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Welcome to All About Nursing with your host, Dr. Joyce Bachelor, executive nurse advisor, Dr. Bachelor, who will present the significant role nurses play in providing healthcare in a multitude of healthcare settings. Listen to some of today's key nurses who work in practice in academia settings and talk about the challenges they face in today's modern medical world.
So please welcome the host of All About Nursing, Dr. Joyce Bachelor. Good evening. I'm your host, Dr.
Joyce Bachelor in All About Nursing and we're live on the BBM Global Network in TuneIn Radio. It is my pleasure this evening to introduce a guest I'm going to have with me, who is Dr. Erin Perez. She is a board certified adult and geriatric nurse practitioner who is also boarded as a subspecialtist in palliative and hospice care.
She currently is a full-time practice nurse doing palliative care consultations for the University Health System in San Antonio, Texas. She's been a local state, national and international speaker for supportive care and hospice care. She's been active in equining therapy for those with behavioral health needs and serious illness. Erin has provided the conversation project to her communities and assisted in the advanced practice, registered nurse and of live nursing education consortium.
She provides pro bono, bounded, notary assistance for community assistance and completion of advanced care planning, legal documents. Erin currently serves as a vice chair for the Texas palliative care and disciplinary advisory council where she's been the lead chair for the creation of the state health and human services website for clinicians and consumers, education and contributor to the legislative reports, recommendations and is currently assisting drafting legislative legislation for bill proposals. Erin is also an expert advisor and member of the Texas Nursing Association and of live care task force. She assists the team in creating policy and helping to have Texas nurses of all levels increase the breadth and depth of their palliative and hospice care knowledge.
Erin was elected as one of the Texas nurse practitioner board of directors in 2018. She is actively involved in improving the Texas advanced practice, registered nurse profession overall. She is a preceptor and assists in various committees and community outreach for APRN education practice and health policy. She has received numerous academic awards and was recently inducted into the University of Texas Medical Branch School of Nursing Hall of Fame and selected by the South Texas Central Texas Organization nurse executives and is the only APRN in San Antonio to be selected for the best 25 nurses of South Central in this category of advancing the art and science of nursing to name a few of her amazing contributions.
So welcome Erin, it's delightful to have you on the show. Thank you so much, Dr. for having me on the show as well. So Erin, maybe we could start by having you just hear some highlights about why you became a nurse to begin with.
So I became a nurse really to help people. I think that's why most nurses become a nurse. But I had a lot of family who was chronically ill and I wanted to be able to help further. So that's what started my education as an associate's degree nurse.
And from there as my associate's degree was coming to the end, I noticed that I needed to go back and continue my education to further help people. So that's kind of how I evolved from an associate's degree registered nurse and now to a a freshly minted DNP at the University of Texas Medical Branch. So I was shout out to my cohort for April 2019. And really I went from being a neonatal intensive care unit to air life, transport to surgical intensive care, then on to hospice, and then I went on to palliative care.
And in between here I had the pleasure of serving as a volunteer for face family clinic, which sort of those that are in need of primary care. So I enjoyed that in the community. So it's been a full circle of life that I've been able to be a pleasure of and an honor to serve my patients and my community. So maybe you could describe the role that you're currently in the kind of work that you're really involved in on a day to day basis.
Oh absolutely. So currently I serve as a supportive palliative care nurse practitioner consultant. So what that means is others in the hospital may find that their patients have a serious illness, they may need pain or symptom management, they may need complex communication for decision making, so really explaining both benefits of that context of the patient's care and decisions that may need to be made, sometimes they're planning to do a wealth of patient and family as well as medical team education and discussions on how best we can serve the patient and family. So can you share why you decided to get into this particular specialty of nursing because it's really a very unique focus.
