New Competency Profile for Licensed Practical Nurses in Alberta

I am deeeeelighted to share that the College of Licensed Practical Nurses of Alberta has launched the 2015 updated Competency Profile for Licensed Practical Nurses!

And most exciting for me is the section on Palliative Care!

Have a look at the new Competency Profile for Licensed Practical Nurses, in particular (document) pages 142- 146 for the Palliative Care Profile. I was honoured to be asked to provide input in the development of these competencies, and am thrilled with the outcome of this document. These are the most specific palliative care competencies for LPN/RPN practice that I know of.

Why are palliative care competencies for Licensed Practical Nurses important?

When I started writing our new text for Practical Nurses (to be published in 2016), I looked for any competencies for Practical Nurses. I looked at the CASN competencies for Registered Nurses. I looked at the National education standards for “Unregulated Care Providers”, the “Ontario Personal Support Workers Vocational Learning Outcomes”, the European Interprofessional Competencies… but did not have a set of competencies that focused on the role of the Practical Nurse.

It is important to have competencies to use when developing and offering education. It is helpful to have competencies to standardize education within a province and across the country. As an individual, it is helpful to have competencies to help identify areas to learn and grown.

 

If I have missed competencies, and if you know of other competencies for Practical Nurses, or Vocational Nurses (as they are sometimes referred to in the USA), please leave a comment below, and/or email me.

Kath’s favorite read this month – ""Generalist plus Specialist Palliative Care – creating a more sustainable model of palliative care"

In the essay “Generalist plus Specialist Palliative Care — Creating a More Sustainable Model”  Dr Timothy Quill and Dr Amy Abernethy propose that even though specialist palliative care consultations improve quality of care, reduce costs, and may increase longevity that all practitioners should have a core set of “basic palliative skills”.

Examples of core skills include the ability to identify patient goals, align treatment with those goals, and provide basic symptom management.  Examples of specialist skills which require additional training and expertise include negotiating complex family meetings and managing refractory symptoms.

The authors identify a few negatives to referring all dying patients to a palliative care specialist: insufficient specialists to address increasing demand, interference with existing therapeutic relationships, and primary care clinicians being led to believe that basic symptom management and psychosocial support are not their responsibility.

I remember a time when I thought that best care for the dying in Canada included registering all the dying with a hospice palliative care program and providing them with specialty consultation as required. (Currently less than 25% of dying Canadians receive support from a specialty hospice service.)

Over the past decade I have come to understand more about the economic and practical challenges to funding, developing and operationalizing fully staffed specialist programs across Canada, including in remote, rural and urban areas. It would be impossible to provide specialist teams for every individual… but it is not impossible to ensure that all generalists have basic knowledge of skills in providing palliative care.

One example of the generalist nurse providing excellent palliative care is the work being done by Home Care Nurses across the country.  Another example is the work being done by Health Care Assistants in providing care for people dying in Long Term Care.  Their work has strengthened my appreciation for the role of primary care providers in delivering good hospice palliative care!

Thanks Drs Quill and Abernethy, (themselves specialists in palliative care), for valuing the role of the primary care providers and for identifying a more sustainable model of hospice palliative care.

Why is palliative care education in Long Term Care important?

Fabulous research by Brazil et al.

Did you know?….

*In Canada, 75% of all deaths occur in
people over 65 years of age, and 75% of these
deaths take place in hospitals and LTC homes (Subcommittee to Update ‘Of Life and Death’, 2000).

Recent estimates for the USA reveal that
approximately 20% of all deaths occur in nursing homes; it has been suggested that this number will climb to approximately 40% by 2020 (Carter and Chichin, 2003).

For most people admitted to a Living Term Care facility, this will be their last home. Unless transfered to hospital to die, most residents will die in the facility that has become their home.  As mentioned in the above quote, the number of deaths in Long Term Care will increase in the coming decades.

In the article (see reference) they suggest that education needs to build on the experience of the nurses, include a focus on the trajectory of dying with chronic disease, and acknowledge the existing culture of care.

This research by Brazil et al suggests that although licensed nurses have much experience with death and dying and perceive themselves as having palliative expertise, there is a gap in palliative care knowledge and skill.

This study highlighted specific knowledge
gaps among licensed nurses, particularly related to managing pain for a resident who is dying. This result is consistent with findings from other studies (Takai et al, 2010). Pain management can be challenging in LTC homes owing to the high prevalence of cognitive impairment and the lack of appropriate tools for its assessment.
Without adequate knowledge and skills, nurses struggle to manage both pain and other PC symptoms effectively.

Challenges to providing education include lack of funding for continuing education, and staff shortages that make attending education sessions difficult.

I would suggest that another challenge is the same old same old issue… “you don’t know what you don’t know”.  If you don’t know that your beliefs are false, or that your knowledge is limited, then you don’t take the time and make the effort to find education! Hence the need to include some basics in core curriculum!

Registered Nurses and Registered Practical Nurses believe in their ability to per-form end-of-life care (from the Self-Efficacy in End-of-Life Care Survey, pg. ) which is not consistent to their knowledge of palliative care, with the average score on the Palliative Care Quiz being 60 % (from the Palliative Care Quiz,) (Palliativealliance.ca )

For those working in Long Term Care – what education  has helped you provide better care?

Kath

NB. I found this article through the wonderful site   “Quality Palliative Care in Long Term Care”  . Exciting research!

*(Brazil, Kevin; Brink, Peter; Kaasalainen, Sharon; Kelly, Mary Lou; McAiney, Carrie; International Journal of Palliative Nursing, 2012 Feb; 18 (2): 77-83 (journal article – research, tables/charts) ISSN: 1357-6321 PMID: 22399045 “Knowledge and perceived competence among nurses caring for the dying in long-term care homes”)

New BC Provincial Practical Nurse Curriculum

Exciting times in BC! There is a NEW Provincial Practical Nurse Curriclum, the program has been extended, and the new Curriculum Guide weaves End of Life Care throughout the program!

I am honoured to have been asked to help a team write their new curriculum. The invitation is to develop the End of Life Care components of the program.  Unlike a post grad certificate, where we can develop themes over a number of consecutive sessions…. The challenge is to determine learning needs at each semester/level, dovetail with course content and pull it all together by the end of the program. It is like building a puzzle, fitting pieces together to create a beautiful whole. But the puzzle is multi-dimension, and extends across time.

To add to the complexity of the project – competencies and learning outcomes are not specified.  Coincidentally I had been talking with Sharon Baxter at CHPCA, and she in turn with Health Canada, to explore the development of palliative competencies for core Practical Nurse curriculum.  The College of Practical Nurses of Alberta (CLPNA) is the only group that has a well defined set of core competencies.  Written in 2005, they are more than ready for a rewrite…. but at least there is a guide to use.

Great project to snuggle in with over the winter fire! The words: best practice, research based, engaging, learner friendly, instructor friendly, diverse teaching strategies, appropriate level, spiral learning theory, limited time, rich, fabulous, relevant…. guide my process.

Kath