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November 2008
Hospice and Palliative Nurses Association eNewsletter

 HPNA is leading the way to promote excellence in end-of-life nursing by:

  • promoting the highest professional standards of hospice and palliative nursing; 

  • studying, researching and exchanging information, experiences and ideas leading to improved nursing practice; 

  • encouraging nurses to specialize in the practices of hospice and palliative nursing; 

  • fostering the professional development of nurses, individually and collectively; 

  • responding to the changing needs of HPNA members and the populations they represent; and 

  • promoting the recognition of hospice and palliative care as essential components throughout the health care system.

 

HPNA Proudly Announces Fellowship in Palliative Care Nursing Program
HPNA has announced initiation of a Fellow in Palliative Care Nursing (FPCN) program to provide recognition of our members who are nursing leaders in education, management, advanced practice and research. The deadline for submissions is December 15, 2008. Link here for additional information and the FPCN screening packet.
     
New! Advanced Practice Mentoring Program
The HPNA Advanced Practice Mentoring Program is a year-long mentoring program focused on developing your role as a palliative care APN. Because HPNA believes that expert mentoring is the best way for advanced practice nurses to improve their skills in the field of palliative care, HPNA has created this program to develop administrative and clinical skills for APNs who want to expand their skills in the field of palliative care, and to apply those skills in the world of clinical experiences.
 
Full details will be available on the HPNA website on December 1, 2008.
 
2008 HPNA Membership Survey
Of our total 1,995 membership respondents, 430 or 22% were Advanced Practice Nurses; 1401 or 70% were Generalist Nurses; 68 or 3% were LP/VNs; 81 or 4% were Nursing Assistants and 15 or 1% were non-nursing HPNA members.
  • 80% of respondents self-purchased their HPNA membership and are not reimbursed by their employer
  • 7% have memberships purchased by their employer
  • 76% of all respondents are VERY SATISFIED or SOMEWHAT SATISFIED with their membership
  • Those who are VERY SATISFIED provided 649 comments about what they find most satisfying about their HPNA membership.
  • These have been shared with the HPNA Board of Directors and the Membership Committee.
  • 2% of respondents are SOMEWHAT DISSATISFIED with their membership.
  • 1% of respondents are NOT AT ALL SATISFIED.
  • 1% of all respondents indicated they would not be renewing their membership. 22 reasons given included: leaving hospice care; 'no benefit'; retiring.
  • 73% of all respondents indicated plans to renew their HPNA membership.
  • The 48 comments received by those who are 'somewhat' or 'not at all satisfied' have been reviewed by the HPNA Board and the Membership Committee.

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

2009 Membership Fees
The HPNA Board addressed this concern by an in-depth analysis and have committed during these difficult economic times to not raise dues in 2009.
 
Clinical Journal
As released earlier this month: Beginning in January, 2009 the Journal of Palliative Medicine (JPM) will be available to you on-line as an additional benefit of your HPNA membership. At the same time, it then becomes another official journal of HPNA, along with our Journal of Hospice and Palliative Nursing allowing JHPN to be more clinically focused. Additionally, you will also be able to subscribe to the JPM (hard-copy), if you choose, for reduced rates.
      
About Us: HPNA Standing Association Committees - Education
This continues our introduction to the HPNA Standing Association Committees, led by HPNA member volunteers and including an HPNA Board Liaison. The Standing Association Committees are the Chapters, Education, Membership, Public Policy and Research Committees. Read more about each committee’s responsibilities by linking here. HPNA members can become involved by submitting a Project Volunteer Form (located in the Members Only area of the HPNA website) or by contacting the National Office at 412-787-9301 to request the form.
  
Chair of the Education Committee, Virginia Valentine, MS, RN, CHPN states: ‘The Education Committee meets monthly to develop ideas for addressing the education needs of patients, families and providers of hospice and palliative care services. This year we have reviewed suggestions and concerns from our members regarding their needs for education in hospice and palliative care. We also reviewed a major report directed at issues and concerns about continuing education for healthcare professionals. Based on these reviews and some brainstorming, the committee has identified some potential strategies for addressing these issues. The majority of our time has been spent developing education materials for patients and families, and for the nurses and nursing assistants who provide care. The Patient/Family Teaching Sheets are designed to help patients and their families deal with the common problems they may face on a daily basis. The Nursing Assistant TIP Sheets have been developed for our Nursing Assistants to help them better understand the illnesses of their patients and suggest some ways for them to make patients more comfortable. One new resource that we began developing this year is the Quick Information Sheet for Nurses. This is designed as a quick, easy to read reference on common illnesses seen in hospice and palliative care settings and will soon be available for purchase. All of these materials are available on the HPNA website.
 
