4502
End of Life
Leader Guide
NATIONAL EDUCATIONAL VIDEO, INC.TM
END OF LIFE HCP33
OUTLINE OFCOURSE CONTENT CONTINUING EDUCATION
Title of Educational Activity END OF LIFE Contact Hours 2
The presenter for our program are the script writers who write the program guide and the script for the program.
The facilitator/subscriber/purchaser of our program can also be considered the presenter as he/she directs the class and the participants through the guide and the video. The distribution of handouts, glossary terms, taking of the pre-test/post-test and discussion of correct answers takes about 20 minutes. The discussion questions should take 30 minutes.
NATIONAL EDUCATIONAL VIDEO, INC. TM 2 © 2002 NATIONAL EDUCATIONAL VIDEO, INC.TM
END OF LIFE HCP33
OUTLINE OF COURSE CONTENT CONTINUING EDUCATION
Objectives Content (Topics) Time Faculty Teaching Frame Method List objectives in List each topic area covered and State the List the Describe Operational and provide a description or time faculty the Behavioral terms outline of the content to be presented frame for persons teaching the topic or method (s) area presenter used for for each teaching topic Describe the importance Definition of End of Life Care Plan. 25 minutes Presenter Video, of having an end of life glossary, care plan. Reasons/purpose for having end of life discussion care plan. questions Provides information on: Spiritual beliefs and values that can be used in guiding decisions regarding treatment and care during last stages of life Individual’s hopes and expectations to be considered in evaluating new treatments.
What is included in an end of life care plan: Advance Directives / Living Wills Health Care Surrogate Do Not Resuscitate Orders Family concerns Where the person wants to die Concerns about pain and suffering Financial considerations Times for review and evaluation
Identify situations when Situations identified when individual is 5 minutes Presenter Video, end of life care plans facing significant life changes or health discussion should be made and/or problems likely to result in decline and/or questions reviewed. death: Entering hospital for serious illness Admitted to long term care facility
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END OF LIFE HCP33
OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued)
Objectives Content (Topics) Time Faculty Teaching Frame Method Differentiate between Definition of spirituality 5 minutes Presenter Video, spirituality and religiosity. Definition of religiosity discussion Importance of differentiating between questions the two which allows for more open communication and ability to identify and meet needs of individual and family/ caregivers
Identify dimensions of the Definition of palliative care 20 minutes Presenter Video, supportive role of the Pain management discussion nurse in palliative care. Nutrition questions Hydration Follow up Terminal hydration reference Sign and Symptoms reading Treatment Dimensions of supportive care Valuing Connecting Empowering Facilitating Encouraging Defusing Mending Giving information Doing for Pain and symptom control Making arrangements Lending a hand Team playing Finding meaning Focusing on living Acknowledging death Preserving own integrity
Recognize significant Physiologic signs and symptoms of 10 minutes Presenter characteristics of impending death caused by irreversible physiologic death. failure of vital body systems. Nurses role in guiding individual and family discussions and decisions
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END OF LIFE HCP33
OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued)
Objectives Content (Topics) Time Faculty Teaching Frame Method Be able to identify Define Spirituality 25 minutes Presenter Video, spiritual needs of Ways to express spirituality Discussion patients. Identify spiritual resources questions Chaplains Priests / Ministers Lay Ministers from churches Bible Music Prayer Daily Devotions
Spiritual Assessment Video, JAREL Well-Being Scale discussion Taxonomy of Spiritual Diagnosis questions Spiritual Distress Spiritual Pain Spiritual alienation Spiritual anxiety Spiritual guilt Spiritual anger Spiritual loss Spiritual despair
Write an end of life care Blank sample form provided to practice. 15 minutes Presenter Video, plan for a patient. Can use the case presentation in discussion discussion questions or have one of questions, participants volunteer Hand outs
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END OF LIFE HCP33
INTRODUCTION
OBJECTIVES
At the end of the program the learner will be able to:
1. Describe the importance of having an end of life care plan.
2. Differentiate between spirituality and religiosity.
3. Identify situations when end of life care plans should be made.
4. Identify dimensions of the supportive role of the nurse in palliative care.
5. Recognize significant characteristics of physiologic death.
6. Be able to identify spiritual needs of patients.
7. Write an end of life care plan for a patient.
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END OF LIFE HCP33
GLOSSARY OF KEY TERMS
ADL’S Refers to activities of daily living such as bathing, eating, dressing, toileting, and transferring.
Advance Directives Written documents or oral statements in which instructions are given by an individual expressing desires relating to health care and includes, but is not limited to a living will, designation of health care surrogate and in some states an anatomical gift.
Do Not Resuscitate Orders A written order by a physician to not institute cardio-pulmonary resuscitation.
End of Life Care Plan A way to set goals for medical treatment, social, emotional and spiritual supports in all stages of a person’s care from the time they face serious illness or decline until their death. It provides a context within which new treatments can be considered in light of the patient’s personal goals.
