Even when life is nearing its conclusion, it remains full of choices.
Should she pursue an aggressive course of treatment? Does he want a more holistic approach to healing? Perhaps her family has questions of a spiritual nature. His family might be working together to plan the wake.
It’s in this area of care where Chris Coletta-Hansen, APRN-BC, MSN, ACHPN, has found her calling.
Working as a nurse practitioner for the new Transitions in Care palliative consultation service at Grand View Hospital in Sellersville, Pa., Coletta-Hansen has found an ever-evolving field that yields a new level of job satisfaction. “Palliative care is the perfect arena in which to practice the art and science of nursing,” says Coletta-Hansen. “It really does fit the whole paradigm.” Filling a need
Transitions in Care emerged after about two years on the drawing board, says Cathy Haberle, RN, BS, CHPN, the palliative manager of Grand View’s hospice program. But the seeds were planted several years ago, when a young man with gastric cancer needed the hospice services.
The patient wanted to pursue some curative treatments, which largely disqualified him from the hospice program. Ultimately, his case fell through the cracks of the system. But, Haberle says, it spurred the hospice staff to think about how to fill the symptom-management gaps in the hospice care-delivery system.
” ‘Palliative’ is a big buzzword in medicine right now,” Haberle says. “A lot of facilities have inpatient programs. A patient comes in, and they’re not ready for hospice. So you work on managing their symptoms and having those care-planning discussions that are pivotal in pulling information together to help them decide what is their goal for care.”
Coletta-Hansen came on board in January. She spent two months getting oriented to the facilities and case management and meeting the growing brigade of physicians who volunteer their time and services. The program officially began accepting patients March 17.
“What’s unique to Grand View’s system is that outpatient component,” Coletta-Hansen says. “They don’t have to be on home care in order for us to see them.”
Haberle has been in the hospice field for 20 years, and she has watched the palliative care movement unfold. Most of her first patients had cancer, but now she sees a variety of chronic conditions such as pulmonary diseases and congestive heart failure.
“People are living longer,” Coletta-Hansen says, “but the converse side of that is they’re sicker longer. Medicine has changed because of technology and treatment options.”
The goal of the Transitions team is to bridge all the potential gaps in the treatment process that a greater variety of diseases and more advanced treatment technologies have created.
“We’re looking to provide seamless care delivery,” Haberle says. “There’s people that yo-yo, especially in the end-stage diseases like cardiac. They go into an episode of congestive heart failure and end up in the hospital. The hospital gets them patched up and stabilized, and they go home with home care.”
But, Haberle says, home care typically lasts only two to three weeks. “After that, they might end up in the hospital again and so on. It becomes a cycle,” she says. “So we try to meet them where they’re at and bring some specialized symptom management to them and hopefully break that cycle.”
Coletta-Hansen consults with home care services, visits patients in the hospital to help get their symptoms under control, and puts discharge plans in place. She coordinates with specialists, and then follows the patients’ care at home. Though she juggles 10 to 15 cases on an average day, Coletta-Hansen says she loves helping patients get their lives in order.
One-stop supportCathy Haberle, RN, BS, CHPN
With Transitions in Care, Grand View patients now have one-stop support. They can receive aggressive pain symptom management, as well as physical, psychological, psychosocial, emotional, and spiritual care.
Growth areas of the program that are targeted for the future include the provision of home health aides, a beefing up of social work and chaplaincy programs, and, ultimately, to become more than a consultative service — an all- encompassing program.
“Grand View had the foresight to put a nurse practitioner in this role,” Coletta-Hansen says. “It’s like bringing a physician level of care to the home. But the art of nursing still is a gift that comes with that. … We bring that specialized caring skill set, in terms of looking at the bigger picture, and not seeing our patients as just their disease or treatment, but as a whole person.”