Running head: COMMUNICATION DEFICITS 1. Communication Deficits Among the Bedside Nurse and Palliative Care Team. Linn L. Groom

Transcription

1 Running head: COMMUNICATION DEFICITS 1 Communication Deficits Among the Bedside Nurse and Palliative Care Team Linn L. Groom California State University, Stanislaus

2 COMMUNICATION DEFICITS 2 Communication Deficits Among the Bedside Nurse and Palliative Care Team Introduction A palliative care team should consist of representatives from different disciplines, be interdisciplinary in nature, in order to be the most effective and efficient. The coordination with the palliative care team ensures the best possible care and pain management for the patient and the patient s family. Palliative care teams help patients and their families go through the stages of the dying process and help ease the stages of the dying process (Dobrina, Tenze, & Palese, 2014). The problem with palliative care teams is that goals and care have to be a team effort in order to give the most effective care. No one member of the team can have their own opinion and method for what they think is right for the patient and family. Goals should be created as a team, based on family and patient needs (Muehlbauer, 2013). In the palliative care team, the primary focus is that of the family and patient and the goals they have (Lundberg, Olsson, & Fürst, 2013). Evidence The team should include a registered nurse, physician, spiritual advisor, and a social worker at the minimum working together in order to be effective (Muehlbauer, 2013). Without a cohesive unit working together, the team aspect is lost. Teams can work together effectively toward the same goals that the patients and patients families have. A randomized control trial on the impact of inpatient palliative care teams shows that there is greater patient satisfaction when palliative care teams are utilized and that patients report a better quality of life upon discharge than those that received the usual care (Gade et al., 2008). Lower health care costs, $14,486 compared to $21,252 per visit, and less future admissions resulting in intensive care unit (ICU) admissions 12 vs 21 were also reported in this study (Gade et al., 2008). If palliative care teams

3 COMMUNICATION DEFICITS 3 are utilized effectively, patient satisfaction and quality of life increase and costs of admission decreases. Application The palliative care team at Lodi Memorial Hospital consists of one palliative care doctor and two palliative care nurse practitioners at Lodi Memorial Hospital. The doctor does not physically come to the hospital, the two nurse practitioners take shifts at the hospital and are available Monday through Friday from 8am to 5pm. We have general social workers but not one specifically allocated to the palliative care team. Usually, one of the nurse practitioners will be assigned to a palliative care patient. That nurse practitioner will visit with the patient and family, write orders, then speak with the discharge advocate about discharge options. The bedside nurse is often left out of the patient care conversations with the palliative care nurse practitioner and the practitioner s notes are not usually documented in the patient chart until after the 7pm shift change or the next morning. The problem we have at our institution is not that the palliative care team itself is problematic, but that it is not a properly functioning palliative care team. According to the evidence above, the palliative care team should have at a minimum registered nurse, physician, spiritual advisor, and a social worker in order to be effective. Our current palliative care team is made up of the nurse practitioner consulting with the social worker. It can be frustrating on the bedside nurse when there is information that may be pertinent to patient care but the nurse practitioner is unavailable and not communicating regularly with the bedside staff. Not utilizing the palliative care team properly can impact patient satisfaction negatively, cause readmission into higher levels of care on future visits, and effect the cost of the hospitalization stay.

4 COMMUNICATION DEFICITS 4 Conclusion A palliative care team is shown to be beneficial to acute care settings, such as Lodi Memorial Hospital, when a minimum mixture of members actively participate and contribute toward patient and family goals. All members of the team should be aware of family/patient goals and have a means of communication; team meetings, patient care notes, team rounding. Based off of the evidence and its application to Lodi Memorial Hospital, a palliative care team would be an asset to the organization. In its current state, the palliative care team at Lodi Memorial is not a true palliative care team because it lacks the minimum involvement from bedside nursing and spiritual counsel. Restructuring the way the palliative care team operates, setting up a clear channel of communication to be followed, and involving the bedside nurse and spiritual advisor in the palliative care plan are important steps to proceed with if the palliative care team is to be successful at Lodi Memorial Hospital. By ensuring an adequate palliative care team, hospital stay costs associated with these particular patients will decrease and overall patient and family satisfaction will increase.

5 COMMUNICATION DEFICITS 5 References Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care nursing models and theories. International Journal Of Palliative Nursing, 20(2), Gade, G., Venohr, I., Conner, D., McGrady, K., Beane, J., Richardson, R. H., &... Della Penna, R. (2008). Impact of an Inpatient Palliative Care Team: A Randomized Control Trial. Journal Of Palliative Medicine, 11(2), doi: /jpm Lundberg, T., Olsson, M., & Fürst, C. (2013). The perspectives of bereaved family members on their experiences of support in palliative care. International Journal Of Palliative Nursing, 19(6), Muehlbauer, P. M. (2013). Palliative Care. ONS Connect, 28(1),