By Gary Weisbrich
Every care team strives for whole-person care, but it is not easy. What makes the palliative care model unique is that it gets dedicated resources, and the institution commits to a champion on the executive level.
Designated professional clinical specialties are consulted throughout the day in a team setting. Besides the physician and advanced practice nurse, other specialties might include pharmacy, social work, and spiritual care. In larger hospitals, a designated team is the gold standard, but smaller hospitals usually borrow clinicians from these different specialties to facilitate goals of care conversations.
I asked clinicians on our palliative care team at Providence St. Patrick Hospital in Missoula, MT, to share their thoughts:
“We know in palliative care that each domain in terms of a patient’s health/illness experience is critical to achieve “healing” even in the face of progressive, terminal disease. While each person on the team might be an expert in one of those domains (i.e. physical, spiritual, social), it is hard for any one person to be an expert in ALL domains. We also know that a person’s physical symptoms may be directly impacted by spiritual distress or social issues (or vice versa), and so if we are not addressing all of the different aspects of care, we really aren’t likely to meet the needs of the patient or family, at least not in a timely manner. As a care provider, I value the talents of my co-workers (in other disciplines) and know that as a team we can provide so much more to those we serve.” — Judy Gustafson, nurse practitioner
“I’ve experienced palliative care in both the individual provider role along with interdisciplinary teams, and it’s clear that each discipline gets a different view of how best to serve the patient. Without other disciplines, those recommendations are lost. Studies have demonstrated how the support of the team also helps the team members avoid burnout. This has been true for me with the teams I’ve interacted with.” — Dr. Nick Furlong, physician
“As an interdisciplinary team, we work together to identify and address individuals’ needs, whether physical, emotional, spiritual, cultural, or otherwise. By drawing on our strengths as specialty caregivers and providers, we develop whole-person care plans, assuring we address symptom management, spiritual support, advance care planning, and other care needs unique to individual patients and their families.” — Jennifer Paul-Detienne, RN
“I treat physical pain and symptoms. However, I also care for patients experiencing emotional and spiritual pain. Sharing our perspectives in our meeting gives us better insight to address these different but related pain issues and come up with the best way to care for the patient.” — Brittany Hobbs, pharmacist
“The interdisciplinary team demonstrates that the whole is greater than the sum of its parts. As individual practitioners in palliative care, we each have our own view of patients, family dynamics, of medical conditions, of existential distress. Sometimes I’m aware of my limitations as a medical provider, but more often I need the input of the other members of the team to help illuminate the entire experience of the patient and family.” — Dr. Chris Jons, physician and medical director
Our team meets every morning to review the current patients and the new referrals. We begin with a time of meaningful reflection. We take turns with a quote, question, or brief reflective story. Today, the question was, “In the past week recall an experience or encounter that has affirmed your work” and then “recall an encounter that has challenged your resolve to give whole-person care.” Our challenges included feeling overwhelmed and not having enough time to give quality care; not feeling effective; or realizing that a patient would be best cared for in hospice but knowing that they are not yet ready for that. Our affirmations included returning from vacation and feeling rejuvenated; feeling like we helped make a patient’s goals a reality; experiencing a sacred encounter with a World War II veteran; and advocating for an inmate to see her family and partake in a meaningful religious ritual prior to dying. Finally, we share the burden of what is discussed in the patient goals of care meetings. Carrying this alone accumulates and takes a toll; sharing eases the burden.
Transitioning to patients, we identified a woman who was having breakthrough pain. The bedside nurse didn’t want to give too much pain medication. The patient wanted her pain to be controlled and yet remain awake enough to visit with her family, which is a tough balance. This provided an opportunity for our pharmacist, physician, and nurse practitioner to devise a new pain plan. The whole palliative team got some education about different pain medications and the use of opioids — something not necessarily taught in nursing school. In this situation, the concern for addiction was less of an issue than controlling the pain. The nurse practitioner and pharmacist touched base daily regarding the new pain regimen. The palliative care RN asked the spiritual care provider about the patient’s continued agitation and existential concerns that were causing spiritual and emotional pain. When the chaplain visited, the patient said, “I am not afraid of dying. Yet, if I were honest, I am a little afraid of the unknown.” We openly talked about her concerns, and she said, “I am going downhill physically and emotionally.” One of her goals was to receive anointing and a small piece of Communion. The chaplain consulted the music clinician, who offered soothing harp music. This model of care allows for the whole person to be touched, body, mind, and spirit.
The PC-IDT model uses multiple specialties to care for the patient/family using a truly integrated plan of care. Whole-patient care can be a reality because the body, mind, and spirit are treated as one — one team focused on one patient, collaborating with a shared vision.
Gary Weisbrich, BCC-ACHPC, is manager of spiritual care at St. Patrick Hospital in Missoula, MT.