2009 Na Core 5 09 Website Sample

8/2/2019 2009 Na Core 5 09 Website Sample

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Hospice and PalliativeNursing AssistantCore Curriculum

Editor:Mary Ersek, PhD, RN, FAAN

Associate ProfessorUniversity of Pennsylvania, School of NursingPhiladelphia, PA


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TABLE OF CONTENTS

Contributors ....................................................................................................... ivReviewers ......................................................................................................... vIntroduction ........................................................................................................ vii

__________________________________________________________________

Chapter 1: Overview of Hospice and Palliative Nursing Assistant Practice..1

Chapter 2: Pain Management at the End of Life .. 9

Chapter 3: Management of Other Symptoms at the End of Life...................21

Chapter 4: Ethical Issues at the End of Life...................................................33

Chapter 5: Communicating at the End of Life ...............................................43

Chapter 6: Cultural Considerations at the End of Life ..................................53

Chapter 7: Loss and Bereavement ................................................................61

Chapter 8: Spiritual Care at the End of Life ..................................................71

Chapter 9: Care of the Patient and Family When Death is Nearing .............77

Chapter 10: Personal and Professional Development ....................................87

Appendix A: Case Studies and Questions........................................................97

Appendix B: Case Studies Answers.................................................................107


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INTRODUCTION

Nursing assistants work in a wide variety of settings, including long-term care,hospitals, home care, and hospice. They play a central role in providing care to patientswith progressive, life-limiting illnesses, and in providing care and support for the familiesof those patients. Since 2003, the Alliance for Excellence in Hospice and PalliativeNursing, comprised of the Hospice and Palliative Nurses Association (HPNA), theNational Board for Certification of Hospice and Palliative Nurses (NBCHPN), and theHospice and Palliative Nurses Foundation (HPNF), has committed itself to enhancingthe education and professional development of nursing assistants.

In 2001, HPNA established nursing assistant membership, an unusual and bold

step given that nearly all professional nursing organizations exclude nursing assistants.The Association underscored their support for this group of care providers by publishinga position statement entitled, The Value of the Nursing Assistant in Palliative Care. Inthis document, nurses, administrators, and healthcare organizations are urged torecognize that care provided by nursing assistants is critical to achieving establishedgoals of care for patients with progressive, life-limiting illness and their families.

1HPNA

also offers a variety of educational opportunities and products intended for nursingassistants. These include the Nursing Assistant Computerized Educational Program(NA-CEP), components of the Generalist Clinical Review Train-the-Trainer Workshop,and Nursing Assistant teleconferences. NBCHPN has provided certification for hospiceand palliative nursing assistants since 2002. As of 2009, there are over 3,700 dedicated

nursing assistants throughout the United States who have achieved this distinction.Every year, the Hospice and Palliative Nurses Foundation offers scholarships fornursing assistants to take the certification examination.

With this revision of the Hospice and Palliative Nursing Assistant CoreCurriculum, HPNA strives to continue to support nursing assistants and nourish theirdevelopment as integral members of the palliative care team. Like the first edition, itsgoal is to enhance the palliative care knowledge base and skills of nursing assistantsworking in all clinical settings. The principles that guided the development of the firstedition of the Core Curriculumremain unchanged in this revised edition. We believethat:

Better educational preparation for Nursing Assistants results in more effectivecare for patients with progressive, life-limiting illnesses and their families.

To participate actively in planning and providing quality care to palliative carepatients and their families, Nursing Assistants need to possess specializedknowledge and skills.


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Nursing Assistants who are educated and involved in the care of patients withprogressive, life-limiting illnesses and their families experience greater jobsatisfaction, which may in turn decrease job turnover that threatens the qualityand consistency of palliative care.

Although Nursing Assistants do not make decisions about medical therapies oradminister medications, they are responsible for observing and reporting thesymptoms for which these therapies are given, and for observing and reportingresponses to the therapies. In addition, their attitudes towards certain therapies,such as opioids and artificial nutrition, are communicated either directly orindirectly to patients and families. Thus, Nursing Assistants need to be aware ofthe reasons for instituting or withdrawing therapies and to realize that theirattitudes influence patients and families. For this reason, the Hospice andPalliative Nursing Assistant Core Curriculumcontains information about medicaltherapies for several symptoms.

This edition contains revised and updated content in every chapter. A newfeature has also been added: case studies and questions for each chapter to assesslearning and assist in preparation for the certification examination. The Core Curriculumis designed to be used either by Nursing Assistants or by educators who prepareNursing Assistants for clinical practice. We hope that all users of the book will grow intheir ability to teach about and provide high-quality, compassionate care to patients withlife-limiting illness and their families.

Mary Ersek, PhD, RN, FAANEditor, Hospice and Palliative Nursing Assistant Core Curriculum

Hospice and Palliative Nurses Association:

Address: One Penn Center West, Suite 229Pittsburgh, PA 15276-0100

Phone: 412-787-9301Fax: 412-787-9305Email: [email protected]

Cited References:

1. Sidwell JC, Ersek M, Kestner M, Miller Kraybill B. The value of the nursingassistant in palliative care.Position statement. Approved by the HPNA Board ofDirectors January 2009. Pittsburgh, PA: Hospice and Palliative Nurses

Association; 2009. Available at:http://www.hpna.org/DisplayPage.aspx?Title=Position%20Statements.


