We need robust programs that demonstrate measurable outcomes and are an alternative to physician-assisted suicide.
Inspired by her work as a hospice nurse, Kim Kuebler decided to further her education and begin services for rural residents in Michigan. Today, as an adult nurse practitioner in oncology with a specialization in palliative care, she runs an independent practice called Adjuvant Therapies, Inc. She provides general medical care for many adults, along with special care for people with chronic illness and cancer. Her program is based on the Macmillan nurse model that began in Great Britain in the 1970s as a way to care for cancer patients and their families in their own communities, especially those communities in which palliative care was not available. In Adjuvant Therapies’ first year, Kuebler saw more than 200 patients. Medicare and third-party reimbursement cover Kuebler’s services under codes for chronic illness.
“[The Macmillan nurse] is a time-tested model,” Kuebler said. “As a palliative care nurse practitioner, my goal is to identify patients sooner for palliative care interventions and then to stay with them throughout the course of their disease.”
According to Kuebler, this model offers patients what many Americans lack: continuity of care. She visits patients in their own homes and often consults with other health care providers in her community. She is also a nurse educator at Saginaw Valley State University. Nursing students interested in palliative care follow Kuebler to various sites and attend lectures on pain and symptom management.
“I try to pick up patients as early as possible. Half of my patients are in their seventies and eighties, and I work with them as a primary care provider,” she explained. Her work includes developing a plan of care with the patient and their families—and then following patients through until death.
“I have come across many patients who are over-drugged and poorly managed. There is a lack of understanding of what these patients need,” she said. “We can’t go on encouraging an anecdotal basis for teaching nurses—hospice care began that way, but now we have an evidence-based model.”
Kuebler also works with other professionals, primarily Carol Scot, M.D., a hospice medical director in Lansing, which is about 100 miles from Kuebler’s practice in Lake. Kuebler serves patients in four Michigan counties, covering an area whose circumference is about 100 miles.
“At first I was a little hesitant because of the distance between us,” Scot said. However, she quickly found that telecommunications kept the two in touch, and that she could visit patients a few times each month.
“The fact that her practice has grown speaks well for her,” Scot said. “In my 18 years here, I’ve seen lots of nurse practitioners who work directly with doctors in clinics where they can get a quick consult. Not many go out on their own.”
When patients need additional support, Kuebler consults with a psychologist and pastoral care services. She also works with a massage therapist.
“I don’t bring in more and more services,” she said. “If all a patient wants is a home health aide, that’s what I’ll arrange. But I don’t simply discharge a patient to hospice, I stay involved in the plan of care as their primary health care provider.”
Last fall, Kuebler traveled to Oxford, England, to observe Macmillan nurses in practice and to learn more about how they work. More recently, she was appointed to the Michigan Governor’s Advisory Committee on End-of-Life Care, on which she represents advanced nursing practice in oncology and palliative care. She will be involved in nursing education, practice and policy. A self-described political activist, Kuebler said, “We need robust programs that demonstrate measureable outcomes and are an alternative to physician-assisted suicide.”
Later this year, W.B. Saunders will publish Kuebler’s book, End-of-Life Care Clinical Practice Protocols for the Advance Practice Nurse, written with Berry and Heidrich.
For more information, contact Kuebler at 517.544.3088 or at kkkuebler@aol.com.