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December 2008 Hospice and Palliative Nurses Association eNewsletter

Results from the May 2008 membership survey were distributed to the appropriate Standing Association Committees.   

Chapters Committee: A total of 421 members were emailed follow-up information related to 'starting a local chapter' and 'locating existing chapters' as per their request.

Public Policy Committee:  When asked 'what tools or support would you need to be an effective or a more effective policy advocate' all membership levels rated Advocacy/Policy Training as the most needed.   In response to this information, the Public Policy Committee has planned:

• Public Policy Article Review Teleconference- free for members

• Tuesday, February 24, 2009 at 3 pm ET.  

• discussing 'Netting the Hospice Butterfly: Politics, Policy and the Translation of an Ideal'.   

The full 2008 Membership Survey Summary is posted on the HPNA website. Link here    

The HPNA 2009-2012 Research Agenda is now available.  Link here.

The HPNA Board developed the special interest groups (SIGs) as a way to provide networking among members with similar interests via email (listserv). As a HPNA membership benefit, there are no additional fees associated with participating in the SIGs. Signing up for a SIG includes agreeing to the listserv rules or 'etiquette'.   You must have an email address to participate.

The current HPNA Special Interest Groups (SIGs) are:

• Advanced Practice Nurse (APN) - Frequently Asked Questions from this SIG are posted in Members Only

• Cultural Diversity

• Geriatric

• Nursing Administration

• Nursing Assistant

• Pain

• Pediatric

• Public Policy

• Research

Want to sign up for one or more SIGs?  Log into Members Only area of our website and visit the 'Change my Information' tab.  This is where HPNA members choose to join or remove themselves from SIGs lists.  Questions? Email SIG@hpna.org 

The HPNA Board of Directors, at their July, 2008 Board meeting, approved the HPNA Research Agenda presented by the Research Committee.   This agenda will be presented at the Annual Assembly in March, 2009, published in JHPN and available for distribution via the HPNA website.  As HPNA activates their 2009-2012 strategic plan, this research agenda will be instrumental in communicating to our nursing colleagues in the field of hospice and palliative care as well as to those in other nursing specialties, the focus of our future research directions.  As we collaborate with the National Palliative Care Research Center (NPCRC), the National Hospice and Palliative Care Organization (NHPCO), the American Academy of Hospice and Palliative Medicine (AAHPM) and the Center to Advance Palliative Care (CAPC), the research agenda will be instrumental in defining HPNA's priority areas of symptom/disease management to provide evidence based nursing practice.

Insomnia is the most common sleep disorder in the United States affecting 1/3 of adults at some point in their lives' and 10% chronically.  The lack of sleep threatens all areas of a persons' well-being from physical health to personal relationships to work performance.  The prevalence of insomnia increases with age and is higher in women.  A higher prevalence is also observed among those with lower socioeconomic status, divorced, widowed, recently stressed, depressed and abusing drugs or alcohol.  The key to treating insomnia is usually to treat its underlying cause.  Drug therapy is most appropriate for short-term use.  Extended therapy may be appropriate when a cure to the underlying problem is unavailable.

Benzodiazepine receptor agonists are the primary group of sedative/hypnotic drugs used to treat insomnia.  This group includes the benzodiazepine temazepam (Restoril^®) as well as the non-benzodiazepine hypnotic drugs that act on the same receptor but are structurally dissimilar to benzodiazepines such as zolpidem (Ambien^®, Ambien CR™), zaleplon (Sonata^®), eszopiclone (Lunesta^®).  These drugs reduce the time it takes to fall asleep, and those with a longer duration of action reduce the number of nighttime awakenings, thus increasing total sleep time.  The benzodiazepines have demonstrated suppression of slow wave sleep (the type of sleep believed to restore wakefulness and energy) of which the clinical effects are unknown.  Both drug types in this group have the potential to cause physical and/psychological dependence.

The newest drug for the treatment of insomnia is the melatonin receptor agonist ramelteon (Rozerem™).  It is indicated for sleep onset insomnia and has no effects on sleep architecture.  Ramelteon is a selective agonist of melatonin receptors MT1 and MT2 in an area of the hypothalamus responsible for determining circadian rhythms and synchronizing the sleep-wake cycle.  Compared to melatonin (an OTC supplement), ramelteon is 8x more selective for MT1 and MT2 and has 6x greater affinity for MT1.  Ramelteon showed no evidence of dependence or abuse potential in clinical trials.

In March of 2007, the FDA issued warning on adverse events for all sedative-hypnotic drug products regarding the risk of serious allergic reactions and hazardous behaviors while under the influence of these drugs.
      From Hospice of the Bluegrass Pharmacy News to Use: May/June 2008

The management of nausea and vomiting may be a difficult symptom to manage with multiple receptors, neurotransmitters, and pathways contributing to its occurrence.  General principles to managing this symptom are to identify and treat the underlying cause, decide which pathway is triggering the symptom, choose the most potent antagonist for the specific receptor, choose the optimal route of administration, and optimize fluid and electrolyte status.

