Addressing Life Limiting Illness in Elders

Abstract

Background: Elder patients often experience chronic life limiting conditions, such as vascular diseases, malignancies, renal or liver failure, stroke, advanced heart or lung disease, neurodegenerative disorders, and dementia. The 1995 SUPPORT study demonstrated a pervasive lack of communication between patients and their health care providers about goals of end of life care, significant levels of inadequately treated pain in seriously ill and dying patients, and, most importantly, discrepancies between stated preferences of care and continued use of aggressive care. Purpose: To address this issue in elder patients, Massachusetts General Hospital developed The RN Residency: Transitioning to Geriatrics and Palliative Care, an innovative program funded by the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration. Methodology: The RN Residency program is a nine-month residency program. This program utilizes cohort learning to build skills and competencies to improve practice and initiate unit based quality improvement. The National Consensus Project for Quality Palliative Care's Clinical Practice Guidelines serve as the blueprint for end of life education, along with The End of Life Nursing Education Consortium Curriculum and other resources from the Center to Advance Palliative Care and Hospice and Palliative Care Nurses Association. The John A Hartford Foundation Evidence-based geriatric curriculum serves to structure education for the older adult patient. Findings: Evaluation is ongoing, including qualitative assessments and pre- and post-test of skills and attitudes toward seniors. Summary Concluding Statement: The RN Residency provides nurses knowledge and expertise through state of the science, evidence-based palliative care and geriatric education, thereby improving end of life care for elder patients.