NURS 6331: Screencast Lesson Plan Lesson Overview Name: Screencast Title: End of Life Interventions: Can they cause more harm than good? Environment: (on-site, online, or hybrid) On-Line Screencast Goal: To teach nursing students and nurses that at the end of life IV hydration, tube feeding and forced feeding may not be beneficial to the patient. Description of Screencast lesson: This screencast begins with a scenario of a patient at the end of her life. With this patient in mind, the screencast will review whether IV fluids, Tube Feedings and forced feedings are appropriate at the end of life. The screencast will then discuss some interventions that may provide end-of-life comfort. Learning Objectives · At the end of this screencast, learners will be able to analyze the use of IV Fluids, Tube Feeding and Forced Feedings at end-of-life · At the end of this screencast, learners will be able to describe interventions which may not be beneficial at the end-of-life and why Identify at Least One in Each Area Pre-Licensure QSEN Competencies Integrated Processes Clinical Relationships 1. Patient-centered care FORMCHECKBOX 2. Teamwork and collaboration FORMCHECKBOX 3. Evidence-based practice (EBP) FORMCHECKBOX 4. Quality Improvement (QI) FORMCHECKBOX 5. Safety FORMCHECKBOX 6. Informatics FORMCHECKBOX 1. Nursing process FORMCHECKBOX 2. Caring FORMCHECKBOX 3. Communication and documentation FORMCHECKBOX 4. Teaching/ Learning FORMCHECKBOX 1. Varied sources of data FORMCHECKBOX 2. Similar options FORMCHECKBOX 3. Prioritization FORMCHECKBOX 4. Teaching FORMCHECKBOX 5. Notes: ​​​​​​​​​​​​ FORMCHECKBOX ______________ Rationale: Rationale: Rationale: Script Actions on Screen Audio/Narrative PowerPoint Slide: Interventions at the End-Of-Life: Do they cause more harm than good This screen cast, intended for nursing students and nurses will discuss interventions at the end of life and whether they may be causing more harm than good. PowerPoint Slide: Learning Objectives · Analyze the use of IV Fluids, Tube Feeding and Forced Feedings at end-of-life · Determine why some interventions are not beneficial at the end-of-life · The learning objectives for today’s screencast are to analyze the use of interventions at the end of life such as IV fluids, Tube Feeding, and Forced Feeding. We will determine why these interventions may not always be beneficial to patients and discuss those interventions which may provide comfort at the end-of-life PowerPoint Slide: Scenario · A 97 year old patient at the end of life wants to die and wants to be left alone. Her family wants to do everything in their power to keep her alive as long as they can. · Picture An elderly patient (Mrs. Lovely), has reached the end of her life. She is 97 years old, has dementia, congestive heart failure and end stage kidney failure. She has expressed that she is ready to die. She has no desire to eat or drink and no longer wants t.

1. NURS 6331: Screencast Lesson Plan
Lesson Overview
Name:
Screencast Title:
End of Life Interventions: Can they cause more harm than
good?
Environment:
(on-site, online, or hybrid)
On-Line
Screencast Goal:
To teach nursing students and nurses that at the end of life IV
hydration, tube feeding and forced feeding may not be
beneficial to the patient.
Description of Screencast lesson:
This screencast begins with a scenario of a patient at the end of
her life. With this patient in mind, the screencast will review
whether IV fluids, Tube Feedings and forced feedings are
appropriate at the end of life. The screencast will then discuss
some interventions that may provide end-of-life comfort.
Learning Objectives
· At the end of this screencast, learners will be able to analyze
the use of IV Fluids, Tube Feeding and Forced Feedings at end-
of-life
· At the end of this screencast, learners will be able to describe
interventions which may not be beneficial at the end-of-life and
why
Identify at Least One in Each Area
Pre-Licensure QSEN Competencies
Integrated Processes

2. Clinical Relationships
1. Patient-centered care FORMCHECKBOX
2. Teamwork and collaboration FORMCHECKBOX
3. Evidence-based practice (EBP) FORMCHECKBOX
4. Quality Improvement (QI) FORMCHECKBOX
5. Safety FORMCHECKBOX
6. Informatics FORMCHECKBOX
1. Nursing process FORMCHECKBOX
2. Caring FORMCHECKBOX
3. Communication and documentation FORMCHECKBOX
4. Teaching/ Learning FORMCHECKBOX
1. Varied sources of data FORMCHECKBOX
2. Similar options FORMCHECKBOX
3. Prioritization FORMCHECKBOX
4. Teaching FORMCHECKBOX
5. Notes: FORMCHECKBOX
______________
Rationale:
Rationale:
Rationale:
Script

