RaewynRobinsonEmmaAg new

Dynamic duos: Nurses in partnership: 

Dynamic duos: Nurses in partnership Raewyn Robinson – Clinical Nurse Specialist Emma Agnew – District Nurse Palliative Care Service

Introduction: 

Introduction Partnership Issues Challenges Rewards

NZ Palliative Care Strategy: 

NZ Palliative Care Strategy Improving access to generalist palliative nursing Improving access to specialized palliative nursing Education to develop District nurse palliative care role District Nurse as key patient contact

Case Study: 

Case Study Mrs Lodger – age 56 Metastatic non small cell, Left armpit Treatment – surgery and chemo Development of symptoms Headaches Additional lumps Nausea and vomiting Hospitalisation

Assessment: 

Assessment Patient very fatigued, falling asleep Pallor Unsteady mobility Headaches Armpit – lumps dry Husband intense, stressed and busy Reason for chemo?

Family Issues: 

Family Issues Husband’s concern re his wife's deterioration Husband working full-time in motel Family wedding Concern re son coping

CNS Issues: 

CNS Issues Felt “overwhelmed” at intensity Needing “time- out” to reassess situation Aware of “sense of urgency” for husband to have answers Facilitating genuine hope

Plan: 

Plan Contact husband to affirm his “gut instinct” Bring forward family travel and wedding plans Follow-up – oncology (vomiting) Family arrangements and photo shoot

Week two: 

Week two CNS visit Monday – no DN yet Mrs Lodger – sleeping Mr Lodger – very stressed, sleeping poorly, increasingly highly strung, physical cares of wife

Plan for week two: 

Plan for week two Return within 24 hrs Complete Support Needs Level (SNL) for Carer Support, personal cares b.d. and equipment i.e. electric bed, wheelchair District Nurse to admit to service District Nurse to phone or visit daily CNS to visit weekly once pt stable, or p r n Pt to attend family wedding

Third WeekAssessment: 

Third Week Assessment Condition deteriorating Increasing instability and falls Increasing hallucinations & memory loss Right armpit breaking down Pt bright within herself

Third Week Plan: 

Third Week Plan Liaise with GP – meds and visit Liaise with DN – dressings and visits Liaise with family Liaise with nursing agency

Disease Progression: 

Disease Progression DN liaison with CNS Increasing hallucinations No improvements Struggling with swallowing medication

Final event: 

Final event CNS arrangement Overnight event Hospital admission Hours left Three day vigil

District Nurse challenges: 

District Nurse challenges New to palliative care Intensity of situation and overwhelmed Concerned re – enough contact, anticipating changes, new issues Hallucinations Mobility Emotional/psychological support Balance between tasks and palliative care – urgent verses important

CNS challenges: 

CNS challenges Availability of DN’s – initial visit Handing over to DN’s Communication between DN and CNS Clear boundaries re scope of practice Less emotional/ relational involvement

Rewards – District Nurse: 

Rewards – District Nurse Huge opportunity for education with a specialist CNS Support – less isolation and load shared More holistic, less task orientated role

Rewards - CNS: 

Rewards - CNS More emotionally balanced Wider picture of palliative care Input into quality of palliative care Widening the net JOINT REWARD – reflection - share emotional load - brain storming PATIENT REWARD – staff continuity - awareness of another tier of knowledge and experience backing DN

CONCLUSION: 

CONCLUSION Patient – personal and family goals achieved Partnership promotes effective, high quality service Challenges and rewards for both Achievable Palliative Care Strategy if given staff, skills and time

Any Questions?: 

Any Questions?