I absolutely, really when I started nursing I did not have an inkling that I wanted to do hospice or palliative care and really at that time there was not really palliative care, there was hospice that was emerging but not palliative care. It wasn't until I was in the surgical intensive care unit that I started to feel that there was a different way that we could best help people. I saw that we were doing a lot of procedures, I think that we were doing a lot of things to patients but not necessarily for them and I didn't feel like some of the patients were really versed as to the risk and benefit of what we were doing and as nurses we are uniquely prepared for being able to see the day in and day out changes especially with the continuity of care. But I merged over to hospice from ICU which was a little culture shock but I found quickly within about two years that I just had an extreme passion for it and from there I started having further education, further mentoring, board certification and continued on to hospice for the next ten years and then while I was in nurse practitioner schools I decided I wanted to have the benefits of both sides of the house, I wanted to be able to do hospice if I needed to but I would like to palliative care aspect because not all patients are at end of life, a lot of them are continuing on concurrent treatment, some of them actually improve so much that they don't need palliative care at all so they might just be with you for a short term.
So I wanted the flexibility to be able to help the patients on both sides not just one particular point in their life. I had really admired that you're doing this, we're having the critical care nurse for a long time before I went into the administrative side of nursing. I always felt like families were in such distress as they were trying to figure out what their loved ones would want done at the end of life and it was always this desire to really have them celebrate their loved ones end of life just like they celebrated the birth and sometimes having these conversations can be very difficult and people need to be ready for it and most people are not so I admire that you've gotten really focused on developing a lot of education for consumers as well, is that correct? Yes it is, I think that the more education that our patients families we all are consumers, even the colleagues that we work with but I think the more education that we can have on this topic we celebrate the birth, we celebrate birthdays, we celebrate all of these things but when it comes to more serious illness and more serious conversations about what would you want if the risk or benefits were not necessarily in your favor or if it's not something that you would actually want to endure as a patient.
So I think it's important that it's a key to child care, communication and education. And so you have a lot of education materials, some of them I would like to talk a bit more about whether or not some of them help to address the advanced care planning but right now this is all about nursing, I'm Dr. Joyce Bachelor, we're live on the Vietnam Global Network and it's time for us to take a short break. Hello, I'm Rob Moyer of the Ocean River Institute.
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I'm Dr. Joyce Bachelor, the host of the show and I before the break was having a great discussion with Dr. Aaron Perez who has got just amazing experience working on palliative care and really helping to address some of the end of life issues. I had just started to ask Aaron if she could tell us a little bit more about the educational materials that she's created that really help to address advanced care planning and maybe even for our listeners, share a little bit more about what does that mean when we say advanced care planning.
Oh, absolutely Dr. Bachelor. So advanced care planning is really a conversation between you and your healthcare clinician, you and your healthcare team, your immediate family, those that really need to know and understand your perspective, what your values are, what your goals are, what's most important because I think in life we can always, at this point in healthcare technology, we can always keep people alive. That is no longer the question.
The question becomes how do you want to live with a life that we're given and what context. So advanced care planning covers what most people know as a medical power attorney. So if something happens and you lose medical capacity meaning you may be able to talk to your family very clearly but judgment, reasoning, and processing is not there. Then who do you have confidence, who do you respect and trust to make decisions based on your values, not their values but your values.
So the medical power attorney in Texas, we require one primary medical power attorney and then we have alternate number one, alternate number two. From there we also have what's called an advanced directive. Sometimes people also call it a living bill and that looks at in specific situations that you are either termed with an irreversible condition or a terminal condition. Would you want to have comfort elected meaning do you want to withhold or compassionately withdraw any kind of artificial life sustaining measures.
And on these advanced directives or this living will you can actually spell out in different instances what your terms are, what you would want. I actually remember a teacher who had five different categories and said if this diagnosis do XYZ and she just kind of laid it out in a map and I was just blown away by her insight and judgment as to what her wishes are at that time. Now on the flip side I can tell you I had a veteran that I took care of and he had completed his advanced care planning with the Veterans Association and he actually went to the extreme measure of telling his wife and his medical providers even if you think that I'm in a terminal state and that I'm dying. I still want to be kept alive at all costs and he outlined it and that meant full resuscitation even if they feel like he's dying.
