Pain and Palliative Nursing - a Team Approach

“A Nurse’s Perspective of Pain and Palliative Care” was the topic of the Sept. 26 meeting of the Texas Medical Center Pain and Palliative Care Grand Rounds.

Featured guests were members of St. Luke’s Episcopal Hospital’s Palliative Care Center nursing team, including Jane C. Sidwell, a certified hospice palliative nurse and advanced-practice, licensed master social worker; Dot Kite-Powell, a registered, advanced-practice nurse; and Amy Calvin, Ph.D., also a registered nurse and the team’s nurse researcher.

The St. Luke’s Palliative Care Center began to take shape in 1999, when a part-time palliative care registered nurse was hired to assist Porter Storey, M.D., associate professor of geriatric medicine at Baylor College of Medicine and, now, palliative care services’ medical director at St. Luke’s, with consultation services for program development and treating palliative and pain patients.

Today, the palliative care team includes Storey, Sidwell, Kite-Powell, Calvin, and Amy Haworth, an advanced-practice, licensed master social worker. The team’s motto is, “Being here, being there, being everywhere.”

“In the acute-care setting, when we began our palliative care services, it was important to lay the framework and establish the tone for what we were there to do,” Sidwell said.

Sidwell recalled how many people misunderstood the concept of palliative care, thinking it was solely devoted to death. The team members were even sometimes called “angels of mercy.”

“Yes, that’s what we do,” Sidwell said, “but our emphasis is how we can help people live well until they die.”

Palliative care is defined as both a very active plan of care for patients whose diseases are progressive and unresponsive to curative treatment, and advanced-illness management with services delivered by an interdisciplinary team who coordinates a plan of care with the attending team of health care providers.

The St. Luke’s palliative care team helps families, caregivers and friends cope with advancing illness; continue all reasonable efforts to prolong life and alleviate symptomatic distress; and prepare for a shift from “curing” to “comfort measures only.”

The team has made it a mission to network at every instance, in order to get the word out about their services. This includes chatting in the cafeteria and banter in the bathroom.

“We take the opportunity to talk and work, hand in hand, with other health care professionals to provide comfort and alleviate stress and suffering,” Sidwell said.

Potential hospital-based palliative care benefits include reduction in symptom burden; care aligned with patient and family preferences, such as advance directives; patient and family consensus on medical care goals; improved patient and family satisfaction; and improved utilization outcomes (e.g. length of stay, intensive care unit days, readmission rate, hospice referral rate, and emergency room use).

Powell said the number of palliative care patients at St. Luke’s is steadily increasing. In 2000, there were 216 palliative care service referrals. By the end of this past September, there were 578 – and the year isn’t over yet.

Criteria for palliative care services include patients who are approaching the end of life with pain, shortness of breath caused by neurological malfunction, nausea, vomiting, constipation or other distress; patients with changes in code status resulting from disease progression and changes in level-of-care needs; and families and/or those significant to the patient who would benefit from comfort, education on signs and symptoms of approaching death, and/or assistance coping with imminent death.

The team’s plan of conduct consists of four steps:

• “Perceive it”: Death in the ICU

• “Conceive it”: A business plan for development

• “Believe it”: Commitment to symptom management and alleviation of distress

• “Achieve it”: Palliative care in the acut- care setting

Sidwell said by integrating palliative care services throughout the hospital, bedside teaching and mentoring, and palliative care education, the team’s plan would be on the way to completion.

The St. Luke’s palliative care team plans to expand the program by increasing consultations for symptom management, alleviating suffering, enhancing communication, sharing in the decision-making process, and appropriately utilizing care environments.

Sidwell closed the session with a quote from Cicely Saunders, founder of the modern hospice movement.

“Nurses were the first to respond to the challenge of palliative care and remain the core of the personal and professional drive to enable people to find relief, support, and meaning at the end of their lives.”

Richard E. Wainerdi, Ph.D., Texas Medical Center president and CEO, said these informal meetings, where issues of pain and palliative care are discussed, and knowledge is shared, are open to patients, students, medical professionals, or anyone who has an interest in the subject.

“When these meetings began, they started out rather small. We’re delighted to see how much they’ve grown and know there are even more people in the community and on the TMC campus who may be interested in this topic,” Wainerdi said.

The next meeting takes place Nov. 21 from noon to 1:30 p.m., at Trevísio on the sixth floor of the John P. McGovern Texas Medical Center Commons, 6550 Bertner Ave.

Dates for the 2003 meetings are Feb. 27, May 22, Aug. 28 and Nov. 20. For additional information, contact Lori Nelson at (713) 791-8800.

On another note, the first-ever, one-day, Living with Chronic Pain Conference, sponsored by the National Chronic Pain Society, takes place Saturday, March 8 at the George R. Brown Convention Center. Conference highlights include keynote speaker Patch Adams, M.D., the physician known for wearing a red, rubber clown nose to entertain both pediatric and adult patients, and made famous in 1998 when Robin Williams brought his story to the big screen; special guest, comedian Jerry Lewis, and lunchtime speaker, Porter Storey, M.D.

The National Chronic Pain Society is incredibly fortunate that Jerry Lewis has decided to hook up with the society, said Helen Dearman, the group’s president and conference coordinator. He has suffered chronic pain for many years due to injuries sustained in performing decades of slapstick comedy.

Before the conference begins and throughout the day, a health fair will also take place, and will feature chronic pain information for both patients and caregivers.

Conference cost is $85 per person for pain society members, $100 per person for nonmembers. For more information on the conference or the National Chronic Pain Society, contact Dearman at (281) 357-HOPE (4673).

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©2006 Texas Medical Center

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