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PAL-A-ROUNDS: An Innovative Teaching Method for Nurses (721)
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Schedule with Abstracts
transitioning them to a more appropriate location for end-of-life care. Implications for research, policy, or practice. (1) PCUs can be non-monitored and staffed to accommodate dying ICU patients receiving mechanical ventilation, dialysis, hemodynamic support, and other life-sustaining treatments. (2) PCUs are well suited to align treatments with patient preferences through the use of time-limited trials of life-sustaining measures.
Vol. 41 No. 1 January 2011
Barriers to Conducting Advanced Care Discussions for Children with Life-Threatening Conditions (720)
hand, more than 50% of clinicians believed that the following were never or rarely a barrier: clinician concern about losing the trust of the patient, lack of importance to clinician(s), laws and regulations, ethical considerations, conflict between the patient and parent, and concern about the patient receiving less attention from the health-careteam once advanced care discussions began. Conclusion. Significant barriers to conducting advanced care discussions for pediatric patients exist. Implications for research, policy, or practice. Future studies should focus on strategies to overcome these challenges.
Amy Durall, MD, Children’s Hospital, Boston, MA. (Durall has disclosed no relevant financial relationships.)
PAL-A-ROUNDS: An Innovative Teaching Method for Nurses (721)
Objectives 1. Identify barriers to conducting advanced care discussions for children with life-threatening conditions. 2. Identify issues that are less likely to be barriers to advanced care discussions for children with life-threatening conditions. Background. Although some data exist regarding barriers to advanced care discussions among the care of adult patients, very little pediatric data exist. Research objectives. Identify barriers to conducting advanced care discussions for children with life-threatening conditions. Methods. Physicians and nurses from practice settings where advanced care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors about advanced care discussions. Results. The survey had 266 respondents (54% response rate). Of the respondents, 53% percent were medical/surgical critical care clinicians, 20% were cardiac critical care providers, and 27% specialized in oncology. Nurses comprised 60% of respondents and 40% were physicians. Regarding work experience, 43% of clinicians had practiced fewer than 10 years, 30% had practiced 10-19 years, and 27% had practiced 20 years or more. The top-three barriers to conducting advanced care discussions were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. On the other
Chad Farmer, MD MA, Axis Palliative Healthcare, LLC, Tampa, FL. Linda Stennett. Mary LePiere. Lisa Frappier, RN, LifePath Hospice, Tampa, FL. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Describe the basic format of PAL-A-ROUNDS educational sessions. 2. Identify at least one benefit for the adult learner with sessions presented in the PAL-AROUNDS format. Background. Research shows that attention span and ability to retain information decreases after 15 minutes among adult learners. In addition, most nurses report that they do not have time during their typical workday to attend educational sessions of 30 minutes or longer. This suggests a need to identify an innovative way to deliver palliative care education. Research objectives. (1) Present palliative care topics effectively and efficiently to acute inpatient care nurses. (2) Increase participation in palliative care educational sessions. (3) Evaluate participant satisfaction with the PAL-A-ROUNDS teaching format. Methods. PAL-A-ROUNDS were created in a 300bed community hospital as 10-15 minute, multimedia, interactive presentations covering diverse palliative care topics, such as, pain assessment; breaking bad news; and palliative care versus hospice. PAL-A-ROUNDS were presented at each of the seven nursing stations by the traveling PALA-ROUNDS team (physician presenter, nursing
Vol. 41 No. 1 January 2011
Schedule with Abstracts
education specialist, nurse manager) using a tablet PC with PowerPoint slides and a portable dry erase board. Satisfaction surveys were conducted at the conclusion of PAL-A-ROUNDS sessions. Results. From the seven nursing stations, 55 nurses participated in a single PAL-A-ROUNDS topic. Seventy-one percent (39) felt the overall quality of the activity was excellent and 27% (16) felt the quality was good. Ninety-five percent either strongly agreed (30) or agreed (23) that the short format/audiovisuals/location were beneficial and helped achieve the desired activity objectives. Ninety-seven percent either strongly agreed (29) or agreed (25) that as a result of the activity, they would use the information in the care of their patients. Conclusion. Participants found that a shorter format at the location where they are performing their duties was beneficial and that they would use the information to care for their patients. Implications for research, policy, or practice. Offering shorter, focused educational sessions where patient care is delivered may increase satisfaction, increase participation in learning seminars, and translate into incorporation of palliative care principles at the bedside.
