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primary vS. specialist Palliative Nursing

primary vS. specialist Palliative Nursing. 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.

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primary vS. specialist Palliative Nursing

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  1. primary vS. specialist Palliative Nursing

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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) Primary Palliative Care

  7. 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 Specialty Palliative Care

  8. 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

  9. RESOURCES FOR SPECIALTY APN PRACTICE

  10. 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

  11. Palliative Nursing: Scope and Standards of Practice 5thedition. 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.

  12. Competencies for the Hospice and Palliative Advanced Practice Nurse2nd 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

  13. 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-GeroCNS

  14. 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

  15. 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

  16. Competencies for Hospice and Palliative Advanced Practice Nurse. 2014 Core Curriculum for the Advanced Practice Hospice and Palliative Nurse 2ndedition. 2013

  17. Position Statements: Artificial Hydration and Nutrition in Advanced Illness Assuring High Quality in Palliative Care Legalization of Assisted Suicide Palliative Sedation Role of the Nurse when Hastened Death is Requested The Ethics of Opiate Use Within Palliative Care The Nurses Role in Advance Care Planning Withholding and /or withdrawing Life Sustaining Therapies

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