Palliative Care: Not Just for the Dying
Although palliative care has traditionally centered within the hospice movement, the art and science of easing pain and improving quality of life is being redefined by nurses for people living with chronic diseases. Instilled with the importance of caring for patients and families regardless of their age, location, culture, or socioeconomic status, nurses are ideal providers of palliative care, for this population.
“One of the biggest challenges to palliative nursing care is that as soon as you offer it to patients, they think of hospice and are reluctant to accept the help because they think it means they’re going to die,” says Gannel Jean-Pierre `13 DNP. As an advanced practice nurse, he collaborates with physicians, social workers, and other caregivers to help ensure that patients receive consistent relief for pain and other symptoms. “Done right, palliative care can be a support system for patients and their families that is available to them no matter where they are treated or how advanced their illness might be.”
It’s a model of care that Jean-Pierre brings to work each day to improve the lives of patients who have had strokes or aneurysms are living with chronic conditions such as diabetes or congestive heart failure. He sees a critical need for palliative care for vulnerable populations with advanced chronic illness in New York City as they transition between inpatient and outpatient environments
To help the most vulnerable patients, Jean-Pierre’s first job is often to educate them about the benefits of palliative care and help them understand that pain and symptom relief can be provided at the same time as treatment for disability or disease.
A new postdoctoral fellowship is supporting Jean-Pierre’s efforts to educate patients and improve the quality of their care. He is the first recipient of Columbia Nursing’s Palliative and End-of-Life Care Fellowship, funded with a grant from the Louis and Rachel Rudin Foundation. Jean-Pierre’s experience in geriatrics, oncology, and hospice made him a natural fit for the fellowship, according to Assistant Professors Penelope Buschman, MS, PMHCNS-BC, FAAN, and Marlene McHugh, DNP, DCC, FNP-BC, ACHPN, FPCN who established the program to improve care for aging patients and promote a holistic approach to treatment.
“Whatever the illness may be, whether it is cardiac disease or cancer, we want to help patients and families understand how palliative care fits hand-in-glove with active treatment,” says Buschman. “To accomplish this, we have to overcome any perception that palliative care is somehow substandard or not designed to help patients live their lives to the fullest extent possible. This requires nurses to be prepared to manage pain and symptoms throughout the trajectory of illness.”
One patient at a time, Jean-Pierre is changing minds about what it means to receive palliative care. Stroke survivors, for example, can receive palliative care to help them cope with the loss of physical or mental capacity. For diabetics, palliative care might involve providing relief from pain caused by nerve damage in the feet or stress caused by vision loss as the disease progresses. Patients with chronic heart failure can benefit from palliative care focused on easing symptoms such as fatigue, shortness of breath, and loss of appetite.
“My job is to listen very carefully to patients and families, to understand how they approach illness, and to educate them about how palliative care can help them achieve their goals,” he says.
A native of Haiti, Jean-Pierre’s experience volunteering with the Haitian Red Cross changed his mind about pursuing a career in finance for nursing. He applied for the fellowship to gain knowledge of evidence based guidelines for the provision of palliative care. Jean-Pierre completed his first rotation in the palliative care service at NewYork-Presbyterian Hospital. Joined by medical fellows, he currently practices at Montefiore Medical Center in rehabilitation and anesthesia services, with McHugh as his preceptor. He will also have rotations in a chronic pain clinic and a home care setting. In addition, he is working with professor Janice Smolowitz, DNP, EdD, ANP-BC on a clinical scholarship project using evidence based palliative care practice. Outside of the fellowship, two masters students in the acute care nurse practitioner program, Jessica Nymeyer and Sara Beachler, are doing clinical rotations with McHugh as part of a palliative care sub-specialty.
“We are teaching the next generation of nurses to bring a palliative care sensibility to all of the care they provide,” says McHugh. “As nurses, we identify patients in terms of who they are as people, and as members of their families and communities, so that we can maximize quality of life at every stage of illness.”