And so that was kind of hard on the wife to witness but also the healthcare team knowing that we're hurting and not helping which is what our goal should be is to help not hurt. But I think it's 180 degrees different but it is your planning is just really getting down to what each individual and unique desire is for life and we're not going to be able to live longer. How do you want to live? Some of the other documents that Texas has that's unique I don't know for other states but we have an in-hospital do not resuscitate do not intubate as well as an out-of-hospital do not resuscitate form that is unique for Texas.
Every time a patient comes into the hospital or a acute care facility if their wishes are for natural packing. They may still want to continue on full treatment maybe they need to go from the ER to the ICU do concurrent care but their wishes is if something's happened they'd want a natural packing then each time they're required for their medical attending physician to put an order in the chart. Those processes change with Senate Bill 11 that passed in Texas last session and a special session but the out-of-hospital do not resuscitate has never changed and it requires either a multitude of either the patients, medical power of attorney, adult children are kind of go through a series of who can sign and then it has to be signed by an attending medical physician and either a notary or two witnesses not related to life letter marriage. Those are three documents and then the fourth document is what's called a durable power of attorney and that's really a financial.
Most of the time that has to go through an attorney there are some instances that we can use a notary the patient can fill that out but that's specific for finances unless there's a caveat that can also allow them to have a medical power of attorney but those are some of the key documents for advanced care planning and also there's literature that shows when patients have these conversations whether they're using just plain old conversation like we're doing now they use maybe the conversation project which is a free kind of a toolkit if you would for people to start having those conversations or maybe kitchen table conversations from Garrett Colall in Texas people are happier people actually have less angst there's also financial benefit that you know we're not expending money that they're not wanting that's really non-beneficial if they get to certain points in their healthcare continuum so I think when you do the right thing for the right reason for the right patient then everybody has a positive outcome. And you know it's a really wonderful way of describing it because I know that sometimes it's challenging for physicians, staff and other healthcare workers to interact with the families and have families understand that they're really doing this as a good thing and not trying to withdraw care that they think their family members still wants but as you said to have those kinds of conversations is critical so I was just curious you know what how does somebody prepare themselves to be able to do this kind of work really well because it takes a special person in my opinion to be able to talk to people around things that are pretty sensitive. Well I appreciate that sentiment I think nurses though are uniquely positioned and educated because nurses are the front lines no matter what level of nursing you're practicing in you are the front lines we are there when they are there when they are passing away and they are no longer with us and I think it's one of you know and thankfully as a nurse you've probably seen this a hundred times different times that patients and families need that clarification of diagnosis and prognosis and risk and benefits and knowing maybe they're level in who's on artificial pressure support that is an artificial life that's the same measure or other things but I think when we start as nurses to support each other we start to educate each other we start to engage and then empower you know us as professionals at all levels to further our education our knowledge our abilities of skills and complex communication having discussions on medications should just be like having a discussion on what your wishes would be you know I always say there's a hundred percent mortality for everybody I don't know anyone yet you know then there's a hundred percent mortality so I think it's one of how can we best prepare and educate ourselves but sometimes there's things in our own professional personal life that has come up that we need to be mindful of and how do we overcome some of our nervousness our fear of the unknown through education and mentoring that's awesome we are coming to you live from the BBM Global Network and Tune in Radio it's all about nursing and Dr. Joyce Bachelor and we'll continue this conversation when we come back thank you Psychologist Master Certified Coach and CEO of the Executive and Organizational Development firm True North Leadership Dr.
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Get in touch today. I'm your host, Dr. Joyce Bachelor, all about nursing and we're live on the BDM Global Network and Tune in Radio. Before the break, Dr.
Anne Perez, who's the board certified adult and geriatric nurse practitioner, was telling us about some of the incredible resources that are available to help people really understand what advanced care planning is about and how to do power of attorney and have the meaningful conversations with your loved ones before you find yourself in a situation wondering what your loved one would want done if they were in the intensive care unit or had some sort of serious illness come on very suddenly. So maybe, Erin, you could tell our listeners, where can they find this information because it sounds like it's just really invaluable kinds of things that they might like to use. Oh, absolutely. So I am partial to Texas.
