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Telephone Nursing is not limited to a single specialty or "shape" and is ever changing. It can be a single nurse on the telephone or nurses working in a large call center. Every nurse who does much of their professional work via the telephone has something special to contribute to the "science" of this specialty, and should consider sending his or her story to TNT.
The focus of this issue is Hospice Nursing, with emphasis on how the telephone is used to educate, support and counsel those patients who are terminally ill, along with their caregivers and families. Hospice care is an interdisciplinary, individualized form of care that emphasizes pain control and symptom management rather than attempting curative treatment.
Hospice related services are provided primarily in a patient's home (approximately 90%), most often with the assistance of family and friends, as well as volunteers. Communication with caregiver and families is a vital part of Hospice care-- with the ongoing reassurance and support from nurses making a key difference in the quality of family and patient life. Even after the patient dies, bereavement care is critical to supporting families -- and it may be needed for at least a year after the death of the patient.
by: Mary Lee Warren
Hospice, a philosophy of care for the terminally ill which is revolutionizing the way people die, is sweeping the country. Since 1974 when the first hospice in the United States opened in Connecticut, more than 2,000 hospices have opened across the United States.
Most hospices are independent agencies that are similar to home health agencies, except that hospice patients must have a prognosis of days, weeks, or months, not years. Hospice care is geared specifically to the special physical, emotional, spiritual, and social needs of terminally ill patients and their families and is delivered by interdisciplinary teams made up of physicians, hospice nurses, home health aides, social workers, chaplains, bereavement counselors, and volunteers.
Most patients stay in their homes and are cared for by family and friends with the support of the hospice staff. The hospice philosophy of care is a wholistic one emphasizing pain control, quality of life, and comprehensive support for the patient and the family. The focus of care is comfort, rather than cure.
Although hospice is an ancient concept which predates the invention of the telephone, today the telephone is a vital tool to the hospice nurse. Hospice nursing is definitely "hands on," a great deal of work with the families and patients is done by phone. When hospice families are admitted to service, they are told that we will always be available to them. Telephone nursing plays a big part in that availability.
If you don't have a medical background, it can be a frightening thing to take care of a loved one who is terminally ill. Family members who are thrust into the role of caregiver sometimes question their ability to cope. They worry about the possibility of a crisis and getting help when they need it. When they are told that there is a hospice nurse on duty 24 hours a day, and that they can call and talk to a nurse at any time, they are relieved. The telephone is the patient and caregiver's main link to nursing expertise, emergency care, emotional support, and bereavement support. In other words, the telephone means security. And many times, if the family member knows that the security is there, they don't need to use it.
Hospice nurses spend much of their time on the telephone talking to caregivers (and patients when possible) about levels of pain, changes in symptoms, changes in medications, and different treatments to try. Caregiver have questions that range from constipation to intractable pain, from confusion about when to give medications to "how do I tell our grandchildren?" An experienced, knowledgeable hospice nurse can handle most of these questions by phone. In addition, she can often assess pain and symptoms and, depending on what the standing orders are, an either tell the caregiver to increase the pain medication, or tell them what measures to take while she (the nurse) calls the doctor for new orders. The nurse always has the option of making a home visit to assess the situation in person or to give needed care. When the nurse feels an unscheduled home visit is necessary (usually for pain or symptom control), she tells the caller that help is on the way, and usually can give a time of arrival so that the caregiver knows what to expect.
One of the most poignant aspects of hospice care is the emotional needs of the caregiver and family members. They are losing someone they love. Their grieving starts before the death and continues, sometimes for years. These emotional needs must be addressed along with those needs caused by the stress of caring for the patient. Many times these needs are met by long, comforting talks with the nurses, either face to face or by phone.
Most hospice patients have DNRs and plan to die at home. And most of the time this is a quiet, peaceful event. There are times, though, if death is sudden or if a caregiver panics, that a daytime staff member needs to reassure the caregiver by telephone while the case manager/nurse is on the way to the patient's residence. If the crisis happens at night, a backup call nurse can do the same thing, while the on-call nurse is on the way. A calm, reassuring voice on the phone can prevent a call to 911, which could result in a terminally ill patient being resuscitated in an ambulance (something that our patients definitely do not want).
Hospice care began as neighbor helping neighbor - one person saying to another, "I will help you through this difficult time." That attitude of "the personal touch" still exists. But today, telephone nursing enables us to be in touch with our patients more often, more efficiently, and more effectively. It does not replace direct patient contact, it adds to it. Although the early hospice workers had no concept of how important telephone nursing would become to good hospice care, the telephone is an integral tool for the hospice nurse of today.
Mary Lee Warren is the Executive Director of Judith Karman Hospice, Inc
Stillwater, Oklahoma 74075
Email at: hospice@ns.fullnet.net
[Readers who wish to answer and chat with Mary Lee are encouraged to contact her personally]
Dear TNT,
So nice to see so many folks interested in hospice. I'm the CEO of a 12 year old hospice in central florida. We have a hospice house, caregiver program, creative arts program, foundation, day care and pre-hospice program.
If we can help, give me a call and we'd be glad to. I'm from the old days when hospice folks didn't charge one another for help...
