Exciting times in BC! There is a NEW Provincial Practical Nurse Curriclum, the program has been extended, and the new Curriculum Guide weaves End of Life Care throughout the program!
I am honoured to have been asked to help a team write their new curriculum. The invitation is to develop the End of Life Care components of the program. Unlike a post grad certificate, where we can develop themes over a number of consecutive sessions…. The challenge is to determine learning needs at each semester/level, dovetail with course content and pull it all together by the end of the program. It is like building a puzzle, fitting pieces together to create a beautiful whole. But the puzzle is multi-dimension, and extends across time.
To add to the complexity of the project – competencies and learning outcomes are not specified. Coincidentally I had been talking with Sharon Baxter at CHPCA, and she in turn with Health Canada, to explore the development of palliative competencies for core Practical Nurse curriculum. The College of Practical Nurses of Alberta (CLPNA) is the only group that has a well defined set of core competencies. Written in 2005, they are more than ready for a rewrite…. but at least there is a guide to use.
Great project to snuggle in with over the winter fire! The words: best practice, research based, engaging, learner friendly, instructor friendly, diverse teaching strategies, appropriate level, spiral learning theory, limited time, rich, fabulous, relevant…. guide my process.
Kath
One Response
Hi Kath. I’ve just read your article in winter issue of Care Magazine from CLPNA. I was thrilled to see your comment that … it is unethical that a person should have to endure pain until they are atively dying!!…I work in a long-term care facility and that is my biggest beef. The drug companies must make trillions on the sale of Tyleon plain and ES, because that is 99% of the time what our Residents get prescribed. My Mom has recently been moved to a care facility and has dementia/Alzheimers. Three years ago the Mini-Mental was 23/30. Last week it was 13/30. So she can’t find the bathroom, doesn’t know what a toilet is, can’t say where she has pain exactly, just, Oh, my back. Over and over.
We moved her to Care from a Lodge on Nov. 10th at 4 pm. By 4 pm on the 11th the HomeCare RN had got her Risperidone 25mg X1 daily and PRN changed to Risperidone X2 daily. She had contacted the Geriatric Doctor. But the pain meds come prescribed by her family physician.
In this new place they have 2 LPN’s for 125 residents by day and 1 at night. They give all the PRN’s and have to do a pain diary and assessment of the resident before they give anything other than what is in the dosette. The HCA’s give the dosette meds. So Mom went virtually a whole month without any pain medication, even though she had been on Tramadol X4 daily, prn. My Dad was her caregiver then, and it helped a bit, but even that did not hold her. I asked them to give me the prn meds so I could give them to her and that was just out of the question. Three doctors and the pharmacist intervened, what a mess, and finally the pharmacist found an old order that gave him the right to put it in the dosette X4. So, she finally has it, but it doesn’t hold her. She definitely needs something stronger.
I asked her family Dr. for Dilaudid, as my friend in Victoria who works with Dementia pts. in a locked unit said they used it there regularly, and what a good thing it was for her patients. No bad behaviors and not much pain, so they were comfortable, with few side effects. Other than addiction, and Mom will be 91 in April, so I’m sure she won’t be looking for a drug dealer any time soon. But it just tears at me to see her so distressed, and I can’t help her. However, her Dr. was horrified, and said,We can’t do that. Dilaudid is a last-resort drug and if everything else fails we still have that. So she suffers. And so do so many other Alberta residents.
I’m glad you said it was unethical that they should be in constant pain. I looked up Tramadol on an Opioid Comparison chart from the web and found that Tramadol and Tylenol #3 are 1/10 the strength of Morphine, orally. I am trying to get Mom moved out of that facility, and have someone higher up than HCRN’s working on it, but it takes time.
Another need/issue is for Couples. They could not provide a place for the parents together, so she is in one facility and he is across a parking lot in another, so he can walk there each day. He is also 91 and 3 weeks ago had a heart attack, I think from stress of being separated. In June they will have been married 70 years. Never were separated. If you saw one, you saw the other. He’s taking it hard that she has to be alone, as he was the main caregiver. She was getting out of hand but I never expected this. I think it is abuse of the elderly, not just for my Mom. But having her impacted this way surely has opened my eyes to this issue. I am an LPN working with long-term-care residents, but of course, I give the prn’s, so I never thought they wouldn’t. I didn’t have the physicians signature on the Power of Attorney, so they didn’t listen to me then. Now, I have it, and will be getting it for Dad also, before the time I really need it.
Thank you for your time. Would there be a course for Dementia/ Alzheimers that I could take online that Alberta would recognize? Thanks for your help and ear!
Sincerely, Betty Wiebe [email protected]…