Structure and processes of care

161 Pages·2015·7.895 MB·English

by  Ferrell, Betty R

HPNA PALLIATIVE NURSING MANUALS
Structure and Processes
of Care
HPNA PALLIATIVE NURSING MANUALS
Series edited by Betty R. Ferrell, RN, PhD, MA, FAAN, FPCN, CHPN
Volume : Structure and Processes of Care
Volume 2: Physical Aspects of Care: Pain and Gastrointestinal
Symptoms
Volume 3: Physical Aspects of Care: Nutritional, Dermatologic,
Neurologic and Other Symptoms
Volume 4: Pediatric Palliative Care
Volume 5: Social Aspects of Care
Volume 6: Spiritual, Religious, and Existential Aspects of Care and
Cultural Aspects
Volume 7: Care of the Patient at the End of Life
Volume 8: Ethical and Legal Aspects
HPNA PALLIATIVE NURSING MANUALS
Structure and
Processes of Care
Edited by
Betty R. Ferrell, RN, PhD, MA,
FAAN, FPCN, CHPN
Professor and Director
Department of Nursing Research and Education
City of Hope Comprehensive Cancer Center
Duarte, California
1
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Library of Congress Cataloging-in-Publication Data
Structure and processes of care / edited by Betty R. Ferrell.
p. ; cm. —(HPNA palliative nursing manuals ; volume )
“Content for this series was derived primarily from the Oxford Textbook of Palliative
Nursing (4th edition, 205), edited by Betty R. Ferrell, Nessa Coyle, Judith A. Paice.
The Textbook contains more extensive content and references so users of this Palliative
Nursing Manual are encouraged to use the Textbook as an additional resource.”—Preface.
Includes bibliographical references and index.
ISBN 978–0–9–022375–5 (alk. paper)
I. Ferrell, Betty, editor. II. Oxford textbook of palliative nursing. 4th edition. 204.
Based on (expression): III. Series: HPNA palliative nursing manuals ; v. .
[DNLM: . Hospice and Palliative Care Nursing. 2. Palliative Care. 3. Terminal Care.
WY 52.3]
R726.8
66.02′9—dc23
204036629
This material is not intended to be, and should not be considered, a substitute for medical
or other professional advice. Treatment for the conditions described in this material is
highly dependent on the individual circumstances. And, while this material is designed to
offer accurate information with respect to the subject matter covered and to be current
as of the time it was written, research and knowledge about medical and health issues
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Printed in the United States of America
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Contents
Preface vii
Contributors ix
. National Consensus Project for Quality Palliative Care 
Constance Dahlin
2. Hospital-Based Palliative Care 3
Patricia Maani-Fogelman and Marie Bakitas
3. Home Care and Hospice Care 47
Marilyn Bookbinder and Romina Arceo
4. The Intensive Care Unit 57
Jennifer McAdam and Kathleen Puntillo
5. Palliative Care Nursing in the Outpatient Setting 77 v
Pamela Stitzlein Davies
6. Long-Term Care: Focus on Nursing Homes 05
Joan G. Carpenter and Mary Ersek
7. Clinical Interventions, Economic Impact, and
Palliative Care 7
Patrick J. Coyne, Thomas J. Smith, and Laurie J. Lyckholm
Appendix I. Sample CQI Study Proposal to
Improve End of Life Care Using FOCUS-PCAD 3
Appendix II. Carepath: Palliative Care for
Advanced Disease 37
Index 43

