Looking to the Future of Compassionate Care: Implementation of a Holistic Perinatal Palliative Care Program

Abstract

<h2>Women’s Health Poster Presentation</h2><h3>Purpose for the Program</h3> This program provides family-centered holistic perinatal palliative care (PPC) during the perinatal period. <h3>Proposed Change</h3> Establishment of an effective interdepartmental, interprofessional palliative care team to support patients and their families throughout the perinatal continuum. <h3>Implementation, Outcomes, and Evaluation</h3> The current perinatal bereavement program was evaluated, and the literature on PPC was reviewed. A staff survey was performed to assess staff awareness, understanding, and comfort regarding PPC. A PPC planning team was created. After analysis of the findings, an interdepartmental strategy for PPC education, which included nurses, medical residents and attendings, and social workers, was developed. This team attended palliative care conferences and evaluated other PPC programs. A plan was developed for improving support for our patient population. This plan included didactic presentation with discussion and shadowing opportunities for all members of the health care team. An electronic PPC documentation tool was created to collect demographic, obstetric, and follow-up data on all perinatal bereavement patients. Data were used to identify the need for PPC services. The PPC planning team networked with resources in the community, which allowed for coordination of care beyond the acute care setting. A relationship with community perinatal palliative care programs was developed, allowing for patient referrals, which lead to more comprehensive holistic perinatal support in the care of patients. The support of outside palliative care has provided an opportunity for increased patient advocacy, education in the community, and improved preadmission and postdischarge care. The program coordinator continues to promote awareness of palliative care at public events throughout Maryland. Staff and patients voiced increased satisfaction with the current palliative care program and the positive effect it has on our community. <h3>Implications for Nursing Practice</h3> The Johns Hopkins perinatal staff provides palliative care for approximately 100 families each year. This includes all patients who have a prenatal diagnosis of a fetal life limiting condition, unexpected fetal deaths, and missed abortions. Although the care of PPC patients is emotionally daunting, nursing staff have developed crucial palliative care skills obtained through PPC education. Nurses identify and have access to PPC support resources. Evidence-based coordination of services allows for nursing to provide holistic family-centered care. PPC skills and interprofessional support empower nurses to advocate for their palliative care patients. Opportunities exist for continual evaluation, development, and research of the effect of services on patients and their families.