End of Life Care in ICU: Online Support for Nurses

Transcription

1 End of Life Care in ICU: Online Support for Nurses Brenda Hearson RN, MN, CHPCN(C), CNS Janice Nesbitt, RN, MN, CHPCN(C), CNS CACCN Conference September 26, 2015 Statement of Disclosure and Bias We have no commercial conflicts or biases to disclose. 1

2 What do we do? National knowledge management centre on advanced illness, palliative and end of life care, loss and grief for patients, families, health care providers, researchers and educators Topics Asked and Answered Ask a Professional Discussion Forums Tools for Practice Patient Teaching Tools The Exchange 2

3 By the numbers 97,000 visits per month 89 per cent visitors highly satisfied 1 silver medal 616,599 Views on YouTube 4,840 Followers on Twitter 190 countries 5,085 subscribers pages 1,424 likes on Facebook Funding provided by 3

4 New Online Tools for Practice Launching in January 2016 Methadone for Analgesia in Palliative Care Course MyGrief.ca First Nations Inuit Metis Empowerment Tool LivingMyCulture.ca Case #1 65 yo woman admitted to ICU with CVA. She is intubated and ventilated. After 2 weeks she is not improving at all. Her GCS is 5. After a family meeting, there is a decision to remove her from the ventilator and discontinue her tube feeding. The family s biggest concern is that she not suffer. Her daughter is particularly anxious about what to expect in the coming hours to days. She is also wondering what to tell her children about Grandma s illness. 4

5 The Gallery 500 video clips 5

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7 Case # 2 65 yo previously healthy Chinese man admitted post MVA with extensive head & thoracic injuries. After a week in ICU, he develops a fever and is quite diaphoretic. WBC 32; Na 128; K 3.4. Investigations do not find a source of infection. No response to treatment. ACP R. The healthcare team are going to talk to the family about changing this to ACP M, and even think that ACP C could be considered. They are not sure how to start this conversation. Family struggling; want everything possible done. Staff uncomfortable and divided. 7

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9 LivingMyCulture.ca Series of videos to support patients and families Personal narratives people living with advanced illness, health providers, community leaders Organized by culture (person and theme) and themes (across cultures) Explore barriers and enablers to culturally safe and inclusive care for patients and families. Experiences with the Canadian health care system How beliefs are expressed in customs, practices Ways to improve care Cultural groups engaged Chinese, East Indian, Ethiopian, Filipino, First Nations, Inuit, Iranian, Italian, Pakistani, and Somalian 9

10 Case #3 45 yo First Nations woman with acute on chronic renal failure and CHF. Her shortness of breath is not well managed on her current scheduled morphine, despite aggressive dose increases. RR 44 ABG shows that she is acidotic. She becomes myoclonic and diaphoretic. The team makes the additional diagnosis of opioid induced neurotoxicity. Due to her multiple comorbidities, there is discussion as to whether to rotate her to hydromorphone to fentanyl infusion to manage her dyspnea and treat the neurotoxicity. Many family members visiting, concerned, quiet. 10

11 First Nations Inuit and Metis Tool Beliefs, values and traditions related to living with advanced illness, decision making, loss & grief Videos and printable handouts Educational resources for patients and families Informs your practice to ensure culturally safe care Geographically and culturally diverse Skidegate Haida Gwaii Rankin Inlet File Hills Nunatsiavut Happy Valley Goose Bay We koqma q Mi kmaq Vancouver Regina Six Nations of the Grand River 11

12 Case #4 52 yo man with ALS is admitted with respiratory failure and despite aggressive treatment, dies within 48 hours of admission. His wife is distraught, and hesitate to leave ICU. She is returning to their lakeside home where they have lived together for the last few years. Staff are concerned about her since she seems so alone. No children. 12

13 Online Grief Modules Accessible web based option offers grief support for people living with loss, regardless of time or geography MyGrief.ca For families and friends affected by loss Online multimedia text based, videos (personal stories) Normalizes and validates grief experience Offers education, hope, and encourages self care Complementary to existing grief resources 13

14 We encourage you to: Browse Canadian Virtual Hospice Share information with colleagues and families Invite your comments re the new tools Questions? Brenda Hearson Janice Nesbitt 14