So if you go to HTTPS forward slash forward slash HHS dot TEXAS dot GOV forward slash services forward slash health forward slash palliative P-A-L-I-A-T-I-V-E hyphen care, that is going to take you to the Texas Health and Human Services and a disciplinary advisory council. And there is a consumer site, there is a clinician site, there's also a hospice site, so it really clearly defines palliative care and hospice care services. The other one is www.c-a-p-c-c-o-r-g. So that is the center to advance palliative care.
Your listeners can go ahead and plug in their address and if they would like to find a palliative care provider, they can try and locate a facility or a provider for them, but also it gives lots of resources in regards to not just advance care planning things that happen when you have a serious illness, maybe symptom management pain, shortness of breath, constipation, anxiety, depression, appetite, you name it, the center to advance palliative care really has a number of resources. And when we're also talking just specifically for advance care planning, nothing else in regards to palliative care. You can go to a conversation project, just type that in and it pops right up. And then also, Garrett Colwell with Kitchen Table Conversations is on social media with Facebook as well as pop that into your Google bar and it will pop right up.
So those are our four really good sites and I'm always available as a resource to patients and patients. Should your listeners want to reach out to me, I'm always happy to answer an email or call. Thank you, that's wonderful. As you were speaking, I was thinking about how we used to call this palliative care and now it's been modified to support palliative care.
Maybe you could share a little bit about why this additional terminology has been added. Oh, absolutely. So, traditionally we would say palliative care or hospice care and we found through research that a lot of times patients, families, but also healthcare providers have this knee-jerk reaction when we say palliative care and I think death and dying and also associated with hospice. And so what we found was when we add supportive palliative care kind of decreases that A.C.
and also improves their misconceptions about what the service line actually provides for either themselves or their loved ones or their patients. The supportive palliative care is just kind of to help those that are in need of that service to have less A.C. and actually kind of keep an open mind as to what the service is actually going to be doing for consultation. Thank you.
I think you did a great job of explaining really it's talking about what kind of quality of life and not just quantity because I know there's many times when critical care nurses and other nurses in general will feel like the care people are receiving isn't really doing anything but families have not yet had enough time to process about their loved one and what perhaps is the best thing for them. And you see things go on sometimes for longer than you wish could happen for some of these different patients that we care for. Thank you so much for sharing that. You really have just a switch gears just a little bit.
You've done a whole lot in terms of being involved in health policy and your activities with all of that. That's got to be a time consuming perseverance and patients and skills. So maybe you can tell us a bit more about your role in health policy related to supportive palliative care. So thank you.
So I really got involved in Texas. I actually testified about two sessions ago in the 84th legislative session that Texas is far behind in regards to palliative care or we were. And so that was a creation of HB or health bill 1874 by representatives or was and that is what created the Texas interdisciplinary advisory council for palliative care. From there I've been working with 17 other experts interdisciplinary team members that are palliative care and oftentimes hospice care providers and as a council we were charged initially to answer a few questions that the legislature had specifically that was lined out in that bill as well as education.
They gave us several different deliverables that we needed to do and so we have thankfully as a council been able to provide education to our community. Our state at large we have provided not only one legislative report but we just published a second letter for in December. We've created the clinician as well as consumer palliative care website for HHS or health and human services for Texas. I'm very proud on our educational front last fall when we unveiled our legislative report.
We also had national leaders for palliative care come and present and we had provided over 300 continuing education hours for people that were there but also webinar. So there is a wealth of things that we're doing policy wise that kind of leads over into the advisory council and I'm happy to talk a little bit more with that shortly. So we are coming to you live from P.D. Global Network and Tune in Radio.
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You know, listen to all about nursing, live in the BBM Global Network and Tune in Radio. I'm Dr. Joyce Bachelor, the host of the show and prior to our break, Dr. Anne Perez was sharing with us some of the amazing work that she's been doing, helping to introduce health policy that supports palliative care.