I think everybody does telephone nursing in hospice though they probably don't give it much thought. Lots of intervention, assessment and education are via the phone, otherwise we'd have to have twice the nurses to make all the home calls to deal with the concerns and changes in this volatile area of care. Our support program, for pre-terminal or stabilized patients relies heavily on telephone support since we get no reimbursement for any of the services.
There are so many patients who are facing end of life issues who need this type of program and who are not adequately served by home health agencies.
Re: your webzine. Glad to know of one more creative services for nurses from a Florida base.
Take care...
Becky McDonald
Email: Becky@sundial.net
[Readers who wish to chat with Becky are encouraged to contact her personally]
Dear TNT,
Early this year while completing a certificate in Volunteer Studies I saw a need for a grief telephone counselling service to be offered by our Hospice. With this in mind I decided to write my assignment on the feasibility of such a venture. With only 6 weeks to complete this project I set about collating as much information as possible. This proved to be a bigger task than I had first thought.
I could find no Hospice in Australia that offered this service, apart from locating a few paragraphs here and there on the subject. I was finding the going difficult. Another frustrating problem I found were people not returning my phone calls or correspondence, with time running out I decided to scrap the idea and submit my assignment on human resource training.
Listed below are some of the factors I felt should be investigated:
*24 hour service?
*Training of Volunteers in grief counselling: How much would be required?
*Office accommodation availability at the Hospice
*After hour calls to be switched through to the home of on-duty counsellor
*On call qualified supervisory support/back-up for on-duty counsellors
*Callers requiring help; patients on our programme, their families and friends
*Cost of setting up this service
*Availability of funding
I would appreciate any ideas, as I would still like to work on this project, and who knows one day it may actually be a reality!.
Kindest Wishes
Helen
Email: r.flavel@webmedia.com.au
[Readers who wish to answer and chat with Helen are encouraged to contact her personally]
Intro, from the Editor
Christine Schaeffer is a hospice nurse. A very special hospice nurse.
With an AA RN plus a BS in epidemiology and communicable disease control, Chris has been practicing nursing for 10 years. Her background includes experience as a medical-surgical nurse, skin care consultant, in-service director for a nursing unit, four years of missionary nursing, and home health telephone triage. For the last two years she has been doing hospice nursing -- both "in the field" and as a telephone triage hospice nurse.
Chris is active on the Internet -- surfing the web, talking with colleagues and educating the public on the role of hospice. She gave TNT some of her very precious time to tell her story -- in her own words. I found it remarkable. And here it is.
[Internet links in this letter not available except in electronic form and have been added by the Editor of TNT. It is strongly suggested you read the entire letter before exploring the links within in.]
Dear TNT,
Hospice nursing is a great job but certainly one that stands far apart from traditional nursing. Because of its uniqueness I often find "normal" nurses (i.e. med/surg) not quite able to understand what it's like.
The newest phraseology for a terminal illness is "life-span that can be measured in terms of months, not years". Terminal illnesses are now called life limiting illnesses. Palliative care is not passive care. On the contrary. Palliative care concentrates on aggressively coordinating physicians, nurses, social workers, chaplains, volunteers, bereavement counselors, as they help increase the QUALITY of a person's life until their death. When I use the word aggressive I mean it only in the sense that hospice nurses are the strongest patient advocates I've ever had the pleasure of working with. They represent to the physician the desires of the patient and his/her family. Once in a home hospice program a patient rarely has to leave the home, and most never do. Virtually all issues can be dealt with by the nurse assessing the patient in person and then contacting the doctor over the phone. The doctors trust our judgment, and issues orders based on the nurse's assessment. There are exceptions to this scenario, but it is the most common way it works.
We are currently in the process of building our inpatient hospice, so all of our telephone counseling is directed toward the home hospice scenario. One of the things I get really excited about in nursing is the whole concept of PATIENT ADVOCACY. I think that the nurse is the advocate for that patient, interceding on his/her part with every discipline. If more nurses saw themselves as possibly making a huge difference in someone'' life, perhaps their professional self-esteem would be higher, and they would value their jobs more. I distinctly remember med-surg hospital nursing as a period of my life that I merely SURVIVED. I couldn't accomplish anything completely because of high acuity, short staffing, etc. When I say completely, I mean that I couldn't ever sit down with a patient and be able to really help them emotionally put their illness in its place. That's what we do with hospice. Teach folks to live life to its fullest DESPITE their illness.
We also teach families that they truly are the best caregivers - that they don't need someone with RN or LPN or MD after their name to help turn and reposition their mom or dad. That they don't need a health professional there to bathe them or give meds. For so long in American society we've beaten into the families/friends of patients the inpatient concept: "once you enter our institution you will do things OUR way", and the ever present implication that every family member/friend is obviously brainless and has absolutely no right to question doctors, nurses, or the rules of the hospital.
In home hospice our families do everything. We are there to help teach them and provide respite care as needed. We continually have to break down the ingrained idea that only nurses can give narcotics, or injections or IV's. A lot of our work is giving pep talks, teaching, hand holding, teaching, calling doctors and changing pain med/symptom control meds around, teaching, etc. The operative word here is teaching. Our specialty is teaching. Giving away the tricks of the nursing trade. Empowering our families with the medical knowledge necessary to care for their loved one in his/her last days. We do our teaching progressively as the patient declines. The initial visit in the home is often so emotionally charged that the family cannot remember a lot of the hands-on teaching that was done. So, the after-hours staff picks up the ball from there and re-teaches the family how to do basic patient care. From bathing, to toileting, to drawing up and administering meds.
