Looking to the Future of Compassionate Care: Implementation of a Holistic Perininatal Palliative Care Program

Purpose for the program:

This program provides family centered holistic perinatal palliative care during the perinatal period.

Proposed change:

Establishment of an effective interdepartmental, interprofessional palliative care team to support patients and their families throughout the perinatal continuum.

Implementation, outcomes and evaluation:

The current perinatal bereavement program was evaluated. Perinatal palliative care (PPC) literature was reviewed and researched. A staff survey was performed to assess staff awareness, understanding and comfort regarding PPC.  A PPC planning team was created. After analysis of the findings, an interdepartmental strategy for PPC education, which included nurses, medical residents and attendings, and social workers was developed. This team attended palliative care conferences and evaluated other PPC programs.  A plan was developed for improving support for our patient population.  This plan included didactic presentation with discussion and shadowing opportunities for all members of the health care team. An electronic PPC documentation tool was created to collect demographic, obstetric, and follow-up data on all perinatal bereavement patients.  Data was utilized to identify the need for PPC services.  The PPC planning team networked with resources in the community allowing for coordination of care beyond the acute care setting. A relationship with community perinatal palliative care programs was developed allowing for patient referrals, leading to more comprehensive holistic perinatal support in the care of patients.  The support of outside palliative care has provided an opportunity for increased patient advocacy, education in the community and improved preadmission and post-discharge care. The program coordinator continues to promote awareness of palliative care at public events throughout Maryland.  Staff and patients voiced increased satisfaction with the current palliative care program and the positive impact it has on our community.

Implications for nursing practice:

The Johns Hopkins perinatal staff provides care for approximately a hundred palliative care families each year.  This includes all patients that have a prenatal diagnosis of a fetal life limiting condition, unexpected fetal deaths and missed abortions. While the care of PPC patients is emotionally daunting, nursing staff have developed crucial palliative care skills obtained through PPC education.  Nurses identify and have access to PPC support resources.   Evidenced based coordination of services allow for nursing to provide holistic family centered care.  PPC skills and interprofessional support empowers nurses to advocate for their palliative care patients.   Opportunities exist for continual evaluation, development and research of impact of services on patients and their families.

Keywords:

Perinatal Palliative Care, Fetal Death, Perinatal Loss