Palliative Care Needs Assessment 1. Please choose your position: Staff Nurse 51.8% 100 Nurse Manager 7.8% 15 Advanced Practice Nurse/Nurse Educator 7.8% 15 Nursing Assistant/Patient Care Tech 13.0% 25 Primary Care Coordinator 5.7% 11 Social Worker 5.2% 10 Pharmacist 6.7% 13 Nurse Practioner 2.1% 4 Other (please specify) 9 answered question 193 skipped question 11 2. Palliative Care is specialized medical care for people with serious illnesses. True 84.8% 173 False 15.2% 31 1 of 12
3. Palliative Care is focused on providing patients with relief from pain, shortness of breath, nausea, constipation, difficulty sleeping and other distressing symptoms associated with serious illness. True 93.6% 191 False 6.4% 13 4. Palliative Care and Hospice Care provide the same service. True 18.1% 37 False 81.9% 167 5. Palliative Care services are provided on a specialized nursing unit. True 16.7% 34 False 83.3% 170 2 of 12
6. Palliative Care applies to situations where there is evidence of decline and the patient has DNR or CMO orders. True 64.2% 131 False 35.8% 73 7. The philosophy of Palliative Care is compatible with that of aggressive treatment. True 24.5% 50 False 75.5% 154 8. Palliative Care integrates the psychological and spiritual aspects of patient care. True 96.1% 196 False 3.9% 8 3 of 12
9. A team approach is used to address the needs of patients and family members. True 98.0% 200 False 2.0% 4 10. Palliative Care offers emotional and spiritual support to help patients cope with their illness. True 96.1% 196 False 3.9% 8 4 of 12
11. In what situations do you think a Palliative Care consult should be considered? Symptom Management 83.4% 146 Discussion of plan of care and patient goals 85.1% 149 Advance Directive discussions 72.6% 127 Communication of prognosis 73.1% 128 Hospice Care discussions 82.9% 145 When conducting a family meeting 76.0% 133 Pain management 88.0% 154 Other (please specify) 4 answered question 175 skipped question 29 5 of 12
12. Please rate how frequently the following ethical dilemmas occur in your work setting: Never Rare Occasionally Frequently Rating Average Patient and family having different goals than medical staff 4.0% (7) 11.4% (20) 46.9% (82) 37.7% (66) 3.18 175 Use of advanced directives 4.6% (8) 15.4% (27) 38.3% (67) 41.7% (73) 3.17 175 withholding/withdrawing life sustaining treatments 13.7% (24) 24.6% (43) 46.3% (81) 15.4% (27) 2.63 175 Discontinuing life support 32.6% (57) 21.7% (38) 32.0% (56) 13.7% (24) 2.27 175 Providing futile care (no hope of success) 14.3% (25) 23.4% (41) 38.3% (67) 24.0% (42) 2.72 175 Continuing unnecessary diagnostic procedures 10.9% (19) 18.3% (32) 41.7% (73) 29.1% (51) 2.89 175 Uncertainty about the patient's understanding of their prognosis 5.7% (10) 12.0% (21) 50.3% (88) 32.0% (56) 3.09 175 Providing honest information vs. destroying hope 8.6% (15) 14.3% (25) 45.7% (80) 31.4% (55) 3.00 175 Time limitations to address the patient's emotional needs 8.6% (15) 13.7% (24) 42.3% (74) 35.4% (62) 3.05 175 Other ethical issues: 5 answered question 175 skipped question 29 6 of 12
13. Please share any additional thought, comments, and suggestions regarding a palliative care consult team here at SMH. Thank you for taking the time to complete the survey, as your input is important to us. 15 answered question 15 skipped question 189 7 of 12
Page 1, Q1. Please choose your position: 1 Nurse Practitioner (it is spelled wrong in the above selection) Oct 26, 2011 10:25 AM 2 MEDICAL ASSISTANT Oct 24, 2011 9:39 AM 3 staff physician Oct 22, 2011 11:45 AM 4 Administration Oct 20, 2011 4:53 AM 5 iv team Oct 19, 2011 5:39 PM 6 educator Oct 19, 2011 3:34 PM 7 RN liaison -home care Oct 19, 2011 1:35 PM 8 Clinical Director Oct 19, 2011 10:47 AM 9 clinician Oct 19, 2011 8:53 AM Page 2, Q11. In what situations do you think a Palliative Care consult should be considered? 1 with end of life care issues Oct 26, 2011 2:24 PM 2 when frequent readmissions are occurring for the same problem (sometimes multiple readmits within days of each other) Oct 22, 2011 4:04 PM 3 Any symptom management as a result of therapies; eg. chemo. Oct 19, 2011 2:03 PM 4 end stage disease Oct 19, 2011 8:05 AM 8 of 12
