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University of California grant to train ICU nurses about palliative care

Monday August 5, 2013
Kathleen Puntillo, RN
Kathleen Puntillo, RN
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Nurses at five University of California medical centers — UC Davis, UC Irvine, UCLA, UC San Diego and UCSF — will be trained how to integrate palliative care into their existing ICU care plans thanks to a two-year, $1 million grant funded by UC.

"Palliative care isnít routinely involved in the care of patients in the ICU," said Kathleen Puntillo, RN, PhD, professor of nursing, emeritus, in the Department of Physiological Nursing at UCSF. "Many people think this means end-of-life care, but palliative care is about nurses, doctors and other specialists working together to provide an extra layer of support. Itís appropriate at any stage of a serious illness and can be provided along with curative treatment."

Co-investigator Puntillo is working on the project with the grantís principal investigator Wendy Anderson, MD, MS, and co-investigator Steven Pantilat, MD, of the UCSF School of Medicine.

As a researcher for the past 22 years, Puntillo focused on the assessment and treatment of pain in critically ill patients and the importance of improving quality of life and communication with healthcare providers for ICU patients and their families. She said she knows how difficult it can be to provide patients with relief from the symptoms, pain and stress of a serious illness.

According to the American Academy of Hospice and Palliative Medicine, while there are 5,150 hospice programs and 1,635 hospital palliative care teams in the U.S., the number isnít enough to meet the needs of the aging baby boomers. By 2030 the nationís geriatric population is expected to reach 30 million, creating a need for more palliative care programs, reports the National Palliative Care Research Center.

Puntillo said nurses can play a big role in bridging the palliative care gap, and a 2010 report issued by the Institute of Medicine concurs. The IOM report noted nurses are ideal providers of palliative care because nursing, like palliative care, focuses on pain and symptom management, patient advocacy and education of the patient and family.

In April, the UCSF team invited nurse leaders from each of the five medical centers to take part in their first program. The three-day training took place at UCSF, and covered the nursesí roles and responsibility in palliative care, use of empathy and how to deal with conflict with patientsí families.

"Many nurses have never been formally trained in how to actively participate in a family meeting," Puntillo said. "We teach them how to identify key elements needed to prepare for the meeting and discuss goals of care. We help nurses work with patients and their family members, so families understand the treatment plan and prognosis and have their questions or concerns addressed in the meeting."

Debi Boyle, RN, MSN, AOCNS, FAAN, oncology clinical nurse specialist and palliative care nurse leader at UC Irvine Medical Center, was one of the first nurse leaders to take part in the April training.

"We learned there can be big differences in what we as healthcare providers say to a patientís family and what the family understands," Boyle said. "Nurses play an important role in serving as a liaison between the patientís family and the doctor."

Puntillo said ICU stays can be difficult for patients and families, and integrating palliative care into ICUs has been proven through research studies to have a number of positive outcomes for patients, families and hospitals. Palliative care also decreases length of stay in the ICU, she said.

According to research by Puntillo and several organizations, such as the National Institutes of Nursing Research, "palliative care can improve the management of patientsí symptoms, as well as improve communication between patients and providers and increase satisfaction among patients and their families," Puntillo said.

In June, Puntillo and Anderson began to visit the five medical centers to oversee and support training as nurse leaders at each of the sites begin training bedside nurses. The programís goal is to train 600 bedside nurses during the next two years and put systems in place to ensure and expand the practice of palliative care.

While the program is being introduced to ICU nurses first, Puntillo said nurses in other units, and even other hospitals outside the UC system, have expressed an interest in training.

"We believe that all ICU patients need and deserve palliative care," said Puntillo, who received the 2012 Distinguished Career Award from the American Association of Critical-Care Nurses.

Last year, Anderson received a UC innovation center fellowship during which the UCSF team trained 68 bedside nurses to provide palliative care in the ICU.

"As soon as we sent a flyer out on the workshops, they immediately filled up," Puntillo said. "Weíve received excellent feedback from the nurses who have undergone our palliative care training, and Iíve spoken with nurses in other parts of the country who would like to see a similar program offered at their facilities."

For information, visit www.UCSF.edu.


Linda Childers is a freelance writer. Send letters to editorWest@nurse.com.