All Palliative Care Projects
Title of project:
Guidelines for the nursing administration of subcutaneous dexamethasone in the palliative setting
Funding body: Internally funded by the Nurse Maude Hospice Palliative Care service and the Institute
Project description: The project is to develop best practice guidelines for the administration of sub-cutaneous dexamethasone in the palliative care setting. This project has been started because anecdotally there is variation in practice and there is little published evidence. A survey of NZ community hospice palliative care services will be undertaken to get 'expert' opinion to standardise the sub-cut administration of dexamethasone. The survey will be conducted via email or telephone using a structured questionnaire. The survey results will be used to develop best practice clinical guidelines for the administration of sub-cut dexamethasone. These guidelines will be piloted and approved for use within the Nurse Maude generalist and specialist services and also shared with other palliative care services.
Project update: The survey has been completed and final report written. The guidelines have been developed, piloted and implemented in to the Nurse Maude generalist and specialist palliative care services.
Project outcomes: Report on the ‘Guidelines for the nursing administration of subcutaneous dexamethasone in the palliative setting: a survey of NZ Hospice palliative care services’.
Walker, J, Lane, P & McKenzie, C. (2010). Evidence-based guidelines: a survey of subcutaneous dexamethasone administration in palliative care. International Journal of Palliative Nursing,16(10), 494-498.
Further information: Lead researchers – Pauline Lane and Clare McKenzie, Clinical nurse specialists, Nurse Maude Hospice palliative care service
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Title of project:
Online palliative nursing education for community based nurses – Phase 1
Funding body: External funding from the Cancer Development Fund, MOH. Internal support from Nurse Maude Hospice Palliative care service, Christchurch Polytechnic Institute of Technology and the Institute.
Project description: This project is specifically aligned with the Cancer Control Strategy (MOH, 2003) priority of improving palliative care services. This project will develop two online courses in palliative nursing for the primary health care sector. They will be written for registered nurses providing generalist palliative care in the community and in residential care. The online courses will provide foundational knowledge in care of the dying using the Liverpool care pathway as a framework. Topics will include nursing assessment, symptom management, psycho-social support, and communication. This will support face-to-face teaching currently offered by Hospice Palliative care specialist services and Liverpool Care Pathway facilitators. The courses will be formally evaluated through course evaluations, effectiveness and usability studies.
Project update: this project commenced in February 2010 with the first course 'Care of the Dying Person: managing pain' offered in August 2010. The second course ''Care of the Dying Person: managing nausea and vomiting'commenced on February 7, 2011.
Further information: Project manager – Jackie Walker, Research Nurse, NZICHC
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Title of project:
Online end of life nursing education for community based nurses – Phase 2
Funding body: External grant from Genesis Oncology Trust and internal support from the Nurse Maude Hospice Palliative care service, Christchurch Polytechnic Institute of Technology and the Institute.
Project description: This project will further develop online education for registered nurses on assessment and symptom management in care of the dying using an online learning management system. The introduction of the Liverpool Care Pathway (LCP) into aged care facilities has stimulated the need for more generalist palliative care education for nurses. Most nurses receive limited palliative education in their training, so additional education will be vital to the success of the LCP and for improving patient’s quality of care. However, there are recognised barriers to accessing face-to-face education (e.g. time, cost, staff shortages) which can be addressed by more flexible, accessible online education. This phase of the project is being undertaken as a joint venture with Nursing and Human Services, Faculty of Health, Humanities and Science, Christchurch Polytechnic Institute of Technology.
Project update: this phase commenced in November 2010 with the planning and development of three further courses. These courses are: 'Challenges in chronic care', 'managing respiratory symptoms' 'Cultural perspectives of death and dying' and they will be offered in 2011.
Further information: Project manager – Jackie Walker, Research Nurse, NZICHC
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Title of project:
Development and implementation of a clinical protocol for the management of lymphoedema in palliative care patients
Funding body: 2010 Campbell Ballantyne Fellowship funded by the Nurse Maude Foundation.
Project description: This project will evaluate the outcomes of a clinical protocol for the management of lymphoedema in patients receiving palliative care or wound management. Lymphoedema is a very distressing chronic condition in some metastatic cancers (e.g. breast and bowel) but with ongoing conservative treatment improvements in function, mobility and patient comfort can be achieved. Currently, the physiotherapist receives abut 60 palliative referrals for treatment annually and treats patients receiving wound care who also have lymphoedema. To achieve best outcomes for patients, a collaborative approach between the physiotherapist and nurses in the management of lymphoedema has been developed. A clinical protocol with clearly identified referral points, key assessment and screening tools, will be developed to ensure patients get appropriate assessment and treatment. The clinical protocol will be designed to develop a team approach where nurses can provide some conservative treatment, resulting in patients receiving earlier treatment and better outcomes.
This project will involve two audits to evaluate the outcomes of the clinical protocol. A baseline audit before the implementation of the clinical protocol, and one audit after 3-6 months usage of the pathway.In addition, an anonymous, voluntary survey will be undertaken to obtain nurses’ views on the usefulness of the clinical protocol using a written questionnaire.
Project outcomes: This project was completed in January 2011 with the implementation of a lymphoedema management protocol, an undertaking of two audits, the development of lymphoedema management training for registered nurses and publication of the project report. The results of the first audit of lymphoedema management was presented by Mary Thomson at the Hospice and Palliative care conference in Wellington, New Zealand. Two publications from the project are planned for 2011.
Further information: Lead researcher – Mary Thomson, Physiotherapist, Nurse Maude Hospice Palliative care service
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Title of project:
Plasma concentrations of cyclizine and its metabolites obtained during continuous subcutaneous infusions in the palliative care setting
Funding body: Campbell Ballantyne Foundation, Clinical Pharmacology, Christchurch Hospital and Nurse Maude Hospice Palliative care service
Project description: This pilot study aimed to observe cyclizine and norcyclizine concentrations in palliative patients receiving continuous subcutaneous infusions of cyclizine to establish the range of concentrations seen in palliative patients as steady state is approached. A secondary aim was to examine the CYP2D6 status of these patients both genetically (using DNA samples) and phenotypically (using cyclizine: norcyclizine ratios). Blood samples were taken daily from day 1 – 4 and multiple blood samples were taken on day 5. An evaluation of sedation and nausea/vomiting status using a rating scale was made at each blood sample time. A third aim was to qualitatively explore the experience of palliative patients being involved in research and their experience of receiving subcutaneous cyclizine. The qualitative part of the study was undertaken using semi-structured taped interviews on or after the final day of the study.
Project outcomes: journal article in press
Further information: Jane Vella-Brincat, Clinical Pharmacist.
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