Palliative Care Online: A Pilot Study on a Pancreatic Cancer Website (722) Marian Grant, DNP CRNP RN, University of Maryland School of Nursing, Reisterstown, MD. (Grant has disclosed no relevant financial relationships.) Objectives 1. Discuss how the Internet is being used increasingly for health information and support. 2. Discuss the methodology and findings from a pilot study of having a palliative care nurse practitioner available to answer questions on a leading pancreatic cancer website. 3. Discuss the opportunity for further study on providing aspects of palliative care online. Background. Patients with pancreatic cancer and their families could benefit from palliative care services but may not have access to them. An emerging option is the Internet, which is becoming an important source of health information and a link between patients, families, and healthcare providers. Research objectives. (1) Determine if patients and their families would use a webpage where
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they could access a palliative care nurse practitioner (PCNP). (2) Identify the palliative care needs of patients and families who accessed that Webpage. (3) Determine the helpfulness of the webpage/PCNP. Methods. Descriptive quantitative and qualitative Results. The PCNP webpage was visited 650 times by 395 unique individuals over an 8-week study period. Forty-eight participants posted a total of 55 questions or sent e-mails to the PCNP. The majority of questions (66%) fell into one of the eight domains of palliative care. Of these, most of the questions, 42%, asked about physical aspects of pancreatic cancer with the next largest domain, 11%, being psychological concerns about the illness. The other third of questions had to do with non-palliative aspects of pancreatic cancer or its treatment. Twenty participants (5% of total visitors) completed an online survey. Although statistical significance was not achieved, most survey respondents found the PCNP website helpful. It was considered easy to use and participants found information and support there and recommended that the PCNP page be an on-going resource. Conclusion. The Internet can be used to offer aspects of palliative care such as information, support and advice to patients and families dealing with a life-threatening illness. Implications for research, policy, or practice. Further research is needed in this evolving area.
‘‘I Want to Be Taking My Own Last Breath’’: Patients’ Reflections on Illness When Presenting to an Emergency Department at the End of Life (723) Corita Grudzen, MD MSHS, Mount Sinai School of Medicine, New York, NY. Susan Stone, MD MPH, Cedars Sinai & UCLA, Venice, CA. Sarita Mohanty, MD MPH, University of Southern California. Karl A. Lorenz, MD MSHS, VA Greater Los Angeles Healthcare System, Los Angeles, CA. Jacqueline Torres. Joanna Ortiz, BA, Mount Sinai School of Medicine, New York, NY. Stefan Timmermans, PhD, UCLA, Los Angeles, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Discuss what motivates patients to visit emergency departments (ED) at the end of life.
Schedule with Abstracts
transitioning them to a more appropriate location for end-of-life care. Implications for research, policy, or practice. (1) PCUs can be non-monitored and staffed to accommodate dying ICU patients receiving mechanical ventilation, dialysis, hemodynamic support, and other life-sustaining treatments. (2) PCUs are well suited to align treatments with patient preferences through the use of time-limited trials of life-sustaining measures.
Vol. 41 No. 1 January 2011
Barriers to Conducting Advanced Care Discussions for Children with Life-Threatening Conditions (720)
hand, more than 50% of clinicians believed that the following were never or rarely a barrier: clinician concern about losing the trust of the patient, lack of importance to clinician(s), laws and regulations, ethical considerations, conflict between the patient and parent, and concern about the patient receiving less attention from the health-careteam once advanced care discussions began. Conclusion. Significant barriers to conducting advanced care discussions for pediatric patients exist. Implications for research, policy, or practice. Future studies should focus on strategies to overcome these challenges.
Amy Durall, MD, Children’s Hospital, Boston, MA. (Durall has disclosed no relevant financial relationships.)