And so maybe you could go back to tell us a little bit more about that, Anne, because it's really quite interesting the kind of things that you're helping to create and the differences making. Oh, certainly Dr. Bachelor. So kind of continuing on for the Texas Palliative Care Interdisciplinary Advisory Council.
The first session, so the 85th session, we were able to come together and support Senate Bill 919, which is by Senator Jose Rodriguez, which allows physician assistants and advanced practice registered nurses when it comes to palliative care and hospice care patients that we are now able to have a signature authority for our Texas form, for the other hospital, I'm sorry, for our Texas form for the death certificate. Unfortunately, due to the political climate, we were not able to continue on for the out of hospital, do not resuscitate. But we are now allowed to sign for the death certificate. There was a lot of financial strain, emotional strain for our patients that we care for at end of life, that without being able to sign a death certificate, we're placing unnecessary barriers and burdens.
So we are now able to do that. Now moving forward to this session, I'm pleased to announce that Senator Johnson has Senate Bill 916 in Texas, as well as Representative Chairman Derwas, who has HB 2057, both are now companion bills, and it looks to number one, clarify the meaning of hospice in the Texas Health and Safety Code, two, it gives a clear definition of the port of palliative care definition in the statute, and then three, creates a study with HHC in allows for partnerships and additional resources to be brought into HHC, so there's not a fiscal note, to look at Texas and the data that we are needing for specific vulnerable populations that have serious illness. There's studies out there that have been done by, in New York, the Morrison study, what most people are familiar with, which looked at inpatient, serious illness, and palliative care, which looked at, depending on the diagnosis, it was pretty impressive either. They say $2,000 to $4,000 for hospital admission, just by having supportive palliative care as the inpatient.
They also have an economic impact in making an economic case for palliative care that was published, that was built around the Morrison study that came out in December of 2018. When we look at community-based palliative care, California actually did a really great study, and some of your listeners may be familiar. They did partners in palliative care pilot with MediCal palliative care patients, which is a community based only, not so much inpatient, but it looked at patients that had dual eligible MediCal as their MediCade and Medicare recipients, and they highlighted the top, I want to say, five diagnosis that they felt was the most in me for this specialty care, and really had the interdisciplinary team come from the supportive palliative care, and what they found was they had a three to one. So again, we're bringing the right kind of care to the right patient at the right time, and not only are we improving how they're living in their quality of life, but the French benefit is actually improved fiscal stewardess and improved healthcare outcomes.
Sometimes patients and families don't know that when supportive palliative care is brought to them earlier, actually we have a longer life, not a shorter life. So it's important to get supportive palliative care in sooner rather than later. Thank you for raising that, because I think that back to the point you were talking about earlier, when people heard palliative care hospice, they thought you bring this kind of specialty service in like at the last few days of life, when in fact that's not what we want. And so I think what you're describing really does call out that this is again a service that I think the listeners, if you have family, if you're a family member and you have a loved one, this is a wonderful thing that you can educate yourself about because it really can help make a difference for everybody involved.
So thank you for sharing that, and I wish you the best of continuing your perseverance with this Erin and her legislation. So how can members of the public, including those perhaps in positions of power and others working in healthcare, help to really promote a better understanding of supportive palliative care? Often times I would say, Joyce, is to look within our own facilities, our own institutions, because most of the time there's going to be somebody that is either practicing in palliative care or wants to practice in palliative care, but I would say also looking out toward your palliative care affiliates, is there, you know, go to the Center to Advance Palliative Care, plug in your address, look and see who's the closest provider, who is the closest facility that's providing the specialty care, and make a phone call or an email. There should be maybe some advisory council, so if you look at your state, if you're going to look at health and human services, type in your state and put in palliative advisory council, there's a number of states now in the United States that are creating advisory councils to do just that to improve on the care for the subspecialty, but also improve with legislation to provide access.
