[KittieLoverRN]

Hello Fellow Nurses;

I am looking to develop a "Learning Needs Assessment Tool" to administer to nurses (RN's and LPN's) who are interested in learning more about End-Of-Life and/or Hospice & Palliative Care.

This tool should focus on what information the nurse feels he/she needs to know to provide competent and quality end-of-life care.

Anyone have a good link to share and/or have questions to add to this tool that would interest you??

Thanks in advance for your interest and help!

KittieLoverRN in Michigan!

[The unexplainable Moo Cow]

Hello and welcome KittieLover RN,

Not exactly sure how I can contribute to your project or how the tool would be implemented but I do have a question related to a hospice pt I cared for once.

Obviously both of us don't know the pt's history and I don't remember the initial dx, but before my shift began the pt was made hospice. Orders were written out, the pt was non-verbal and to my memory would not have have an issue with pain.

She was not in the "dying process", if you will, at this point. No acute distress throughout the night, respiratory status was stable and controlled a-fib if memory serves correctly. Report given to day shift RN and I'll be back the next night.

Upon start of my shift I learned they started a morphine drip. Whoa! What did I miss? How did I not see her in pain for all 12 hours of my shift? Ack!!! Now I do not remember the exact indictations for the drip but I certainly do remember feeling bad for not catching what the physician seemed to so obviously see.

I know the story here does not have enough meat on the bones to say whether I completely screwed up. But what gives? She could not verbalize to me any pain, grimacing, restlessness and moaning were absent. Is there something I missed? That is, are there other indicators for pain?

[KittieLoverRN]

Hello Moo Cow;

In response to your question regarding pain in the hospice patient, as we all are aware, pain can be manifested in many ways. If a patient is non-verbal, restlessness and/or grimiscing would be my first indicator. In the case scenario you describe, maybe the morphine drip was not started for pain specifically....maybe it was initiated for respiratory distress? In hospice, we use morphine to slow the respirations of those with COPD type diseases. Many times there are no indicators of pain, just difficult respirations. It works well!

And, sometimes if we cannot isolate the problem, we do try a little morphine to see if the non-verbal patient responds to the intervention. We usually don't initiate a drip right off the bat, but use small amounts of sub-lingual morphine to see how the patient tolerates the medication and if the distressing symptom disappears.

In this case, I really don't think you "missed" anything. People with end stage disease process can change quickly as I'm sure you are aware. One minute they may be comfortable...the next, they are uncomfortable.

Don't stress over this....I'm just glad they started the morphine for the patient. Rather to error on the side of comfort and a little sedation, rather than not know what is the issue!

Keep the faith Moo Cow!!!

KittieLoverRN in Michigan

[cougarnurse]

Hi, Kitty! In Home Health Care Management & Practice, Vol. 11, No. 6 pages 11-25, there is an article on a Learning Needs Assessment Tool for someone with CHF. Here is a link to the article; you need to log in to see the whole article. Perhaps it may help??

'Cat'

[KittieLoverRN]

Hi Cat....

Thanks so much for the link/article. I will check it out! This "tool" is a portion of my practicum for my masters and I am looking for input in the form of articles and input from nurses as to what they need and what to know about providing end-of-life care. So I'm sure the link you provided will help!

Thanks again & glad to chat with you!!!

KittieLoverRN in Michigan

[cougarnurse]

I know the artilce is a bit 'old', but I am sure that you can utilize the general idea.

Have you checked any of the Hospice journals? Lippincott has a few that may be of use.

[KittieLoverRN]

Yes, I am a member of the Natl Hospice and Palliative Care Association, so I receive all journals....I've scanned them, but have not found what I'm looking for. Today, I networked with an instructor at a local university...she is also going to talk with some of her colleagues and try to find some info for me!

Thanks for the suggestion!

[stillearning]

KittieLover
Do go to the website for your Hospice and Palliative Care Organization http://www.nhpco.org/templates/1/homepage.cfm

There, search out the Standards of Practice -- only members can access them on the site.

Then, turn each standard into a self-assessment question, place it on a Likert scale (usually 1 to 5) with a range of responses:
Always, Usually, Sometime, Rarely, Never

You can ask your staff if they know how to APPLY the standard.
You can ask if they've had occassion to USE the standard (and request an example)
You can ask if they UNDERSTAND the standard and would appreciate additional training/education on it's intention or implementation.

You can do almost anything that allows you to MEASURE where your nurses & other staff ARE in relation to what national standards say they should practice.

There you have it -- a learning needs assessment.

Tally up the responses, make a plan to address those noted as most "needed" by your staff in the coming year.

Hope this is useful!

--p