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September 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.

 
Of our total 1,995 membership survey 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.  This participation rate doubled that of our 2005 Membership Survey!

The majority of respondents in all areas identified their ‘Primary Work Function’ as ‘Clinical Patient Care’. The top ‘Primary Work Setting’ for the APN members is ‘Hospital: other unit or scattered beds’ and for all other members was ‘multiple settings depending upon patient’s residence’.  Related to Satisfaction with HPNA Membership, 39% of all respondents selected ‘Very Satisfied’ and less than 1% indicated ‘Not satisfied at all’.  All of these comments regarding level of satisfaction have been reviewed by the HPNA Board of Directors and the Membership Committee.  Based on comments, some changes have already been implemented (e.g. changed content of this enewsletter) and more will be forthcoming.  The HPNA Board of Directors will also include the survey results in Strategic Planning this Fall.  

HPNA educational product and service content for the e-newsletter are purposeful topics of which many members stated they were 'unaware'.  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. 
 

Jean Gordon, RN, Chair of the Membership Committee states: “The Membership Committee is responsible for the overall promotion of membership and membership services through various activities, such as participation in marketing activities of HPNA and review of pertinent sections of the HPNA website. The Committee oversees assessment of membership services through development of a member survey every 3 years. The survey results are analyzed and trended and the committee makes recommendations to the Board on organizational changes as representative of the members’ responses. Two HPNA annual award nominations are reviewed and selected and the membership fee structure is examined every three years. A major focus of the Membership Committee is recruitment and retention strategies.”   Link here to the 2008 committee roster and 2007 end of year Membership Committee report.  
 

 
Nursing Assistant TIPS sheets
 

Nursing Assistant TIPS Sheets were developed in response to membership request for one-page instructional handouts for use in Nursing Assistant education.  The development of these teaching sheets is an on-going process of the Education Committee and the website is updated as additional TIPS sheets are approved by the HPNA Board.  Currently there are 11 Nursing Assistant TIPS Sheets and 4 of these have been translated into Spanish.  Since these sheets are copyrighted by HPNA, the HPNA logo must be retained; however Agency logos may be added to the 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. Link here to Nursing Assistant TIPS.  
 

 
In June 2003, discussions began with representatives of HPNA, NBCHPN and HPNF, and a consultant to discuss how we could collectively move forward to have a greater impact on communicating the value of providing excellent nursing care at the end of life for all Americans. Our unified vision is to ensure that all persons become aware of the impact of those with hospice and palliative nursing care knowledge and expertise and their ability to deliver high-quality end-of-life care.

 
The desire to achieve this purpose has lead to the formation of The Alliance for Excellence in Hospice and Palliative Nursing.

 
The mission of the Alliance for Excellence in Hospice and Palliative Nursing is to serve as the unified voice in hospice and palliative nursing to integrate and coordinate end of life care with other members of the interdisciplinary team, to act as a visionary for specialty trending nursing issues, to be a primary resource fostering excellence in hospice and palliative nursing, and to advance end of life care for the benefit of the public at large. 

 
To that end, members of the Board of Trustees (Presidents of the three sister organizations and the CEO) have participated in a 6-8 minute film about the Alliance that will be available on the Alliance website this Fall.  Distribution of the film will include 1.2 million AARP members, be viewed on Google, You Tube and available through CNN, MSNBC, etc.  The main message of the film was to not only describe the mission of each organization, but to help the consumer understand the role of hospice and palliative nurses and to offer the opportunity for the consumer to talk to trusted hospice and palliative nurses through a toll-free phone number.  "We are excited about this film and feel that it definitely reaches out to the public in ways that fulfill our mission" says Alliance President, Jane Sidwell. 

 
Roxanol® is a concentrated immediate release morphine. The strength is 20 mg/mL. This drug can easily be confused with conventional liquid morphine concentrations. Serious errors can occur when the concentrated form, 20 mg/mL is confused with the standard concentrations of 10 mg/5mL or 20 mg/5mL.