One of the unique parts of hospice nursing is the amount of spiritual and emotional issues that come up and are critical to the patient's actual quality of life. The primary emotional issue is that of remaining as independent as is possible until the last possible moment. The families struggle as they see their loved one decline, wanting to feed them, give boatloads of meds, etc. The dying person has no interest in food (and little use for it) and so this can become a real battle ground. This feeding issue extends into tube feeding, TPN and IV rehydration. Often as not it is the family member that is uncomfortable, not the patient. I spent a lot of telephone time explaining this (as kindly as possible) to the family member. I try and stress the need for the dying patient to be able to control what's going on for as long as possible. The issue of continuing with meds that the patient can barely swallow and has no interest in taking (I am not talking about pain or symptom control meds) is just as potent.
Spiritual crises are very real and while we have chaplains, it is often the nurse on the phone who first recognizes a problem. The families often haven't even thought of spiritual issues and yet as they describe the patient's pre-death visual phenomena and their discussions with people who have already died and "gone on before" it is often an excellent opportunity to ask if there may be a need for chaplain visit. Often they have a church family of their own that we encourage them to call upon, but if they are not connected to a group then we can have a hospice chaplain make a visit. Sometimes they are interested in a sacrament or a ritual, but often they just want someone to hold them and pray with them and help them with their fears. I find that these situations are very fulfilling.
The triage nurse has to evaluate over the phone the potential need for a home visit by an on-call nurse. He/she needs to have a thorough understanding of the hospice/palliative concept in order to be able to know when a visit is needed. In my agency all of our telephone nurses also have to have worked in the field . We have found this to be extremely important to keep them aware of the situations unfolding in the patient homes. I have worked in regular home health before, but home hospice nursing is incredibly different. The emphasis is not on the number of visits made, but rather on the quality of the visit. It is not unusual for an on-call nurse to walk into a patient's house and be there for 3-4 hours as a crisis is slowly resolved. Typical crises would include: increased/uncontrolled pain, uncontrollable nausea or vomiting, severe terminal agitation, patient actively dying, death. The actual death is often no where near as stressful as the dying process, especially of the patient has been in our program long enough to receive a lot of teaching and preparation. Not so typical crises can include: a patient bleeding out (secondary to an open tumor or a coagulopathy because of liver failure), spiritual distress, suicidal ideation.
When the telephone nurse first receives a call he/she must determine very quickly whether or not an on-site visit is needed. If a visit is obviously needed then the on-call nurse should be dispatched immediately and then a little more counseling can be done over the phone while the on-call is enroute. I find that the fact that it can take 60 minutes for a nurse to get to the home can be very stressful for the family, so talking with them while he/she is on his/her way can be very helpful. It is almost always our goal to avoid re-hospitalization and/or activating the 911 system, and talking calmly to the family while the on-call is driving over can prevent them triggering the EMS system.
The decision about whether a visit is made rests with the triage nurse. It is the triage nurse that has been following the phone conversations through the shift, and it is the triage nurse who will continue to follow on the phone after a skilled field visit is made. The criteria for a home visit are simple and few. Symptom management , sudden changes in status, and death all merit visits. The harder to define reasons can include emotional upheaval in the home, spiritual issues, and bowel/bladder assessment. On every extended hours shift there must be one nurse in charge, and in our agency it is the triage nurse. It is impossible for a field nurse to have his/her finger on the pulse of the agency if he/she is sitting in patient's home dealing with a pain crisis. There is always tension between the dispatcher and the dispatchee when the weekend is old and everyone is tired, but the fact of the matter is that the patients and their problems take priority.
While working the phones about half of my time is spent counseling families about the dying process and the other half is spent dealing with issues surrounding pain medicines. The counseling role can be extremely draining for the nurse as grief stricken family members agonize over various signs that they are seeing in their loved one. The medication issues involve titrating up on existing meds and the procurement of new meds.
Since being in home hospice and dealing so much with MD's on the phone, I have found that the better prepared I am when I speak with them, the better. While that sounds simple, when I'm taking a new call every 5-10 minutes, it can be very easy to be discombobulated when the doctor calls back. This doesn't impress him, nor does it enhance his opinion of hospice nurses. I have done incredible amounts of personal research into medications, symptoms and diseases since coming into hospice. This has greatly improved my effectiveness as a nurse and an advocate. The physicians are generally very willing to discuss pain meds when they realize that the nurse is knowledgeable and competent. I have accumulated a lot of resource material that really helps as I discuss issues such as equianalgesic conversions. It isn't uncommon to run across a doctor that may not be familiar with a particular med. I have accumulated medication inserts from as many hospice-like meds as I can, and read them carefully, so I know as much as I can when talking with the doctors. I have been really encouraged by my experiences with physicians in the hospice setting. Many of them are really encouraging and are anxious to do anything to help the patient.
