The online journey through the process of death

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During a May snowstorm in Kenora, Ontario, registered nurse Barbara Pernsky was reminded of the rewards that come with helping patients at the end of their lives. That day, her chemotherapy patients told her how happy they were to see the snow because they were afraid they’d never see it again. Pernsky says those predictions turned out to be true, and her patients’ optimistic outlook on the harsh realities of life in northern Ontario made her feel privileged to care for them. She was inspired to do everything possible to provide them with the best care, including becoming one of Canada’s first RNs to earn the Hospice Palliative Care certification from the Canadian Nurses Association (CNA).

Launched in 2004, the palliative care certification is one of 14 currently offered by CNA. Janet Mann, an RN and manager of the certification program, says CNA has offered certification programs since 1991, when the first group of neuroscience nurses was certified. Today more than 12,600 RNs are certified in areas ranging from gerontology to critical care pediatrics. By 2006, Mann says there will be three new certifications in rehabilitation, orthopedics and community health. All nurses, regardless of their specialty areas, must re-certify every five years.

“By going through the voluntary certification process, nurses are testing themselves,” says Mann. “Certification is one way for a nurse to enhance her professional development.”

Mann says every nurse seeking certification must complete an application, including references and a demonstrated 3,900 hours worked in the particular specialty area. CNA does provide a guide to prepare students for the exam, but studying is self-directed. Candidates then write a four-hour exam that tests their skills on a range of topics in their specialties. For hospice palliative care, those topics include caring for the patient and family, pain and symptom management, and dying and death management.

Pernsky wrote the exam last April, and while it was challenging, it was the isolation of studying for nearly five months that required the most perseverance to overcome. At that time, Pernsky was the only nurse in Kenora studying for the certification, so she joined an online study group with nurses in Thunder Bay and Fort Frances.

Pernsky says obtaining her palliative care certification has brought many rewards, including the personal satisfaction she derives from achieving her goals and the expertise it allows her to share with patients and fellow healthcare providers.

“We (nurses) have a responsibility to provide evidence-based care, to maintain the newest knowledge and provide the best care to patients.”

Pernsky says the learning she’s obtained from her hospice palliative care certification rounds out her rewarding patient experiences. “Palliative care is the art of nursing,” she says. “As much as I want to take the cancer or the multiple sclerosis away, I can’t do that. What I can do is listen to (patients) and do the best I can to make them comfortable and maintain their dignity.”

Pernsky, who also obtained her oncology certification from CNA in 1997, spent 15 years of her 26-year career working with oncology patients in northwestern Ontario. She began as a chemotherapy and palliative care nurse in a local cancer outreach centre. Most recently, she worked in the early detection of cancer program at the Northwestern Health Unit before leaving that post to obtain her primary health care nurse practitioner certification by distance studies through Lakehead University.

Pernsky received her diploma in nursing from Confederation College and her BScN from Lakehead and hopes to complete her nurse practitioner course in August. As a nurse practitioner, she would like to continue working with palliative care patients in any setting.

“Assisting patients and families as they journey through the process of death requires a high level of nursing expertise,” she says. “My palliative care certificate and my RN (EC) (nurse practitioner certification) will assist me in providing the care patients require.”