facilities and home health care agencies are putting Terminal but not yet Hospice patients in an in-between model called Palliative Care. More attention is given to quality of life holistic issues and listening to the patient and family and keeping the patient comfortable. This approach is valuable

    In Oregon, the Assisted Suicide State, there is a lot of ongoing research into end-of-life concerns so Palliative Care is ever changing and progressing.

    Would highly encourage schools to teach as much as possible about Palliative Care and end-of-life issues. Also, Drs really need a LOT of classroom and clinical time in Terminal Bedside Manners! including how to address Advance Directives and gently discussing DNRs with patients and families before dire emergencies
  8. by   micro
    I don't remember, so I don't think it was much. Most by experience and even with experience.....it seems determinant on where you are working, the doc, etc.
  9. by   bandaidexpert
    Our MD's document palliative care in progress notes instead of ordering Hospice. I deal with alot of palliative care related to wound management. I recently took a short CEU course on this subject, very interesting.
  10. by   Tookie
    Adrienurse
    good topic - have you got any good sites you would recommend for further reading on this subject
    At our facility - aged care area - we consider that all residnts are really in their fianl stages of life and in many ways our care should be focused around palliative care principles - I will add here - l have been at this current facility for over 5 years and out of the 50 beds there would be at least 20 residnts who have been there longer than me.
    Would be grateful for good sites to add to my favorites -
    Thanking you in advance
  11. by   aimeee
    None. But some of us were given the opportunity to spend a day with Hospice as one of our "specialty" days. I would love to see a course in palliative care required for nurses in long term care settings especially.
  12. by   adrienurse
    I realize now that palliative care and hospice care are interchangeable in a lot of ways. We have a 30 bed palliative care unit in my facility. It is an inpatient facility that focuses on symptom and pain control and family support. For some reason actual hospices are a little bit less recognized in my city. Although I am a gerontologic nurse, I call on my skills in palliative care very often. It is really a philosophy of respect and support of anyone that is terminal.

    Sandra, you asked about some resources. Off the cuff here are a few:

    Victoria Hospice Society www.fcns-caregiving.org/archives.html

    Some reading suggestions. I especially recommend the publication by the Victoria Hospice Society. I refer to it heavily in terms of symptom control in active dying phase -- have never seen it explained better. www.library.ubc.ca/extension/courses/nurs409g.htm

    I was happy to know that the Canadian Nurses Association will now be offering certification in Palliative care.
  13. by   Tookie
    Thank you Adrienurse
    Have added them to my favourites and will send them to myself at work - l can make time at work to read them properley
    In Australia now there are a number of reconised courses being run on Palliative care at different levels - I cant remeber to what level of degree/ diploma etc - will try and remeber to chach that out when work settles a little - hopefully at the end of this week.
  14. by   MollyJ
    I think Palliation is a mindset. When I went to nursing school LONG AGO it was the care versus cure mindset. Now I don't want what I write here to denigrate this fine nursing program described above; it sounds like something I could personally be very interested in. It sounds like a voice in the desert.

    My old diploma program did not address palliation per se, but we talked alot about nursing care and nursing problems. However, I personally did the critical care route and I think that working those high tech environments pulls the nurse away from the care mentality and towards the "cure" mentality. Please--I am not saying that critical care nurses are uncaring. But when nurses get caught up in a culture of doing it because it can be done, calling anything but doing that high tech procedure "malpractice", etc, they've started to focus, along with their medical colleagues, on Cure VS Care.

    So many critical care nurses post here and say, "Geez, i can't believe what we are doing in my ICU to old people who are demented, chronically ill or care home residents." These nurses are rebelling against the "cure" paradigm.

    Palliation and "care" are beautiful, under-utilized concepts. Ultimately, as Americans confront the notion that we can provide more health care than we can afford to provide, embracing palliation and "care" will become the face of health care.

    I formerly did case management on high tech peds cases. These children and their families needed care vs cure thinking injected into their cases. So much was done to these children because we had the technology and it could be done. But little was done in the way of asking, "SHOULD it be done?" Even when the questions were asked the families were so wrapped up in the fast-moving, high tech care "steam engine", that families felt paralyzed to jump off of the train. They'd already entered into the curative mindset culture. Pursuing the elusive "curative" technology in these children's cases OFTEN forced their families into a frankly dysfunctional maelstrom.

    As a culture, families and the public expect miracles, cures, happy endings. They've seen that outcome out of high tech care so often, that they ill conceive of anything else. But the fact is that high tech care often serves people poorly.

    viva la palliation!

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