For this lesson we will briefly discuss hospice and palliative care. While they both care for those that are terminally ill, palliative care is also meant for any life-limiting illness (ELNEC, 2012). This includes such conditions as respiratory failure, congestive heart failure and renal disease. There are ethical issues involved with those people who are under either hospice or palliative care (Beauchamp & Walters, 2008; Dempski, 2009; HFA, 2012; Westrick, 2009). Physician assisted suicide, terminal sedation and euthanasia are all topics that can be brought up by family when facing end of life issues. These are issues that students need to cover before entering the clinical setting (ANA, 2012; Bookbinder, Kiss, & Matzo, 2005; Nelson & Hope, 2012; Scheckel, 2012).This PowerPoint presentation will introduce the students to the concept of Hospice care and Palliative care. Included in the instruction will be such resources as whiteboard, overhead projector, case studies, role play, brainstorming, journalling, live interaction through Skype or Facebook video chat, and paper handouts (Teeley, 2011). Before each class the students will have assigned readings and web fieldtrips that will be covered in the next class period. At the end of this unit, a post-test will be given to the students with a passing grade of 75% necessary to successfully complete this section (Iwasiw, Goldenberg, & Andrusyszyn, 2009; Nelson & Hope, 2012; Teeley, 2011).
Describe the differences between hospice and palliative care. Explanation given to students regarding the differences between palliative care and hospice. Topics that will be covered are how hospice requires DNR, the patient have 6 months or less left to live, primarily used for terminal cancer and all life prolonging treatment must be stopped. Palliative care does not require all of those things and is best used for any life-limiting illness such as heart disease or renal failure (Bookbinder, Kiss, & Matzo, 2005; Eliopoulos, 2005; HFA, 2012; Kass-Bartelmes & Huges, n.d. ; NHPCO, 2012). White board, web sites prior to class, reading in text and handouts given at beginning of class will help provide students with this information. Integrate Hospice and Palliative Care into care plan. Will provide information to students via white board and PowerPoint slides to give them the tools to include aspects of end of life care to their patients who are facing these issues. This will include methods of approaching these issues with families through role playing and case studies (Beauchamp & Walters, 2008; McDonald, 2007; Westrick, 2009). Identify listing of area hospice and palliative groups. Utilizing web field trips prior to this class, will explore hospice and palliative care groups in the area the students live. To assist them with this task, will utilize either Skype or Facebook video chat to have spokesmen from a local hospice group and a local palliative group to address the class and answer questions afterward (Dempski, 2009; Iwasiw, Goldenberg, & Andrusyszyn, 2009; Lentz & Sherman, 2005; McDonald, 2007; Scheckel, 2012). Examine wishes of patients for hospice and palliative care even when contrary to their own views. In this section will explore the students own opinions about end of life issues. This will include covering ANA Code of Nursing Ethics, physician assisted suicide, euthanasia, and terminal sedation. It will also take a look at recent court cases that have dealt with end of life issues; Karen Quinlan, Nancy Cruzan, and Teri Schiavo (ANA, 2012; Beauchamp & Walters, 2008; Dempski, 2009). This material will be covered by white board, short paper written about court cases, brainstorming, and reading from text. Students will also be encouraged to journal their thoughts on end of life issues and how their point of view changes from beginning of class to the end.
Student outcomes. By the end of class, students should be able to explain the differences between hospice care and palliative care when asked by families or patients facing end of life issues (Eliopoulos, 2005; Kass-Bartelmas & Huges, n. d.; Nelson & Hope, 2012). By the end of class students should be able to find resources of both groups to provide information to families and patients. In addition they will be able to integrate this information into the care plan (Eliopoulos, 2005; Lentz & Sherman, 2005; NHPCO, 2012; Westrick, 2009). By the end of the class students will appreciate the impact end of life issues have on the family unit (Dempski, 2009; Eliopoulos, 2005). By the end of class students would be able to explore available resources in areas students come from. Resources used for instruction will be White board, overhead projector, handouts of hospice and palliative care groups. This will be accomplished by having live discussions with spokesmen from each of the two groups from the area (Teeley, 2011). Also will have students write a short paper about how they would seek out and share resources with family and patients (Dempski, 2009; HFA, 2012; Lentz & Sherman, 2005; Nelson, 2008; Westrick, 2009) . By the end of class students will be able to integrate ethical considerations of hospice and palliative care into their care of patients with these issues. To help with this will have class write a 3-5 page paper about one of the three legal cases that have provided guidelines for end of life care. The three cases will be Karen Quinlan, Nancy Cruzen, & Teri Schiavo (Beauchamp & Walters, 2008; Dempski, 2009; Kass-Bartelmes& Huges, n. d.). In addition the class will explore their place as a nurse in situations such as terminal sedation, euthanasia, and physician assisted suicide (ANA, 2012; Dempski, 2009). These skills will be taught using case studies, role playing and practice in the nursing lab (Lowenstein, 2011; Teeley, 2011).
