PRIMARY VS. SPECIALIST PALLIATIVE

NURSING

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ROLE OF APRNS IN HEALTH CARE

IN THE CHANGING LANDSCAPE OF HEALTHCARE, NURSING, PARTICULARLY APRNS, HAVE BEEN IDENTIFIED AS AN ESSENTIAL ELEMENT OF IMPROVING CARE AND ACCESS UNDER HEALTH CARE REFORM.

APRNS ARE UNIQUELY QUALIFIED AND POSITIONED TO PROVIDE PALLIATIVE SERVICES, PARTICULARLY IN THE RURAL AND COMMUNITY SETTINGS.

INSTITUTE OF MEDICINE 2010

PATIENT PROTECTION AND AFFORDABLE CARE ACT 2010

PALLIATIVE NURSING

PALLIATIVE NURSING FOCUSES ON: CARE DELIVERY TO INDIVIDUAL PATIENTS AND FAMILIES; PATIENTS WITHIN SPECIFIC DISEASE POPULATIONS; AND PALLIATIVE CARE ISSUES WITHIN HEALTHCARE AND SOCIETY AS A WHOLE ENTITY.

PALLIATIVE NURSING EMBRACES AND REFLECTS A HOLISTIC PHILOSOPHY OF CARE PROVIDED TO PATIENTS WITH SERIOUS OR LIFE-THREATENING ILLNESS IN DIVERSE HEALTH SETTINGS, ACROSS THE LIFE SPAN.

PALLIATIVE NURSING: SCOPE AND STANDARDS

ANA AND HPNA 2014

DELINEATION OF PALLIATIVE NURSING

• ALL NURSES PRACTICE ASPECTS OF PRIMARY PALLIATIVE CARE.

• SPECIALTY PALLIATIVE NURSING

• REGISTERED NURSES EMPLOYED BY HOSPICES TO WORK ON HOSPICE UNITS, IN THE HOME, OR SKILLED FACILITY SETTINGS.

• REGISTERED NURSES EMPLOYED BY PALLIATIVE CARE TEAMS TO WORK ON DEDICATED PALLIATIVE UNITS, OUTPATIENT SETTINGS, OR IN THE HOME.

• TWO ADVANCED PRACTICE PALLIATIVE NURSING ROLES

• THE GRADUATE LEVEL PREPARED SPECIALTY NURSE WHO ADVANCES PALLIATIVE IN NON CLINICAL AREAS SUCH AS EDUCATION, ADMINISTRATION, OR RESEARCH.

• THE ADVANCED PRACTICE REGISTERED NURSE (APRN) , USUALLY A NURSE PRACTITIONER OR CLINICAL NURSE SPECIALIST WHO IS CLINICALLY FOCUSED.

PALLIATIVE NURSING: SCOPE AND STANDARDS ANA AND HPNA 2014

PALLIATIVE NURSING ESSENTIALS

• KNOWLEDGE• DISEASE STATE, PROGNOSIS, PHARMACOLOGY, EVIDENCE BASE TO PRACTICE

• COMMUNICATION• ASSESSMENT (PERSPECTIVES, SYMPTOMS, BELIEFS, VALUES, CONCERNS,

COPING), GOALS OF CARE, RELATIONSHIPS, EDUCATION, COLLABORATION, COORDINATION

• PRESENCE• ACTIVE LISTENING, AVAILABILITY, ACKNOWLEDGEMENT

PRIMARY PALLIATIVE CARE

PROVIDED BY ALL HEALTH CARE PROFESSIONALS• MANAGEMENT OF CHRONIC ILLNESS

• BASIC SYMPTOM MANAGEMENT

• COMMUNICATION

• ADVANCED DIRECTIVES

• RESOURCES/TRAINING: • ELNEC (END OF LIFE NURSING EDUCATION CONSORTIUM

• EPERC (END OF LIFE/PALLIATIVE EDUCATION RESOURCE CENTER)

• CAPC (CENTER TO ADVANCE PALLIATIVE CARE)

• NHPCO (NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION)

SPECIALTY PALLIATIVE CARE

• RECOGNIZED AS SUBSPECIALTY IN NURSING, MEDICINE, SOCIAL WORK, AND CHAPLAINCY

• PROVISION OF CARE THAT IS • FOCUSED ON ALLEVIATING SUFFERING AND PROMOTING QUALITY OF LIFE

FOR PATIENTS AND FAMILIES WITH COMPLEX NEEDS WHO ARE LIVING WITH A LIFE THREATENING ILLNESS OR SEVERE ADVANCED ILLNESS.

• INTERDISCIPLINARY• PROVIDED BY PROFESSIONALS WITH SPECIALTY TRAINING/CERTIFICATION IN

PALLIATIVE CARE

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CURRENT STATUS OF

PALLIATIVE EDUCATION FOR ADVANCED PRACTICE NURSES

• FEW GRADUATE PROGRAMS HAVE SPECIALTY PROGRAMS WITH DUAL EDUCATION IN PARTICULAR POPULATION FOCI AND PALLIATIVE CARE

• EDUCATIONAL FORUMS BY NATIONAL ORGANIZATIONS REPRESENTING HOSPICE AND PALLIATIVE CARE – HPNA, AAHPM, NHPCO

• REGIONAL EDUCATION – APRN ELNEC

• URBAN EDUCATION BY ACADEMIC SETTING

RESOURCES FOR SPECIALTY APN PRACTICE

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APRN FELLOWSHIPS IN PALLIATIVE CARE

ONLY 6 APN FELLOWSHIPS IN PALLIATIVE CARE 5 FOR THE PALLIATIVE NP – ONE FOR PALLIATIVE CNS

BY CONTRAST, THERE ARE 106 PHYSICIAN FELLOWSHIPS IN PALLIATIVE CARE.