We do not currently have standing orders or critical pathways or algorithms. We use the patient's individual physicians for all orders, but if we are unable to contact the primary MD we can call one of our two hospice medical directors for emergency orders. I have been very encouraged by having medical backup in these two men. They are really good, and are invaluable resources concerning symptom control issues. It would be hard to imagine not having a doctor available for us when we simply cannot get a hold of the primary MD. When I worked in regular home health as a triage nurse we did not have medical backup, and subsequently would have to hospitalize patients when we could not control a symptom and also couldn't get a hold of an MD.
We are currently evaluating an algorithm booklet specific for hospice, but it will be a little while before I would be able to recommend it for use at our agency. We also use Peter Kaye's "Notes on Symptom Control In Hospice & Palliative Care" , an excellent resource for all hospice nurses. I have developed an on-call log that helps in the concise recording of every phone call. It also serves as a tool to show me what additional follow-up and paperwork need to be turned in.
I look forward to hearing from other Hospice Nurses and sharing experiences -- and hope this gives everyone a better feel for how telephone nursing and hospice fit together.
Chris
email to:clsinfo@erols.com
[Readers who wish to chat with Chris are encouraged to contact her personally]
Good interviewing and asssessment techniques are the backbone of all nursing, but especially important in Telephone Nursing, where the nurse is unable to see the patient and must rely on the description given by a "proxy" examiner. The following resources are geared toward helping nurses in assessment related to hospice or palliative care.
Quality of life assessment is an area that needs further research in hospice care. A variety of tools can be used, and some interviewing can be done over the telephone. The author below states that the patient should be the primary resource for quality of life assessments rather than the caregiver. Read on to find out why!
Quality-of-Life Assessment in Palliative Care written by Susan C. McMillan, PhD, RN, FAAN -- addresses the ability of instruments to measure the quality of life of palliative care patients, an assessment that is critical to optimal care management. This article was one selected from the Cancer Control Journal at the web site of the H. Lee Moffitt Cancer Center and Research Institute in Tampa Florida. Other outstanding articles are available.
The URL for this article is at: http://www.moffitt.usf.edu/providers/ccj/v3n3/article4.html
The URL for Cancer Control Journal is at: http://www.moffitt.usf.edu/pubs/ccj/ccj.html
Pain assessment is frequently done over the telephone in all nursing specialties, often using the 0 to 10 scale. A common approach is to ask the patient "on a scale of zero to ten, zero being 'no pain' and ten being the 'worst pain you can imagine', what number would you give your pain?" One resource on children's pain assessment felt that "zero" is not used with children, as they will verbalize that they do not have pain when appropriate. With smaller non-verbalizing children, behavior must be used to estimate the intensity of pain over the telephone.
The Talarian Map is a hypermedia assistant for cancer pain management. This web site of information is based on the Clinical Practice Guideline on the Management of Cancer Pain, a publication of the Agency for Health Care Policy and Research, Public Health Service of the U.S. Department of Health and Human Services. Learn more about pain assessment, watch QuickTime movies on pain or addiction, check out their Java-based calculator for converting drug dosages for opioids. The "mother" site for this incredible resource is the Washington State Cancer Pain Initiative (WSCPI), an independent, non-profit, grass roots organization directed towards improving the management of cancer pain throughout the state of Washington.
The URL is at: http://www.stat.washington.edu/TALARIA/TALARIA.html
The URL for WSCPI is at: http://www.fhcrc.org/~wscpi/cpi.htm
According to an article at the WSCPI site, St. Elizabeth's Medical Center in Yakima WA has developed Pain and Symptom Management Protocols, along with a multi-site trial of the system. St. E's trendsetting efforts were praised by the National Hospice Organization. You should certainly read the full story.
The URL is at: http://www.fhcrc.org/~wscpi/news7.htm
After you've completed an assessment, a good resource for pain management is the Roxane Pain Institute. In addition to online resources and newletters and conference listings, they have a slide show on pain with 75 jpeg graphic images available for downloading. This web site is also the home for the Hospice Nurses Association Home Page.
The URL is at: http://www.Roxane.COM/
Depression and the mental health status of a patient can be difficult to assess when combined with complex medical disorders, cancer, or grief issues. Major depression can occur in about 25% of patients with cancer. However, some emotional turmoil can be expected when a patient is aware they have a terminal disease, and a nurse can help sort out these symptoms and make appropriate referrals.
The Agency for Health Care Policy and Research (AHCPR - US) has facilitated the establishment of Clinical Guidelines for Depression which they encourage practitioners to use in patient assessment and management. It includes a detailed section on depression and cancer, dementia, and other disorders. In addition, the effects of specific medications on mood is examined. Well worth reading for all nurses.
The URL is at: http://isis.nlm.nih.gov/ahcpr/dep/www/dep1ctxt.html
Nurses are often on the front-lines of sharing "bad news" with patients and families -- along with helping them to cope with it. Telephone contacts are difficult because the telephone nurse must show warmth and compassions using voice, inflection and the content of the message.
Ida Sim, MD from the Stanford Division of General Internal Medicine shares information on How To Give Bad News including advance preparation, support and case studies.
The URL is at: http://www-med.stanford.edu/school/DGIM/Teaching/Modules/badnews.html
Chronic obstructive pulmonary disease (COPD) offers challenges to nurses in both assessment and intervention -- and is a common diagnosis found in hospice patients.