The concept of palliative care is not widely known. Many doctors still feel that it is merely an extension of hospice. In addition, many doctors are reluctant to introduce end of life provisions as it requires them to acknowledge the patient has reach a point that treatment is no longer a viable option. Early integration of palliative care can actually enhance effectiveness of disease directed treatment for patients with serious and complex illnesses. It can also improve quality of life and provide support for families. Prior to beginning the instruction, a self-assessment will be provided for the students to take prior to the first class. This self-assessment will provide stepping off place for the nurse instructor and a place to begin instruction. Also, students will journal their own feelings about end of life issues and by the end of the class will include how their views have or have not changed (Bastable & Doody, 2008; Iwasiw, Goldenberg,& Andrusyszyn, 2009; Nelson, 2008; Worral, 2008). Formative evaluation consisting of quizzes, question and answer periods, and short focused papers will be provided at regular intervals in order to ascertain if students are understanding material as it is being taught. If there are discrepancies in what instructor has taught and the level the students show understanding in the formative evaluations, revision of timeline of material including re-instruction of the missed or misunderstood material if necessary (Iwasiw, Goldenberg, & Andrusyszyn, 2009). The purpose of formative evaluation is to make adjustments to the educational activity being done. Once the program has finished, a summative evaluation consisting of a comprehensive test and/or longer more focused paper to tie together all aspects of class will be conducted to ascertain information transmission effectiveness (Bastable & Doody, 2008; Stavropoulou, 2012).
These websites add more information and resources for nursing students. There are also a few that deal with dying. Philadelphia Inquirer: Seeking a Good Death. This has five real life scenarios that show how different families dealt with end of life issues. More information can be found at http://www.phillynews.com/packages/end_of_life And on euthanasia; Euthanasia Research and Guidance Organization, http://www.finalexit.org/more.html In addition to these sites, students will be required to view and critique one of the following movies for their application to end of life issues. The movies they can choose from are: Brian Song-the true story of Brian Piccalo, a football player and his fight against cancer. Terms of Endearment-story of a mother and daughter how they deal with death after the daughter is diagnosed with cancer. The Sea Inside-story of a quadriplegic man who explores euthanasia and right to die. Land Before Time and Bambi-both deal with death of a mother on a child's level. X-Men: The Last Stand-three main characters are killed yet the school and the team continue to help humanity. Rodan-while this is a Japanese monster movie, if the two main creatures are transformed into a married couple, the final scenes are even more heartbreaking. When one mate is hurt by the military and falls into the volcano, the other one, rather than live alone, joins it in the volcano. This leaves their offspring to be brought up by other monsters on Monster Island-home of Godzilla. By including these two different timespans for movies I have programs that both those students of my age group (35-50) and those of my daughters age group (18-22) to choose from.
To recap what we have discussed for this class, hospice and palliative care are both very important aspects of end of life care. Hospice is associated with terminally ill patients who have less than six months to live. It requires the patient to have a do not resuscitate (DNR) order in place and all life prolonging treatment must end. Palliative care is not just for terminally ill patients with some form of cancer. It can be utilized for those patients who suffer from chronic illness like renal failure or heart disease as well. No DNR is required and life prolonging treatment can be continued. Nursing takes in the prevention of illness, alleviate suffering and the protection promotion of healthcare. Nurses are to adhere to a tradition of self-reflective care enduring with a code of ethics primary to goals and obligations(Dempski, 2009; Westrick, 2009). The code of ethics serves the obligations and duties of every individual. It is non-negotiable ethical standard of the profession. Code of ethics is set as a guide for nurses now and the future. Nurses, no matter what the circumstances, respect the worth, dignity and rights of all human beings irrespective of nature of the health problem (ANA, 2012). End of life issues like physician assisted suicide or euthanasia are against our code of ethics. Terminal sedation-or the administration of medication to help the patient sleep then allowing nature to take its course is permissible but is generally handled by palliative care nurses and is part of the advance directive of the patient (ANA, 2012; Beauchamp & Walters, 2008; Dempski, 2009). Advance directives and healthcare power of attorney are two important legal forms to help direct the care of the patient when they are unable verbalize it (Pere, 2012; Westrick, 2009).
The references here come from texts and websites. The entire listing of references would be provided to students at the start of class. Also will encourage students to share websites and/or journals found with other students that apply to this class.
