PAGE 2
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
MARCH 2015
Guest Editorial GUEST EDITORIAL: A CARE PERSPECTIVE: PALLIATIVE CARE As a current graduate nursing student in clinical rotations, I have been exposed to a variety of different practices and specialties. One of the many challenges encountered has been changing my frame of thought from acute inpatient care as a staff nurse to outpatient primary care as an advanced practitioner. Clinical rotations allows for a variety of experiences in short period of time. These experiences will help to guide what my future practice as a Nurse Practitioner will look like. Palliative care is a hot topic in current practice. With continued health care advances, individuals are living longer with chronic illness, sometimes with an improved quality of life. The term palliative care often holds a negative connotation. Frequently, you hear people saying, ‘‘All they want to do is talk about death.’’ I cannot say that my knowledge and experience with palliative care was much different than that before doing a clinical rotation with a palliative care team. Joining a palliative care team for a semester allowed me to view the care of chronic illnesses form a different vantage point. The real question that palliative care poses is this: ‘‘How do you want your care to look in the future?’’ Having a goals of care discussion with a patient is essential in delivering quality health care. This discussion does not have to be left for a palliative care team to initiate. Primary care practitioners need to recognize that the extent to which they would choose to treat someone may not align with the extent of care they want to receive. Chronic medical illnesses and continued medical intervention often leads us to the following question: ‘‘Which is more important: Quality or quantity?’’ Primary care practitioners have the perfect avenue to implement discussions about goals of care, which ultimately will serve as a guide to help direct all patient care. Additionally, an important role of a primary care practitioner is to develop advanced directives and power of attorney health care (AD POA-HC). Aiding in the discussion and completion of these documents will ensure that a patient’s wishes will be honored in all health care settings. It is unfortunate that first encounters with palliative care often occur when the goals of care can no longer be discussed. This is when it is even more crucial to have a documented AD POA-HC. The scenario has been encountered far too many times during my rotation that an individual is critically ill and unable to voice their wishes and additionally do not have any documented AD POAHC. These patient encounters have opened my eyes to the importance of having those difficult discussions with my future paJ Vasc Nurs 2015;33:2-3. 1062-0303/$36.00 Copyright Ó 2015 by the Society for Vascular Nursing, Inc. http://dx.doi.org/10.1016/j.jvn.2014.12.004
tients. My view of caring for individuals has been changed forever by engaging in these difficult conversations. Ask your patients how they want their care to look; you may be surprised by their response. Julia Lewis, BSN, ONC Aurora Health Care, St. Luke’s Medical Center Milwaukee, Wisconsin
E-mail address: [email protected] FROM THE EDITOR.
What is palliative care? Palliative care is patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care assists increasing numbers of people with chronic, debilitating, and life-limiting illnesses. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice. The following features characterize palliative care philosophy and delivery:
Care is provided and services are coordinated by an interdisciplinary team; Patients, families, palliative, and nonpalliative health care providers collaborate and communicate about care needs; Services are available concurrently with or independent of curative or life-prolonging care; and Patient and family hopes for peace and dignity are supported throughout the course of illness, during the dying process, and after death. The National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care is a clinical document to promote optimal palliative care. The references provide evidence-based practices upon which to build palliative care programs. Within the 8 domains, the Clinical Practice Guidelines for Quality Palliative Care focus on promoting both the philosophy of palliative care and raising awareness of the necessity of quality palliative care with recommended practices. It provides a practical guide to the provision of palliative care. The National Quality forum (NQF) has developed a more formal definition of quality palliative care and established quantitative measures as the basis for developing and testing quality indicators appropriate for palliative care. The NQF has identified each of the NCP domains as a particular problem to be addressed by specific preferred practices. The publication of ‘‘A Framework for Palliative and Hospice Care Quality Measurement and Reporting’’ by the NQF addresses the need to develop quantifiable quality indicators to monitor patient outcomes.
Vol. XXXIII No. 1
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
The NCP and the NQF have advanced palliative care by formalizing the concept and differentiating it from other types of care. Eight domains of palliative care have been identified:
1. 2. 3. 4. 5. 6. 7. 8.
Structure and processes of care; Physical aspects of care; Psychosocial and psychiatric aspects of care; Social aspects of care; Spiritual, religious, and existential aspects of care; Cultural aspects of care; Care of the imminently dying patient; and Ethical and legal aspects of care.
PAGE 3
On March 26, 2013, the NCP for Quality Palliative Care released the third edition of the ‘‘Clinical Practice Guidelines for Quality Palliative Care,’’ which can serve as a blueprint for creating new palliative care programs and guiding developing programs. The guidelines describe elements of best practices for eight practice domains: structure and processes of care; physical aspects of care; psychological and psychiatric aspects; social aspects of care; spiritual, religious, and existential aspects of care; cultural aspects of care; care of the patient at the end of life; and ethical and legal aspects of care. The guidelines are available for free download at www.nationalconsensusproject. org.