The Universy of Iowa's Virtual Hospital site has a well-done teaching file on COPD with pulmonary hypertension and cor pulmonale written by Michael W. Peterson MD. It includes medically ordered tests commonly performed, diagnosis and treatment, along with an online test if you wish to check your knowledge.
The URL is at: http://vh.radiology.uiowa.edu/Providers/TeachingFiles/PulmonaryCoreCurric/COPD/COPD.html
The National Jewish Center for Immunology and Respiratory Medicine sponsors a LungLine -- a free consumer information service that handles thousands of calls each month. This same organization also provides single copies of consumer publications (including emphysema and chronic respiratory disease).
The URL is at: http://www.njc.org/markethtml/Lungline.html
The toll-free number available Monday-Friday from 8am to 5pm Mountain time is: 1-800-222-LUNG
The Internet offers a growing number of excellent resources for Hospice and Palliative Care Nurses. Email addresses are provided where available for those nurses without World Wide Web access.
The Hospice Nurses Association is an international professional association with the mission of promoting excellence in hospice nursing. It is also the largest hospice nursing association in existence. Their website includes issues of their newsletter Fanfare along with information related to hospice nursing certification.
The URL is at: http://www.Roxane.COM/HNA/
To contact the National office via email use hnafan@usa.pipeline.com
Hospice Hands with webmaster James Nash includes a huge collection of Internet links related to the topic, a Question/Answer forum, Hospice Around the World, and Hospice Employment. Sign his guestbook and perhaps find some new hospice nurse-friends on the Internet. It's obvious Jim has done a great deal of work on this web site and it deserves your attention!
The URL for this site is at: http://gator.net/~jnash/hospice.html
James Nash is reachable by email at: jnash@gator.net
April 16 1997 is the date for an important teleconference on the topic of "Living with Grief". For more information, check out the web site of the Hospice Foundation of America, the nation's largest not-for-profit public charity. Find out how your organization can register to be a "downlink" for this two and one half hour discussion originating in Washington DC. The first teleconference hosted in 1994 was seen at more than 900 sites by over 40,000 people including hospice staff. Also look for detailed information on other hospice activities and hospice stories.
The URL is at:http://www.hospicefoundation.org/index.htm
A special kind of caring can be found at Hospice Web. A part of that site is HospiceTalk -- a web-based chat board with comments from hospice nurses all over the world. You can post basic information about your hospice for all to read. It also has a members-only section and links to other hospice sites.
The URL is at: http://www.teleport.com/~hospice/
The National Hospice Organization or NHO educates about and is an advocate for the fundamental philosphy and principles of Hospice Care. Their General Information section includes "How to Find a Hospice" with listings by state, conference/education information, plus a members-only section.
The URL is at: http://www.nho.org/
The Bereavement and Hospice Support Netline, a project of the University of Baltimore, funded by a grant from Hospice Foundation of America offers an on-line directory of bereavement support groups and services, and bereavement programs in the United States.
The URL is at: http://www.ubalt.edu/www/bereavement/
The Oncology Nurses Society also known as ONS ONLINE boasts a graphically pleasing front page. However full access is strictly limited as a membership benefit to members of the Oncology Nursing Society (ONS). If you are a current ONS member, you may register online. Else you can subscribe for a yearly fee. There is a PREVIEW icon that allows you to check out some of the site features, which look very comprehensive. Noted under the clinical section are inclusion of 'algorithms' for oncology care.
The URL is at: http://www.ons.org/
You are strongly encouraged to visit the Project on Death in America site. The goal of PDIA is "to understand and transform the forces that have created and now sustain the current culture of dying. To this end, the project supports epidemiological, ethnographic, and historical research and other programs that illuminate the social and medical contexts of dying and grieving." Funded by the philanthropist George Soros, this project has grant funds available for the study of death and dying and is a *must see* web site.
The URL is at: http://www.soros.org/death.html
You can email the Director of PDIA (Kathleen Foley) at: pdia@sorosny.org
Founded in 1976, The Association of Death Education and Counseling is an international, multidisciplinary organization dedicated to improving the quality of education, counseling and care-giving pertaining to dying, death, grief and loss; to promoting the development and interchange of related theory and research; and to providing support, stimulation and encouragement to its members and those studying and working in related fields. This site also offers subscription information about three publications: Forum, Death Studies and Omega
The URL is at: http://www.adec.org/
To contact via email use: ADECoffice@aol.com
For physicians, there is the American Academy of Hospice and Palliative Medicine web site with information about this academy, events and meetings, products and publications and related links. Part of the mission of this organization is to take an active role in the future education of physicians, informing and educating practicing physicians about appropriate care of the dying patient, bringing the hospice philosophy of care into the medical school curriculum, and participating in research aimed at improving all aspects of patient care.
The URL is at: http://www.ahp.org/
You can email the Academy at: aahpm@aahpm.org
When searching for cancer related answers on the World Wide Web, an important site is OncoLink, from the University of Pennsylvania Cancer Center. This detailed and information rich web page can be searched in a variety of ways including by disease, medical specialty, or search engine. An award-winning site that is not to be missed!
