NACC Module 14 - Care of the Dying Person and their Family

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Orientation slides used in Instructor Development Day, orientation for instructors teaching the new NACC PSW Program Module 14.
Integrating palliative education on a palliative approach in end of life care.

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  • Preparation and on the invitation to the webinar:Please review and then bring the new NACC PSW Module 14 “Essentials in Hospice Palliative Care” companion resources to the webinarIdentify learning needs related to teaching Module 14Submit topics to kath@lifeanddeathmatters.caInstructor Guide:Print a copy of the Instructors Guide:
  • Know how to contact us at LDMBe comfortable integrating the revised Module 14 using - “Essentials in Hospice Palliative Care” resourcesSubmit your questions/concernsGet to know you!Wish we could be gathered around a nice campfire, browning marshmallows, and staring at the night sky while discussing Module 14!FocusModule 14, and the Essentials Resources.However, you may have some other questions/concerns.If I can not address them easily right now, then I will get back to you with the answers, send group email/phone.
  • Know how to contact us at LDMBe comfortable integrating the revised Module 14 using - “Essentials in Hospice Palliative Care” resourcesSubmit your questions/concernsGet to know you!Wish we could be gathered around a nice campfire, browning marshmallows, and staring at the night sky while discussing Module 14!FocusModule 14, and the Essentials Resources.However, you may have some other questions/concerns.If I can not address them easily right now, then I will get back to you with the answers, send group email/phone.
  • Poll
  • Put your comments in the chat lineMost people do not receive the support of a specialized HPC team.Most people die with chronic illness, and are not identified as dying until the last days.Therefore, if we want to provide great care for people through end of life, good symptom management, wholistic care, etc… then we need to integrate a palliative approach in our caregiving… People should not have to die in pain because no one realized they were dying imminently.Baby Boomers have started turning 65. Not long before they start to reach the age of life expectancy.1/5 people over 65 in 2026 as opposed to 1/20 over 65 a hundred years ago!Number of deaths CHPCA by 2056 – Annual death rate will double to almost 480,000Length of stay in careNumber of caregivers decreasingLength of time requiring care increasingBaby Boomers are coming! BCAHC, Canadian Strategy for Cancer Control, Task Force: “How are we going to prepare the coming workforce to care for our aging and dying?”Realized that if funding was provided it would go first to doctors, nurses, social workers… and then maybe… to the Practical Nurses… and PSWs.Time to just get moving. Colleges asked us to develop study guides, we looked at the other expressed challenges, and started to try to meet the diverse needs of students and instructors and colleges.“……palliative care is a place, an inpatient unit where people go to die and where they are cared for by nurses, physicians, and counsellors specializing in palliative care. These students, mostly nurses working in critical care, acute medicine,emergency, or long-term care, did not know that they could providequality palliative care where they were, or that their many patients withchronic life-limiting conditions could benefit from application of palliativecare principles. Palliative care is for people with cancer, they believed — people who are best cared for by those who specialize in this form of care, in places (hospices, palliative care units, home) where dying people should be cared for. These nurses believe that where they work is the “last best place” for people to die — even though most Canadians, in fact, die in inpatient health-care settings. The moral distress felt by these nurses when they are not able to access specialized palliative services on behalf of their patients is palpable. Reliance on specialized services is partly responsible for the nurses believing that they are not equipped to care for the dying or that care of the dying is not within their remit.”    Chronic Illness, Palliative Care,and the Problematic Nature of DyingBy Kelli StadjuharCJNR 2011 Vol. 43 No 3, 7 –15 Who Is in Need of Palliative Care?Specialized models of palliative care have historically been developed forcancer patients. It is now recognized, however, that individuals withchronic conditions such as heart disease, stroke, chronic respiratory illness,diabetes, dementia, and renal disease could greatly benefit from applicationof the principles of palliative care (Kristjanson, 2005).  Current models of palliative care — primarily specialist models — arenot necessarily appropriate to meet the needs of the expanding populationof people who could benefit from application of the principles ofpalliative care.  A “palliative approach” has been recommended as one way of applying specialized knowledge in the field of palliative care to a wider range of patients, with a variety of diagnoses, cared for in a variety of settings, at earlier stages in the illness trajectory (Kristjanson, 2005).  A palliative approach takes the principles of palliative care and applies them tothe care of any sick person, regardless of their illness (Katz & Peace,2003).  A palliative approach does not closely link the provision of carewith prognosis, but focuses on conversations with patients/families abouttheir needs and wishes; comfort measures; support for psychosocial, spiritual,and cultural issues; information requirements; and provisions fordeath and for care after death (Coventry, Grande, Richards, & Todd, 2005;Jackson, Mooney, & Campbell, 2009).  A palliative approach recognizes that, although not all people with life-limiting illness require specialized palliative services, they do require care that is aimed at improving quality of life by preventing and relieving suffering through early identification, assessment, and treatment of physical, psychosocial, and spiritual concerns(Krisjanson, Toye, & Dawson, 2003).  In short, a palliative approach differs little from respectful, compassionate, knowledgeable nursing care for patients and their families at any point in the health–illness trajectory.