Educational Resource Update: Journal Club
Held on the 3rd Wednesday at 3 pm ET, HPNA’s Journal Club provides nursing professionals form across the country the opportunity to meet to critically evaluate a journal article on a monthly basis via teleconference. Each Journal Club if facilitated by a leader in hospice and palliative nursing. All aspects of the journal article are discussed, including the content, research design and methods, conclusions, and applicability to practice. Articles are provided before the session to allow all to participate in a professional discourse on the article. The Journal Club is only open to HPNA members and there is no fee. Call 412-787-9301 to register.
   
HPNA is Heard (HOW and WHERE you are being represented by HPNA)
On September 17th this year HPNA board member, Janet Snapp represented HPNA at The Cancer Quality Alliance (CQA) meeting in Alexandria, Virginia. This group fosters collaboration among diverse stakeholders to improve cancer care quality. HPNA was invited to join this group last year to ensure sensitivity to the provision of palliative care for this patient population. This group is co-chaired by Patricia Ganz, MD, a medical oncologist and Chair of ASCO’s Quality of Care Committee, and Ellen Stovall, President and CEO of the National Coalition of Cancer Survivorship.
 
Members of CQA include cancer care providers, patient advocacy groups, certifying and accrediting organizations, public and private payers, federal agencies, foundations, and other national organizations involved in improving the quality of cancer care. HPNA welcomed the opportunity to share our voice with this prestigious group.
 
The members encouraged the sharing and implementation of measures, tools, and practical programs to incrementally improve systems of care. A major focus of the CQA is the Blueprint for Quality Cancer Care Center. This monograph is a set of five cancer care case studies that present examples of ‘case failures’ and ‘best case’ care. Together, the scenarios represent a ‘Blueprint’ for action toward a vision of the best cancer care imaginable and achievable. The Blueprint is published on CQA’s website, www.cancerqualityalliance.org.
 
The CQA hopes that through the efforts of policy-makers, health care providers, cancer survivors, and other cancer advocates, including now HPNA, that we can achieve the needed system changes to ensure that best-case care will be universally accessible to cancer patients and their loved ones. We will continue to represent our members with this most important mission. 
 
Pharmaceutical Update: Drug Interaction Reminder
Shelly Sullivan, Pharm.D. Candidate
 
Patients talking any antibiotics from the quinolone (Levaquin®, Cipro®, Avelox®) or tetracycline (doxycycline, monocycline) families should be advised of a possible drug interaction with metal cations. Metal cations (including aluminum, calcium, iron, magnesium, and zinc) bind these antibiotics in the gastrointestinal tract and inhibit their absorption. Dairy products (like milk and yogurt), antacids, multivitamins and other electrolyte supplements should not be administered concurrently with these antibiotics. To avoid this reaction, quinolones and tetracyclines should be administered either 2 hours before or 6 hours after any product containing these medications.
 
From Hospice of the Bluegrass Pharmacy News to Use: Nov/Dec 2007
 
Practice Matters: Dead or 'Almost Dead'?
Christine G. Westphal RN, MSN, CCRN, APRN-BC, ACHPN
 

Historically, death was defined as the absence of heartbeat and breathing. In 1968 the Harvard Ad Hoc criteria (1) expanded the criteria for determination of death (absence of heartbeat and breathing) to one that included irreversible cessation of all function of the entire brain including the brain stem. This was termed ‘brain death’ and soon became part of the Uniform Determination of Death Act (2).
 
Death is self-evident when there is no heartbeat or breathing; however, absence of brain function is not so evident. The law does not specify how absence of brain function is to be determined; however, clinical parameters have been established for determining brain death in adults (3) and children (4).
 
Although there are some differences between the adult and pediatric populations, in general, the clinical parameters include:
1) Coma or unresponsiveness (evidence of acute central nervous system catastrophic event, excluding other contributing factors such as a complicating medical condition, drugs, toxins and/or hypothermia);
2) Absence of brain stem reflexes as assessed by examination of cranial nerve function including papillary, corneal, oculocephalic, cough and gag reflexes;
3) Absence of spontaneous breathing.
 