The URL is at: http://oncolink.upenn.edu/
The Internet offers all nurses a glimpse of Hospice groups and organizations around the world.
City Hospice Number 1 at Lakhta village, 20 kilometers (12 miles) north of St Petersburg (Russia), was established by British journalist Victor Zorza and celebrated it's fifth anniversary in 1995. This event was featured in the St. Petersburg Press' Oct 10-16 1995 issue.
The URL for the St Petersburg Hospice is at: http://www.spb.su/sppress/127/loving.html
To read the St Petersburg Press (Russia) check out => http://www.spb.su/times/index.html
Scotland's first Children's hospice can be seen via a web page entitled Children's Hospice Association Scotland. This web page includes facts about the Scotland hospice, two case studies (family and physician views) along with news releases.
The URL is at: http//www.eolas.co.uk/ab/CHAS.html
A thorough and well done special communication on developing Palliative Care services in Saudi Arabia is available via the Annals of Saudi Medicine. This article looks at the experience of King Faisal Specialist Hospital and Research Centre in Saudi Arabia in developing a palliative care service for the terminally ill since 1989 in the hope that other institutions in the Kingdom will be encouraged to do likewise. The cultural perspectives sections are especially interesting for nurses worldwide.
The URL is at: http://www.kfshrc.edu.sa/annals/154/94207/94207.html
To read the Annals of Saudi Medicine, the URL is at http://www.kfshrc.edu.sa/annals/
Hope House is a Children's Respite Hospice located in the United Kingdom. Near Oswestry, Shropshire, the hospice cares for terminally ill and life-limited children within the area, as well as providing community support, practical help for families at home and advice and counselling.
The URL is at => http://www.digiserve.com/hauraki/hope_hse/hope_hse.htm
In 1980 the Outstretched Hand Foundation was founded by Teresa Spencer Plane RN one of the nurse pioneers of the modern concept of Hospice Palliative care in Australia. Located in New South Wales, this charitable organization aims to determine the needs of the dying and their families and the bereaved in the community, to act as an advocate for them, and to initiate public awareness programs and professional education and training.
The URL is at: http://www2.hawkesbury.uws.edu.au/BuddhaNet/helphand.htm
A Hospice HelpLine is a feature of the Hiroshima Association for the Promotion of Hospice in Japan. They use trained volunteers to staff a telephone line for consultations regarding hospice care. Established in April 1995 as a volunteer organization in response to the lack of hospice cate facilities and access to hospice-related consultations in Hiroshima.
The URL is at: http://www.hiroshima.ntt.jp/fukusi/naiyou/wlf102-e.html
The Zen Hospice Project organizes programs dedicated to the care of people approaching death and to increasing all our understanding of our own impermanence. They run a small hospice in a restored Victorian house near the San Francisco Zen Center (USA). This web-site is an award winner along with a "must see".
The URL is at: http://www.well.com/user/devaraja/index.html
The Oncology Nursing Society is having it's 7th Annual Fall Institute in Phoenix, AZ on Nov 8-10, 1996. For more information contact: Julie Jackson (412)921-7373 X222
The 18th annual Symposium and Exposition of the National Hospice Organization will be held on Nov 6-9 in Chicago Illinois. For more information contact: NHO at (703) 243-5900
The American Association for Death Education (ADEC) has it's 19th Annual Conference in conjunction with the 5th International Conference on Grief and Bereavement in Contemporary Society. It will feature over a dozen national and international speakers and leaders in death, dying and bereavement fields. To be held in Washington DC with the date set for June 25-29, 1997. For more information contact:
ADEC, 638 Prospect Avenue, Hartford, CT 06105-4250
Phone (203) 586-7503 - FAX (203) 586-7550
or via email at ADECoffice@aol.com
The URL for more information is at: http://www.adec.org/attract.htm
Newcastle on Tyne is holding it's second annual conference on November 14th 1996 entitled Palliative Care: Home, Hospice or Hospital? A fresh look at an old debate. The conference will be of interest to all professionals working in the field of palliative care.
For further information please contact:
The Education Department
Marie Curie Cancer Care
Marie Curie Drive
Newcastle on Tyne, NE4 6SS UK
Tel 0191-2737931, Fax 0191-2723067
The Trent Palliative Care Center is having a confernce entitiled Making Progress in Palliative Care - From experience to evidence. It will be held March 10-11, 1997 in Sheffield, United Kingdom.
Topic/Keywords: symptom control, quality of life, cost effectiveness beyond cancer
For more information contact:
Secretariat: Mrs Pauline Hutchinson
Trent Palliative Care Center
Sykes House - Little Common Lane
Abbey Lane, S11 9NE Sheffield, UK
Tel: (+44 114) 262 01 74 Fax: (+44 114) 236 29 16
E-mail: 106002.413@compuserve.com
Five Days in Palliative Care is the topic of a Canada based conference from Nov 25-29. The focus is on neurologic disorders in palliative care.
