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October 2008 Hospice and Palliative Nurses Association News

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

1. promoting the highest professional standards of hospice and palliative nursing;  

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

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

4. fostering the professional development of nurses, individually and collectively;  

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

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

 
When asked to reate 28 specific Membership Benefits, all membership levels (APN, Generalist Nurse, LP/VN, NA and non-nursing members) rated these 4 benefits as VERY IMPORTANT:

• Access to experts in end-of-life care;

• HPNA website;

• Member pricing to take an NBCHPN certification exam;

• and membership in HPNA as a way to keep current in hospice/palliative care.

The 5 benefits of which most respondents were UNAWARE are:

• Practice Driver product;

• Journal Club;

• Spanish version of HPNA Patient/Family Teaching Sheets;

• Nursing Assistant TIPS Sheets; and the

• HPNA Nursing Assistant Newsletter

The content for the e-newsletter is including the topics of which many members stated they were 'unaware'.  These benefits will also be addressed in other HPNA member materials.

Please let us know your thoughts about the new enewsletter content or offer your suggestions by emailing us at membership@hpna.org.
 

 
HPNA Standing Association Committees
 

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. 
 

Joy Buck, PhD, RN, Chair of the Public Policy Committee states:  "Since its creation in 2005, the HPNA Public Policy Committee (PPC) has followed policy issues and legislation that impact hospice and palliative care nursing, disseminated information about critical policy issues to HPNA members and made recommendations to the Board for action when appropriate.  Currently, the PPC is monitoring twenty-seven bills that focus on nursing safety, workforce and APRN issues, funding for palliative care research, access to comprehensive hospice/palliative care in cancer, HIV/AIDS and the elderly, advance care planning and hospice regulatory issues.  You can find detailed information about legislation that the committee is currently following and other valuable policy and legislative resource in the Public Policy section of the HPNA website.

Based on the results form the most recent membership survey, HPNA members think that health policy is very important and that they would like to be more actively involved.  Some members have a fair amount of policy advocacy experience, but many are looking for resources to be more effective.  For the past three years, the PPC has conducted several concurrent sessions at the annual conference and last year they sponsored a policy pre-conference workshop on policy advocacy.  The PPC is committed to building on these well-received educational offerings and is working on a formalized plan to offer the membership additional educational offering and policy advocacy resources.  

From 2005-2007, the PPC focused most of its attention on national policy issues.  While federal policy is particularly important, especially related to Medicare reimbursement issues, the PPC felt and the Board agreed that more attention needed to be given to policy initiatives at the state and regional levels as well.  To this end, with the assistance of Chad Reilly, our National Office staff, the PPC developed a State Ambassador Program that was launched at the 2008 annual conference.  To date, this exciting program has four State Ambassadors and we are looking for additional Ambassadors.  If you are interested in policy and want to help HPNA follow cretical policy issues in your state, please contact Chad Reilly at chadr@hpna.org for more information.

Link here to HPNA Public Policy Guiding Principles
 

 
Patient/Family Teaching Sheets
 

Twenty-three Patient/Family Teaching Sheets have been developed by the HPNA Education Committee and approved by the HPNA Board.  Fifteen of these have been translated into Spanish.  These free resources are available on topics such as Managing Depression and Managing Spiritual Distress.  Located under the 'Education' tab on the HPNA website, this page is updated as new teaching sheets are developed.  Link here for the full listing.  As with the HPNA Nursing Assistant TIPS Sheets, these sheets are copyrighted by HPNA.  The HPNA logo must be retained; however Agency logos may be added to these Patient/Family teaching sheets with permission.  For more information, contact the National Office at 412-787-9301 or email the HPNA Education Department at educationdept@hpna.org.
 