The pathways are the Chemoreceptor Trigger Zone (CTZ), vomiting center, vestibular apparatus, visceral-afferent receptor (GI tract), and cerebral cortex.  The neurotransmitters involved are serotonin, dopamine, acetycholine, and histamine.  The primary underlying causes may be cardiac disease; intra-abdominal conditions such as motility disorders, constipation, gastroparesis, bowel obstruction, cirrhosis, intra-abdominal infections or radiotherapy; metabolic conditions such as hypercalcemia, hyponatremia, renal failure; drug intolerances; central nervous system stimulus - vestibular apparatus or cerebral cortex, such as cerebral tumors, infections, and vestibular disorders. 

Antiemetics are neurotransmitter blocking drugs.  Some first line antiemetics for each receptor site are the following:  prokinetic - metoclopramide, antidopaminergic (CTZ) - haloperidol, antihistamine/anticholinergic (vestibular) - meclizine, scopolamine, and corticosteroid (CNS) - dexamethasone.  Depending on the etiology of the nausea and vomiting multiple antiemetics may be required.   Phamacologic management will necessitate scheduled dosing with prn dosing per a tolerated route of administration.

SAVE THE DATES:
2010 AAHPM/HPNA Annual Assembly: March 3-6, 2010; Boston, MA
2011 AAHPM/HPNA Annual Assembly: February 16-19, 2011; Vancouver, Canada     

• Professional Nurse:  Effective Ways of Educating Palliative Care Concepts to Staff (Wed. Jan. 14, 2009; 12 Noon ET)

• Journal Club: Opioid Conversions (Wed. Dec. 17, 2008; 3 pm ET

• Nursing Assistant: no teleconference due to Holiday

Preparing your educational programs for 2009? Link here for 2009 teleconference schedule.

• Our 24th Patient/Family Teaching Sheet is now posted: Hospice Care in the Nursing Home Link here for full listing

• Two new Position Statements: Value of the Licensed Practical/Vocational Nurse in Palliative Care and Withholding and/or Withdrawing Life Sustaining Therapies

• Two revised Position Statements: Shortage of Registered Nurses and Value of the Professional Nurse in Palliative Care

• International Neighborhood Information Sheets: 14 documents shared from the 2008 HPNA Clinical Practice Forum are posted in Members Only/Cultural Diversity Resources tab

• Can’t remember your password? Email membership@hpna.org

As of January 2009 the HPNA Nursing Assistant Newsletter will be available electronically only. It will be e-mailed to the HPNA Nursing Assistant members.

The HPNA Nursing Assistant Newsletters will continue to be published 6 times a year and will continue to offer the regular features:

• 'Lead article'

• 'Ask the Expert'

• Calendar of upcoming teleconferences

• News from the HPN Foundation, and

• Newest section 'Did you Know?'

As well as other information specifically addressing the Nursing Assistant.

To access the current issue and archived issues, please go to http://www.hpna.org/ and log into Members Only. Click Nursing Assistant Newsletters (you can read the newsletter online or print from your computer for a hard copy).

HPNF receives grant from Purdue Pharma L.P. to support the translation project of HPNA. Patient/Family Teaching Sheets and Nursing Assistant TIPS Sheets will continue to be translated into Spanish with this new grant. Translations into other languages as requested on member surveys will be implemented once the Spanish sheets are complete.

HPNF December Scholarships: Five HPNF Conference Scholarships of $200 and four Certification Exam Scholarships for tests passed in June, September or November are open for applications until December 1. Winners will be notified later that month.

Key to Your Heart gift cases make lovely hostess gifts for Thanksgiving and the Holidays. Consider ordering some for your friends and family today. See contact info below.

Five ways to make an end of the year gift to HPNF: 1) Online 2) Check in the mail 3) Credit card by telephone 4) IRA rollover 5) bequest. Gifts support member benefits like teaching sheets and scholarships.

Donations, Applications, Information: http://www.hpnf.org/ or Laura Ristau, Director of Development, 412-787-9301.

If you are not receiving the publications included with your membership, please contact us.  The mailing lists for Journal of Hospice and Palliative Nursing is prepared from our database at the National Office.  The journal is sent second class mail and is not forwarded.  

Please keep us informed of your mailing address or email address changes so that you receive full benefit of your membership.  The Members Only area of the HPNA website has been enhanced to permit current members to edit personal contact information: address, phone number, email address etc.  Change your contact information at Member Login or call us at 412-787-9301.  Thank you.