For more information contact:
Continuing Education Faculty of Health Sciences
1200 Main St. West, Hamilton, ON, L8N 3Z5
Phone: 905-525-9140 Ext. 22671 Fax: 905-572-7099
Email: Studd@fhs.cus.mcmaster.ca
For Continuing Education credits, the August 1996 issue of AJN Online has an article entitled: Advance Directives, Most Patients Don't Have One, Do Yours? by Margaret W. Berrio, RN, MS, and Maureen E. Levesque, RN. In the same online is also an article relevant to Hospice nurses entitled Controlling Diarrhea in the HIV Patient also with CE credit.
The URL can be found at http://www.ajn.org then click on the AJN icon, then August 1996 issue.
Another great article from AJN is Seven Ways to Empower Dying Patients by M. Catherine Ray, MA. Matter of fact, AJN has included a subsection of their magazine named Dealing with Death for quite a while. Check in your local health library for hardcopy issues.
The URL is for this article is at: http://www.ajn.org/ajn/1996/6.5/a605056e.1t
Indiana University offers an intriguing approach to education with Grief in a Family Context. This bi-level, 3 credit undergraduate/graduate course will next be taught in Spring semester of 1997. This course was offered completely over the Internet, using the capabilities of the World Wide Web and e-mail, both private (one-to-one) e-mail and an e-mail discussion list established for the course.
For more information check this URL: http://www.indiana.edu/~hperf558/
A list service or "listserv" for short is a discussion group accessible on the Internet via email.
HOSPIC-L is a hospice care discussion group. You can join this group by sending the message "sub HOSPIC-L your name" (without the quotes, of course) to listserv@ubvm.cc.buffalo.edu
Make sure you keep any messages that are sent back to you that confirm you have 'subscribed', as it will contain information on how to send messages and how to unsubscribe when you no longer want to participate.
If you have problems subscribing you can reach the human administrator of the list via email at: hospic-l-request@ubvm.cc.buffalo.edu
Hospice, A Photographic Inquiry. This exhibition is the culmination of three years of work by the Corcoran's curator of photography and media arts, Philip Brookman, by its guest co-curators, the noted photographic scholar Jane Livingston, her associate Dena Andre, and by their staffs. Site also includes the full schedule of American cities where you can visit the full exhibit of wonderful photographs.
The URL is at: http://pathfinder.com/@@uKE25wUA9SjubZOn/twep/artslink/exhibitions/hospice/
The Boston Globe featured a story called Choosing a Good Death. It focuses on a single patient who chose hospice care. The Globe does a excellent job of portraying the subject.
The URL is at: http://www.boston.com/globe/hospice/series.htm
For a more unusual approach to photography and death, Memento Mori or Death and Photography in 19th Century America by Dan Meinwald shows how differently death was viewed just a century ago.
The URL is at => http://www.cmp.ucr.edu/terminals/memento_mori/default.html
TNT's Editor has a large web index of sites related to the topic of death and dying with subject areas such as grief, religious beliefs, philosophy, death in literature, and Hospice. There are many worthy individual Hospice organizations with sites on the web that are listed there.
Feel free to visit!
The URL is at: http://www.cyberspy.com/~webster/death.html
Nurse Epidemiologist (RN, MPH, Doctoral Student in Epidemiology) doing Telephone Triage Health Outcomes Research looking for colleagues doing the same.
Contact M.Jane Mohler at Medical Directions,Inc. Suite "A", Tucson, AZ, USA 85715
or by email at jmohler@md-inc.com
Should telephone nursing skills be added to the education curricula for student nurses? The Nursing Standard Online in their May 8, 1996 issue addresses this topic. Telephoning a nursing department: caller's experience is written by Gerald Farrell RMN RGN DipN CertEd MSc, a Senior Lecturer at the Tasmanian School of Nursing, University of Tasmania, Launceston, Tasmania. In his research, a nursing department was defined as "a hospital ward or a community nursing unit, which might include, for example, a school nursing setting or a hospice."
Nursing Standard Online is the first weekly nursing journal from RCN Publishing Company, RCN short for the Royal College of Nursing, a UK based trade union and registered charity. The URL for this article is at: http://www.nursing-standard.co.uk/week33/research.htm The URL for Nursing Standard Online is: http://www.nursing-standard.co.uk/
On November 5, 1996, a U.S. Presidential election campaign that has been underway for almost two years draws to a close.
If you are a U.S. nurse, make sure you VOTE on November 5th. Make your voice heard.
For more information about why nurses should vote, check out ANA's RN Voter web site.
RN Voter is part of a larger section at ana.org called Capitol Watch.
The URL for RN VOTER is at: http://www.ana.org/gova/votenews.htm
The URL for Capitol Watch is at: http://www.ana.org/gova.htm
Telephone Nursing across U.S. states lines is a controversial topic. The National Council of State Boards of Nursing or NCSBN has announced its intent to propose a revised model for nursing regulation that will be more in step with current technological trends, such as telenursing. This might include a regulatory model that incorporates the characteristic of a multistate license. More information on this topic can be found at the NCSBN web site under HighLights of Events from their August 1996 Annual Meeting.
In the meantime, TNT suggests you check with your State Board of Nursing and internal legal resources about any regulations that may apply to your organization prior to advising patients in other states from where you are licensed.