 
The National Consensus Project for Quality Palliative Care (NCP) promotes and supports implementation of the NCP's Clinical Practice Guidelines (2004).  The NCP further supports the Preferred Practices for Palliative Care developed by the National Quality Forum (2007) with the goals of increasing access to specialty palliative care programs and supporting integration of palliative care into all systems of care.  The NCP is guided by a task force comprised of four national palliative care organizations:  American Academy of Hospice and Palliative Medicine (AAHPM); Center to Advance Palliative Care (CAPC); Hospice and Palliative Nurses Association (HPNA); and National Hospice and Palliative Care Organization (NHPCO).  HPNA serves as the administrative home of the NCP, and Vikki Newton is the Project Coordinator.

Read More

 
The Joint Commission is launching a national campaign to help Americans work with their health care professionals to better manage pain.  The new education campaign is part of The Joint Commission's award-winning Speak Up^TM program that helps patients become more informed and involved in their health care.

Speak Up^TM brochures also are available on understanding caregivers, understanding medical tests, recovering after leaving the hospital, preventing medication mistakes, preventing infections, preparing to become a living organ donor, avoiding wrong site surgery and preventing errors in care.  Brochures can be found at www.jointcommission.org.  All of the Speak Up^TM brochures are available in an easy-to-read format and in Spanish.

 
Palliative Sedation
Maureen Lynch, MS, APRN, BC, ACHPN, ACON
 

Palliative sedation is the use of non-opioid medications to induce varying degrees of unconsciousness, but not death, in an effort to relieve otherwise refractory and unendurable symptoms in imminently dying patients.  It is often referred to as a treatment of last resort.  It is distinct from euthanasia, assisted suicide, or any intervention such as inappropriate escalation of analgesic or sedative doses where the intent is solely to end life.  Comfort in dying is the priority goal of palliative sedation therefore the use of life sustaining treatments such as CPR, dialysis are discontinued.

The ethical justification for palliative sedation is based in precepts of dignity, autonomy, beneficence, fidelity, non-malefience, and the rule of double effect.  Legal support is found in the 1997 U.S. Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg.

Interdisciplinary assessment of the patient is critical to determine the refractory nature of his/her suffering, and to assure ongoing communication with the patient, family/significant other/surrogate decision maker, and other helath care providers.  Benzodiazepines such as midazolam, or barbiturates such as pentobarbital are commonly used to induce palliative sedation.  Opioids are continued if needed for control of symptoms but are unreliable as sole agent for palliative sedation.  Nursing care focuses on physical and emotional support for the patient and family.  For further information see:

     HPNA Position Statement on Palliative Sedation

Articles from Journal of Hospice and Palliative Nursing:

1. Claessens, P, Genbregge, E, Vannuffelen R, Broeckaert, B, Schotsman, P & Menton, J. (2007) Palliative Sedation and Nursing - The Place of Palliative Sedation with Palliative Nursing Care.  Journal of Hospice and Palliative Nursing.  Vol 9 (2) 100-106.
   

2. Bruce, SD, Hendrix, CG, Gentry, JH (2006).  Palliative Sedation in End Life Care.  Journal of Hospice and Palliative Nursing, 8(6), 320-327.

American Academy Hospice and Palliative Medicine Positoin Statement on Palliative Sedation http://www.aahpm.org/positions/sedation.html

American Medical Association (2008).  Report of the council on ethical and Judicial Affairs CEJA Report 5-A-08:  Sedation to unconsciousness at end of life.  Accessed 7/16/08 from http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_5a08.pdf

Fast Fact #106 Morphine and Hastened Death
http://www.eperc.mcw.edu/fastfact/ff_008.htm

Fast Fact #106 Controlled Sedation for Refractory Suffering part 1
http://www.eperc.mcw.edu/fastfact/ff_106.htm

Fast Fact #107 Controlled Sedation for Refractory Suffering part 2
http://www.eperc.mcw.edu/fastfact/ff_107.htm

Hospice & Palliative Care Organization of Massachusetts Palliative Sedation Protocol, April 2004
http://www.hospicefed.org/download/pal_sed_protocol.pdf

