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• W2334455559 abstract "OPEN ACCESSMarch 29, 2016A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: Adolescent With Cystic Fibrosis Terry Murphy, MD, D'Anna Saul, MD, Elizabeth Hollenkamp, RN, BSN, Matthew Niedner, MD, James Azim, JD, MD, Adam Marks, MD, Cecilia Trudeau, Katie Lehmann, LMSW, Maureen Giacomazza, RN, Patricia Keefer, MD, Ken Pituch, MD Terry Murphy, MD University of Michigan Medical School Google Scholar More articles by this author , D'Anna Saul, MD University of Michigan Medical School Google Scholar More articles by this author , Elizabeth Hollenkamp, RN, BSN University of Michigan Medical School Google Scholar More articles by this author , Matthew Niedner, MD University of Michigan Medical School Google Scholar More articles by this author , James Azim, JD, MD University of Michigan Medical School Google Scholar More articles by this author , Adam Marks, MD University of Michigan Medical School Google Scholar More articles by this author , Cecilia Trudeau University of Michigan Medical School Google Scholar More articles by this author , Katie Lehmann, LMSW University of Michigan Medical School Google Scholar More articles by this author , Maureen Giacomazza, RN University of Michigan Medical School Google Scholar More articles by this author , Patricia Keefer, MD University of Michigan Medical School Google Scholar More articles by this author , Ken Pituch, MD University of Michigan Medical School Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10372 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This resource is one of a three-module workshop using a case-based approach to teach interprofessional learners about end-of-life (EOL) care in dying hospitalized patients. This module is specific to an adolescent with end-stage cystic fibrosis and how to approach hospital-based care for this dying child and her family, encompassing symptom management and anticipatory EOL guidance to performing a death exam and debriefing. Methods: The module includes video, questions/answers, and a pocket card. Ideally, the group of learners should consist of seven to 10 learners from a multidisciplinary background including but not limited to nurses, physicians, social worker, spiritual care providers, and respiratory therapists. The ideal team for moderating this workshop includes 2–3 individuals, preferably with differing professional backgrounds, who have comfort and familiarity with pediatric EOL. Results: At our institution, from 2010–2013, we presented our workshop to over 200 nurses, medical students, house officers, fellows, respiratory therapists, social workers, and spiritual care providers. Participants completed a 16-item retrospective posttest to assess confidence in knowledge and skill domains important in caring for dying children. Eighty-six percent of those surveyed agreed or strongly agreed that the workshop “helped me participate more effectively in the care of the patient as (s)he neared death.” Eighty-six percent also felt that the workshop “reduced the anxiety or stress I would otherwise have experienced in caring for the patient as (s)he neared death.” Discussion: This workshop has been refined over the past five years of implementation to reflect this current module. Our evaluation shows a clear improvement in confidence corresponding with the workshop, and data following inpatient deaths suggest that the workshop is applicable in the clinical realm. To the authors' knowledge, it is the first structured workshop of its kind to address pediatric EOL care. Educational Objectives By the end of this module, learners will be able to: Recognize the sources of distress in the patient, family, physicians, nurses, and other support staff in providing care at end-of-life (EOL).Assess and learn dosing and routes of at least one opioid to use for pain or dyspnea in an adolescent.Identify phrases that can reassure staff and families that use of opioids can be safe and appropriate in EOL care.Distinguish delirium from agitation near the EOL.Identify sources of agitation in a dying patient.Describe at least one pharmacologic and one nonpharmacologic method to treat agitation near the EOL.Learn to provide anticipatory guidance about what physical symptoms to expect during the dying process.Demonstrate phrases that may comfort family members.Discuss ways that families may be able to create valuable memories.Learn key steps in performing a death exam.Review postmortem expectations and care plan. ReferencesBiese KJ, Moro-Sutherland D, Furberg RD, et al. Using screen-based simulation to improve performance during pediatric resuscitation. Acad Emerg Med.2009;16(suppl s2):S71–S75. http://dx.doi.org/10.1111/j.1553-2712.2009.00590.xMedline, Google ScholarDonoghue AJ, Durbin DR, Nadel FM, Stryjewski GR, Kost SI, Nadkarni VM. Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial. Pediatr Emerg Care.2009;25(3):139–144. http://dx.doi.org/10.1097/PEC.0b013e31819a7f90Medline, Google ScholarLexicomp Online Web site. http://online.lexi.com/action/home.Google ScholarMacDonald N, Oneschuk D, Hagen N, Doyle D, eds. Palliative Medicine: A Case-Based Manual. 2nd ed.New York, NY: Oxford University Press; 2005.Google ScholarMeyer EC, Ritholz MD, Burns JP, Truog RD. Improving the quality of end-of-life care in the pediatric intensive care unit: parents' priorities and recommendations. Pediatrics.2006;117(3):649–657. http://dx.doi.org/10.1542/peds.2005-0144Medline, Google ScholarNational Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 2nd ed.Pittsburgh, PA: National Consensus Project for Quality Palliative Care; 2009.Google ScholarPhysicians' Handbook on Medical Certification of Death: 2003 Revision. Hyattsville, MD: National Center for Health Statistics; 2003. DHHS publication (PHS) 2003–1108.Google ScholarTruog RD, Burns JP, Mitchell C, Johnson J, Robinson W. Pharmacologic paralysis and withdrawal of mechanical ventilation at the end of life. N Engl J Med.2000;342(7):508–511. http://dx.doi.org/10.1056/NEJM200002173420712Medline, Google ScholarTruog RD, Cist AF, Brackett SE, et al. Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine. Crit Care Med.2001;29(12):2332–2348. http://dx.doi.org/10.1097/00003246-200112000-00017Medline, Google ScholarWrede-Seaman L. Pediatric Pain and Symptom Management Algorithms for Palliative Care. Seattle, WA: Intellicard; 2005.Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED All appendices are peer reviewed as integral parts of the Original Publication. Instructors Guide Cystic Fibrosis.docx CF Case Discussion Answer Key.docx CF Case Discussion Worksheet.docx CF Case Facilitator guide.docx EOL Workshop Algorithm Card.pdf EOL Workshop Self-Evaluation Tool.doc Tell Mom I'm Not Afraid to Die.mp4 To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMurphy T, Saul DA, Hollenkamp E, Niedner M, Azim J, Marks A, Trudeau C, Lehmann K, Giacomazza M, Keefer P, Pituch K. A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: Adolescent With Cystic Fibrosis. MedEdPORTAL. 2016;12:10372. https://doi.org/10.15766/mep_2374-8265.10372 Related A Child's Last Hours—Multidisciplinary Training in End-of-Life Care for Professionals Working in Children's Hospitals: Newborn With Lethal Congenital Anomalies A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: School-Aged Child With Terminal Cancer A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: Adolescent With Cystic Fibrosis Copyright & Permissions© 2016 Murphy et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsCystic FibrosisWorkshopPalliative CarePediatricsEnd of LifeDyspneaPain Management Disclosures None to report. Funding/Support None to report. tabs.loading" @default.
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