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
MARCH 2015
Guest Editorial GUEST EDITORIAL: A CARE PERSPECTIVE: PALLIATIVE CARE As a current graduate nursing student in clinical rotations, I have been exposed to a variety of different practices and specialties. One of the many challenges encountered has been changing my frame of thought from acute inpatient care as a staff nurse to outpatient primary care as an advanced practitioner. Clinical rotations allows for a variety of experiences in short period of time. These experiences will help to guide what my future practice as a Nurse Practitioner will look like. Palliative care is a hot topic in current practice. With continued health care advances, individuals are living longer with chronic illness, sometimes with an improved quality of life. The term palliative care often holds a negative connotation. Frequently, you hear people saying, ‘‘All they want to do is talk about death.’’ I cannot say that my knowledge and experience with palliative care was much different than that before doing a clinical rotation with a palliative care team. Joining a palliative care team for a semester allowed me to view the care of chronic illnesses form a different vantage point. The real question that palliative care poses is this: ‘‘How do you want your care to look in the future?’’ Having a goals of care discussion with a patient is essential in delivering quality health care. This discussion does not have to be left for a palliative care team to initiate. Primary care practitioners need to recognize that the extent to which they would choose to treat someone may not align with the extent of care they want to receive. Chronic medical illnesses and continued medical intervention often leads us to the following question: ‘‘Which is more important: Quality or quantity?’’ Primary care practitioners have the perfect avenue to implement discussions about goals of care, which ultimately will serve as a guide to help direct all patient care. Additionally, an important role of a primary care practitioner is to develop advanced directives and power of attorney health care (AD POA-HC). Aiding in the discussion and completion of these documents will ensure that a patient’s wishes will be honored in all health care settings. It is unfortunate that first encounters with palliative care often occur when the goals of care can no longer be discussed. This is when it is even more crucial to have a documented AD POA-HC. The scenario has been encountered far too many times during my rotation that an individual is critically ill and unable to voice their wishes and additionally do not have any documented AD POAHC. These patient encounters have opened my eyes to the importance of having those difficult discussions with my future paJ Vasc Nurs 2015;33:2-3. 1062-0303/$36.00 Copyright Ó 2015 by the Society for Vascular Nursing, Inc. http://dx.doi.org/10.1016/j.jvn.2014.12.004
tients. My view of caring for individuals has been changed forever by engaging in these difficult conversations. Ask your patients how they want their care to look; you may be surprised by their response. Julia Lewis, BSN, ONC Aurora Health Care, St. Luke’s Medical Center Milwaukee, Wisconsin
E-mail address: [email protected] FROM THE EDITOR.
What is palliative care? Palliative care is patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care assists increasing numbers of people with chronic, debilitating, and life-limiting illnesses. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice. The following features characterize palliative care philosophy and delivery:
Care is provided and services are coordinated by an interdisciplinary team; Patients, families, palliative, and nonpalliative health care providers collaborate and communicate about care needs; Services are available concurrently with or independent of curative or life-prolonging care; and Patient and family hopes for peace and dignity are supported throughout the course of illness, during the dying process, and after death. The National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care is a clinical document to promote optimal palliative care. The references provide evidence-based practices upon which to build palliative care programs. Within the 8 domains, the Clinical Practice Guidelines for Quality Palliative Care focus on promoting both the philosophy of palliative care and raising awareness of the necessity of quality palliative care with recommended practices. It provides a practical guide to the provision of palliative care. The National Quality forum (NQF) has developed a more formal definition of quality palliative care and established quantitative measures as the basis for developing and testing quality indicators appropriate for palliative care. The NQF has identified each of the NCP domains as a particular problem to be addressed by specific preferred practices. The publication of ‘‘A Framework for Palliative and Hospice Care Quality Measurement and Reporting’’ by the NQF addresses the need to develop quantifiable quality indicators to monitor patient outcomes.
Vol. XXXIII No. 1
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
The NCP and the NQF have advanced palliative care by formalizing the concept and differentiating it from other types of care. Eight domains of palliative care have been identified:
1. 2. 3. 4. 5. 6. 7. 8.
Structure and processes of care; Physical aspects of care; Psychosocial and psychiatric aspects of care; Social aspects of care; Spiritual, religious, and existential aspects of care; Cultural aspects of care; Care of the imminently dying patient; and Ethical and legal aspects of care.
PAGE 3
On March 26, 2013, the NCP for Quality Palliative Care released the third edition of the ‘‘Clinical Practice Guidelines for Quality Palliative Care,’’ which can serve as a blueprint for creating new palliative care programs and guiding developing programs. The guidelines describe elements of best practices for eight practice domains: structure and processes of care; physical aspects of care; psychological and psychiatric aspects; social aspects of care; spiritual, religious, and existential aspects of care; cultural aspects of care; care of the patient at the end of life; and ethical and legal aspects of care. The guidelines are available for free download at www.nationalconsensusproject. org.
