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Nurses help palliative care programs grow at Alexian Brothers Health System

Monday February 6, 2012
From left, RNs Ellen Norton and Maureen Swiderski have helped grow the palliative care programs at St. Alexius Medical Center in Hoffman Estates, Ill., and Alexian Brothers Medical Center in Elk Grove Village, Ill.
From left, RNs Ellen Norton and Maureen Swiderski have helped grow the palliative care programs at St. Alexius Medical Center in Hoffman Estates, Ill., and Alexian Brothers Medical Center in Elk Grove Village, Ill.
(Photo courtesy of Alexian Brothers Health System)
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By John Grochowski

As they work to empower seriously ill patients to make decisions regarding their own care, Ellen Norton and Maureen Swiderski find there's much education to be done. And not just with the patients.

"We're also educating our staff, our physicians, everybody in the medical world what palliative care is," said Swiderski, RN, MSN, APN, CHPN, who leads the palliative care program at Alexian Brothers Medical Center in Elk Grove Village, Ill. "There's a common misconception that it's exactly the same as hospice. Palliative care is focusing on comfort, quality of life, decision-making, but throughout the course of the disease [whereas] hospice is palliative care at the end of life."

Educating people about this difference has become a priority for the Alexian Brothers Health System, which spent a year developing palliative care programs before hiring Swiderski and Norton, RN, MSN, APN, CHPN, OSN, who heads the program at St. Alexius Medical Center in Hoffman Estates, Ill.

The APN-led programs begin with consultations requested by attending physicians. Norton said the next step is a whole-patient assessment as the team strives to relieve suffering and enhance quality of life.

"I think the key here is communication," Norton said. "If there is misinformation and information gaps, we seek to complete that information for [patients] so they ... make well-informed health choices. Everybody has choices, and they're not always aware of that."

"We focus a lot, too, on the symptom management aspect of their care," Swiderski said. "Pain management, nausea, shortness of breath.

"We're really being an advocate for the patient, making sure they do understand that their expectations are the same as the healthcare team's expectation."

About a year's worth of research went into development of the programs, which are slightly different at the two facilities. Palliative care committees were formed at both institutions, and Swiderski said the committees continue as support systems as the programs grow.

Guest speakers guided the committees to analyze which care model would work best for the Alexian facilities.

After the preliminary work, Alexian hired Norton and Swiderski. Norton had been an RN case manager with a hospice background and experience in ICU, med/surg and home health. Swiderski had been finishing her master's degree while working in an oncology, palliative care and hospice unit at Northwestern Memorial Hospital in Chicago.

"There's a ton of great tools out there," Swiderski said. "I know both of us rely heavily on the Center to Advance Palliative Care. That has just a wonderful plethora of resources. Just make sure you're implementing a program that works with your institution. You can't necessarily take from what you've seen work in one institution and expect that to work exactly that way in yours. You have to have some flexibility and vision."

Norton added, "The other bodies of work that have been done are the National Consensus [Project for Quality Palliative Care] and the National Quality Forum for Palliative Care. You can keep in touch with those documents and those guidelines, and the Joint Commission has recently come up with certification that can kind of provide a gap analysis or give you a template for the pieces and things that you want to excel to and reach for."

Whatever model is chosen, hospitals need to understand palliative care is a team effort.

"We interact with everybody, from physical therapy to dietitian to chaplain to social workers," Swiderski said. "So in developing a program, you should have buy-in and support from the physicians and nursing, but also from everyone else because we really find that we work closely with a lot of different disciplines."

The bottom line is all about giving patients the guidance and empowerment they need and deserve.

"Palliative care always has been the ideal model of healthcare, alleviating suffering, ameliorating stress in the patients," Norton said. "The World Health Organization says everyone is entitled to palliative care.

"It doesn't matter what country, if you're industrialized or not, everyone is entitled to this."

John Grochowski is a member of the Nurse.com Nursing Spectrum editorial team.

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