3. Actions on Screen
Audio/Narrative
PowerPoint Slide:
Interventions at the End-Of-Life: Do they cause more harm than
good
This screen cast, intended for nursing students and nurses will
discuss interventions at the end of life and whether they may be
causing more harm than good.
PowerPoint Slide:
Learning Objectives
· Analyze the use of IV Fluids, Tube Feeding and Forced
Feedings at end-of-life
· Determine why some interventions are not beneficial at the
end-of-life
·
The learning objectives for today’s screencast are to analyze the
use of interventions at the end of life such as IV fluids, Tube
Feeding, and Forced Feeding. We will determine why these
interventions may not always be beneficial to patients and
discuss those interventions which may provide comfort at the
end-of-life
PowerPoint Slide:
Scenario
· A 97 year old patient at the end of life wants to die and wants
to be left alone. Her family wants to do everything in their

4. power to keep her alive as long as they can.
· Picture
An elderly patient (Mrs. Lovely), has reached the end of her
life. She is 97 years old, has dementia, congestive heart failure
and end stage kidney failure. She has expressed that she is
ready to die. She has no desire to eat or drink and no longer
wants to take medication. Her family wants her to try IV fluids,
and possibly insert a feeding tube since she is not eating. They
want try to force her to eat when she does not want to. Mrs.
Lovely has an advance health care directive that states she does
not want any interventions at end of life. Let’s keep this patient
in mind as we go through possible interventions.
NOTE: This slide and corresponding narrative were deleted due
to time constraints.
PowerPoint Slide:
As nurses we want to help
· As nurses we are taught non-maleficence: “to do no harm”
· At the end of life are we doing harm by not doing everything
in our power to safe a patient?
· Picture
As nurses, we are taught to do everything we can to help a
patient and keep them alive. At the end of life, if a patient has
made the decision that they are ready to die and they do not
want any interventions, we, as health care practitioners must
learn to respect that and let the patient “just be”
PowerPoint Slide:

5. Commonly Requested Interventions
· At end of life, there are interventions commonly requested
IV Fluids
Tube Feeding
Feeding a patient who does not want to eat
· Picture
As patients are dying, their requests become very few. Family
members and caregivers however, often want to do things to
prolong a patients life. Examples of these life prolonging
measures are IV fluids, Tube Feeding and trying to force a
patient to eat or drink when they no longer have the desire
PowerPoint Slide:
Instead of providing energy and nutrients to the patient, IV
fluid can cause the opposite effect and result in:
·
Swelling
·
Pain
·
Difficulty breathing
The addition of fluids at end of life is sometimes requested by

6. family members so the patient does not get dehydrated.
Research shows that IV fluids at the end of life do not prolong
life or add to quality of life. IV fluids may have the opposite
effect and can cause swelling, pain, dyspnea or even congestive
heart failure. With the addition of these complications, it may
shorten a patient’s life rather than prolong it. If Mrs. Lovely
got IV fluids at this point, it may be difficult to find a vein,
even the insertion could be traumatic. Once the IV is inserted,
the fluid may “third space” or go into areas that the fluid was
not intended for. It could cause Mrs. Lovely great discomfort.
Mrs. Lovely already has congestive heart failure. The fluid may
cause her more harm than good. Are there situations where IV
fluids might be appropriate at the end of life? Think about his
here. Record your thoughts, do some research and be prepared
to discuss this when at our next class.
PowerPoint Slide:
Tube Feeding
· For a person at the end of their life, their body may not have
the strength to process the nutrients of tube feeding.
· Picture
When a person’s body shuts down at end-of-life, they will most
likely not be able to endure the surgery that it takes to insert a
feeding tube and they may not be able to process the nutrients
from a tube feeding. If the patient cannot process the nutrients,
symptoms of bloating and discomfort may occur. This
counteracts the goal of comfort at the end of life. Mrs. Lovely
would not be a candidate for surgery as she has congestive heart
failure and her heart would not withstand the surgery.
PowerPoint Slide:
Feeding at the end-of-life

