As National Hospice and Palliative Care month, November is an appropriate time to reflect on the importance of this service not just for end-of-life care, but as an extra layer of support for patients of any age who are facing serious illnesses. The focus of palliative care is to provide physical, emotional and spiritual care for the patients and their families. However, conversations about end-of-life decisions are often difficult for family members and health care practitioners alike.

AHS is addressing the need for staff to be able to successfully communicate at this crucial time with IMPACT-ICU (Integrating Multidisciplinary Palliative Care into the Intensive Care Unit) training. IMPACT-ICU, funded by a grant from the California Health Care Foundation (CHCF), trained 70 AHS nurses this year on leading the sensitive palliative care discussions with families of ICU patients. Highland Hospital is one of only four public hospitals in California to receive this funding. The AHS Foundation manages this grant.

Linda Bulman PA-C, AHS Co-director of Palliative Services, led the IMPACT-ICU training to develop communications skills and increase confidence in nurses to speak to patients’ families about goals of palliative and end-of-life care. AHS executives and ICU nursing leadership supported Bulman’s project during which she trained six nursing “Champions” to teach and support the program as a future resource.

“I want nurses to have more resources in their tool-kit and build upon the skills they already use for more of these conversations at the bedside,” Bulman said. “The goal of this training is to increase their confidence in providing palliative care.”

For three months, ending in December, the nurses who participated in IMPACT-ICU training will be shadowed and mentored by IMPACT-ICU “Champions” who will provide real-time guidance to answer questions, and troubleshoot challenging situations.

As part of this project, the nurses are required to complete three surveys to measure the effect of the training and subsequent coaching. One survey was administered before the class and the second was given at the end of the four-hour training. The last one will be administered in December. The surveys assess the nurses’ confidence in engaging doctors, as well as patients and their families, in discussions regarding palliative care. Changes in confidence levels have already been observed, and overall, the participants expressed high levels of satisfaction with the training.

In addition to training current staff, Bulman is teaching resident physicians how to have these tough conversations with their patients. She wants everyone to know that the Highland Hospital palliative care team can be called as soon as a patient is experiencing a serious illness. Their goal as an interdisciplinary team is to manage symptoms that come with a disease and to wrap an extra layer of support around their patients and families.

Edited on June 22, 2018.