Page 2, Q12. Please rate how frequently the following ethical dilemmas occur in your work setting: 1 the need for better understanding of procedures with family members and addressing results of outcomes 2 Family having unrealistic expectations of patient's prognosis and ability to triumph over disease. 3 NOT APPLICABLE TO MY WORK SITUATION-NOT INVOLVED IN DIRECT CARE 4 Why must Advance Directives and POA forms be brought in for each and every admission? This virtually ensures that a patient's wishes be put on hold while agressive treatments are pursued. Why shouldn't the patient's wishes be entered as part of the permanent record (like allergies, etc), and subject to change as the patient wishes. 5 I think we could do a better job when there is a decision to continue when we as healthcare providors introject our opinion into the situation. Often, without even speaking families can see our feelings regarding THEIR decision. Nursing's role should be to provide the best care no matter what the plan of action entails Oct 19, 2011 2:16 PM Oct 19, 2011 2:03 PM Oct 19, 2011 11:32 AM Oct 19, 2011 9:44 AM Oct 19, 2011 8:15 AM 9 of 12
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Page 2, Q13. Please share any additional thought, comments, and suggestions regarding a palliative care consult team here at SMH. Thank you for taking the time to complete the survey, as your input is important to us. 1 I look forward to the input and recommendations from the palliative care team. Oct 24, 2011 10:01 PM 2 I think many opportunities and patients that would/could benefit from palliative care are lost because the pcp's won't invite another party into the med mgmt picture Oct 22, 2011 4:04 PM 3 that might be a nice way to put everyone on the same page Oct 21, 2011 9:37 AM 4 I think pt/family education is needed. I see too often people that are suffering and the families seem to have unrealistic expectations when the pt.'s prognosis is poor 5 I think sometimes the thoughts/feelings of the patient are overlooked in certain situations. I have seen a lot of fear, anxiety, withdrawing, because patients are scared because doctors don't explain things to them very well and the nurses are afraid to tell them more because they don't know what was communicated to the patient. Also, they are scared of what is happening to them and there is no calming them, just a rushed environment where they feel they are "waiting out their time". So I think Pallative care is very important to patients and I'd like to see more of it within the hospital for patients. Oct 20, 2011 3:15 PM Oct 20, 2011 8:07 AM 6 much needed program Oct 20, 2011 7:42 AM 7 Wonderful approach. I have the opportunity in my other pharmacy practice setting to see many models throughout US and find this team approach to benefit the patient very much. Thank you. 8 unnecessary procedures and invasive and non-invasive testing on the elderly and end stage patients. families need to be aware of decision making in regards to unfavorable results. Undue stress placed upon the patients who have to undergo procedures, i.e., preps needed for diagnostic procedures. 9 Great concept and program! A nurse liaison as part of the team would be a great connector between bedside nurses and the palliative care team to ensure that patient and staff needs are adressesed and met. She can easily explain services and needs to both parties. Oct 19, 2011 9:51 PM Oct 19, 2011 2:16 PM Oct 19, 2011 2:03 PM 10 Pharmacy should be an integral part of the process. Oct 19, 2011 12:30 PM 11 more education to staff nurses on how to contact someone to talk to family. Oct 19, 2011 11:19 AM 12 Also an issue, the "Code Status" being left blank on admission, making a full code mandatory by default. many patients come back to us for symptom management, and the legal structure makes agressive treatment a necessity. If we respect our patients and their wishes, this must change! 13 a presentation of the function of palliative care would be a needed resource of information for surgical patient care 14 I think this will be a valuable service for the hospital and will require support from multiple disciplines. Oct 19, 2011 9:44 AM Oct 19, 2011 9:18 AM Oct 19, 2011 8:49 AM 15 palliative care in the PACU occurs rarely but when it does the pt comes out of Oct 19, 2011 8:26 AM 11 of 12
Page 2, Q13. Please share any additional thought, comments, and suggestions regarding a palliative care consult team here at SMH. Thank you for taking the time to complete the survey, as your input is important to us. OR=surgery has been aborted and one nurse is consumed with the palliative care of one pt and family-it is very time consuming and takes manpower from the PACU staff that is still recovering multiple pts coming out of the OR 12 of 12