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Hospice and Palliative Nursing Assistant Core Curriculum 21

CHAPTER 3

MANAGEMENT OF OTHER SYMPTOMS AT THE END OF LIFE

Patricia Berry, PhD, APRN, GNP-BC, ACHPN

Original AuthorBeth Miller Kraybill, RN, BSN, CHPN

I. Introduction

A. Definitions

1. Signs: objective indicators of illness; things that can be seen by an observer; e.g.,fever as a sign of infection; lack of urine as a sign of kidney failure; increased

respiratory rate as a sign of difficulty breathing2. Symptoms: subjective features of illness as defined by the person experiencing

them; e.g., pain and nausea; descriptions of symptoms often include

a) Frequency (how often the symptom occurs)

b) Duration (how long the symptom lasts)

c) Amount of distress experienced by the person

B. Why is the management of symptoms important?

1. Unrelieved symptoms

a) Interfere with activities of daily living (ADLs),e.g., walking, eating sleeping, taking care of oneself

b) Cause distress and suffering

c) Decrease quality of life (QOL)

2. Managing symptoms quickly may prevent a negative cycle: increased discomfort distress, including anxiety more discomfort suffering

C. Frequency of symptoms

1. People with progressive, life-limiting illness often experience many symptoms

2. Rather than reviewing all end-of-life (EOL) symptoms, this chapter will focus onnine of the most commonly occurring symptoms

D. Nursing Assistant roles in symptom management

1. Observation and reporting

a) The Nursing Assistant often spends more time with patients and families than

other team members, so they are best able to observe, interact with thepatient and family and collect information

b) Information about symptoms can be collected by

i. Observing and listening for signs (e.g., wet or noisy breathing, red oropen areas on the skin) and symptoms (e.g., patient tells you they feelshaky when they get out of the bed or a chair)

ii. Watching for signs (e.g., agitation, confusion, restlessness)

Symptom Management

is important for

quality of life.


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32 Management of Other Symptoms at the End of Life

IV. Summary

A. End-of-life symptom management is a challenge that requires the commitment of allcare providers

B. Nursing Assistants have an important role in observing, reporting, and intervening onbehalf of their patients

C. Effective prevention and treatment of symptoms enhances quality of life and eases thedying process for patients and their families

ADDITIONAL REFERENCES AND RESOURCES

1. American Association of College of Nursing (AACN) and the City of Hope National MedicalCenter. Module 3: Nonpain symptoms at end of life. End-of-Life Nursing EducationConsortium (ELNEC) Geriatric;2008.

2. Edwards M, Ersek M. Nursing Assistant End-of-Life Care Computerized Education Program(NA-CEP). Pittsburgh, PA: Hospice and Palliative Nurses Association; 2006.

Resources available at www.hpna.org

HPNA Patient/Family Teaching Sheets

Final Days Food and Fluid at End of Life Managing Constipation Managing Shortness of Breath Managing Fatigue Assisting Families to Manage Fatigue

Managing Nausea and Vomiting Managing Restlessness Managing Delirium Managing Anxiety Managing Depression

HPNA TIPs Sheets

TIPs for Constipation TIPs for Managing Fatigue

HPNA Quick Information Sheet

Delirium in Hospice and Palliative Patients


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98 Case Studies and Questions

CHAPTER 3MANAGEMENT OF OTHER SYMPTOMS AT THE END OF LIFE

Case Study and Questions

Mr. Alfred Jerome is a 59-year-old patient with advanced lung cancer admitted to your hospiceprogram several weeks ago. You are the certified nursing assistant from the hospice and havebeen visiting him three times a week to help with personal care. During your last visit, you notethat Mr. Jerome is less responsive, and that his breathing sounds congested and noisy

1. What end-of-life symptom is Mr. Jerome having?a) Shortness of breathb) Fatiguec) Deliriumd) Noisy breathing

2. What observation is the most important related to Mr. Jeromes symptom? Ifa) there is a suction machine availableb) there are secretions in his mouthc) his oxygen is in placed) his urinal is within reach

3. After notifying the registered nurse of this change in Mr. Jeromes status, which of thefollowing should you do next?a) Position Mr. Jerome on his left side with the head of the bed raisedb) Be sure that Mr. Jerome has his urinal and call light within easy reachc) Provide Mr. Jerome with a hand and/or foot massaged) Reassure Mr. Jerome that this symptom will go away in a few days


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Hospice and Palliative Nursing Assistant Core Curriculum 111

CHAPTER 3MANAGEMENT OF OTHER SYMPTOMS AT THE END OF LIFE

Answers

1. What end-of-life symptom is Mr. Jerome having?

a) Shortness of breath. Incorrect - Shortness of breath (dyspnea) is difficult breathing orlabored breathing.

b) Fatigue. Incorrect -Fatigue is profound tiredness, which is unrelieved by rest, with alack of physical and mental energy and weakness that interferes with ADLs.

c) Delirium. Incorrect - Delirium is excessive restlessness withincreased mental andphysicalactivity most often caused by organ failure that cause chemical imbalances, butcan also be caused or worsened by medication side effects, dehydration, infections,urinary retentions, stool impaction, lack of oxygen (hypoxia), tumors in the brain, orunresolved fears about dying.

d) Noisy breathing. Correct - Noisy respirations are moist, noisy respirations caused by thepooling of oral and respiratory secretions at the back of the throat, with an inability tocough and clear the airway. This most commonly occurs in comatose patients. Thoughit is not uncomfortable for the patient, the families are often distressed hearing therattle or the noisy respirations. Assure the families that the patient is not drowning oruncomfortable because of this. Repositioning the patient from side to side with the headof the bed elevated promotes drainage and can ease the noise. Reinforce thatsuctioning is not usually necessary and may even create more secretions. Avoid usingthe term rattle; use the words congestion or noisy breathing.

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