UNIT OBJECTIVESDescribe the differences between hospice and palliative care.Integrate Hospice and Palliative Care into care planIdentify listing of area hospice and palliative groupsExamine wishes of patients for hospice and palliative care even when contrary to their own views 2
LEARNER OBJECTIVES By the end of class student will: Know the qualifications for hospice care. Know the qualifications for palliative care. Communicate to families regarding resources available for families and patients. Appreciate the impact end of life issues have on the family unit. Integrate the ethical considerations of hospice and palliative care 3
EVALUATION OFINSTRUCTION Palliative care requires education to enhance end of life care. Self-assessment of students prior to first class; journaling to explore own end of life beliefs Formative evaluation at regular intervals. Revision of material as needed to fulfill learning goals Summative evaluation at end of class to determine if goals have been met 4
WEB RESOURCES FORSTUDENTS Compassion in Dying http://www.thebody.com/cid/cidpage.html Project on Death http://www.soros.org/death University of TX Medical Branch-CD interactive resources http://www.multimediallab.com Choice in Dying http://www.choices.org 5
CONCLUSION Hospice care for those very close to death Requires DNR All life prolonging care must be stopped Palliative care not just for terminal illness No DNR required Life prolonging care may be continued Chronic illness can benefit from palliative care Ethical issues with end of life care 6
REFERENCESAmerican Nurse Association (2012) Code of Ethics for Nurses.Retrieved fromhttp://www.nursingworld.org/mainmenucategories/ethicsstandards/codes/ethicsfornurses.aspxBastable, S. B. & Doody, J. A. (2008). Behavioral objectives. InS. B. Bastable Nurse s educator: Principles of teaching andlearning for nursing practice. (3rd ed., pp. 383-427).Sudbury, MA: Jones and Bartlett.Beauchamp, T. L. & Walters, L. (2008). Contemporary issues inbioethics. (2nd ed.). Mason, OH: Cengage Learning. 7
REFERENCES-CONTINUEDBookbinder, M., Kiss, M., & Matzo, M. L. (2005). Death and society.In M. L. Matzo & D. W. Sherman Palliative care nursing: Quality careto the end of life. (2nd ed., pp. 89-115) New York, NY: Springer.Dempski, K. (2009). Advance directives and end-of-life decisions. InS. J. Westrick & K. Dempski Essentials of nursing law and ethics (pp.282-288), Sudbury, MA: Jones and Bartlett.Eliopoulos, C. (2005) Gerontological nursing. Philadelphia, PA:Lippincott Williams & Wilkins.End of Life Nursing Education Consortium (2012). About ELNEC.Retrieved from http://www.aacn.nche.edu/elnec 8
REFERENCES-CONTINUEDHospice Foundation of America (2012). About Hospice Foundation.Retrieved from http://www.hospicefoundation.orgIwasiw, C. L., Goldenberg, D., & Andrusyszyn, M-A. (2009). Curriculumdevelopment in nursing education. Sudbury, MA: Jones and Bartlett.Kass-Bartelmas, B. L. & Huges, R. (n.d.). Advance care planning:Preference for care at end of life. Retrieved fromhttp://www.ahrq.gov/research/endlifria/endria.htmLentz, J. & Sherman, D. W. (2005). Professional organizations andcertifications in hospice and palliative care. In M. L. Matzo & D. W.Sherman Palliative care nursing: Quality care to the end of life (2nd ed., pp.117-132). New York, NY: Springer. 9
REFERENCES-CONTINUEDLowenstein, A. J. (2011). Role play. In M. J. Bradshaw & A. J.Lowenstein (Eds). Innovative teaching strategies in nursing and relatedhealth professions (5th ed., pp. 187-205). Sudbury, MA: Jones andBartlett.McDonald, M. E. (2007). The nurse educator’s guide to assessinglearning outcomes (2nd ed.). Sudbury, MA: Jones and Bartlett.National Hospice and Palliative Care Organization (2012). AboutNHPCO Retrieved from http://www.nhpco.orgNelson, J. E., & Hope, A. A. (2012). Integration of palliative care inchronic critical illness management Respiratory Care, 57(6), 1004-1013.doi:10.4187/respcare.01624 10
REFERENCES-CONTINUEDNelson, M. J. (2008). Ethical, legal, and economic foundations of educationalprocess. In S. B. Bastable Nurse as educator: Principles of teaching andlearning for nursing practice (3rd ed., pp. 25-49). Sudbury, MA: Jones andBartlett.Pere, K. (2012). Developing nursing expertise in caring for older advancestage heart failure patients and their families in palliative and end of life care.Canadian Journal of Cardiovascular Nursing, 22(3), 12-17 Retrieved fromhttp://www.ncbi.nlm.nih.gov/pubmed/22908522Scheckel, M. (2012). Selecting learning experiences to achieve curriculumoutcomes. In D. M. Billings & J. A. Halstead Teaching in nursing: A guide forfaculty, (4th ed., pp. 170-187). St. Louis, MO: Elsevier/Saunders. 11
REFERENCES-CONTINUEDStavropoulou, A. & Kelesi, M. (2012). Concepts and methods ofevaluation in nursing education-a methodological challenge.Health Science Journal, 6(1), 11-23. Retrieved fromhttp://www.hsj.grTeeley, K. H. (2011). Multimedia in the classroom: Creatinglearning experiences with technology. In M. J. Bradshaw & A. J.Lowenstein Innovative teaching strategies in nursing and relatedhealth professions (5th ed., pp. 293-308). Sudbury, MA: Jonesand Bartlett.Westrick, S. J. (2009). Patient teaching and health counsuling.In S. J. Westrick & K. Dempski Essentials of nursing law andethics. (pp. 91-95). Sudbury, MA: Jones and Bartlett. 12