Palliative Care/Paon Management Nurse Prctitioner

*

603-***-**** *********@*****.***

*** ******* ******, **********, ** 03102

EVA BARGER, APRN

Hospice/Palliative Care, Pain Management

SKILLS AND PROFICIENCIES:

SYMPTOM MANAGEMENT FOR GRAVELY ILL AND/OR DYING PATIENTS I have extensive training and years of experience managing the symptoms of severely ill or dying patients in hospitals, in their homes, in nursing homes, and in hospice houses, including alleviating pain, dyspnea, nausea, vomiting, constipation, diarrhea, anxiety, depression, and more. SYMPTOM MANAGEMENT FOR CHRONICALLY ILL PATIENTS

In addition to providing chronically ill patients with the services just listed, I help them anticipate future health changes and make prudent decisions before crises occur. HELPING PATIENTS MAKE END-OF-LIFE DECISIONS:

I have a deep knowledge of end-of-life issues (physical, psychological, social, legal, and financial), acquainting thousands of patients with them and helping them make informed decisions about their life-limiting conditions and/or end-of-life concerns, including:

• UNDERSTANDING AND ACCEPTING THEIR PROGNOSES:

This is the foundation for prudent end-of-life decisions.

• UNDERSTANDING & DEVELOPING APPROPRIATE CARE PLANS: Choosing curative, aggressive palliative care, or hospice-based care.

• UNDERSTANDING & ADOPTING ADVANCED DIRECTIVES,

including DNR, DPOAH, living wills, and POLST/MOLST. RECENT EMPLOYMENT:

Catholic Medical Center (CMC)

100 McGregor Street, Manchester, NH 03102

(October 2023-April 2024)

In conjunction with just one other Nurse Practitioner and one Social Worker, I’ve provided comprehensive, compassionate palliative care to the hundreds of gravely-ill patients treated each year in Catholic Medical Center’s 330-bed full-service hospital. Physicians here have regularly asked me to work with their patients in the Emergency Room, in Intensive Care, and, of course, on Med-Surg floors. Afflictions of these patients have ranged from cancer and heart disease to neurodegenerative diseases and other less common illnesses, with quite a few afflicted with multiple diseases simultaneously. In the least urgent of CMC’s settings, I’ve helped patients (and, as appropriate, their families) understand their diagnoses and treatment options, manage symptoms, develop reasonable plans of care, complete advance directives, and (when necessary) transition to hospice care. Less frequently but more critically are those times when I’ve helped patients and their families evaluate painful options such as those associated with terminal extubation. Whether acting in crisis situations or not, my constant efforts have been to find ways to provide my patients the very best quality of life that’s possible in their particular circumstances.

• I am seeking employment elsewhere because, as part of its April 18th major Reduction in Force, CMC eliminated my position as one small part of its slashing (according to its own Press Release) of overall staffing levels by the equivalent of 142 full-time positions! 2

In my 13 years as a Palliative Care APRN

I’ve conducted countless patient visits,

including . . .

Thousands of OUTPATIENT CLINIC palliative care consults.

Thousands of IN-HOME palliative care consults.

Hundreds of IN-HOSPITAL palliative care consults.

Hundreds of HOSPICE VISITS for symptom management needs.

Hundreds of RECERTIFICATIONS of current hospice patients. I’ve initiated and conducted

thousands of discussions . . .

With GRAVELY or TERMINALLY-ILL patients covering their . . .

• PROGNOSIS

• GOALS OF CARE

• MEDICAL PLAN OF CARE

(curative vs. life-prolonging, palliative vs. hospice)

• ADVANCE DIRECTIVES

(including DNRs, POLST, living wills, and DPOAs).

And with FAMILY MEMBERS AND HEALTH CARE PROVIDERS about . . .

• GOALS OF CARE

• END-OF-LIFE CARE

• HOSPICE ELIGIBILITY

In those same years, I’ve collaborated . . .

With 100+ LOCAL AND REGIONAL PROVIDERS

I’ve provided palliative advice and/or services to the patients of far more than 100 New England area providers, including PCPs and specialists in pulmonology, nephrology, neurology, oncology, and other fields, plus directors of nursing homes and assisted living facilities, coordinating care and providing clinical assessment and recommendations.