So I would try on that. You can also look at maybe the National Hospice and Palliative Care Organization, but I would try and start locally with wherever you're at, trying to find local and plugging that in that way. That's wonderful. And, you know, I think, I wanted to just ask you, how do you keep yourself centered when you're in fact working with many patients, families, potentially when it's not all happy notes that you're involved in?
I was just curious if you could share a little bit about that. Self-care is definitely important. We also teach our fellow colleagues to continue on with self-care, whatever that may be. For me, I have been doing, I did hospice for about 10 years, and then I've been doing palliative care, whether it's inpatient or outpatient or both, going on seven years now, so almost 17 years.
And you're right, it's not always good news that you're sharing, or it's not what we're hoping for in your clinical situation. So I think if you put it as a health care provider, you are providing the best care to your patient for what's needed and what they desire at their point in their health care, then it takes it off to it's not that you are not doing your job. You are not the failure. It is, we always hope for the best.
We always preempt them and tell them that we're there to help them, not hurt them. But in medical care, whether we're doing something intentional or not, if we start to hurt, and that's not the intent, right, it's always to help, then we have to put it to them as to say, how much more would you want to do? And what would that look like? What's important?
So I have to say, kind of keeping that in my head as to how am I best helping a patient? If not me, if things don't go to the best that we're hoping for. And knowing that we're doing everything that we possibly can't, even if it's aggressive symptom management. So I hate when people say, oh, there's nothing more that we can do, or you just need to go hospice.
Those are not phrases really that are helpful for patients, families, or our colleagues. But if we can say, there may not be something that I can do to cure this illness that's causing you so much distress, that there's a lot that we can do to help make you feel better and help your family help you. Does that make a little bit? Does that help a little bit?
And I think that describes it really, really well, because as you were talking, I was thinking that sometimes you're caught in the middle with staff potentially also lobbying you to try to have families think differently because they have their own opinions. And so you can get caught in the middle, I would imagine. Sometimes when people feel like families are making, they're not making the decisions that they wish they'd make. But everybody's different, and I think we have to always honor and remember that.
So that's a great way of describing it. And it sounds like just listening to you this evening that you obviously have a, let's feel like the work that you're doing is so meaningful that that that's another way that it really helps you to continue to really push forward with a lot of the work that you're doing. Does that resonate with you, Erin? I would absolutely say, so this work is humbling.
It's meaningful, but it's most importantly impactful because we only have one chance to do it right. And this is the most important one. That's great. This is all about nursing.
I'm your host, Dr. Joyce Bachelore, live on the B-Bimboable network and tune in radio and it's time to take a short break. Do you ever wonder why certain things are happening in your life? How to start a business or a new direction?
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Welcome back everyone. You're listening to all about nursing, life and the Beebeum Global Network in Tune and Radio. I'm Dr. Joyce Batch with the Hostess Show and prior to the break, Dr.
Anne Perez was sharing with us a lot of great information about supportive palliative care and the legislative bills that she's been working on and the kinds of things that she herself does to keep herself very centered and rejuvenated. Being involved in work that can be sometimes, I would imagine, very emotionally draining. At the same time, I can tell that you have an amazing passion for this and this is very meaningful work for you. I was just curious if they could share perhaps a story of a patient that highlights how this can really become good for everybody involved.
Oh, absolutely. There is a young man that I got to know last year who was 24. He had been treated at the age of 13 for osteosarcoma and had amputation and went through treatment and had been essentially in remission. Then it came back and they founded and he was in an extreme pain crisis, anxious, crying.
They called us in to help us pain. I can tell you very quickly, it was over a matter of maybe four hours that I went from somebody who was dreaming and crying to somebody who was now resting, asking for his favorite taco to go down to San Antonio. I'm sorry if you saw that. In his family just in awe that we were able to not only control his pain but also allow him the quality of life so he can do the things that he wanted to do.
Not only did he want to cry and decide that taco but he wanted to also have his video games. He was a big video game where whether it was old school Nintendo or it was on the computer or it was Xbox. I think I got to establish a wonderful relationship not only with this young man, his family, the pediatric oncology team, the oncology nurses that were taking care of him because he is what we call an adolescent young adult. He is in that in between.