  • Of the 70% who will die over years, less than half will have advanced warning, and will know in advance that they are dying.
  • Please apologize if the PSWs are not impressed with this terminology! 
  • Have a look at your copy of Module 14Comment?Questions?Content?
  • Have a look at Module 14, the outlineLook at the Instructors Guide….Instructors Guide/Teachers Guide
  • Option #2 - Instructor determines how to allocate the marks for the Study Guide, notifies students of the 35 questions that will be marked. Include a combination of questions from Baggage and Beliefs, Concepts and Content, and Integration and Application. (from NACC to the college)
  • Competency basedDeveloped to address diverse learning needsCan be adapted to meet the needs of your students
  • What do you see?
  • What do you see?Study guide – activities to explore beliefs and baggage (attitudes), learn new concepts and content (knowledge) and then try these new ideas out in integration and application (skills)Marking:
  • Put your comments in the chat line….
  • What provides comfort to you?Look at what you brought with you today – in your backpack, purse, pocketsWrite on a white board….
  • Always easier to critique someone else’s work, see what is missing, what you want to add… etc.. Than it is to start from scratch.
  • Audio recordings ~ 10 min – available 24/7 on the internetRole plays to illustrate specific topics, guest lectures from subject matterexperts, communication skills demonstrationsOver 60 titles,Accessing PodcastsInformation, links to arrive by August 30thWill receive a key to access podcats according to the number orderedOne year subscription
  • Estimated teaching timeLearning outcomesResources at a glanceInstructor prepStudent prepLesson plan: discussion, presentationsActivities, group activities, options
  • Too much information, too much of any good thing is difficult…. So look at the resources, and choose the priorities for your group.You students, your clinical,….
  • Audio recordings ~ 10 min – available 24/7 on the internetRole plays to illustrate specific topics, guest lectures from subject matterexperts, communication skills demonstrationsOver 60 titles,Accessing PodcastsInformation, links to arrive by August 30thWill receive a key to access podcats according to the number orderedOne year subscription
  • Be in touch with us! If you have concerns, questions, celebrations, let us know!
  • Provide straws and perform activity as discussed in the video or shown on page 61 textTeaches people about the experience of dyspnea, a common symptom at end of lifeHelps people to better understand the patient’s experienceHelps people know how to respond if/when they care for a person with dyspneaAsk for feedback on the straw experience – what did they feel?Straw exercise – Page 61 TextReflection ActivityFor this exercise you will need three drinking straws and a spaceto walk. Persons with respiratory or heart problems should not dothis exercise.ExerciseTake one of the straws and pinch one end in half lengthwise so youcan squish it into the end of the next straw. Repeat with the thirdstraw. You should now have all three straws forming a single extralongstraw that you can breathe through with some tension.Take the long straw and put one end in your mouth. Plug your nose.While breathing only through the straw with your nose pluggedwalk for 2 minutes.ReviewWhat you have just experienced may give you a sense of whatsome patients experience on a daily basis—dyspnea.What did that feel like? Select three adjectives to describe thesensation. What if that sensation happened spontaneously? Whatwould you think had happened?Take a moment to breathe deeply (without the straws!) and enjoythe deep easier breaths.
  • Put your comments in the chat line….
  • What provides comfort to you?Look at what you brought with you today – in your backpack, purse, pocketsWrite on a white board….
