Learn why nurse advocates need more training in serious illness and end-of-life care and how they can improve communication in these situations with ANA\California Member and media-trained nurse, Dr. Rebecca V. Hoden, DNP, RN, CHPN.
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Jared Fesler 0:17
Welcome to the Amplified RN News Show where we're turning up the volume on nursing news in California. I'm your host, Jared Fesler. And today we're going to be diving into the topic of enhancing healthcare communication in serious illness care. We're joined by ANA\California member and media-trained nurse, Dr. Rebecca Hoden. Dr. Hoden, thank you so much for being here today. Can you tell us a little bit about why you're an expert on this topic?
Dr. Rebecca Hoden 0:41
Thank you, Jared. I'm so glad to be here talking about this. I'm a registered nurse and educational leader. I'm an expert in hospice and palliative care. And what I mean by that I care for people with serious illness and their families. And I help people and healthcare professionals feel confident to talk about serious illness and goals of care and how to have these conversations.
Jared Fesler 1:13
Wonderful. Well, thank you again, you know, my first thought is going back to education. Nurses go through years of education and include, you know, being on the floor and engaging with patients during preceptorships, and trainings and onboarding. Is this something that is just not covered enough? Or is it not covered at all, in terms of this communication with those who have serious illnesses?
Dr. Rebecca Hoden 1:41
This is one of my favorite subjects to talk about, you know, nurses and other healthcare professionals go through years of training, certification, and work on the job. The truth is, in general, this is one of those pain points in healthcare. Both nurses and physicians, on average, receive about 13 hours of training in hospice and palliative care and end-of-life care. This is program total. And that's the equivalent of like one 12-hour shift on the floor. So if healthcare professionals don't receive enough training in this, and they don't feel comfortable or confident talking about these issues, how can we expect that healthcare professionals are equipped to lead patients and families through these goals of care Conversations?
Jared Fesler 2:45
I'm sure it can't be the easiest conversation to be having with patients, either. What sort of when these conversations aren't happening are perhaps at the level or content that should be discussed in these conversations when those patients or their family members have serious illness? What is the effect on the patients and their families?
Dr. Rebecca Hoden 3:13
You know, it's interesting. I remember once I drove up to a patient's home, to help him start hospice care, and is this beautiful, gorgeous RV, right in the driveway. The patient's wife answered the door and she had tears running down her face. And she told me that my patient had retired that week at the age of 65. And also that week, they received news that his cancer had progressed, and that he was nearing the end of life. And they said to me, had we known had we been told that the cancer could have progressed in this way. We would have restructured our lives and our priorities, to make the time to travel before retirement. And these are the things that I hear a lot with patients and families, patients and families trust that their health care professionals their healthcare team will help them make these informed decisions and begin conversations. At the same time, healthcare providers often wait to have these conversations because they worry about upsetting patients taking away hope, and saying the right thing. So we're looking at a catch-22 here of both patients and families are waiting for these conversations and healthcare professionals need more support to begin These conversations.
Jared Fesler 5:02
So you're saying this is really coming down to a lack of preparation, perhaps on both parts. Families are underprepared because they don't have these conversations early enough. And then there's a lack of preparation, perhaps from the healthcare provider or nurses perspective, to to feel confident in having these conversations and knowing that you're going to say the right thing. Is that what you're saying?
Dr. Rebecca Hoden 5:28
Yes, and and this is not a surprise, in the United States, we are we are culturally ingrained to avoid talking about serious illness, and death and dying. So when these conversations need to happen, it's often when a patient is already very ill may be dying, families are reeling from the shock of the experience. And that's not always the best time to start conversations. What would it look like if we could start these conversations before these experiences happen? Or in stages throughout this journey for patients and families?
Jared Fesler 6:14
Could you put some, you know, maybe boundaries or guidelines out there, for those that are listening? How many people are using how you live care?
Dr. Rebecca Hoden 6:28
You know, palliative care, one of the best-kept secrets, you know, this is, this is a service that supports patients and families with serious illness throughout serious illness. And here, it makes me sad, you know, according to the World Health Organization, only about 12% of people who could use palliative care services actually receive them.
Jared Fesler 6:59
Hmm. That's interesting, it makes us wonder, do you know why that number is so low?
Dr. Rebecca Hoden 7:09
You know, a lot of this is connected to what we've already said that, that this rises and falls on on communication, and how these important conversations play out so that patients and families are prepared. And sometimes these conversations don't materialize in time. And that's why there's such a gap.
Jared Fesler 7:34
So 13 hours is, is really the limit on on the amount of exposure, if you will, to this type of care and ensuring that you can have these conversations, what are you saying is the solution then is it to increase those number of hours to provide different levels of education or care? What are you asking nursing educators and leaders to do?
Dr. Rebecca Hoden 7:58
Yeah, from a nursing perspective. You know, nursing educators are, are so competent, they know their stuff. What we really need, we need to rehaul the nursing curriculum in general so that we can intersperse these communication issues, serious illness issues through the curriculum. To do that. We need educators. And you know, we hear a lot about a nursing shortage in our nation, what we really need to talk about is a nursing educator shortage, because we have to support educators to to train the nursing workforce to be prepared to face conversations.
Jared Fesler 8:50
You know, this is reminiscent of a conversation that we are having recently and how issues regarding veterans health as another area that requires an understanding of communication and an understanding of this specific needs of that population in that community. And this seems very in line with that train of thought that there needs to be more specific type of training and and interfacing with these populations to ensure that nurses are properly trained and educated to have these conversations and have them at the right time. What is your call to action to nurses and nurse educators to increase the amount of education relative to hospice and palliative care and those with serious illnesses?
Dr. Rebecca Hoden 9:39
Yeah, you know, if you're a current educator, we need you so much, and finding ways to incorporate these pieces into a curriculum. It is possible in small chunks within didactic courses, but we can also incorporate these pieces into clinical placements, Nurse residency programs preceptorship experiences. So there's there's lots of small ways that nurse educators can, can work to to develop these skills with their with their students. And in order for us to really support the nursing educator workforce, thank goodness, we have many legislative bills that are that are on the horizon. And the one that I'm watching most of all is called S 2243, which is the palliative care and hospice Education Training Act, or pajetta. And this is going to increase the number of palliative care trained faculty in the nursing workforce, so that we can support the development of these careers so that nursing educators feel equipped to guide students in these in these areas.
Jared Fesler 11:09
Well, Dr. Hoden, thank you so much for being on the show here today. What a great call to action to support some legislation that is out there right now to tackle exactly what you're saying the solution is let's add more educated nurses. And let's have more nurses that are equipped with these types of experiences and conversations. Incredibly important topic, Dr. Hoden and thank you for your time for being here and those that are tuning into the Amplified RN News Show. We'll see you in the next episode.
Dr. Rebecca Hoden 11:37
Thanks for having me, Jared.
Jared Fesler 11:39
Thank you.
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