The Global Impact of Advances in Pain Management Nursing Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN Professor & Research Scientist City of Hope Medical Center Duarte, California With gratitude to the ELNEC Project team and nurses throughout the world. Approximately 7.6 million people die from cancer in the world each year. Most die in pain, often with little to no access to pain relief. ACS, 2011 1
80% of the world's population, including more than 5 million patients with terminal cancer, lacks adequate access to pain treatment. In more than 150 countries, morphine is simply not available. Statement of professor Sevil Atasoy, president of the International Narcotics Control Board, to the United Nations Economic and Social Council. July 30, 2009 (http://www.incb.org/documents/president_statem ents_09/2009_ecosoc_substantive_session_publis hed.pdf). Around the world, nurses are dedicated to changing that reality. 2
LCDR Carma Erickson Hurt, RN, MSN, OCN Balboa U. S. Naval Medical Center (San Diego, CA) Transforming pain management in active duty and as a volunteer now retired throughout the world. The Role of Witness and Moral Agent Firsthand Observation/Providing Voice Ceremonial Role/Ritual Expert Witness Visionary Kahn and Steeves, 1996 Creating Expertise and Knowledge in Pain Management 3
End of Life Nursing Education Consortium (ELNEC) Initiated in 2001 ELNEC Trainers in 73 countries across 6 continents Pain as one module but integrated throughout Module 1 Palliative Nursing Care Module 2 Pain Module 3 Symptom Management Module 4 Ethics Module 5 Culture Module 6 Communication Module 7 Loss, Grief, Bereavement Module 8 Final Hours Rose Virani, RNC, MHA, OCN, FPCN Senior Research Specialist City of Hope EUROPE Albania Armenia Austria Azerbaijan Croatia Czech Republic Estonia Georgia Germany Hungary Iceland Ireland Kosovo Lithuania Macedonia Norway Romania Serbia Slovakia Slovenia Spain Switzerland Ukraine 4
Russia Tajikistan Sumatra ASIA China, Hong Kong, Singapore, India, Japan, Korea, Kazakhstan, Kyrgyzstan, Mongolia, Philippines, Sumatra Taiwan, Tajikistan, Thailand, Malaysia Ayda Nambayan, RN Philippines ELNEC Organizers UICC ELNEC Palliative Care EOL Class Leukemia Patients Organizers, Faculty and Students 5
Philippines Hyun Sook Kim, PhD, RN, MSN, MSW Republic of Korea Vision and leadership to improve care of the dying in Korea Held 2 national ELNEC courses with 350 participants Translated ELNEC into Korean Extending from ELNEC Core to Geriatrics and Pediatrics 6
Sayaka Takenouchi, RN, BSN, MPH Kyoto University, Japan Sayaka Takenouchi, PhD, RN Kyoto University Developed needs assessment in identifying major barriers to pain management and palliative care Educating nursing students and practicing nurses Changing culture Translated ELNEC Core into Japanese Translated ELNEC Geriatric into Japanese John Lunn, RN, MDiv Vellore and Delhi, India 7
John Lunn, RN, MDiv Global Mission: India, Liberia & Malaysia Provides care and comfort to the body and soul Organized an ELNEC training course to teach healthcare providers in India about pediatric palliative care Orchestrated an ELNEC course in Malaysia, June 2012 Oesophageal Squamous Cell Carcinoma Patients name: Tabitha Age: 84 years Location: Mathagiro Diagnosis: Cancer of the oesophagus with stent in situ, fungating and ulcerated Date of diagnosis: 2 11 2012 Diagnosis through biopsy in an Endoscopy procedure Date first seen in our clinic 29 02 2012 Referred due to pain Tabitha was in a lot of pain that she could not be able to carry out her day to day work. She was not in any pain killer during referral. Tabitha was started on Paracetamol tablets, moved on to Morphine due to the increased scale of the pain. Initially she was on 5mg four hourly and now currently on 10mg four hourly. She is now pain free and despite her age, she is able to tend to her small farm and sheep with ease. Please find the photos attached taken in a Home Visit on 29 02 2012. Since then she has been a steady visitor to our clinic. She is very happy with her new life since hospice got involved in her care! 8
Nairobi Fostering Nursing Presence Pam Malloy, RN, MN, FPCN American Association of Colleges of Nursing (AACN) and ELNEC Kenya Jamaica 9
Expert Attention to the Body and Relief of Symptoms VCU Palliative Care Program / Massey Cancer Center Patrick Coyne, RN, MSN, APRN, BC PCM, FAAN, FPCN & Colleagues Model of interdisciplinary care Aggressive and systematic attention to symptoms Model inpatient unit Palliative Care Leadership Center AFRICA Egypt Kenya Liberia Malawi Nigeria Rwanda South Africa Tanzania Zambia Zimbabwe 10
Africa Joyce Marete, KRCHN,DIPHEd Nanyuki, Kenya Leaving Nairobi to go back to her small village to provide palliative care Understanding the culture Researching wound care related to cancer "Suffering is by no means a privilege, a sign of nobility, a reminder of God. Suffering is a fierce, bestial thing, commonplace, uncalled for, natural as air. It is intangible; no one can grasp it or fight against it; it dwells in time is the same thing as time; if it comes in fits and starts, that is only so as to leave the sufferer more defenseless during the moments that follow, those long moments when one relives the last bout of torture and waits for the next." Written by Cesare Pavese Nardos Gorgios, MD 11
Morphine for 1 month, Tanzania Ocean Road Cancer Institute, Dares Salaam Know the country you wish to help and your role What are their expectations? What cultural and ethical issues may impact your plan and goals? Who is your go to person in this region? What institution/individuals may be barriers? Whose idea is the assistance? What will be your role? Do not reinvent the wheel. 12
Enhanced WHO public health model 13
Recognition of training is critical! 14
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Nursing Team at Hospice Casa Sperantei Brasov, Romania Provides many educational endeavors between nurses and physicians to promote better pain management and palliative care Competencies developed for nursing schools Conclusion This is a profound path for those who care for the dying. It is the path that the great healers and teachers of the past have walked. And it is a path of sanity that clinicians and caregivers can discover, day after day, as they care for the dying. It is also beneath the feet of every human being. Fortunately, we live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well being, resilience, and survival. May we see into the life of things, and may we have the courage to actualize compassion in our lives for the benefit of all those who suffer. Halifax, JPSM Vol. 41 No. 1 January 2011 16