He's had a pediatric cancer. The pediatric has been treating him and then we have this recurrent but now he has 24 years of age. He is a young man. He is no longer a pediatric.
So what do we do? So I've had the privilege of helping establish and kind of build out the adolescent young adult program here at my hospital. So that is one standout case that just comes to mind. It was a little rough and rocky but fine tuning adjustment, listening to your patient and clinical exams that way you can make any whatever may come your way.
It's interesting to show that because I had shared on one of the radio shows that I got interested in becoming a nurse after being hospitalized at the H5 after being hit by a truck and I had sustained several injuries. But the thing that was amazing is that watching the kind of compassion that nurses can have when they're interfacing because the person that made a big difference and started to really listen to me as a child, her name was Joyce and I always vowed to go up and be like her. And so I think that what you're describing is again a reason why you're probably in the most amazing role is to help that transition from adolescence to young adult because I could tell you when I was told that I needed to stop going to my pediatrician at the age of 18, I had a difficult time with that because he'd been with me through so many difficult situations. And so that's a transition sometimes we don't appreciate but it's very real to patients.
So thank you for sharing that. So any other kind of story that you'd like to share to show the kind of difference that you and the team that you work with are baking? Oh, I can share you a personal one. I have my 93-year-old favorite first division World War II Marine at home and he moved up to San Antonio a couple of years ago after his health started failing and we realized that he had in stage right by the heart failure in the presence of pretty serious kidney disease and he had already made his wishes known that he didn't want dialysis that treat me for the symptoms or what you can but I don't want really extraordinary measures like artificial support to be done.
But so anyway he's had a few bottles with his heart in his kidneys and he is still with us and really I can share with you the admissions that he's had education and communication with the medical team from the ER to the intensive care unit at different, whether it was private hospitals or the VA hospital has really been eye-opening as to the patient experience and the family experience because what we have experiences when you say DNR or DNI or do not resuscitate, do not intubate. A lot of times people jump to conclusions and say do not treat which is not true. Your can actually start at the initial day of diagnosis of whatever serious illness. It just took him you know 91 years to figure out that he has right side of heart now that's not being adequately treated and how do we help make his symptoms better.
So right now we are adjusting to whatever his normal is. He also was found with a bagel bladder and often not to have surgery and so how do we adjust his diet to what he wants because he loves Denny's. He loves that in case doctors in A so just to shout out to Denny's but to to to that's his favorite and my copy but it's not necessarily good for any of his systems that's going but that's what brings him pleasure just like milk and fluid and so I think he has taught us a lot of how to truly be flexible and listen to what your loved one is telling you when he says I have got to have something and you know that that is the eight cup of fluid for the day what do you do at this point his decision is we can have an extra diuretic for the symptoms if they come up but let me enjoy the pleasure because right now functionality is going eyesight is almost gone hearing is decreasing so we're talking about what makes him happy what makes him feel pleasure and that what he gets to choose to eat and drink and what he gets to listen to if that's the first late at night or if we have to DVR and record it so I think having your own loved one in your home who is now chronically ill and outlived and your right he has now outlived the prognosis of two years ago how do we best help him and so I think he he has taught me a tremendous amount he has got that marine Texas grit like no one I've ever seen so I think you know that has taught me a lot and it's actually made me a better provider to help more patients being at least who are not going through this and I was going to say it in his age and with everything going on he deserves to be able to do the things that you're describing so that's that's an awesome story thank you for sharing that this is all about nursing I'm your host Dr. Joyce Bachelorette we're live on the beat him global network and tune in radio and we'll continue the conversation we come essential nutrients LLC is the brainchild of entrepreneur Barbara Burns inspired by a desire to help others Barbara worked with a team of scientists to develop unique nutritional liquid supplements with the goal to improve the quality of your life glucose amine zinc and calcium are essential to well-being and this is the focus of essential nutrients LLC whether you're a professional athlete weekend warrior student business owner or homemaker essential nutrients offers products for everyone including the family pet and they're easy to take no pills health requires commitment exercise a good diet proper supplementation and action so take action today and get your supply of essential liquid nutrients by visiting www.essential-liquids.com don't put off your health any longer take essential products today and start to measure the difference.
