Make changes to palliative and end-of-life care in Canada
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1 CNA Webinar Series: Progress in Practice Make changes to palliative and end-of-life care in Canada Louise Hanvey Louise Hanvey Consulting March 10, 2014 Canadian Nurses Association, 2012
2 Jill Norman, RN, MSc Acting Senior Nurse Advisor Practice and Policy Division Canadian Nurses Association
3 CNA Webinar Series Make changes to palliative and end-of-life care in Canada Due to the large number of participants in this webinar, only questions in writing can be accepted, during or at the end of the presentations. To submit a question: 1. Click the Q&A button. 2. Select All Panelists from the drop-down menu. 3. Type your question in the field. 4. Click Send.
4 Louise Hanvey, RN, BN, MHA Louise Hanvey Consulting
5 What is palliative care? Palliative care is the provision of care aimed at relieving suffering and improving the quality of living and dying. This model of care is appropriate for any person at any stage of a life-threatening illness, regardless of age. Source: CNA Position Statement. Providing Care at the End of Life. Palliative care involves: Assessment and management of pain and symptoms Psychosocial support for the patient and family/caregivers Spiritual support Social support
6 The Current Context
7 Nurses provide care To Canadians who are diagnosed with life-limiting illnesses Across the life span Across all settings
8 RNs Employed in Canada 2010 N = 268,512 Area of Responsibility Medicine/Surgery 17.0 Geriatrics/Long-Term Care 9.7 Home Care 2.8 Oncology 3.3 Critical Care 7.4 Emergency Care 6.7 Community Health 5.4 Pediatrics 2.8 Ambulatory Care 2.5 Mental Health 5.0 Maternity/Newborn 5.7 Occupational Health 1.0 Operating Room/Recovery 4.9 Several Clinical Areas 1.4 % of Nurses Employed
9 The trajectory of dying is changing Chronic disease accounts for more than 72% of all deaths in Canada As Canadians age with chronic illnesses and frailties, and as younger Canadians continue to face life-limiting and chronic illnesses, they are all both living and dying. The course of their illness may be less predictable
10 What do Canadians say? Support palliative care Reduces stress and burden on families Improves quality of life Want to die at home with their families 75 Realize they can access PC outside of a facility 49 Have any experience with PC % Source: Canadian Hospice Palliative Care Association. Fast Facts. Hospice Palliative Care in Canada
11 What do Canadians say? Want nurses involved in their PC 94 Are comfortable talking with nurses about care at end of life 88 Trust nurses 84 Do not feel the P/T governments place high enough priority on PC % *Source: Shifting Public Perceptions of Doctors and Health Care: FINAL REPORT Submitted to: The Association of Faculties of Medicine of Canada. EKOS RESEARCH ASSOCIATES INC. February 2011
12 The current situation in palliative care Progress and leadership in hospice palliative care in Canada Model specialized palliative care programs palliative consultation teams, palliative care units in hospitals and Lack of access to these specialist services
13 Challenges
14 Challenges Lack of access 16% to 30% Differences across the country Gaps in the continuum Funding
15 Challenges Long-term care Nurses highly motivated Need more education, support, team work Time shortages and lack of staff
16 Challenges Home care Funding Research supports palliative home care supporting people to stay home Model reducing acute care hospital length of stay
17 Challenges Caregivers Provide more than 80% of care for people with chronic illness 54 hours per week Impacts employment
18 What other challenges do you face in your practice? Share it in the Q & A box.
19 The Future Solutions
20 Canadian Hospice Palliative Care Association. A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. Revised and Condensed Edition 2013.
21 An integrated, palliative approach People of all ages Have a life-limiting or chronic illness or to those who are aging early in the illness trajectory Early conversations about needs/wishes In all health-care settings Home, long-term care, primary care with Support from specialist teams when needed The Way Forward
22 An integrated palliative approach is better for Canadians Physical, psychosocial and spiritual needs All stages of illness Autonomy Enhances their quality of life throughout illness Culturally Sensitive
23 An integrated palliative approach is better for the health-care system Addresses hospitalizations and use of interventions Health-care providers in the community are educated and skilled Support when needed by specialist palliative care team All nurses in all settings of practice are education and skilled and are supported in implementing the palliative approach
24 How do we make this happen?
25 Vision of person-centred Care Providing safe, compassionate, competent and ethical care; Promoting and respecting informed decision-making; Preserving dignity Promoting justice
26 Coordination Central hub and spoke approach North Haven, New Zealand Specialist nurse educator and advisor Increased capacity in primary care 90% of care in the home/community
27 Interprofessional teams 10 community-based consult teams for 12 communities Advance practice nurses, physician, social worker/ and volunteer coordinator Nurse coordinator primarily responsible
28 Key roles for Registered Nurses When it comes to the integrated palliative approach to care, nurses get it. They are best placed to link together primary and secondary care services and to create partnerships. The Way Forward. Innovative Models of Integrated Hospice Palliative Care
29 Key roles for Registered Nurses Nurse navigators Advocate, educate, support Information exchange
30 Support for nurses in long-term care Nursing staff wanting more education to support their knowledge, skills, confidence Better team work/communication Inadequate staffing Grief burden Source: Quality Palliative Care in Long-Term Care: A Community-University Research Alliance. Long-Term Care Homes: Hospices of the Future. Submission to the Canadian Nursing Association Expert Commission.
31 Tools for Change
32 Advance care planning
33 What do we need? Nursing education! Central to effective programs Generalist and specialist Undergraduate, postgraduate Continuing education
34 What do we need? Nursing education! Competencies and Indicators for Undergraduate Nursing Education CASN Competencies for Specialist Nurses CNA LEAP Pallium Canada
35 What do we need? Nursing leadership! Advocate for improved access to high quality integrated palliative care. Develop/adapt nursing standards for the provision of high quality, integrated palliative care
36 Nursing leadership
37 Advocate in your community!
38 Questions and comments? Share your resources!
39 CNA Webinar Series Make changes to palliative and end-of-life care in Canada Due to the large number of participants in this webinar, only questions in writing can be accepted, during or at the end of the presentations. To submit a question: 1. Click the Q&A button. 2. Select All Panelists from the drop-down menu. 3. Type your question in the field. 4. Click Send.
40 For more information: Photo credits: istock Canadian Nurses Association, 2012
41 Upcoming Webinar Get tips and hints for using e- Therapeutics: Available on NurseONE.ca April 16, 12 to 12:45 pm ET (English) April 17, 12 to 12:45 pm ET (French) Canadian Nurses Association, 2012
42 Thank you! Canadian Nurses Association, 2012
43 To leave this webinar After a few seconds, you will be redirected to our evaluation survey. Once you have completed the survey, you will be redirected to the certificate of participation. Canadian Nurses Association, 2012
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