6. Palliative care symptom control that is client-centred; the time to change nursing practice is now!
7. Promoting self-care and wellbeing for nurses and midwives Robin Girle, Margaret Martin and Keith Jones
Alaina Evanson MACN Palliative care clients often require a combination of subcutaneous medications that can be delivered by a continuous delivery device (CDD) such as a smart pump (e.g. CADD Solis) or a syringe driver (e.g. Niki T34). Using combinations of 2-4 drugs mixed into one CDD is fairly common in Australia but this is not necessarily the case in other places internationally. There are disadvantages for using combinations of drugs together as there is limited research on compatibility of drug combinations commonly administered for palliative care patients. The practice of administering combinations of medications by a CDD are subject to physicochemical changes which can alter their efficiency and safety. Some medication combinations considered compatible and safe in the clinical environment have been shown to be incompatible in the laboratory. Some combinations have research data that is both compatible and incompatible or there is no evidence at all to support the combinations being used. The practice of combining 2-4 drugs into one CDD could be seen to be clinician-centred rather than client-centred (saves time for the clinician). The control of the CDD medications is in the hands of the health care professionals since no break-through doses can be given. There are significant benefits of only using one drug per CDD. The primary benefit of only having one drug per CDD is the capacity to provide the client with quick and efficient break-through doses or patient demand doses (PCA). Some CDD also allow for clinician doses. When using only one drug per CDD the maximum time for the delivery volume may often be stable for more than 24 hours. Having a longer delivery time has benefits for the clients/families. Clients often benefit from a longer time free from the healthcare visits as this can provide them with a sense of normalcy and privacy. It is time to rethink the practice of combining multiple medications into one CDD. This presentation will provide a different perspective for nurses to consider.
South Eastern Sydney Local Health District (SESLHD) Nursing and Midwifery Practice and Workforce Unit (NMPWU) are committed to the development and support of a nursing and midwifery workforce which is person centred and focused on the delivery of high quality, safe, compassionate care. Evidence suggests that patient experiences and job satisfaction will be further enhanced by improving the wellbeing of staff and conversely poor staff health has a negative effect on patient outcomes (McDonald et al. 2013; Maben 2013; Lowes et al. 2015; & Durkin et al. 2013). The NMPWU recognise a high degree of physical and emotional strength is required to consistently deliver high quality compassionate care. It is important for nurses and midwives to build resilience to endure the fatigue, pressure, stress and emotion experienced in their professional environments. We care for others, but how often do we take time to care for ourselves. This poster will portray the innovative approach NMPWU took to promote and enable self-care and wellbeing for SESLHD nurses and midwives. The bodies of work and resources developed have provided staff with opportunities to consider physical, mental and emotional wellbeing. The resources were designed to help focus on elements of wellbeing that can be practiced every day by staff on their own, with their teams or with patients. Seligman’s (2011) theoretical framework for happiness was used to inform the work which promotes mindfulness, reduces fatigue, creates good habits for a healthy balance between caring for self, and for others. The resources’ incorporate the NMPWU’s heart of caring conceptual framework including connecting human to human, engaging as a team, promoting self-care and wellbeing and promoting effective workplace cultures. The poster will portray the bodies of work completed and resources developed along with evaluation and exploration of future opportunities.
References: Gilbert, B. 2013, Medicines in palliative care, Nurses for Nurse Network webinar recording, viewed 21 March 2015, <https://www.nursesfornurses.com.au/cpd> Hurst, M. & Steil, N. 2016, A systematic review of subcutaneous medication dosing guidelines in palliative care, Journal of Pain and Symptom Management, 51(2), 412-413, <http://dx.doi.org.libraryproxy.griffith.edu.au/10.1016/j. jpainsymman.2015.12.014> Rose, M. & Currow, D.C. 2009, The Need for Chemical Compatibility Studies of Subcutaneous Medication Combinations Used in Palliative Care, Journal of Pain & Palliative Care Pharmacotherapy, 23(3), DOI:10.1080/15360280903098382 Thomas, T. & Barclay, S. 2015, Continuous subcutaneous infusion in palliative care: a review of current practice, International Journal of Palliative Care, <http://dx.doi. org/10.12968/ijpn.2015.21.2.60>
61