7. · Losing appetite at the end of life is normal
· Forcing someone to eat when they do not want may take away
from their quality of life
· Eating can add to discomfort, the goal is to provide comfort
· When individuals choose to stop eating or drinking it can be
their way of taking charge of the completion of their life
· Picture
It is hard for family members and caregivers to see their loved
ones lose the desire to eat or drink. You don’t have to force a
person to eat. Going without food and/or water is generally not
painful, and eating can add to discomfort. Loss of appetite is
normal and is a part of dying. Patients may have lost the ability
to swallow, especially if they have dementia. They may have
forgotten how to swallow. Sometimes, giving up food or drink
is the one thing that a person can control in their dying process;
it may be their way of accepting their death. Mrs. Lovely has
refused food for 3 days now and her family is distraught
because they feel they are starving her. How would you explain
to the family that feeding is not beneficial at this point? Make a
video (maximum 3 minutes) with your explanation and upload it
to the blackboard under discussions by day 7.
NOTE: This slide and corresponding narrative were deleted due
to time constraints.
PowerPoint Slide:
Interventions that may provide comfort
· Some interventions may be appropriate for comfort, they

8. include:
Foley Catheter
Suppositories
Paracentesis/Thoracentesis
Antibiotics
There are some interventions that are palliative, may be
appropriate and may provide additional comfort at the end of
life. In my experience, if an individual has discomfort in their
body, it may be keeping them from being at peace and
preventing them from dying. When the patient is comfortable,
they, many times, die after. I had recent scenarios when a
suppository for a patient with a fever who could not longer
swallow, she died as soon as her fever went down. In another
scenario, a patient who was retaining urine, died shortly after a
catheter was inserted and 1000 cc of urine was obtained. For
patients with excess fluid in their lungs or abdomen, if they can
get to an outpatient clinic, it is often beneficial to drain the
fluid so that they can breathe better, it often gives patients a
better quality of life. If a patient has a fever due to infection
either in their lungs or in a wound, antibiotics can relieve the
infection can provide the patient comfort.
Note: This slide was deleted due to time constraints. The
patient’s handouts are available in the reference section.
PowerPoint Slide:
Handouts
IV Hydration

9. ·
Link 1
Tube Feeding and Eating and the end-of-life:
· Link 2
These handouts, although informative to health care providers
are intended for patients to give them an understanding of the
implications of IV Hydration, Tube Feedings and Forced
Feedings at the end-of life.
PowerPoint Slide:
References
Here is a consolidated list of references related to comfort
measures at the end of life. Feel free to use these references as
information for yourselves and your patients as questions come
up about end-of-life interventions
Picture
Here is a picture of my grandmother and my son. She was able
to die at home, with no interventions as she wished. My son and
I were able to visit her 3 months before she died. This picture
captures the essence of my grandmother’s dying journey.
As follow up, please look at the links provided in the reference
section and print out the handouts provided. Be prepared to
come to class to discuss your thoughts on “letting your patient
be” when it is their time and your thoughts on being
comfortable letting a person die when it is their time.
Thank you for listening to this screencast. Feel free to leave any
feedback in the comments when you are submitting your

10. assignments.
Thank you for listening to this screencast. Feel free to leave any
feedback in the comments when you are submitting your
assignments.
Evaluate and Revise
If I were to recreate my Screencast, I would:
Do as I have done and incorporate Feedback from Instructor:
1) Added references and handouts for the audience and their
patients
2) Added pictures
3) Added to the narrative that the patient had an Advance
Health Care directive indicating her wishes
Self Observation:
1) The objective was removed indicating that after the
screencast, students will be able to describe interventions which
may be appropriate for the end of life. This section was
removed from the PowerPoint due to time constraints and
therefore should be removed from the objectives. There is
however, a task in the screencast for the students to research
this topic for class.

11. Rubric for Video: Explaining End of Life Interventions to
Family
Teacher Name: R Garrison

12. Student Name:
________________________________________
CATEGORY
4
3
2
1
Score
Concept
Student has a clear picture of what they are trying to achieve.
Student can describe what they are trying to do and generally
how his/her work will contribute to the knowledge base of the
family of a dying patient.
Student has a fairly clear picture of what they are trying to
achieve. Student can describe what they are trying to do but has
dome trouble describing how his/her work will contribute to the
knowledge base.
Student has a fairly clear picture of what they are trying to
achieve but has difficulty describing it to the audience.
Student does not have a clear picture of what they are trying to
achieve and has difficulty describing the concept to the
audience.