PAL-A-ROUNDS: An Innovative Teaching Method for Nurses (721)
Objectives 1. Identify barriers to conducting advanced care discussions for children with life-threatening conditions. 2. Identify issues that are less likely to be barriers to advanced care discussions for children with life-threatening conditions. Background. Although some data exist regarding barriers to advanced care discussions among the care of adult patients, very little pediatric data exist. Research objectives. Identify barriers to conducting advanced care discussions for children with life-threatening conditions. Methods. Physicians and nurses from practice settings where advanced care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors about advanced care discussions. Results. The survey had 266 respondents (54% response rate). Of the respondents, 53% percent were medical/surgical critical care clinicians, 20% were cardiac critical care providers, and 27% specialized in oncology. Nurses comprised 60% of respondents and 40% were physicians. Regarding work experience, 43% of clinicians had practiced fewer than 10 years, 30% had practiced 10-19 years, and 27% had practiced 20 years or more. The top-three barriers to conducting advanced care discussions were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. On the other
Chad Farmer, MD MA, Axis Palliative Healthcare, LLC, Tampa, FL. Linda Stennett. Mary LePiere. Lisa Frappier, RN, LifePath Hospice, Tampa, FL. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Describe the basic format of PAL-A-ROUNDS educational sessions. 2. Identify at least one benefit for the adult learner with sessions presented in the PAL-AROUNDS format. Background. Research shows that attention span and ability to retain information decreases after 15 minutes among adult learners. In addition, most nurses report that they do not have time during their typical workday to attend educational sessions of 30 minutes or longer. This suggests a need to identify an innovative way to deliver palliative care education. Research objectives. (1) Present palliative care topics effectively and efficiently to acute inpatient care nurses. (2) Increase participation in palliative care educational sessions. (3) Evaluate participant satisfaction with the PAL-A-ROUNDS teaching format. Methods. PAL-A-ROUNDS were created in a 300bed community hospital as 10-15 minute, multimedia, interactive presentations covering diverse palliative care topics, such as, pain assessment; breaking bad news; and palliative care versus hospice. PAL-A-ROUNDS were presented at each of the seven nursing stations by the traveling PALA-ROUNDS team (physician presenter, nursing
Vol. 41 No. 1 January 2011
Schedule with Abstracts
education specialist, nurse manager) using a tablet PC with PowerPoint slides and a portable dry erase board. Satisfaction surveys were conducted at the conclusion of PAL-A-ROUNDS sessions. Results. From the seven nursing stations, 55 nurses participated in a single PAL-A-ROUNDS topic. Seventy-one percent (39) felt the overall quality of the activity was excellent and 27% (16) felt the quality was good. Ninety-five percent either strongly agreed (30) or agreed (23) that the short format/audiovisuals/location were beneficial and helped achieve the desired activity objectives. Ninety-seven percent either strongly agreed (29) or agreed (25) that as a result of the activity, they would use the information in the care of their patients. Conclusion. Participants found that a shorter format at the location where they are performing their duties was beneficial and that they would use the information to care for their patients. Implications for research, policy, or practice. Offering shorter, focused educational sessions where patient care is delivered may increase satisfaction, increase participation in learning seminars, and translate into incorporation of palliative care principles at the bedside.
Palliative Care Online: A Pilot Study on a Pancreatic Cancer Website (722) Marian Grant, DNP CRNP RN, University of Maryland School of Nursing, Reisterstown, MD. (Grant has disclosed no relevant financial relationships.) Objectives 1. Discuss how the Internet is being used increasingly for health information and support. 2. Discuss the methodology and findings from a pilot study of having a palliative care nurse practitioner available to answer questions on a leading pancreatic cancer website. 3. Discuss the opportunity for further study on providing aspects of palliative care online. Background. Patients with pancreatic cancer and their families could benefit from palliative care services but may not have access to them. An emerging option is the Internet, which is becoming an important source of health information and a link between patients, families, and healthcare providers. Research objectives. (1) Determine if patients and their families would use a webpage where
285
they could access a palliative care nurse practitioner (PCNP). (2) Identify the palliative care needs of patients and families who accessed that Webpage. (3) Determine the helpfulness of the webpage/PCNP. Methods. Descriptive quantitative and qualitative Results. The PCNP webpage was visited 650 times by 395 unique individuals over an 8-week study period. Forty-eight participants posted a total of 55 questions or sent e-mails to the PCNP. The majority of questions (66%) fell into one of the eight domains of palliative care. Of these, most of the questions, 42%, asked about physical aspects of pancreatic cancer with the next largest domain, 11%, being psychological concerns about the illness. The other third of questions had to do with non-palliative aspects of pancreatic cancer or its treatment. Twenty participants (5% of total visitors) completed an online survey. Although statistical significance was not achieved, most survey respondents found the PCNP website helpful. It was considered easy to use and participants found information and support there and recommended that the PCNP page be an on-going resource. Conclusion. The Internet can be used to offer aspects of palliative care such as information, support and advice to patients and families dealing with a life-threatening illness. Implications for research, policy, or practice. Further research is needed in this evolving area.
‘‘I Want to Be Taking My Own Last Breath’’: Patients’ Reflections on Illness When Presenting to an Emergency Department at the End of Life (723) Corita Grudzen, MD MSHS, Mount Sinai School of Medicine, New York, NY. Susan Stone, MD MPH, Cedars Sinai & UCLA, Venice, CA. Sarita Mohanty, MD MPH, University of Southern California. Karl A. Lorenz, MD MSHS, VA Greater Los Angeles Healthcare System, Los Angeles, CA. Jacqueline Torres. Joanna Ortiz, BA, Mount Sinai School of Medicine, New York, NY. Stefan Timmermans, PhD, UCLA, Los Angeles, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Discuss what motivates patients to visit emergency departments (ED) at the end of life.