Serial clinical examinations are recommended; however, there is no standardization of who should do the testing, how often or the intervals between examinations. Confirmatory tests such as angiography, electroencephalograms (EEG), transcranial Doppler studies and nuclear brain scan may also be used; however, diagnosis may be made based upon clinical examinations alone.
 
The procedures for determination of brain death are developed at the individual institutional level. There are major discrepancies among facilities in terms of adherence to published guidelines (5, 6). This further complicates the diagnostic process.
 
Although legally and medically brain death is accepted as criteria for declaration of death, it is a difficult concept for many to understand. Once brain death is declared, all medical support can legally be removed. This is often difficult since the person’s heart is beating and air is being moved into the lungs by machines – traditional signs of life. Ethicists, religious scholars and others have raised questions about the validity of brain death as being dead or ‘almost dead’. The topic continues to be explored, discussed and debated even 30 years after becoming part of our history.
References:
1. Report of the AD Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death: A definition of irreversible come; JAMA; 1968; 205:337-340.
2. Uniform Determination of Death Act, 12 Uniform Laws Annotated (U.L.A.) 589 (West 1993 and West Supp. 1997).
3. American Academy of Neurology (1978) Practice parameters: determining brain death in adults Link
4. American Academy of Pediatrics. Guidelines for the determination of brain death in children. Pediatrics, 1987; 80:298-300.
5. Greer DM, Varelas PN, Haque S, Wijdicks E (2008). Variability of brain death determination guidelines in leading US neurologic institutions. Neurology, 2008; 70:284-289.
6. Mathur M, Petersen L, Stadtler M et al. Variability in pediatric brain death determination and documentation in Southern California. Pediatrics, 2008; 121(5):988-993.
 

2009 AAHPM/HPNA Annual Assembly- March 25-29, 2009
The 2009 AAHPM/HPNA Annual Assembly will be held at the Austin Convention Center in Austin, Texas. Full conference registration is now open. Link here for more details and registration. 
 
HPNA is offering 7 pre-conferences on Wednesday, March 25, 2009. Link here for details and to register.
 
AAHPM College of Palliative Care Assembly Scholarship Program - The College of Palliative Care (CPC) is offering scholarship funding to cover meeting registration for those who need assistance to attend the 2009 AAHPM/HPNA Annual Assembly. Qualified nursing applicants may receive this funding if the successfully apply and register for the 2009 Annual Assembly. The deadline for applications is December 19, 2008. Link here for more information and application.

AAHPM College of Palliative Care One-on-One Mentoring Program – Interested in career and professional development advice, but don’t know whom to ask? The College of Palliative Care (CPC) offers an opportunity for students, residents, and junior and midcareer faculty to speak personally at the 2009 Annual Assembly with a senior mentor. The deadline for applications is January 15, 2009. Link here for more information and application.

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
      

Upcoming Weekly Teleconferences Must pre-register at least 24 hours prior to the teleconference by calling HPNA at 412-787-9301 (PN level: $20 for HPNA member with contact hour)

  • Professional Nurse: Writing Objectives (Wed. Dec. 10, 2008; 12 Noon ET)

  • Journal Club: Good Death Inventory: A Measure for Evaluating Good Death from the Bereaved Family Member’s Perspective (Wed. Nov. 18, 2008; 3 pm ET

  • Nursing Assistant: Caring for Elders in their Final Days – aimed toward assisted living and LTC facilities (Wed. Nov. 26, 2008; 3 pm ET)

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

 
Newest posts on the HPNA website

  • Our 23rd Patient/Family Teaching Sheet is now posted: How to Prepare for Potential Bleeding Link here for full listing

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

  • Quality of Life Matters Nov 2008-Jan 2009 newsletter link here

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

 

HPNA Nursing Assistant Newsletter- Going Green

As of January 2009 the HPNA Nursing Assistant Newsletter will be available online only. It will no longer be 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 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).

 
Hospice and Palliative Nurses Foundation News

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: www.hpnf.org or Laura Ristau, Director of Development, 412-787-9301.

 
National Board for Certification of Hospice and Palliative Nurses
 
 NBCHPN Monthly Update Link here
       

For Your Information
Have you moved?

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

Please keep us informed of your 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.