 
Another way to confuse Roxanol® (immediate release morphine) is in the dosing. The dropper of the concentrated morphine is marked in mg and in mL. The dose should always be written in mg and then mL in parentheses. Remember to check doses.  Courtesy of Hospice of the Bluegrass ‘Pharmacy News to Use’ Volume 8, Issue 1 January/February 2007

 
Update on Methadone
By Kelli Gershon, APRN, BC-PCM
 

In recent years methadone has become more popular in the treatment of cancer pain and pain in general, however, we need to be extremely cautious using methadone due to some unique proprieties.  Methadone was first developed in World War II by German scientist and brought to American in 1947.  Methadone is an agonist to mu-opioid and Delta opioid receptors but more uniquely it is an antagonist to n-methyl-d-asparate (NMDA), which might explain its benefit in neuropathic pain.  It has a high oral bioavailability at approximately 80%, with a rapid onset of action at approximately 30 minutes.  The half-life of methadone is extremely long 15 to 60 hours, which makes it very difficult to titrate.   The unique quality of rapid onset and long half-life allows methadone to be both a long acting scheduled opioid and an as needed breakthrough opioid.  It is not recommended to utilize methadone as a breakthrough opioid unless the patient’s scheduled opioid is methadone as well.  Methadone is mostly metabolized via the liver therefore an ideal choice for individual with increased creatine.  Due to methadone being metabolized in the liver utilizing P450 it is important to review all the patients current medications to make sure the methadone level won’t be increased or decreased due to drug interactions.

 
Rotating to methadone can be difficult due to methadone being more potent with increasing prior exposure to other opioids.  This characteristic is due to decrease cross-tolerance, NMDA receptor antagonism, and elimination of active metabolites.   This means if you were rotating a patient from a low oral morphine equivalent daily dose (MEDD) to methadone it would require more methadone than if you are rotated a patient from a higher MEDD.  Due to this unusually equianalgesic chart and the long half-life, initiating methadone and maintaining methadone should only be done by individuals that are well trained in pain management.

 
For an equianalgesic chart for methadone please see AAHPM.org fast fact
 

 
"….I must say that HPNA has done an incredible job at organizing and presenting this conference. It was inspiring, educational and fun!"  Ann Minor, RN-BC, HNC, CHPN of Bristol CT (event attendee)

 
On September 5-6, 2008, the 2^nd annual Clinical Practice Forum was held in Pittsburgh, PA titled "Taking Care of People Who Are Not Like Me".   This conference was the brainchild of the Diversity Task Force responding to your feedback from the Diversity Survey conducted in January, 2007.  More than 2000 HPNA members indicated you needed more information about caring for individuals of all types of diversity – gender, ethnic, religious, disabilities, sexual preferences, etc.    The event was very successful.  More than 35 faculty members came together to share their knowledge.  We opened with "Neighbor Aber" signing "I Like You As You Are" and closed with the Chilean Dancers.  There will be additional spin-off educational products as a result of the valuable information shared at this event.  As noted by President Jane Sidwell, "We have enjoyed the benefits of two outstanding regional conferences over the past two years and we look forward to planning for 2009."
 

 
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.
 

The Generalist Clinical Review Train-the-Trainer programs will be conducted on:
 
1)  Saturday, Sept. 20, 2008 at the Hyatt Regency, Dearborn, Michigan and
2)  Wednesday, Mar. 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 Palliative Sedation (Wed. Oct. 8, 2008 12 Noon ET)

Journal Club Advanced Practice Nurse Service Provision During the Last Week of Life (Wed. Sept. 17, 2008 3 pm ET)

Nursing Assistant Dementia (Wed. Sept. 24, 2008 3 pm ET)
  

• New Position Statement:  Role of Palliative Care Nursing in Organ and Tissue Donation
   

 
Chapter Grant Winners - Five HPNA Chapters win Educational Chapter Grants!  The winners are:  Central Florida, Central New Jersey, Chicagoland, Triad North Carolina, and Triangle North Carolina.  Each chapter received $500 in funding from HPNF to use for educational programming for their members!  
 

Plan ahead for the 2009 Chapter Education Grants!  June 1, 2009 is the deadline.  Contact Laura Ristau laurar@hpna.org or 412-787-9301 for info.  The only restriction is that Chapters may win a limit of two grants in any 5-year period.
 

Clinical Practice Forum Fundraising Results!  We raised over $1,000 in two days.  For those of you following the HPNF Fun Football Fundraising Game, the score was Oddballs 25, Even Keels 36!  All proceeds go to the HPNF Annual Campaign.  Thanks to everyone who participated.  
 

Cell Phone Recycling Clinical Practice Forum was the completion of our Cell Phone recycling program.  We collected 11 phones this year.  If you have some you forgot to donate, contact HPNF for a mailing label to send them directly to the recycling company.  Or give them to a local organization looking for phones.  Thanks to all for your interest!
 

Scholarship Reminders:  December 1 is deadline for Conference Scholarships for Annual Assembly from HPNF.  Certification Exam Scholarship Applications are also due December 1 for exams taken June – November.
 

 
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.