13. Video
Video is complete. Purpose is clearly stated. Student presents at
least 3 reasons why feeding may not be beneficial at the end of
life. Video is quite professional.
Video is mostly complete. Purpose is clearly stated. Student
presents at least 2 reasons why feeding may not be beneficial at
the end of life. Video is somewhat professional.
Video is not complete. Purpose is not stated. Student presents
at least 1 reasons why feeding may not be beneficial at the end
of life. Video is somewhat professional.
Video is not complete. Purpose is not stated. Student presents
at least 1 reasons why feeding may not be beneficial at the end
of life. Video is not professional.
Sound Setup
Video sound is clear with no background noise. All phrases are
well articulated and picked up by the microphone.
Video sound is clear with minimal background noise. All
phrases are well articulated and picked up by the microphone.
Video sound somewhat clear with minimal background noise.
Some phrases are well articulated and picked up by the
microphone.
Video sound unclear with audible background noise. Phrases are
not well articulated and unable to be picked up by the
microphone.
Date Created: Nov 01, 2016 12:55 pm (CDT)

14. © 2013 Laureate Education, Inc.
7
Bullying in Schools
Outline
Thesis: “Bullying is one of the most widely-spread and
dangerous type of violence especially in high schools. It affects
the victims’ psychological and emotional state adversely and
may cause terrible long term effects. Bullying in schools has
never ended despite the efforts by various partners, students
who participate often torment their peers and family; the
behavior follows them their entire life."
Introduction
Violence experienced in almost all schools has over the time
had adverse effects especially on the students’ moral behavior
which shape their future lives. The schools constitute some of
the places which have become the breeding ground for violence
such as bullying among students. The efforts put by various
schools’ stakeholders to offering a lasting remedy does not
seem to bear the expected results. It increases at an alarming
rate (Cornell, Dewey, et al., pg. 32). Therefore, the following
research paper finds how the issue found its place in schools
and its consequences among students. It is also interested in
assessing the current statistics to show how it has affected
different schools.
Background
First, bullying involves one form of violence that is initiated by
one or more students against another who becomes the victim. It
comprises of all forms of physical or psychological intimidation
or harm. Bullying could be direct acts such as teasing,
threatening or hitting. Also, it involves indirect actions such as
spreading rumors or the general social isolation of a person with

15. a malicious intention.
Bullying is a frequent form of violence in schools and involves
harmful acts that cause psychological, emotional, social or
physical harassment among students. It is often carried out by
the senior students who harass the newly admitted students. The
new students seem naïve and therefore, they are the weakest
ones to bullying. Statistics indicate that there about four million
students who become victims of school bullying annually. The
act of bullying causes adverse effects on students. For example,
it destroys the school environment making it unfriendly and
unbearable for most students (Kwan, Grace and Marko, pg. 47).
Therefore, it requires a collaborative effort and strategies that
would eliminate it especially within the confines of learning.
Negative outcomes of bullying in schools
As pointed out, bullying has many adverse effects that derail the
student’s learning despite the parents’ substantial investment
regarding tuition fees. Some of the negative consequences
established are discussed as follows.
Changing student's personality
During admission that marks a student’s entry in school, there
are often great desires and expectations that they hold and
would want to accomplish in the course of learning. For
example, it is indicated that during admission, most students
seem optimistic and hope to achieve their dreams and also meet
new friends. However, after joining, they meet senior students
who intimidate and threaten them. As a result, their desire and
interest towards school and learning change all of a sudden
(Polanin, Dorothy and Therese, pg. 87). Since some of them are
naïve and face constant intimidation from senior students, their
personality about school gets adversely affected.
Dismal academic performance
When the friendly environment that supports and encourages
learning becomes altered, the concentration for learning is
greatly affected. According to the research, bullying in schools
creates an atmosphere of fear for students and makes everything