PROGRAMS HAVE 5 TRAINEES, AND CA HAS 10.

RESULT – APPROXIMATELY 15 NPS ANNUALLY WHO RECEIVE SPECIALTY TRAINING

HISTORICAL OCCUR AT ACADEMIC MEDICAL CENTERS – 5 EAST COAST AND 1 WEST COAST

MOST ESTABLISHED - BI AND MSKCC – NYC

NEWER – DFCI AND MGH - BOSTON

RECENT CREATED – UVM AND CA PROGRAMS

MOST FELLOWSHIPS TRAIN APRNS AS FUTURE PALLIATIVE TEAM MEMBERS OF THEIR PROGRAM.

RESULT - APN FELLOWS STAY IN ACADEMIC MEDICAL CENTER POSITIONS

PALLIATIVE NURSING: SCOPE AND STANDARDS OF PRACTICE

5TH EDITION. 2014 ANA & HPNA

• THE REVISIONS REFLECT THE CURRENT PRINCIPLES AND PRACTICE OF PALLIATIVE NURSING, WHICH INCLUDES BOTH HOSPICE AND PALLIATIVE NURSES, IN COLLABORATION WITH INTERDISCIPLINARY TEAM MEMBERS ACROSS ALL SETTINGS.

• THE SCOPE AND STANDARDS REPRESENT THE NECESSARY KNOWLEDGE, SKILLS, AND ABILITIES DEMONSTRATED BY THE REGISTERED NURSE, THE GRADUATE-LEVEL PREPARED SPECIALTY NURSE, AND THE ADVANCED PRACTICE REGISTERED NURSE WHEN PROVIDING EVIDENCE-BASED PHYSICAL, EMOTIONAL, PSYCHOSOCIAL, AND SPIRITUAL CARE.

COMPETENCIES FOR THE HOSPICE AND PALLIATIVE ADVANCED PRACTICE NURSE

2ND EDITION. 2014 HPNA

• THESE HAVE BEEN COMPLETELY REVISED TO REFLECT THE CHANGES IN PRACTICE OVER THE LAST 12 YEARS.

• THEY COMPLEMENT PALLIATIVE NURSING: SCOPE AND STANDARDS

• TO PROMOTE INCLUSION OF THE TWO ADVANCED PRACTICE ROLES DELINEATED IN THE SCOPE AND STANDARDS OF PALLIATIVE NURSING, THE TITLE DELIBERATELY INCLUDED APN RATHER THAN APRN

REQUIREMENTS FOR CERTIFICATION

• CURRENT, ACTIVE RN LICENSE THAT REFLECTS ADVANCED PRACTICE STATUS (CNS, NP, CRNA, CNM)

• HOLD A MASTERS EDUCATION OR DOCTORAL EDUCATION FROM AN ACCREDITED GRADUATE LEVEL NURSING PROGRAM AND

• COMPLETED SPECIFIC AREAS OF CLINICAL AND DIDACTIC COURSEWORK • HEALTH ASSESSMENT• PHARMACOLOGY• PATHOPHYSIOLOGY

• AMERICAN NURSING CREDENTIALING CENTER (ANCC) WWW.NURSECREDENTIALING.ORG• FAMILY, PEDIATRIC, FAMILY/PSYCHIATRIC/MENTAL HEALTH, ADULT–GERO ACUTE CARE OR PRIMARY CARE NP• PEDIATRIC OR ADULT-GERO CNS

SPECIALTY CERTIFICATION INADVANCED PRACTICE HOSPICE AND PALLIATIVE

• NATIONAL BOARD FOR CERTIFICATION OF HOSPICE AND PALLIATIVE NURSES (NBCHPN) DELINEATES

• CERTIFICATION ELIGIBILITY

• EXAMINATION QUESTIONS

• RECERTIFICATION THROUGH A COMBINATION OF CE, PRESENTATIONS, WRITING, PRECEPTORING, TEST QUESTION WRITING.

• 2013 RESULTS OF APRN CERTIFICATION

• 242 TOOK THE TEST

• 153 PASSED THE TEST

• TOTAL OF ACHPNS 905

• 2014 TESTING JUNE, SEPTEMBER, AND DECEMBER

PALLIATIVE NURSING RESOURCES

• OXFORD TEXTBOOK OF PALLIATIVE NURSING, 3RD EDITION. (2010). B. FERRELL AND N. COYLE EDS. NEW YORK, NY: OXFORD UNIVERSITY PRESS.

• WITTENBERG-LYLES, E., GOLDSMITH, J., FERRELL, B., & RAGAN, S. (2013). COMMUNICATION IN PALLIATIVE NURSING. NEW YORK, NY: OXFORD UNIVERSITY PRESS.

• NATIONAL CONSENSUS PROJECT FOR QUALITY PALLIATIVE CARE. (2013). CLINICAL PRACTICE GUIDELINES FOR QUALITY PALLIATIVE CARE, 3RD EDITION. NATIONALCONSENSUSPROJECT.ORG

Competencies for Hospice and Palliative Advanced Practice Nurse. 2014

Core Curriculum for the Advanced Practice Hospice and Palliative Nurse 2nd edition. 2013

Position Statements:Artificial Hydration and Nutrition in Advanced IllnessAssuring High Quality in Palliative CareLegalization of Assisted SuicidePalliative SedationRole of the Nurse when Hastened Death is RequestedThe Ethics of Opiate Use Within Palliative CareThe Nurses Role in Advance Care PlanningWithholding and /or withdrawing Life Sustaining Therapies