Health Care Surrogate Any competent adult designated by another to make health care decisions on behalf of that individual if the individual is unable to make the decision because he/she is incapacitated for any reason.
Holistic Refers to treating a person as a whole made up of several components that are inter-related and interdependent on each other. They are mind, body, and spirit.
IADL’s Refers to Instrumental activities of daily living. Examples are ability to use the telephone, prepare food, housekeeping, shopping, and responsibility for own medication.
Living Will One type of advance directive. An individual makes known specific wishes regarding types of medical care to be made at the end of life regarding types of treatments/procedures to be made concerning life- prolonging procedures when the individual is not able to make their wishes and desires known.
Health Care Proxy A person appointed to make decisions for an individual regarding health care decisions for that individual in situations in which the individual is not able to make the decision.
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END OF LIFE HCP33
GLOSSARY OF KEY TERMS (Continued)
Palliative Care The comprehensive management of the physical, psychological, social, spiritual, and interpersonal needs of patients. Palliative care is especially suited to the care of individuals who have incurable, progressive diseases.
Pre-Hospital Do Not Resuscitate Orders Orders written by a physician and signed by an individual or the Health Care Surrogate/guardian that allow Emergency Management Personnel to NOT institute CPR in cases of cardiac or respiratory arrest. This is legal in some states, but not all. It does not eliminate other emergency or comfort treatments such as administration of oxygen or pain medication.
Religious Practice One of the ways individuals express personal spirituality. Generally associated with organized religions.
Spirituality An expression of how a person relates to a larger whole, whether it is God, a higher power or the human family. The spiritual dimension of a person integrates and transcends the biological and psychosocial nature.
Spiritual Alienation Loneliness, or the feeling that God seems very far away and remote from one’s everyday life; having to depend on self in times of trial or need; negative attitude toward receiving any comfort or help from God.
Spiritual Anger Frustration, anguish or outrage at God for having allowed illness or other trials, the unfairness or God; negative about institutional religion and its ministers.
Spiritual Anxiety Fear of god’s wrath and punishment; fear that God might not take care of one, either immediately or in the future; worry tat God is displeased with one’s behavior.
Spiritual Despair No hope of ever having a relationship with God, or pleasing God; feeling that God no longer can or does care for one.
Spiritual Guilt Feeling that one has failed to do the things which he or she should have done in life, and/or things which were not pleasing to God; concerns about the kind of life one has lived.
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END OF LIFE HCP33
GLOSSARY OF KEY TERMS (Continued)
Spiritual Loss Feeling of having temporarily lost or terminated the love of God; fear that one’s relationship with God has been threatened; feeling of emptiness with regard to spiritual things.
Spiritual Pain Discomfort or suffering or lack of peace relative to one’s relationship with God; having lack of spiritual fulfillment.
Spiritual Well-Being A sense of harmonious interconnectedness between self, others/nature, and Ultimate other that exists throughout and beyond time and space.
Terminal Dehydration Refers to the process that occurs when a dying person's condition causes the person to gradually reduce fluid intake. As the fluid intake decreases, circulating fluid volume decreases, resulting in dehydration.
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END OF LIFE HCP33
DISCUSSION QUESTIONS
1. HOW IMPORTANT DO YOU THINK PAIN CONTROL SHOULD BE IN TREATING TERMINALLY ILL PATIENTS? WHO MAKES THE DECISIONS REGARDING THE EFFECTIVENESS OF PAIN CONTROL?
Inadequate pain management or fear that pain will not be managed appropriately is probably the major reason that terminally ill patients desire euthanasia or assisted suicide. Patients in pain are unable to concentrate on other issues that may need to be addressed during the last stages of life. There may be other comments that can be discussed and are not necessarily incorrect. The primary response that needs to be concluded from the discussion is that pain management is at the top of the list for terminal patients especially those who have pain.
Who makes decisions or who should make decisions regarding the effectiveness of main control. The patient is the person who should be making decisions regarding the effectiveness of pain control. Use of scales of 1 to 10, one being slight and ten being the most excruciating pain ever experienced, are one way in which an individual can express the extent of pain and the effectiveness of treatment.
2. WHAT IS YOUR GREATEST FEAR ABOUT DYING? WHAT INFORMATION OR SUPPORT WOULD EASE YOUR FEAR?
The answers to this question are personal and are aimed at having an individual face some of their own fears regarding death. There are no right or wrong answers. The key is to recognize ones own fears and understand that some patients may experience the same fears or may experience other fears. Recognizing that the patient has fears, helping them to identify those fears and then taking some action to reduce the fear is the goal of the nurse.
Looking at self and personal fears is very important for staff in being able to work with patients.
3. DESCRIBE A GOOD DEATH. HOW DOES IT DIFFER FROM A BAD DEATH? HOW CAN YOU HELP A DYING PERSON HAVE A GOOD DEATH?
Answers to this question will vary according to individual perceptions about death. Some common responses that may be brought forward are: Good Death Peaceful Painless With family or friends present
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END OF LIFE HCP33
DISCUSSION QUESTIONS (Continued)