  • Put 2 or 3 of the arbutus tree images hereIllustrate growth at the edgeGrowth in the face of adversityWe see this in hospice care, in patients, families and caregivers.It helps to nurture us in the caregiving.Arbutus tree is also a symbol of the caregiving community – as they prepare to deal with the changing face of dying and death in the 21st century
  • We truly hope this materials will be exciting for both the educators and the students!
  • NACC Module 14 - Care of the Dying Person and their Family

    1. 1. Assisting the Person Who is Dying and Their Family:Essentials in Hospice Palliative Care National Association of Career Colleges Revised Module 14 November 3, 2011 1
    2. 2. Goals• Intro new Module 14 & Essentials in HPC resources• Know how to access: • instructors guide, podcasts, order forms, LDM•Q & A• Demo 2
    3. 3. Goals 3
    4. 4. Your goals 4
    5. 5. Why? 5
    6. 6. Exciting time to be alive…• Boomers started turning 65 this year.• Demographics • 100 years ago • 1/20 people over 65 years • 2026 1/5 people over 65.• Annual death rate • By 2056 the annual death rate will have nearly doubled. 6
    7. 7. Interesting time to be dying… Dying is not what we think it is… 7
    8. 8. Pattern of dying has changed…• 10% unexpected - heart attack/accident…• 20% cancer, often with some warning• 30% chronic organ failure, • ups and downs • on deaths doorstep numerous times• 40% dwindling, (>50% with dementia) 8
    9. 9. The challenge…• Decreased length of time requiring care• Decreased family caregivers• Decreased beds per capita, • LOS reduced from 43 months twenty years ago, to only 14 months now. 9
    10. 10. PSWs….Provide 80% of care in long term care 10
    11. 11. Hospice Palliative Care• Gold standard of end of life care• Less than 25% of dying Canadians access the services of a specialty hospice team 11
    12. 12. The good newsNot everyone needs a specialty team! 12
    13. 13. But most people benefit from …. 13
    14. 14. A palliative approachPalliative principles and practices• Anyone with a life limiting illness• Earlier in the disease process• In any setting 14
    15. 15. Don’t let “End of Life Care” become “End of the Road Care” –Integrate Palliative Education! 15
    16. 16. Module 14 16
    17. 17. TerminologyPersonal Support Worker = Health Care Worker Assessment = Gathering information 17
    18. 18. Module 14 18
    19. 19. Module 14 – Assisting the person who is dying and their family: Essentials in HPC • Time – 22 hours • Learning outcomes • Content guidelines • Resources (Instructors Guide, Text, Study Guide, Podcasts, PPT, DVD) • Evaluation (Study Guide, Group Assignment, Final Test) 19
    20. 20. Content - sessions• HPC principles, philosophy• “On being up close & personal w/ the dying”• Physical comfort - common issues• Care in the last days & hours and following death• Self care 20
    21. 21. Evaluation• Study Guide 35%• Group Assignment 20%• Final Test 45% 21
    22. 22. Marking the Study Guide• Beliefs and Baggage (participation)• Content and Concepts (answer key) • Based on learning needs, •choose 35 questions, •include B&B, C&C, I&A 22
    23. 23. Group Assignment• Information for the instructor• Information for the students• Marking scheme (give students a copy)• Case Study #1 • Patient role • PSW role 23
    24. 24. Module 14 is supported by“Essentials in HPC Resources” 24
    25. 25. Essentials Text 25
    26. 26. Study Guide 26
    27. 27. Beliefs and Baggage• Following the exercise on breathing with a straw, … write about your experience with difficult breathing. What did this feel like to you? 27
    28. 28. Concepts and Content• List physical behaviours that you might observe with …. 28
    29. 29. Integration and Application• Case Studies• Questions• Apply in • Lecture • Lab • Clinical setting 29
    30. 30. Teaching Presentations: PPTs 30
    31. 31. Lecture notes for instructors include: Links to resourcesKey pointsSupplementalinformation for use atinstructor’s discretion. 31
    32. 32. “Customize”You can •Personalize for particular needs •Localize for each community 32
    33. 33. Videos 33
    34. 34. Podcast Library 34
