1. Service Learning ProjectBy
Jennifer Held, RN
Ferris State University
My name is Jennifer Held. I am a registered nurse working towards my BSN and this is my service learning project for Ferris Status University BSN program.

2. Introduction
I volunteered at Meadowbrook medical care facility (MBMCF), a 133 bed medical care facility in Antrim county.
Meadowbrook offers inpatient rehab, out patient therapy, and long term care.
my contact person was Elizabeth kaitting, RN who was new to the concept of palliative care.
I volunteered at Meadowbrook Medical Care Facility (MBMCF) which is a 133 bed medical care facility in Antrim county. The facility offers several services to the community but I focused on the long term care part of the facility for my service learning project.
I was originally approached by the facility wound nurse who was working with Elizabeth Kaitting, RN. The wound nurse was looking for advice about treatments for pressure ulcers on a patient who is palliative care. I provided the skin and wound nurse with education about palliative care and how some pressure ulcers may never heal because of chronic disease processes. I started wondering why this patient was not offered palliative care approach considering her declines in conditions.
I approached Elizabeth Kaitting about her patients and palliative care approaches. Elizabeth explained to me that she and her staff could benefit from further education related to palliative care. I approached Elizabeth about doing my service learning project on her unit to help with educating her staff about palliative care. She stated that she would welcome the educational experience for herself, her staff, her patients, and patients families.

3. My role
I worked providing education to Nursing staff about the benefits of palliative care.
I reviewed patient charts and talked to patients who were candidates for palliative care
I then Educated the patients about the benefits of palliative care
Advised nurses on how to use a Flacker scale to help identify patients who could benefit from palliative care
I educated Elizabeth and her nursing staff about the benefits of palliative care compared to aggressive treatment of chronic disease. I provided educational in-services to small groups of staff and also worked individually with different staff reviewing individual patient charts to determine if palliative care was an appropriate approach for the patients. I also talked to patients and encouraged the nurses to have a relationship with their patients so that they would be able to help guide patients to make a decision about whether palliative care was appropriate for them.
I showed the nurses how to use the Flacker scale to help them be able to identify patients who may pass away in the next year. The Flacker scale was used as a guide to determine if a patient required additional assessments to see if palliative care would be appropriate. Center for Improving Value in Health Care (2012) published a guide for long term care and hospice that stated to use the Flacker Mortality scale when doing assessments to determine possibility of patient dying in the next year.

4. What I learned
I learned that palliative care is not appropriate for all patients in long term care facilities.
Nurses need to understand the benefits of palliative care so that they can educate their patients and families about it.
I realized that palliative care is the recommended approach for patient’s with dementia (European Association of Palliative care 2013) .
This was great learning experience for me, that I will remember for the rest of my nursing career. I started my service learning project on Elizabeth’s unit thinking that everyone in long term care could benefit from palliative care. I learned that not everyone in long term care is a candidate for palliative care. Elizabeth’s unit is not like a typical long term care unit. It was full of life and many of the patients had good quality of life and their chronic diseases were stable. Other patients on Elizabeth’s unit did not have quality of life and their disease were not stable and majority of them were changed to palliative care.
I realized that the nurses on Elizabeth’s unit were not aware of the many benefits of palliative care, therefore they were not able to share this education with their patients and/or the patients families. I learned that I did not have to personally educate every patient about palliative care and that by educating the nursing staff I could help provide education to patients, much further than I could have on my own.
When researching during this project, I learned that the European association of palliative care stated that palliative care is the recommended approach for patient with dementia. Elizabeth had several patient with dementia and majority of them were changed to palliative care.

5. Recommendations
Palliative care is very important, It provides the patient with a terminal illness a specialized approach in their care
Spending one on one time with Elizabeth was great because it allowed me to go through individual patients with her
this project allowed me to function as an educator, mentor, and nurse assessing clinical needs all at the same time.
Palliative Care is not fancy or glamorous and there is no intense medical procedure that goes along with palliative care. Palliative care however is very important approach that a patient can chose at any stage of their disease progress. Sometimes doing advanced procedures on patients who are weak or at the end stage of their disease process can do more harm than good. I would recommend that any nurse who has a patient who is having increase weakness and/or at the end stage of a disease process talk to their patient and physician about the benefits of palliative care approach for the patients.
Also, when reviewing a patient for palliative care make sure that you are looking at the patient as a whole, no just the disease or their current setting. For example, just because a patient is a long term care facility does not mean that they should be palliative care. Investigate what physicians and specialist are recommending and the patients current condition.
I would recommend this service learning project to other students, as it allows a unique learning opportunity. I was able to mentor other nurses and give them information that they can use now and in the future. I was also able to talk to patients and/or families to hear the life stories of patients and what they want as a goal for their lives.

6. References
European Association of Palliative care (2013). Recommendations on palliative care and treatment of older people with Alzheimer’s disease and other progressive dementias. Retrieved from:
Center for Improving Value in Health Care (2012). Palliative Care Best Practices. Retrieved from: 13ff-4fa0-b92b-7d1a0cb30fec/Palliative-Care-Best-Practices-Guide pdf.aspx/