The URL for the new regulatory model is at: http://www.ncsbn.org/pfiles/nr960412.html
The URL for the NCSBN is at: http://www.ncsbn.org/
Senator Kent Conrad (D-ND) introduced S. 2171, The Comprehensive TeleHealth Act of 1996 in the Senate on September 30, 1996. Titles are listed briefly; additional info will follow:
THE COMPREHENSIVE TELEHEALTH ACT OF 1996
Title I: Medicare Reimbursement for TeleHealth Services
Title II: TeleHealth Licensure
Title III: Periodic Reports to Congress from the Joint Working Group on TeleHealth
Title IV: Development of TeleHealth Networks
All pending bills (including the above S. 2171) died upon adjournment of this 104th Congress. This new bill, S. 2171, will need to be introduced after January 1997 in the 105th Congress.
David Nickelson, PhD, JD (psychologist & attorney) is the staff person responsible for this legislation. For questions, and information contact him at:
Tel: 202 224. 2043, Fax: 202 224.7776 Email:David_Nickelson@conrad.senate.gov
Now is the time to line up co-sponsors. Ask your Senators to co-sponsor when it is reintroduced in the 105th. Additional info will follow.
From: Nancy J. Sharp, MSN, RN
American College of Nurse Practitioners
1090 Vermont Ave., NW, #800, Washington, DC 20005
Tel: 202 408.7050, Fax: 202 408.0902, Email: ACNP@aol.com
ACNP TeleCommuting Office: Email: Nursharp@aol.com
TNT reports that the THOMAS web site lists Senator Kerrey was co-sponsor, and that this bill was read twice and referred to the Committe on Finance on 9/30/96.
The URL for the THOMAS site is at: http://thomas.loc.gov/
For a site that provides information, web pages and email addresses on your U.S. Senators, check out CapWeb's Senate Page.
The URL is at: http://policy.net/capweb/Senate/Senate.html
More Than One-Liners
Nursing is going through rough times, regardless of specialty.
The Journal of Nursing Jocularity may help make your rough days a little easier to bear. Publisher Doug Fletcher RN brings you a quarterly humor magazine for nurses and health professionals. Available both in hardcopy and this World Wide Web edition. Check out the current online edition for an article entitled Hair by Chemo, Not By Choice -- how a woman on chemotherapy turned her hair loss into an adventure that warmed the hearts of many.
The URL is at: http://www.jocularity.com/
Sig My What?
Sigma Theta Tau, the Honor Society of Nursing, has a web site with sections that includes the Center for Nursing Scholarship, the Virginia Henderson International Nursing Library, and their Book Service. Their mission is to improve global health through the development, dissemination and use of nursing knowledge.
The URL is at: http://stti-web.iupui.edu/
GASS Line - Explosive
A sampling of articles from the International Journal of Nursing Studies can be found on the WWW - with topics ranging from Evaluating the Clinical Nurse Specialist to When the Severely Ill Elderly Patient Refuses Food. Full articles and bibs seem to be included here, so don't miss it. A relatively new "discovery" in TNT's web adventures! Part of the GASS ELSA Database from Elsevier Science. The ELSA server is a project at De Montfort University, one of the largest universities in the United Kingdom.
The URL is for this journal is at: http://elsa.dmu.ac.uk/~elsa/GASS/ns/
The URL for the Elsa Server is at: http://elsa.dmu.ac.uk/
Overheard between two Telephone Triage nurses in a Call Center after discussions of how to offset salaries and costs with revenues...
"Well, we could always do a 1-900 number....."
"Yeah, like 'Enema hotline, can you hold....'?"
-- Submitted anonymously
All Children's Hospital in St Petersburg FL is seeking RN's for their telephone triage program which is currently setting the clinical standard of excellence for pediatric services. This position offers RNs the opportunity to manage after hour pediatrician office calls providing education, information, guidance, emotional support, and counseling. For more information contact: Wendy Smith RN, Nurse Recruiter at 813-892-8222. Resumes may be sent to All Children's Hospital, Human Resources, 500 6th Street South, POB 31020, St Petersburg FL 33731-8920.
NCC certified Registered Nurse with 23 years of inpatient and high risk OB/GYN experience seeks position in Telephone Nursing practice in upstate New York (US) area.
MedSearch America has a website that specializes in jobs for health care professionals. Noted among their job offerings is an ad from a Hospice organization looking for a Telephone Triage RN in Orange County, California.
In a quick-look for other Telephone Nurse positions, TNT noted a "Call Center Manager" position in Hershey PA, "Advice Nurses" wanted in San Francisco and Bakersfield CA, and "Telephone Triage Nurses" in Boston MA.
For details, check under NURSING in MedSearch.
Review Previous Issues of TNT
August 1996 issue - Introductory Issue
September 1996 issue - Featuring: OB Telephone Nursing
The Web Page
The Telephone Triage Nursing Web Site is at http://www.katsden.com/telenurse/index.html
Submissions of interest to Telephone Nurses in all occupations and environments. Preferred material is from Registered Nurses, Physicians and other health care professionals currently involved in the speciality.
Require all submissions by November 10th 1996 for next issue.
Employment Desired
Contact Marie Capezzuti RNC at : drquinn@global2000.net Attn: Marie
A Link to MedSearch America
The URL for MedSearch America is at: http://www.medsearch.com/
Can't Get Enough on Telephone Nursing?
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