National Ethics Committee of Veterans Health Administration (2006).  The ethics of palliative sedation.  Accessed 7/16/08 from http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_5a08.pdf

 
Save the Date

 
The 2009 Annual Assembly sponsored by the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association will be held March 25 – March 28, 2009 in Austin, Texas.  HPNA will be offering 5 pre-conferences. Call for Case Conferences is open through November 3, 2008.  Link Here

Save the dates:

1)  2010 AAHPM/HPNA Annual Assembly:  March 3-6, 2010; Boston, MA

2)  2011 AAHPM/HPNA Annual Assembly:  February 16-19, 2011; Vancouver, Canada

 

The next Generalist Clinical Review Train-the-Trainer program will be conducted on:

Wednesday, March 25, 2009 at the Austin Convention Center, Austin, Texas.

Read More

 
Must pre-register 24-hours prior to the call; to register, phone HPNA at 412-787-9301 

Professional Nurse Spiritual Care (Wed. Nov. 12, 2008  12 Noon ET)

Journal Club Good Death Inventory:  A Measure for Evaluating Good Death from the Bereaved Family Member's Perspective (Wed. Nov. 17, 2008  3 pm ET)

Nursing Assistant Infection Control (Wed. Oct. 22, 2008  3 pm ET)

• SIGs - HPNA members are now able to select/de-select enrollment in the Special Interest Groups (SIGs) within the Members Only section of the website (using the "Change My Information" button).  Changes will take place at the beginning of the next month.
• Changes to a home/work email address will be in effect upon entry.
• Can't remember your password?  Email Membership@HPNA.org

Margaret Campbell, PhD, RN, FAAN, HPNA President-Elect, is the recipient of the 2008 The University of Texas M. D. Anderson Palliative and Hospice Lifetime Nursing Achievement Aware.  Ms. Campbell is currently Administrative Director, Nursing Administration of Detroit Receiving Hospital and Assistant Professor - Research Center for Health Research, College of Nursing at Wayne State University, Michigan.  Her current research is about the behavioral correlates of respiratory distress when the patient is unable to self-report about dyspnea because of cognitive impairment. 

Linda Gorman, RN, MN, CNS-BC, CHPN, OCN,  and Past-President of HPNA was a finalist in the NurseWeek 2008 California Excellence Awards.  She is a Palliative Care Clinical Nurse Specialist at Cedars-Sinai Medical Center in Los Angeles, California.  Ms. Gorman was recognized as a skilled, compassionate, and culturally sensitive member of an interdisciplinary team that coordinates care of terminally ill patients.  She also assists with pain management on an inpatient consultation team.  Her manner inspires trust and confidence for those struggling with end-of-life care issues.

 
Did you know?  Savvy donors identify causes that are of the most importance to them (like Hospice and Palliative Nursing).  Precious discretionary funds are donated to causes which have th emost meaning for them in order to affect the most significant change!  A savvy idea!

Good News:  Included in teh $700 billion economic bailout bill (H.R. 1424, The Financial Rescue Package), signed by President Bush October 3 is the two-year extensions of the IRA Rollover provision.

The provision will be made retroactive to Jan. 1, 2008, and will apply to gifts made from that date through Dec. 31, 2009.

The provision exempts from taxable income any funds transferred ("rolled over") form an Individual Retirement Account (IRA) to a charitable organization.  The following limitations apply:

• The donor must be age 70½ or older.

• The cap on annual IRA rollovers is $100,000.

• The contribution must be a direct gift to a charity (no planned gifts).

December 1 Deadline:  Conference and Certification Exam Scholarship Applications are due December 1.  Five $200 Conference Scholarships from HPNF will be awarded at the Annual Assembly!  This round of Certification Exam Scholarships is for exams taken and passed during the June, September, and November windows.

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

 
NBCHPN Monthly Update  Link here
  

 
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.