Post Dr. Joyce Bachelorette and all about nursing and we're live on the beatable network and tune in radio and prior to the break Dr. Anne Perez who is an amazing supportive palliative care that the best practice nurse here in Texas was telling us a personal story around a family member that she's caring for who's 92 years old correct Aaron? What's your name?
I'm about 93. 93 and certainly in spite of different sorts of challenges is continuing to have his wishes honored which I think is just awesome and your adjusting here as needed which I think is really pretty special. I was going to share as well for personal story that my mom and my dad I support everything you've been talking about and I've been an advocate of this for most of my career but as a family member when I had to do this with my dad and then my mom it was harder than I thought but I know that both my parents not what they wanted which is that they both died at home they did not have a lot of horrible symptoms things were being managed and their children were surrounding them and in my mom's case my son and daughter were able to get from Texas to Connecticut before she died and she waited for them because she didn't last much more but once they she knew that they were there and so you know I have a lot of respect for what you've been talking about and I'm hoping that our listeners are really able to take and appreciate a lot of the things that you're telling us are available on the internet for additional resources so maybe you could tell us what's the most important point you would like our listeners to understand about support of palliative care this evening. Well to kind of sum it up supportive palliative care does not mean that you are automatically experiencing your family having death and dying.
It is all about the living how do you want to live what is important to you that gets down to that autonomy of each unique patient even if you know mom and dad wishes ask them have them clarify that give them questions that they need to be able to help clarify for you so no matter what is coming up you are able to say hey mom and dad shared that with me or my friend shared that with me because I'm a medical private attorney for a friend of mine I think it's one of supportive palliative care is supposed to start on day one not at the very end we know that patients that have supportive palliative care live longer in the studies and we really treat the physical emotional spiritual the whole patient the holistic patient that's where nursing is and it's a team approach there is no I and team so it really does take a team approach but I think when we're when we're looking how do you want to live and what is important to you those are the two things and I'm always happy to be a resource I can send you those websites that you're listening to and click on them if you would like afterwards but I appreciate everybody listening to me and I feel free to answer any questions that may be needed after the show. Well that's wonderful and thank you so much and maybe you'd like to just remind people of a couple of the websites that they could go to particularly the one that you were talking about with the conversations because that sounded like it would be one that would really be very helpful the conversation toolkit. Yes so the conversation project just type that in and it will pop up and then the second one is kitchen table conversations and it's by Garrett Caldwell in Texas those are two wonderful websites to help you with starting that conversation and hopefully the earlier conversations are better the serious illness progresses and sometimes turns into a terminal illness we should have had those conversations so I think in primary care if you're a primary care healthcare provider starts with conversations early just like when you go do your well woman or well mail visit go ahead and start those conversations that are planning is you know part of living as well as whenever that time comes out we need to transition towards the end of our life. And you just said something that I thought was really key is that this is really a lot of teamwork and it sounds like you've been able to work with the physicians as well as social workers and other very important healthcare workers to have them also become better prepared to have these kinds of discussions is that accurate would you say?
Absolutely interprofessional collaboration is a key to communication to get your work patients and families what they need is also as serving your colleagues that are helping care for your patient as well. And it might be good to say one more time if you wanted to type in your zip code I think you would say that or your address you could find resources available to you locally that might be good for people to also hear again. Absolutely. You don't mind hearing?
Sure it's www.capc.org so CAPT is the center to advance palliative care they have one of their links online and that you can plug in and find a local facility or provider if there's one that's close to you. Well I just want to thank you for being on the show this evening you've done a phenomenal job given a lot of great information and again thank you very much for being here and you are listening to all about nursing life and the BBM Global Network in Tune & Radio. I'm back to Joyce Bachelors and host of the show and tune in next week. Thank you very much.
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