    35. 35. Warehouse• Let’s pull it all together… 35
    36. 36. Instructor’s Guide• pulling it all together! 36
    37. 37. Instructors Guide - Outline• Intro• Page 13-16• Comments? Questions? 37
    38. 38. Instructors Guide – see handout • Intro • Allocated teaching time (22 hours) • Learning Outcomes • Resources at a Glance, supplies • Instructor prep • Student prep • Lesson Plan 38
    39. 39. 39
    40. 40. Guide 40
    41. 41. Technical details 41
    42. 42. Instructor’s Guide – download• http://lifeanddeathm atters.ca/facilitators- forums/instructors- guide.html 42
    43. 43. 43
    44. 44. 44
    45. 45. 45
    46. 46. How to access the podcasts 46
    47. 47. 47
    48. 48. 48
    49. 49. 49
    50. 50. 50
    51. 51. Order form 51
    52. 52. Life and Death Matters contact info• info@lifeanddeathmatters.ca• admin2@lifeanddeathmatters.ca• kath@lifeanddeathmatters.ca 52
    53. 53. PowerPoint posted online:Shareslide – see onlinehttp://www.slideshare.net/lifeanddeathmatters 53
    54. 54. 54
    55. 55. Break 55
    56. 56. 56
    57. 57. Group Assignment• Information for the instructor• Information for the students• Marking scheme (give students a copy)• Case Study #1 • Patient role • PSW role 57
    58. 58. Let’s walk through one session - Dyspnea • Teaching Time: 1.5 hours • (with Comfort Basket add .5 hours) 58
    59. 59. Learning OutcomesAt the end of this unit learners will be able to:• Experience dyspnea through participation in the exercise.• Identify 5 questions to ask and what to observe.• Identify three comfort measures for preventing or alleviating discomfort with dyspnea.• Provide a sample report on a patient experiencing respiratory congestion with dyspnea, including a request for nurse’s help. 59
    60. 60. Resources at a glance 60
    61. 61. Supplies, Preparing• Bring in three straws…• Instructor Preparation • Familiarize self with the material • Preview dyspnea video • Comfort basket? • Choose activities, discussion points, 61
    62. 62. Videos 62
    63. 63. Video ActivityStraw exercise –See also page 61 text 63
    64. 64. Beliefs and Baggage• Following the exercise on breathing with a straw, … write about your experience with difficult breathing. What did this feel like to you? 64
    65. 65. PowerPoints – Dyspnea 65
    66. 66. DYSPNEATHE FEELING OF BREATHLESSNESS pgs. 60-68 66
    67. 67. What to look/listen for• (Respiratory rate) • Shortness of breath on• Breath sounds exertion?• Periods of shortness of • Does it settle with breath? rest?• Pauses for breath when • Cough/congestion talking? • Skin color • Fever • Anxiety or fear 67
    68. 68. Concepts and Content• What you might observe when someone is having difficulty breathing: 68
    69. 69. Assessing DyspneaASK the Patient: • “Do you ever have difficulty breathing? • Rate dyspnea with ESAS (text pg.30) • "OPQRSTUV" 69 pgs. 62-63
    70. 70. Integration and ApplicationStudy Guide – p.30Using assessment toolask person abouthis/her breathing 70
    71. 71. Guiding through an acute episode • Acknowledge patient’s “I can hear that you are uncomfortable…” • Touch may help ground individual • Provide a focus message “Look in my eyes…” “Breathe with me…” pg. 67 71
    72. 72. Comfort Basket• Dyspnea presentation….• May want to include the comfort basket here as well 72
    73. 73. 73
    74. 74. THE ARBUTUS TREE 74
    75. 75. The Arbutus TreeA symbol of…• Strength • surviving and thriving in harsh conditions• Growth at the edge between land and sea, between life and death 7575
    76. 76. 7676
    77. 77. Teaching is in invitation to learn And learning is an invitation to teach…. 77
    78. 78. Poem by Deanna Edwards Teach me to die Hold on to my hands I have so many questions Things I don’t understand Teach me to die Give all you can give If you teach me of dying I will teach you to live 78
    79. 79. Thank you!• Feedback and evaluation• kath@lifeanddeathmatters.ca• info@lifeanddeathmatters.ca 79
    80. 80. Facebook, Twitter, LinkedIn….• http://www.facebook.com/LifeAndDeathMatters• Twitter - @LDMatters• LinkedIn - Katherine (Lees) MURRAY• Blog - www.lifeanddeathmatters.ca 80

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