16. around to be disgusting. For example, the school set up becomes
like a small prison where a person’s freedom has been curtailed.
Therefore, students are not motivated to study as they struggle
and wonder why they face such kinds of harassments, especially
from their fellow students. As a result, they end up performing
dismally because they cannot concentrate and pay attention due
to fear and lack of motivation.
Increased school drop outs
When a particular environment does provide a good support
system required, the inhabitants tend to move in search of a
better place (Valdebenito, Sara, Maria and Manuel, pg. 339). In
the same way, the research findings indicate that bullying in
schools creates an unfriendly and unbearable place for many
students. Some students have never gone through any
harassment from home and would not adapt or tolerate bullying
anywhere. For example, they have lived not knowing that
stealing exists. As a result, when they cannot tolerate stealing
and beating from other students, they have no other alternative
but quit school. They may not join any other school as they still
suspect there will be bullying.
Low self-esteem
The environment where an individual has been raised has a
significant contribution on his or her self-esteem. By self-
esteem, it refers to how an individual feel about himself or
herself, for example, if a person has a high self-esteem then he
or she will feel a sense of value and importance and behave
confidently (Polanin et al., pg. 204). Therefore, bullying in
schools has been discovered to make some students feel that
they are weak and not liked or appreciated. For example, a
student can force his classmate to clean his or her clothes. As a
result, students who are victims develop a low self-esteem and
lack confidence in what he or she does or says before people.
Dysfunctional families in future
Lastly, every effect in a person’s life leads to subsequent
repercussions. The experience could either make him or her or
destroy his or her next life. For example, bullying in schools

17. creates an unfriendly place for learning, causes harassment and
demotivates a student’s morale. As a result, a student will
change her or his perspective about education, lose confidence
and finally drops out of school. As a result, they join the society
without any clear picture of what they should do. The result is
that; they get married and have their family. The families led by
people who never finished school often will face many
challenges such as fighting and lack of stable finances to
support the basic needs. When an amicable remedy is not found,
then the cycle of dysfunctional families continues. It creates a
cycle of poverty and increases the dependency ratio in the
society.
Suicide
According to the research, some of the adverse effects of
bullying in schools among students are permanent thus cannot
be reversed. For example, bullying makes some students
develop suicidal feelings. It is also a fatal outcome resulting
from bullying in schools. Some individuals exposed to bullying
become distressed, terrified, or depressed (Valdebenito et al.,
pg. 342). They lose a sense of self-worth and have no reason to
live thus they strangle themselves to death. Some of these
students do not have parental support systems to encourage
them.
Positive Effects of Bullying in Schools
Anything that has side effects will also result in some benefits
though the benefits are entirely outweighed by the adverse
consequences. Therefore, apart from the negative impacts
bullying in schools has caused, it can have positive effects in
schools. For example, the act of bullying may enable
individuals to stand up and become bold, voice their concerns or
defend themselves (Polanin, Dorothy and Therese, pg. 221).
This way, it makes victimized students enforce equal rights for
all the students irrespective of their seniority, age and year of
admission. Also, bullying enables some bullies to support their
individual interests and enhance their outlook. Bullies could get
recruited to demanding jobs such as the military to defend the

18. nations against external attacks.
Statistical Data of the Outcomes in Schools
The current statistics indicates that school crime supplement of
deaths among students can be attributed to mental, physical and
emotional torture resulting from school bullies. For example, an
estimated fourteen percent of high school students have
considered suicide as a way avoiding bullying while fifteen
percent has attempted to commit suicide. Additionally,
according to studies conducted by Yale University, victims of
bullying in various schools are about three times more likely to
consider suicide as a way of escaping the issue. The British
survey also has revealed that almost half of suicides among
school students are associated with bullying among students
(Kwan et al., pg. 87). The trend is worrying, and it is high time
that a suitable plan designed to curb the menace in learning
institutions.
Conclusion
Finally, bullying in the schools as highlighted is a big challenge
for students that go through it since it interferes with their self-
esteem and leads to the loss of their confidence and, in extreme
cases it causes suicidal feelings that make some succumb to
death. Also, the long-term effects of bullying in school cause
many individuals to have dysfunctional families. There are more
worrying effects of bullying other than suicide and behavior
change and occur uniquely among the victims. The school
management needs to come up with appropriate disciplinary
measures and actions to curb bullying in schools.
Works Cited
Cornell, Dewey, et al. "Perceived prevalence of teasing and
bullying predicts high school dropout rates." Journal of
Educational Psychology 105.1 (2013): 138.

19. Kwan, Grace Chi En, and Marko M. Skoric. "Facebook
bullying: An extension of battles in school." Computers in
Human Behavior 29.1 (2013): 16-25.
Polanin, Joshua R., Dorothy L. Espelage, and Therese D. Pigott.
"A meta-analysis of school-based bullying prevention programs'
effects on bystander intervention behavior." School Psychology
Review 41.1 (2012): 47.
Valdebenito, Sara, Maria Ttofi, and Manuel Eisner. "Prevalence
rates of drug use among school bullies and victims: A
systematic review and meta-analysis of cross-sectional studies."
Aggression and Violent Behavior 23 (2015): 137-146.