With SCORES OF MEDICAL FACILITIES

I’ve provided palliative medical services at the following NH facilities: Catholic Medical Center, Bel Air Nursing Home, Courville at Nashua, Fairview Nursing Home, Hillsborough County Nursing Home, the Hospice House of Home Health & Hospice

(HHHC), Langdon Place, Laurel Center, Mt. Carmel Nursing Home, Nashua Crossings, Ridgewood Center, Southern NH Medical Center, St. Teresa Nursing Home, Villa Crest Nursing Home, High Pointe House in Haverhill, MA, as well as a score of other similar facilities in Massachusetts.

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With MANY IN-HOSPITAL PALLIATIVE CARE TEAMS

In addition to my current work in-house at CMC, I’ve worked closely with the Palliative Care Teams at Massachusetts General Hospital, Catholic Medical Center, Elliot Hospital, Concord Hospital, and St. Joseph’s Hospital.

With MEMBERS OF LARGER, SOMETIMES SKEPTICAL COMMUNITIES I forged for Dartmouth Health as well as for Home Health and Hospice strong working relationships with many community physicians, confirming in the minds of many the value of palliative care for providers and for their patients, thereby overcoming their reluctance to entrust their patients to palliative care.

With ANALYSIS AND PLANNING TEAMS

I researched and then drafted for Dartmouth Health as well as for Home Health & Hospice a detailed program analysis, delineating its strengths and weaknesses while identifying ways to strengthen it while increasing its profitability and providing better patient care. Dartmouth Health

87 McGregor Street, Manchester, NH 03102

(November 2015-July 2023)

In Dartmouth’s outpatient clinic and in homes as well, I provided direct care as well as consultation services to patients with serious, complex (and often terminal) illnesses, including persons suffering from various forms of cancer, advanced pulmonary disease, cardiac disease, and neurological disorders. I alleviated their symptoms and worked with providers from other disciplines to promote the best quality of life possible for these patients. I helped them develop reasonable plans of care, complete advance directives, and (when appropriate) transition to hospice. From January 2017 to April 2018, I served as the sole palliative care provider for all of Dartmouth Hitchcock in Southern New Hampshire and, for almost three years, was an integral part of Dartmouth Health’s ALS clinic in Manchester.

• After almost eight years of service there, I was forced to seek employment elsewhere when Dartmouth Health abruptly shut down all of its palliative care clinics in Southern New Hampshire. Merrimack Valley Hospice

360 Merrimack Avenue, Lawrence, MA 01843

(May 2014-October 2015)

For Merrimack Valley Hospice and the associated Home Health VNA, in homes, nursing homes, and assisted living facilities, and at the 21-bed Merrimack Valley Hospice House, I undertook and/or directed patient care and consultation services for a) The Hospice Program

b) The Palliative Care Program.

In those settings, I managed patients’ symptoms, initiated discussions with those who had life-limiting conditions and developed plans of care for them, served as a consultant to area physicians and facilities needing these services, provided on-call care for approximately 80 seriously-ill patients at a time, in their homes and in the High Pointe Hospice House, and collaborated with a team of nurses, therapists, and others who worked with us to provide those services. Once a week, I was the sole provider of all care for patients in this 21-bed hospice house. This included admissions, symptom management, and addressing psycho-social concerns of patients and their loved ones, while simultaneously managing the needs of my in-home palliative care patients.

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Home Health and Hospice Care

7 Executive Park Drive, Merrimack, NH 03054

(July 2011-May 2014)

For Home Health and Hospice Care (HHHC) in Merrimack, NH, at Catholic Medical Center in Manchester, at the Hospice House in Merrimack, in local homes, nursing homes, assisted living facilities, and elsewhere. I provided palliative care for symptom management and developed plans of care for hundreds of seriously-ill patients suffering from illnesses ranging from cancer and heart disease to neurodegenerative diseases and other less common illnesses. In that time, among other things, I served as:

The primary medical provider for HHHC hospice patients under 65 (July-Dec 2012)

The founding prescriber and sole medical provider of the Advanced Illness Management (AIM) Program of Home Health and Hospice. During my tenure at HHHC, my AIM Program

• Quickly brought under control the manifold distressing and life- limiting symptoms of the majority of its patients, discharging them to hospice care.

• Successfully treated many of these patients, discharging them from the home palliative care program with their symptoms well-managed.

One day a week for five months, I was HHHC’s sole prescriber, simultaneously covering all hospital consults, on-call hospice needs, and all palliative care services. I was also the sole prescriber for patients under 65 at HHHC’s hospice house.

