Nancy Joyner – PESI – Nearing the End of Life: Dare to Care

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Nancy Joyner – PESI – Nearing the End of Life: Dare to Care

• Families ask . . . what would you do if this were your loved one? Learn how to reply without bias …
• Creative ways to discuss withdrawing or withholding treatment
• Manage patient pain and symptoms: Medical marijuana, morphine, palliative sedation or fewer medications?
• Tips to guide code status conversations with patients and families
• Resolve family dysfunction surrounding end of life decisions
• Requests to “humanely euthanize”/hastening death: How to respond?
• Hear powerful case studies that provide examples of expert, holistic care

Eleanor is an 83-year-old widowed lady with known chronic heart failure and advanced dementia. She is now hospitalized with a significant stroke and dysphagia. She does not have a healthcare directive and had never discussed what she would want, other than staying at home until she dies. She is full code. Her family still wants resuscitation attempted. Her children admit they are concerned about what is best for their mother.

What are options for Eleanor and her family? Would she benefit from artificial hydration and nutrition? How is she going to receive medications? Can some of her medications be discontinued? Who is going to be her caregiver?

In this compelling seminar, multiple case studies like Eleanor’s will provide you with examples that you can incorporate when care is more important than cure. To deliver expert, holistic care, healthcare professionals need to have a toolbox full of new interventions to promote quality care at the end of life.

Have you ever been asked, “what would you do if this was your family member?” Learn conversation options to use while staying neutral.

Did you know that a patient might enroll on hospice care and be a full code? We will discuss how this is done.

What can we do for patients seeking euthanasia who see this as the best solution? These situations are becoming more frequent. Anticipate how you will respond.

Strategies regarding comfort, communication, choices and control have unique issues and challenges for patients, families and health professionals. We have an obligation to know how to help provide emotional, spiritual, existential, and physical comfort for those who have life-limiting conditions and to support them through difficult decisions. It’s time to think outside the box.

Speaker

Nancy Joyner, MS, CNS-BC, APRN, ACHPN®

Nancy Joyner, MS, CNS-BC, APRN, ACHPN®, is a nationally-recognized consultant, speaker, educator, and author. As a Palliative Care Clinical Nurse Specialist, she currently works for the University of North Dakota’s Center for Rural Health disseminating palliative and end-of-life care awareness and education. Nancy has extensive experience caring for patients and their families experiencing serious illness, frailty, and end-of-life at home and in the acute care setting. With over 40 years of nursing practice, she has provided care to patients receiving intensive care, surgical critical care, oncology, and renal care. Nancy has had training through the Center to Advance Palliative Care, Palliative Care Leadership Center at Fairview Health Services in Minneapolis. She holds a certification as an Advanced Practice Hospice and Palliative Care Nurse and has prescriptive authority within her palliative scope of practice. Nancy is an End-of-Life Nursing Education Consortium trained presenter, having presented and published at local, state, and national levels. She has researched and published continuing education articles on pain, hydration, and nutrition in terminal care, as well as POLST, portable medical orders for those with serious illness, frailty, and nearing end-of-life.

Speaker Disclosures:
Financial: Nancy Joyner maintains a private practice and has employment relationships with CSU Shiley Haynes Institute for Palliative Care, UND Center for Rural Health, UND Dakota Geriatrics, WilliamsTown Communications, and the University of North Dakota. She receives royalties as a published author. Nancy Joyner receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Nancy Joyner is the President of Honoring Choices® North Dakota and is a member of the North Dakota Hospice Association, the North Dakota Cancer Coalition, and others.

Outline

• An Inexact Art & Science

• Illness and dying trajectories
• Frailty
• Dementia
• Prognostication and prognostic scales
• When to refer to palliative care or hospice (disease specific)

• Essentials of Care: Comfort, Communication, Choices, Control

• Comfort Always

• Morphine: Still the gold standard?
• Pain during the final hours of life
• Drug misuse: How to avoid it
• Opioids for dyspnea
• Thirst vs. xerostomia
• Medical marijuana

• Complementary and alternative therapies

• Emotional distress interventions
• The role of spirituality
• Palliative sedation
• Communication: Everyone is Involved
• Advance care planning: More than just a form
• The terminology matters
• Your role in these critical conversations
• How much can we share?
• Truth vs. hope
• Code status discussions
• DNR does not mean do not treat
• Addressing concerns and needs of the family
• Thanatophobia: Is it fear of dying or fear of death?
• Premortem surge
• Near death awareness
• The dying process

• Choices: Shared Decision-Making

• Nutrition & hydration choices
• Voluntarily Stopping Eating and Drinking (VSED): Benefits & burdens
• Life-sustaining treatment
• Non-beneficial treatment choices
• Faith-based influences
• Ventilator support
• Dialysis or renal palliative care
• Devices to extend life
• Hastened death request: Why not humanely euthanize?

• Allowing Control: Patient-Centered Care

• Reframing hope
• What do family members want you to consider
• Who makes the decision
• What about family dysfunction…
• Is the focus quality or quantity?
• Decision to withhold or withdraw care
• Challenging decisions: Honoring patients’ wishes

• Cultivating Moral Resiliency

• Moral resilience–preserving/restoring integrity
• Personal vs. professional grieving
• Enabling character and honorable action
• Ethical Competency

Objectives

1. Analyze how complementary therapies enhance quality of life for patients.
2. Evaluate the risks and benefits of medical marijuana.
3. Categorize the eight domains of the National Consensus Project.
4. Analyze five complications related to artificial hydration and nutrition.
5. Assess ethical issues often seen at the end of life.
6. Formulate two strategies to diminish fear of death and dying.
7. Connect moral resiliency to palliative care.

Target Audience

Nurses, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, Social Workers, Counselors, Case Managers, Chaplains, Clergy

Reviews

Sara M
” Good information for clinicians dealing with death and dying. ”

Karen P
“She’s amazing and I truly am glad that i took this course! ”

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