Envisioned Specialty Role and Setting
I am hoping to be an Oncology Clinical Care Nurse Specialist (CNS) at the Lee Moffit Cancer Centre Foundation at Tampa, Florida, which has been named as one of ‘America’s Best Hospitals’ for Cancer Care for the ninth time. The centre which is a National Cancer Comprehensive Cancer Center has many units for cancer care. I hope to join the psychosocial and palliative care program. The mission of the center is to strive for the prevention and cure of cancers. The main objective of the program is to provide interdisciplinary evaluation of cancer patients. Clinical research trials would be conducted. Translational linkages would be made with appropriate basic science programs. Educational programs and training would be provided for medical students, house staff physicians and fellows. The community too would benefit. (Moffit Cancer Center Foundation, 2008).
Definition of palliative care
Palliative care is defined as an approach for the improvement of the quality of life of patients and their families who have been facing the problems associated with life-threatening illness. This would be achieved through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other associated problems including physical, psychosocial and spiritual ones. (WHO, 2002).
Extended education that I would need for a successful career. Through education and research my confidence would improve delivery of palliative care. Hopefully I shall obtain my AOCN (Advanced Oncology Certified Nurse). (Langhorne 2003). I have to become an expert in the following.
- Continuing education in the non- physical needs of terminal phase patients requiring end-of-life support (Parish, 2006).
- Education to increase the relationship between palliative care and acute care nursing.
- Issues associated with terminal illness and the dying phase (ECU, 2008).
Aim
The aim of palliative care is the provision of multi-disciplinary comprehensive care in advanced disease. (Estfan et al, 2007).
Advance Practice Role Description
- An interdisciplinary multi-theory approach is to be followed. (ECU, 2008).
- I must remember that emerging palliative care trends involve ethical, multicultural and political issues. (ECU, 2008). My practice should hopefully be ethical and without political or multicultural issues.
- Identify the best care principles related to really sick patients and those in the terminal phase. (Parish, 2006).
- Shall be readily responsive to patients and families. (Estfan et al, 2007), using my interpersonal skills.
- Assist in the development of standard palliative care protocols which incorporate the holistic needs of patients in palliative care. (Parish, 2006).
- Identify symptoms and provide efficient symptom control and adequate nursing care (Parish, 2006).
- Become fully competent in pain and symptom management. I understand pain as a complex anatomical, physiological and psychosocial state (ECU, 2008).
- Assessment and recognition of disease progression and the terminal phase. Being well equipped to provide physical care like control of pain, other symptoms like nausea, constipation or weakness. Attending to the psychosocial and emotional aspect and providing supportive care, I hope to be with the patient in all the ups and downs (Reznisky et al, 2007).
- Sincere effort to improve the quality of terminal care and share a special time with the patients. (Ross, 2008).
- Lift the spirit, the courage and the smile of my patients.(Ross, 2008 ).
- Maintain correct documentation for aspects of comfort care about assessment of physical, psychosocial and spiritual care. (Parish, 2006).
- Make a correct assessment and plan the symptomatic treatment to raise the quality of the remaining life. (Parish, 2006)
- Encourage support groups to use their conversation skills on the really ill.
- Continuous and coordinated care is essential in attending to the needs of progressive illness (Estfan et al, 2007).
- Strongly believe in the music therapy for patients. Would encourage the listening of music (Estfan et al, 2007).
- Pastoral care is also instrumental in improving the quality of life at the terminal phase. (Estfan et al, 2007). Shall recommend this to the organization.
- Would ensure that a 24-hour answering phone service is in place for attending calls from patients or families in distress. (Estfan et al, 2007).
Communication skills to improve the mental and physical state of the deteriorating patient
- Improve on clear and honest communication with patients (Parish, 2006).
- Would use good communication skills and counseling to assess the psychiatric status of the patient and respond accordingly. (ECU, 2008).
- Remember that the 5 themes that dominate the last minute conversations are of love, identity, spirituality, everyday talk and difficult relationship talk. (Yingling, 2007).
- Last minute communication involves more than pain, care-giving, dying and funeral arrangements. (Yingling, 2007). I must remember this.
- Listen to the patients’ fears, soothe their symptoms and ease their death.
- The survivor remembers these conversations for a long time.(Yingling, 2007).
- Discuss hospice care and prognosis with patients as is possible (Parish, 2006).
Family theories to be adopted in my practice
I hope to cover 160000 new patients who access the Moffit Cancer Center at the National Cancer Center Network which has an alliance with 21 of the world’s leading cancer centers and this is a not-for-profit relationship. I shall be only one in a large population of the interdisciplinary teams in the center but I will do my bit well. I would provide leadership to incorporate the ‘change model’ in my activities.
- Plan multidisciplinary conferences with the families in order to ensure that the family support for the patients is a part of the management in the terminal phase giving plenty of satisfaction to both patients and families.
- Become a key component of the interdisciplinary healthcare team (Langhorne, 2003).
- Make it important to document the patient –family relationship so that flaws can be discovered in time for retribution.
- My role would be to determine how to ensure that the palliative care patient has a comfortable period with plenty of family support. Family based theories will be adopted to ensure quality care (Parish, 2006).
- The communication that occurs at the end of life is extremely valuable to the surviving partner and dying alike. Survivors recall the enduring love between them, the effect the loved one had, changes in the survivor’s spirituality, solving of the issues between them and thoughts of the pleasurable moments. (Yingling, 2007). I would take care that this kind of communication persists.
- Recognise the symptoms of imminent death to allow the family members to gather close. (Parish, 2006).
Funding
This excellent hospital survives on charitable funds and grant funding. At the beginning of 2008, Grant funding was more than 66million dollars. There is no dearth of funds here. So I expect my role to be supported. I consider that the Psychosocial department as a whole would benefit from my ideas and then the patients. (Moffit Cancer Center, 2008).
References
ECU, “Palliative Care”, Edith Cowan University, 2008, Web.
Estfan, Bassam et al, (2007), “The Business of Palliative Medicine—Part 5: Service Utilization in a Comprehensive Integrated Programme”, American Journal of Hospice & Palliative Medicine® / Vol. 24, No. 3. © Sage publications.
Moffit Cancer Center Foundation, (2008), “Adult Oncology Services”, Web.
Parish, Karen; (2006), “Dying for attention: Palliative care in the acute setting’, Australian Journal Of Advanced Nursing, Vol 24, No. 2, pg 21-25.
Reznisky, Shirli et al, (2007), “Can Family Caregivers of Terminally Ill Patients Be a Reliable Source of Information About the Severity of Patient Symptoms?”
American Journal of Hospice & Palliative Medicine® / Vol. 23, No. 6, 2007, pgs 447-456. © Sage Publications.
Ross, Janice; (2008), “Lessons on the way”, Clinical Journal of Oncology Nursing, Vol 12, No. 4, Oncology Nursing Society.
World Health Organization. National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed.Geneva, Switzerland: World Health Organization, 2002.
Yingling, Julie and Keeley, Maureen; (2007), “A failure to communicate: Let’s get real about communication at the end of life.”, American Journal of Hospice and Palliative Medicine, Vol.4, No. 2. Pgs.95-97, © Sage Publications.