Palliative care unit tailors care to whole patient
Interdisciplinary team provides holistic care
The acute palliative care unit at Summa Health System's Akron City Hospital takes a holistic approach to meeting the needs of patients with advanced complex illnesses and their families.
"The palliative care unit gives us an opportunity to look at everything the patient and the family needs and to provide them with physical, emotional, spiritual, and social support," says Carol Kucharski, RN, OCN, staff nurse, who provides care to patients in the 12-bed unit.
The unit admitted its first patient in August 2006. Now the unit is almost continuously full.
Patients in palliative care have a serious or life-threatening illness and are looking at end-of-life issues, even if their illness is not considered terminal at the time of treatment, Kucharski points out.
The purpose of the unit is to address the needs of the patient and family member and allow them to go back to the home or another level of care. The average length of stay on the unit is three to five days.
"They progress well because we've impacted their lives," she says.
Some of the patients are admitted from Summa's home hospice program for pain and symptom management and return home.
Others have an illness that they eventually will die from and come to the unit for pain and symptom management, then go home with home health care or hospice care.
Facilities
Summa's palliative care unit was designed as a beautiful and soothing place for patients and family members during a difficult period in their lives. The unit has wooden floors, wall sconces, luminous ceiling tiles with nature and cloud images, live plants, and home-like window treatment. There are no restrictions on visits, and pet visitation is encouraged.
The unit has 12 large private patient rooms with space for family and friends to gather, and an area where a family member can sleep.
There are two family rooms where family members can gather to talk or relax, a kitchen area for patient and family use, a community room for private meetings with families and support groups, a kitchen area that family members and patients can use, and a place where they can shower. Patients can use a spa room with whirlpool tub.
The palliative care team includes physicians, RNs, LPNs, a spiritual care coordinator, a pharmacist, a dietician, a social worker, and members of the home hospice care team who work together to develop an individualized plan of care for each patient.
"It's a specialized unit with people from a diversity of backgrounds, including the emergency department, the intensive care unit, telemetry, and oncology. Patients in the palliative care unit have a variety of needs requiring attention," she says.
The interdisciplinary team has daily rounds to address the needs and concerns of each patient and to develop discharge plans. Before the conference, Kucharski gets input from her patients, "so I can feel like I can speak for them," she says.
When she is assigned a new patient, Kucharski conducts a comprehensive assessment that goes far beyond the typical case management assessment.
"I sit down with the patient and family and assess them emotionally to find out information about the family and the family situation. Palliative care is all about meeting people where they are and dealing with any issues they may have," she says.
Part of her job is just to listen.
"I give patients and family members a voice. I allow the patients and family members to verbalize what their needs are, and I really listen to them. I feel a lot better when I have been able to help them by impacting their feelings of frustration and hopelessness," she says.
She facilitates comprehensive management of the patients' physical, psychological, social, and spiritual needs, bringing in other team members when needed.
"People who are dying have extreme needs, and they are very diverse, and each family's needs are different," she says.
Kucharski concentrates on getting issues within the family resolved and may call in a social worker to help with psycho-social issues.
"I may assume the responsibility for bringing family members together. The patients are going to be stressed until their issues are resolved," she says.
The palliative care team makes sure that the patients are comfortable.
"Nurses are reluctant to give large does of pain medication on the other units. We know all about pain medication and what relief it brings. Dying takes courage and it takes someone with expertise to help people through the process of dying," she says.
Three licensed health care professionals per shift work on the palliative care unit, providing care for 12 patients.
"These patients need a lot of attention. The team looks at their nursing needs and provides routine nursing care to keep them comfortable. We try to turn them frequently and provide other care to keep them comfortable so we don't always have to resort medications. It's an honor to work with this population of patients," she says.
Before the unit opened, the RNs and LPNs on the palliative care team went through a two-week orientation program.
The team continues its education at regular meetings and during rounds when the medical director brings in information on various topics that range from managing nerve pain, dealing with terminal agitation, the spiritual side of dying, and how to talk to patients about end-of-life issues, she says.
The acute palliative care unit at Summa Health System's Akron City Hospital takes a holistic approach to meeting the needs of patients with advanced complex illnesses and their families.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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