• ONA

• Nursing Innovation Grant

BScN – 2006 McMaster University-Mohawk College
MSc, PHCNP 2011 McMaster University
CNA Hospice Palliative Care Certification – 2025 – exam written, awaiting results

NPSTAT provides service to long-term care (LTC) homes in the Mississauga-Halton catchment area. Residents are moving into LTC frailer, with multi-morbidity, and require more medical and nursing resources in both their LTC home and in acute care. In 2021, the Fixing LTC Act (FLTCA) required LTC homes to ensure that residents are provided with care or services that integrate a palliative care philosophy. In the act, there is no direction for the LTC homes for provision of palliative care, requiring individual interpretation of the legislation and leading to differences in palliative care models and cultures within NPSTAT catchment area. Registered staff are provided very little palliative care education and mentorship to obtain and maintain competency. The goal of this project is to provide a toolkit with content on different aspects of palliative care to provide a tangible, evidence-based resource for LTC.

Prior to 2020, the Central Local Health Integration Network (LHIN) Home and Community Care team developed a palliative care local resource guide for LTC. This information would have been compiled and distributed prior to the COVID 19 pandemic and the FLTCA. NPSTAT would like to adapt and update the resource document, and provide links to local supports. The NPSTAT Palliative Care Toolkit is a guide to provide to nursing staff in LTC for quick reference on a variety of topics, assessments, and sample communication for palliative and EOL care. This toolkit can be used to provide education and support to LTC staff who have learning needs for all aspects of palliative and EOL care. It would be a written reference, available in hard copy and digitally for ease of distribution, including updated links to external resources and tools. There would be an education component for the staff to understand how to utilize the tool and could be used as part of LTC routine education or as a self-study reference for nursing staff.

LTC is a 24 hours per day service, with differing levels of support and expertise or nurses throughout the day. Particularly for evening/overnight/weekends, LTC nursing staff have minimal supports, increased likelihood of working with nursing agency staff, and less onsite access to management and medical supports. Most nurses learn through individual experiences with palliative patients, as well as from existing supports and continuing education in LTC. Staff have gaps in knowledge and varying degrees of comfort regarding palliative care including: early identification of those who would benefit from palliative care, how to assess signs that EOL is approaching, how to have conversations with residents and SDMs regarding GOC, and symptom management at end of life (EOL). By having both a physical copy and virtual component, resources and support can be available to nursing staff at all times to help improve overall competency for palliative management.

There are several nursing competencies that this project will address. By having easy to use resources that nursing staff can use for practical bedside nursing and resident and family education, the nurse will be a more competent and confident clinician, communicator, collaborator, advocate and leader in by developing an understanding of topics surrounding palliative care up to and including: advanced care planning , how to have a conversation to introduce palliative care and end of life, SBAR template for staff to follow when having conversations with residents/SDMs ,signs of impending death , hydration at EOL, and managing symptoms at EOL – using tools and documentation 

This virtual tool kit can be distributed either in hard copy or virtually to all of the LTC homes in the Mississauga Halton area, and as a platform, could be adopted and distributed by other Nurse-led Outreach Teams (NLOTs) throughout the province. Many of the resources could be adopted to other clinical practice areas including retirement homes and home care. The hope is that we will create a better baseline education and support for all nursing caregivers in LTC.

Michalak, Marnie NP
Hashem, Marzook Admin assistant NPSTAT