Thursday, April 23, 2009

Until we’re really rolling…

I noted in my last post (last month?!?) that my nurse manager supports my proposal to develop a core group of end of life care nurses in our specialty intensive care unit, based on the ELNEC curriculum. This group will have primary responsibility for caring for patients at the end of life, and we will be resources on the topic for our colleagues.

It’s a big unit, and we’re very busy pretty much all of the time. We have 20 beds, and 100 nursing staff. Our house staff includes a dozen and a half residents enrolled in a 6-year surgical subspecialty program; rotating fellows in critical care medicine and interventional radiology; and an ever-changing cast of medical residents rotating through for a taste of our specialty.

And we’ve started counting our dead.

Every few weeks for the last year and a half, we've sent out condolence cards to the families of the patients who died while in our care. We average 10 deaths each month, so a program to improve the end of life care that we provide makes sense.

But the wheels turn slowly in large university medical centers. Or maybe it just seems that way when a project I feel so strongly about is just one of many items on someone else’s agenda.

No, the wheels do turn slowly – slower than I’d like, anyway. But that’s the reality, and so here we are.

This project has been put on the agenda for next week’s all-day off-site meeting of the permanent NICs (nurses in charge), and it is important that this group understand the project and support its goals. I may have up to one hour to present the project and conduct a discussion, or as little as half an hour.

I’m flexible.

Our institution, like too many others, is addicted to the relentless and indiscriminate use of PowerPoint – a surefire way to bore an audience to tears and kill any chance for a useful and productive interaction. You know – teaching and learning, that sort of thing.

I’ve been fighting a lonely battle against this kind of foolishness. So, to answer those folks who may be asking, “Hey, will you be handing out any PowerPoint slides at this presentation to the NIC’s?” the simple answer is, “Fuck, no!”

There are much more effective techniques for presenting information, and I plan to draw upon them next week, and in the coming months. I’ll let you know how it’s going.


I was happy to learn about two new blogs today on the subject of palliative care – Pallimed, and HospiceNP. The network grows…

Bonus - a meditation: