When ever I get the opportunity to help the bedside nurse with end of life care I feel I am actually doing what I was intended to do with my career. I am so honored that the nurse feels comfortable calling me. My latest request occurred last Friday. The nurse was just given a consult for EOL care with my group. She wanted me to stop by and see if there was anything else I could suggest. The patient was a 28 year old man with ALL who developed a fungal infection in his sinuses that spread to his brain and was now actively dying. The family agreed to a DNR status and seemed to be coping well. I was able to adjust the current orders and write for  some back-up orders in case they would be needed over later. I love asking the nurse what other orders they want. They always look so surprised and they seem to enjoy being part of the decision process. We settled on adjusting the Morphine drip, adding orders for Glycopyrrolate, and increasing the Ativan order to 0.5mg q 2 hours prn. I spoke to the family and answered their questions. I taught them what to expect to see when their son's death was eminent, the importance for them to get their rest, the fact that the dying chose their time and to not take it as a failure if he dies when they are not there, and that the family was in charge and could dictate when their son was to be turned and if they want him bathed. I emphasized that this was their time with their son and it was precious. We talked about the use of music and familiar sounds. At this point their son was hypersensitive and rested better with silence. The family liked the idea of aroma therapy and went to the gift shop to purchase some lavender scented lotion. I went over some additional teaching points with the nurses and earned some Brownie points with my Docs for starting a consult for them. It is interesting how I need to be needed as much as the nurse and family needed me.

I will be doing a webinar for NCCN about evidence-based care of the dying and will be show casing the CARES Tool. The webinar is called Optimizing Nursing Care at End of Life. It will be available through NCCN until late June go to http://education.nccn.org/node/64447 to check it out.

I am also continuing to chat with HPNA to sponsor and post the CARES Tool. I am hopeful that I can make the CARES Tool more available to help all of us provide better end of life care. So all positive thought will be appreciated.

I am working on a screenplay based on my novel Resilient Hearts. The novel follows a Palliative Care team and how they care for their patients and each other. My husband loved it so much he is organizing an independent film production company to make it into a movie. This has been a goal of mine since I finished the book. I feel a movie would be a great teaching tool and reach many more individuals. It shows how important setting goals of care and having open communication is to promoting a peaceful and loving death, how very important it is to have self-care.

I also had the pleasure to talk to a nurse practitioner who decided she needed to learn more about palliative care. I was able to help her see how as a nurse we are already focused on providing palliative care and we talked about the difference between providing primary and specialty Palliative Care. Nurses need to become experts in primary palliative care. I think I found a kindred spirit in this NP and I hope to help her appreciate the special gifts she can bring to he patients by providing primary palliative care.

So thanks for checking out this blog. I will continue to stay busy.
Take care,
Bonnie

Had a great experience attending a conference through City of Hope that explored how to establish and develop an effective Palliative Care program. Dr. Ira Byock was there and gave a very inspirational speech. He identified that the medical model is inadequate when caring for the terminally ill and dying because the care must be personal. What a great way to explain the difference in care that must be provided, and personal includes not just the patient but their family and the care givers involved with care. The whole concept addresses the need for listening, compassion, empathy and the importance of personalizing care.

I sincerely believe nurses must step up in their role as patient advocates and function in a primary palliative care provider role which differs from the Primary Care Specialist. Nurses must become well trained and compassionate primary Palliative Care providers. We have our work cut out for us.

Had a great time at the Nursing Symposium at Azusa Pacific University. The attendees enjoyed my talk about the CARES Tool and I had some very lively discussions. I enjoy the enthusiasm of the students and I look forward to the opportunity to talk to them more. With each of my lectures I am reminded of the work that needs to be done to educate about compassionate care of the dying. I am  hoping to have an established organization pick up and promote the CARES Tool so it can be shared with even a broader audience. Wish me luck!

I am getting ready to do my first book signing at the yearly research symposium put on by Azusa Pacific University where I graduated with a DNP in 2013. They very kindly asked me to talk about the CARES Tool and share how it was developed and what is happening with it, all in 30 minutes. For me that will be a challenge. I look forward to seeing the faculty again, and I love being around the students with all of their energy. I am just trying to get organized and deciding what to emphasize during my talk. This is usually a lost cause as I just go off into some  tangent no matter how I plan.

I am making cover submissions to my publisher for my next book Resilient Hearts. I am really hoping it will help bring a better understanding of what goes on with a Palliative Care Team. I am proud of the results and can't wait for others to read it.

So my writing has slowed down and I am trying to adjust. I need to focus on keeping my web site current and doing some research for a possible third book. I hope any one reading this is doing well and I look forward to sharing more thoughts with you.

Take Care

NCCN Conference

Here in Hollywood Florida for the NCCN conference. I had a surprising number of participants stay to hear me give the last lecture of the day. I understand the general scheme of a conference is to go with new things and progress through out the day and end with dying, but just once I would like to be in the middle of a conference so people can stay focused. They won't be tired, or worried about traffic, and could absorb what I have to say.

I have to admit being the last lecture wasn't bad this time. The audience was very responsive and I got some nice comments after. I just wish I brought more CARES Tools and book marks. I hope they check out my web site. Time will tell.

Update 3/1/2015

I received copies of my reference book Compassionate Person-Centered Care of the Dying: An Evidence Based Palliative care Guide for Nurses. It provides additional information and insight into the CARES Tool from Springer Publishing. It is an amazing feeling to hold a years worth of work in your hands. I am very proud of the end result and am looking forward to using the book to help educate staff at City of Hope on care of the dying.

I completed my second book that is actually a novel called Resilient Hearts and signed a contract with Tate Publishing. Resilient Hearts follows a fictional Palliative Care team as they work with terminally ill and dying patients and their families. The novel also focuses on how the team members provide self-care through the central character of Michael Lafata, a doctorate prepared palliative care nurse practitioner.  The story line includes a patient who opts for palliative sedation, providing last wishes for a gentleman dying of heart failure, and arranging special closure activities for a five year old and a retired army officer. The story combines multiple actual events and demonstrates the importance of laughter, compassion, empathy, and understanding. The need for music and joy is explored and shared with the reader. (I don't want to give away everything) I am hoping Resilient Hearts will be available before Christmas.

I want to encourage any of my readers to ask questions about my postings or the CARES Tool. I want this blog to provide further understanding of the use of the CARES Tool and to encourage nurse advocacy and promote communication.

Take Care