AS THE SOLE PRESCRIBER IN THE HHHC ADVANCED ILLNESS MANAGEMENT (AIM) PROGRAM, I PROVIDED:

• PRESCRIBER SERVICES: I guided and/or provided all prescriber-level AIM Program medical services, working closely with area medical facilities, physicians, home health nurses, and other medical personnel to provide better post-hospitalization care for their patients, thereby reducing needless patient suffering and reducing the number of relapses and hospital readmissions.

• ADVANCED ILLNESS TEAM OVERSIGHT: I was the sole provider of medical oversight for the AIM Team, which, in addition to me, consisted of five registered nurses, two social workers, and, as needed, physical therapists, occupational therapists, speech therapists, and LNAs. Together, we regularly cared for 40+ patients in the AIM Program, plus others with chronic symptom management needs.

• IN-HOUSE EDUCATION: Formally and informally within HHHC, I provided ongoing education about the nature, criteria, and benefits of palliative care in general and the AIM Program in particular.

• COMMUNITY EDUCATION: Formally and informally within the local healthcare community, I provided ongoing education about the nature, criteria, and benefits to patients and providers of palliative care in general and the AIM Program in particular and worked to generate goodwill for both services by caring well for those patients enrolled in them.

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EDUCATION AND DEGREES

MSN in ADULT HEALTH/PALLIATIVE CARE

Boston College, Connell School of Nursing, Chestnut Hill, MA May 2011 AA in NURSING, Manchester Community College, Manchester, NH June 2007 BA in LIBERAL ARTS, Magdalen College, Bedford, NH May 1984 LICENSES AND CERTIFICATIONS

Hospice and Palliative Care APRN (Certified by the HPCC) Dec 2027 exp. Adult Nurse Practitioner (Certified by the ANCC) June 2026 exp. APRN License (NH) Dec 2024 exp.

RN License (NH) Dec 2024 exp.

BLS Certification ` May 2025 exp.

DEA License Jul 2026 exp.

CURRENT AND/OR PAST STAFF PRIVILEGES

Catholic Medical Center Manchester, NH

Dartmouth Hitchcock Medical Center Lebanon, NH

Southern New Hampshire Medical Center Nashua, NH

MEMBERSHIPS AND AFFILIATIONS

American Nurses Association

Hospice and Palliative Nurses Association

American Academy of Nurse Practitioners

American Academy of Hospice and Palliative Medicine New Hampshire Nurses Association

PALLIATIVE CARE PRECEPTING

Many semesters of precepting clinical rotations in palliative care for final-year MSN/APRN students from Boston College and UMass Lowell. LECTURES (PRE-PANDEMIC)

“Palliative care for medical/surgical patients” Catholic Medical Center Fall 2011

“Palliative care for elderly patients” Hillsborough County Nursing Home Fall 2011

“Palliative care for heart failure patients” Catholic Medical Center Dec 2012

“Breaking Bad News” Hospice and Palliative Care Federation of Massachusetts Nov 2016

“Therapeutic Cannabis in NH State Law” Norris Cotton Cancer Center Jan 2018 6

References

CATHOLIC MEDICAL CENTER

Manchester, NH

HOSPICE/PALLIATIVE MEDICINE

475-***-**** Anand Cadan, MD

908-***-**** John Mattera, MSW

802-***-**** Hannah Ruede, APRN

603-***-**** Pamela Hickey, MSW

HOSPITALISTS

475-***-**** Mohammed Essa, MD

617-***-**** Michael Malkowski, MD

347-***-**** Pavel Loginov, MD

585-***-**** Hassan Mohamed, MD

603-***-**** Amanda Boutrus, MD

718-***-**** Uzma Naaz, MD

617-***-**** Magdi Zordok, MD

201-***-**** Munder Abuaisha, MD

CASE MANAGERS

978-***-**** Anika Meade, RN

603-***-**** Diane Brace, MSN

603-***-**** Maegan Cudworth, MSW

DARTMOUTH HEALTH

Manchester, NH

ONCOLOGY

215-***-**** Ivy Wilkinson-Ryan, MD

816-***-**** Manik Amin, MD

603-***-**** Simon Khagi, MD

860-***-**** Lindsey Nelson, APRN

617-***-**** Gabriele Southgate, MD (ret.)

PULMONOLOGY

603-***-**** Joseph Hou, MD

603-***-**** Richard Read, MD

LAMPREY HEALTH CARE

Newmarket, NH

INTERNAL MEDICINE

603-***-**** Mary Braun, MD

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