Adult-Gerontology Primary Care Nurse Practitioner- interest in Palliative care, Oncology, Death with dignity, and hospice as an Advanced Practice Nurse. Please see post below to cover these topics and remainder of post.

Post a brief introduction of yourself including your professional interests and explain why these topics interest you. Your post should include how the ANA guidelines, competencies, and code of ethics address these issues and topics. Also include a brief explanation about the differences in roles related to Certified Professional Mid-Wife (CPM), Certified Nurse Mid-wife (CNM), Certified Mid-Wives (non-nurse who follows same criteria as a CNM, CM, APR-Ns, and PAs) and how each of these roles might impact the way you work. Be specific and provide examples.

 

A close family member recently confessed that he didn't understand how anyone could devote their professional life to caring for the terminally ill and their families... in effect, palliative nursing and medicine. Frankly, I wasn't surprised by the comment because death is still a social taboo: an awkward, scary and inevitable moment that confronts us all.

I'm an Advance Practice Nurse (APN) who has been practicing in the field of palliative nursing and hospice care. Over the years that I was here in this field, I have learned to love and take interest in the magic and beauty of caring for those who are terminally ill. I realized that palliative care in gerontology, specifically, is born from a real need of patients, their families and society in general. The need for someone to be alongside and provide support to improve the last moments of life and to consider the patient as a whole person and not just a disease.

Palliative care is given to improve the quality of life of patients who have a serious or life-threatening disease. The role of the advanced practice nurse (APN) has significant value in this speciality. We provide holistic care, along with diagnostic and treatment expertise, and at the same time evaluate cost-effective use of resources. Palliative care APNs are specialists and leaders in disease-modifying care, pain and symptom management, giving attention to highest quality of life possible, and compassionate end-of-life care. The role of the APN has been highly recognised in the US, I can guarantee that. 

But the main aspect in palliative and hospice care that really caught my attention was upon realizing that these patients at the end of life are still able to make decisions and cope with their situation provided they are given enough information. It gave me the motivation to even care for them more, listen to them more, and eventually fall in love with the practice. I remember one patient who felt his oncologist had not told him the truth about his condition. I agree, I too would want to be told the truth. And yet, there are professionals who simply aren't interested in learning how to deliver bad news, to communicate or guide a patient and family at this sensitive time. In my opinion, this is an enormous failure in health care. All doctors, even palliative care doctors, feel queasy when they must inform the family or the patient that nothing more can be done. We should not be afraid of showing our feelings with patients, of letting their experiences hurt us even if they do make us think about our own vulnerability. Being sensitive doesn't mean being weak, but rather being closer to the patient.

Furthermore, palliative and hospice care for the elderly taught me that the art of medicine is not just about treatment options, tests and screening - things ­that are learnt with practice. What is really difficult about being a doctor is how to connect with patients, how to communicate with them taking into account their circumstances and creating confidence based on information. Building a relationship with a patient is a really complicated issue - in the context of palliative care it is essential. Watching the palliative care team was a treat for they are expert communicators. What impressed me most was the team's ability to listen, to words as well as silences and gestures; to interpret what a patient wants to say; to understand concerns and fears; to help patients to face death without drama; to look at patients without judging; to understand the family's role and identify resource needs; and to help patients to manage hope and expectations, based on alleviating symptoms on the worst days and enjoying the best days.

In conjunction with the guidelines on palliative care that ANA has released, I was able to appreciate and understand how nurses are obliged to provide comprehensive and compassionate end-of-life care. This includes recognizing when death is near and conveying that information to families. Nurses should collaborate with other members of the health care team to ensure optimal symptom management and to provide support for the patient and family. ANA established that nurses and other health care providers have a responsibility to establish decision-making processes that reflect physiologic realities, patient preferences, and the recognition of what, clinically, may or may not be accomplished. I learned the hard way that this process often involves collaboration with experts in decision- making, such as ethics committees or palliative care teams. 

In terms of abiding by the Nursing Code of Ethics in palliative care, I learned that the cardinal ethical principles to be followed in palliative and hospice care are-autonomy, beneficence, non-maleficence and justice. The practice has also taught me that palliative care APNs and team members should carry out their responsibilities with honesty and dignity.

In summary, as APNs, we are valuable members of the health-care team, and are in the perfect position to deliver high-quality palliative care. With the help of guidelines by ANA and the ethical principles that bind us through the Code of Ethics, we are indeed instrumental in coordinating the palliative care needs of their patients. Through proper training, APNs are able to provide phenomenal assessment, plan, implementation, and evaluation of palliative care interventions.

Certified Professional Mid-Wife (CPM), Certified Nurse Mid-wife (CNM), Certified Mid-Wives (non-nurse who follows same criteria as a CNM, CM, APR-Ns, and PAs)

Certified Professional Mid-Wife (CPM)

The vast majority of direct-entry midwives in the United States are Certified Professional Midwives. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. Their education and clinical training focuses on providing midwifery model care in homes and freestanding birth centers. In some states, CPMs may also practice in clinics and doctors offices providing well-woman and maternity care.

A Certified Professional Midwife's (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a written examination. The goal is to increase public safety by setting standards for midwives who practice "The Midwives Model of Care" predominately in out-of-hospital settings. CPMs provide on-going care throughout pregnancy and continuous, hands-on care during labor, birth and the immediate postpartum period, as well as maternal and well-baby care through the 6-8 week postpartum period. CPMs provide initial and ongoing comprehensive assessment, diagnosis and treatment.

Certified Nurse Mid-wife (CNM)

Certified Nurse-Midwives are trained in both nursing and midwifery. Their training is hospital-based, and the vast majority of CNMs practice in clinics and hospitals. Although their training occurs in medical settings, the CNM scope of practice allows them to provide care in any birth setting.

A nurse-midwife is a licensed healthcare professional who specializes in women's reproductive health and childbirth. In addition to attending births, they perform annual exams, give counseling, and write prescriptions. The American College of Nurse-Midwives (ACNM)—a professional organization representing certified midwives (CMs) and certified nurse-midwives (CNMs)—reports that 53.3% of CNMs identify reproductive care as their main responsibility, while 33.1% report that it's primary healthcare.

While mostly associated with care around pregnancy, CNM roles include more general healthcare for women as well. This means that certified nurse-midwives can assess and manage contraceptive and birth control methods, offer general gynecological care, and preventive care.

Certified Mid-Wives

Certified Mid-Wives is a form of direct-entry midwives, who are trained to provide the Midwives Model of Care to healthy women and newborns primarily in out-of-hospital settings. They do not have nursing education as a prerequisite for midwifery education.

Certified Midwives are individuals who have or receive a background in a health related field other than nursing, then graduate from a masters level midwifery education program. They have similar training to CNMs, conform to the same standards as CNMs, but are not required to have the nursing component.

Lastly, I firmly believe that nurses and midwives' role are interrelated and are complementary. These professions are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care and treatment is vital. They are also part of their local community - sharing its culture, strengths and vulnerabilities - and can shape and deliver effective interventions to meet the needs of patients,families and communities.