Preface
This is the first volume of a new series being published by Oxford University
Press in collaboration with the Hospice and Palliative Nurses Association.
The intent of this series is to provide palliative care nurses with quick refer-
ence guides to each of the key domains of palliative care. The volumes mir-
ror the domains established by the National Consensus Project for Quality
Palliative Care (NCP), as well as one volume devoted specifically to pediat-
ric palliative care. The series will include:
Volume : Structure and Processes of Care—overview of palliative
nursing care, review of NCP guidelines and practical tools to use in start-
ing and maintaining palliative care programs
Volume 2: Physical Aspects of Care: Pain and Gastrointestinal
Symptoms—pain and other physical symptoms, assessment tools,
pharmacology, and patient teaching
Volume 3: Physical Aspects of Care: Nutritional, Dermatologic,
Neurologic and Other Symptoms—nutrition and genitourinary vii
symptom management, assessment tools, pharmacology, and patient
teaching
Volume 4: Pediatric Palliative Care—key areas of pediatric palliative
care, such as pain and symptom management, communication with chil-
dren based on development level, and key assessment tools
Volume 5: Social Aspects of Care—support of family caregivers and
bereavement support
Volume 6: Spiritual, Religious, and Existential Aspects of Care
and Cultural Aspects—spiritual care and cultural assessment tools
Volume 7: Care of the Patient at the End of Life—including physi-
cal symptoms, discontinuing life support, family caregiver support, and
practical tools such as comfort orders and protocols
Volume 8: Ethical and Legal Aspects—to include decision tools, case
studies, and models of analysis of ethical dilemmas
Content for this series was derived primarily from the Oxford Textbook of
Palliative Nursing (4th edition, 205), which is also edited by Betty Ferrell,
Nessa Coyle, and Judith Paice, the editors of this series. The Contributors
identified in each volume are the authors of chapters in the Oxford Textbook
of Palliative Nursing from which the content was selected for this volume.
The Textbook contains more extensive content and references, so users of
these Palliative Nursing Manuals are encouraged to use the Textbook as an
additional resource.
This first volume lays out the structures and processes that are necessary
to support quality palliative care. Future volumes will focus on individual
aspects of this care.
E We are grateful to all palliative care nurses who are contributing to the
C
A advancement of care for seriously ill patients and families. Remarkable
F
E
R progress has occurred over the past 30 years in this field, and nurses have
P
been central to that progress. Our hope is that this series offers an addi-
tional tool to build the care delivery system we strive for.
viii
Contributors
Romina Arceo, ANP-C Constance Dahlin, ANP-BC,
Nurse Practitioner of Pain and ACHPN, FPCN, FAAN
Palliative Care Clinical Director
Department of Pain Medicine and Palliative Care Service
Palliative Care Massachusetts General Hospital
Beth Israel Medical Center Boston, Massachusetts
New York, New York
Mary Ersek, PhD, RN,
Marie Bakitas, PhD FPCN, FAAN
Marie L. O’Koren Endowed Chair Director of National PROMISE
and Professor of Nursing Center
UAB School of Nursing Philadelphia Veterans Affairs
The University of Alabama at Medical Center
Birmingham Associate Professor
Birmingham, Alabama University of Pennsylvania School x
i
of Nursing
Marilyn Bookbinder, RN, PhD
Philadelphia, Pennsylvania
Department of Pain Medicine and
Palliative Care Laurie J. Lyckholm, MD
Beth Israel Medical Center Department of Hematology/
New York, New York Oncology
Virginia Commonwealth University
Joan G. Carpenter, MN,
Massey Cancer Center
CRNP, NP-C, GNP-BC,
Richmond, Virginia
ACHPN, PhD
Patricia G. Archbold Predoctoral Patricia Maani-Fogelman,
Scholar and Doctor of DNP
Philosophy Student Department of Palliative Medicine
College of Nursing Geisinger Medical Center
University of Utah Danville, Pennsylvania
Salt Lake City, Utah
Jennifer McAdam, RN, PhD
Nurse Practitioner
Coastal Hospice and Palliative Care Assistant Professor of Nursing
Berlin, Maryland Samuel Merritt University
Oakland, California
Patrick J. Coyne, MSN, APRN,
FAAN, FPCN
Clinical Director of the Thomas
Palliative Care Unit
Virginia Commonwealth University
Massey Cancer Center
Richmond, Virginia