Synopsis of Work: Under the auspices of the University of Pennsylvania School of Nursing, six nursing homes in the Genesis Elder Care system put in place a palliative care project that has shifted the way staff members view their role in caring for patients. The Pines, one of the participating nursing homes, put in place top-to-bottom education in palliative care principles that everyone on staff receives, "including the kitchen staff," says Stacey Radcliffe, who has been the administrator at Pines for 10 years. The program model focused on advance care planning, pain and symptom management, and psychosocial issues.

Story Told: Typical interventions focus on pain and symptom relief, and on helping families through the dying process. "If nurses or assistants see that any patient is in pain, they are to act on it," says Michael Crowley, M.D., the long-time medical director at the Pines. "There is greater initiative on the part of the staff as a result, and more integration of care."

Sometimes, the most important intervention can be helping patients to acknowledge a new reality. "We had a patient who was rolled in the door screaming," says Joan Gannon, R.N., director of nursing. "He'd had radiation at a cancer center and his backside was raw from the radiation."

From the man's discharge papers, it was clear that his prognosis was poor, and the treatment essentially pointless. "We sat down and talked with the man's wife first, and explained that his condition was poor. She said we should talk to her husband, so that whatever time they had left together, he could spend it comfortably, without pain. When we talked to him, he said, 'Thank you.' He was doing [the treatment] for her."