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List 5 effects that using an open ended quesons for good communicaon would have 1. encourages conversaon 2. helps the person feel heard 3. prevents misunderstandings 4. helps the dying person share their story 5. validates the persons experience List 5 common physical changes during the last days and hours 1. unresponsive 2. agitaon 3. reduced intake 4. congested breathing 5. muscle twitching Idenfy 4 non-medicaon comfort measures that you could use for someone in pain 1. posioning 2. distracng 3. relaxaon strategies 4. warm blankets 5. give me Idenfy 3 physiological signs that will be present at the me of death 1. no pulse 2. pupils fixed and dilated 3. no resps 4. jaw drop
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What is the first thing that we need to establish when offering pain relief the paents goals List 3 possible causes for nausea and voming 1. medicaon side effects 2. pain 3. anxiety 4. odors Idenfy 3 strategies to support and comfort an individual as intake decreases 1. smaller meals & more frequent 2. provide good mouthcare 3. thickened fluids 4. provide fav food & drink Delirium is a common symptom in the last days and hours. List 3 areas you will need to provide care for the person experiencing delirium 1. personal safety 2. emoonal security 3. orientaon to reality 4. reassurance Idenfy 2 comfort measures when working with a client who has conspaon or diarrhea 1. provide privacy 2. answer call bell ASAP 3. provide easy access to toilet or commode Idenfy 3 roadblocks to good communicaon and why each are not effecve 1. minimizing the problem-person may feel like they have not been heard.
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2. offering false reassurance-implies we don't think things are as serious as they seem. 3. fix it trap-we may see, hear & focus on problems we cant fix Idenfy 4 effecve self care strategies that can assist you in refueling & re-energizing 1. eat food that is nourishing 2. drink water 3. exercise 4. sleep well 5. laugh Strategies that you can use for maintaining therapeuc boundaries 1. acknowledge importance of boundaries 2. be clear of scope 3. clarify your job descripon 4. engage in self care Idenfy 3 signs of dehydraon 1. dry mouth, lips and tongue 2. conspated 3. feels and expresses thirst 4. develops delirium MAID criteria able to receive health services funded by government of Canada 18+ Grievous and irredeemable medical condion Voluntarily requested
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They have informed concern aer being informed of means available to to relieve suffering including plainve care Promong cultural safety Adopng two eyed seeing, incorporang the indigenous wellness framework where spiritual, mental, emoonal, and physical behaviour is expressed, developing cultural homily, sensivity, awareness and competence Preparing for care (4 things) 1. Sort out personal baggage and release personal or systemically biased beliefs, racism, and personal values about care 2. Adopt a trauma-informed approach and proceed mindfully 3. Provide cultural safety for this person and their family by recalling your research into their cultural values, rituals, and pracces 4. Arrange for a translator or assisve technology if the person does not speak English or if there are other barriers to communicaon. Idenfy 3 principles for using medicaon 1. Combinaon of medicaons 2. Breakthrough dose may be needed 3. Dying person determines the goal 4. Easier to prevent than to respond to a pain crisis The HCA is not expected to honor a person and family's individual or community ritual False steps to follow in caring for the diseased except Applying make-up Canadian Hospice Palliave Care Associaon Idenfies the component of of the care process of providing care
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True Caring for a dying person is easy, caring for the family is difficult True Which of the following is not a strategy for learning to help increase knowledge. try to Idenfy topics that pay well In developing a care plan Important for families and staff to know what to do when death occurs True We need to refuel strategies for sub-care nourish your spirit all of the above expected death of a client No need to call 911 common physical changes during the last days and hours of dying No heart beat water Increases energy release and helps cleanse the body of wastes true example of supporng a dying person are all of the above family members become uncomfortable with the noise of respiraon of their loved ones. As a support worker you can Encourage family to contact nurse if congeson increases
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establishing and maintaining boundaries when caring for a dying person may be difficult all of the above families idenfying tradions and rituals. create a comfortable or private place for them all of the above can a caregiver withstand the posive effect of caring for the dying? False health care aides explore and respond to residents' culture, religion, and spiritual pracce true As death nears a dying person's strength remains as normal funcon strength decreases You are at your absolute best. This statement is a sign of compassion fague located in the green zone True strategies for support in a negave workplace includes the following except developing an 'us versus them' atude the last days and hours as a special and sacred me for the dying person true signs may involve compassion fague all of the above The following is not a strategy for developing a strong support network
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Avoid counseling and services All are examples of self-care pracces except Caring for the client aer work self care can stand the most challenging effects of caring for a dying person whilst benefing from the rich rewards of work offers you true Mrs. Elm's major depressive disorder. you should avoid telling her how lucky she is Who is at the center of care? paent and family When working with those who are intuive grievers we need to remember a lack of control guidelines for trauma informed pracce explain, knocking, introduce, etc Who best provides palliave care? Interdisciplinary team Tool for assessing pain PAINAD Involuntary muscle twitching myoclonic twitching
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What is the last thing to go in a dying person Hearing What is compassion fague? Burnout Cooling and motling. Where does it began? fingers and toes Is sing in silence with the dying person a good thing? True Side effects of opioids conspaon, nausea and voming, confusion or delirium, drowsiness Helps you to have a say about the health care you would like to receive if you get very sick and cannot speak for yourself Advanced care planning Independence is sll encouraged in hospice True does every dying person experience every physical change? False When do chemical changes is known in Rigor Mors? 4 to several hours
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Pain is whatever the person says it is True Do some people wait to be alone to die? True Pain is at worst imaginable. It's at 10. What is this? Pain scale What is the principles of hospice and palliave care not to prolong life but improve the quality of life totally bed bound, unable to do any acvity, extensive disease, total care, minimal sips, full or drowsy +/-confusion is what PPS level? 20% mainly sit/lie, unable to do any work, extensive disease, considerable assistance required, normal or reduced, full or confusion is what PPS level? 50 totally bed bound, unable to do any acvity, extensive disease, total care, normal or reduced, full or drowsy +/-confusion is what PPS level? 30 MAID refers to the process whereby a person requests and receives a lethal substance that causes their death. True If MAID is approve, it takes a mandatory 10 days period of reflecon. True
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Do not atempt CPR DNACPR trying to understand another person's feelings and needs empathy program provided for those whose death is expected in less than six months, or to the bereaved Hospice Loss of appete Anorexia paterns of decline during the dying process trajectories ability to speak from a neutral posion to clarify care needs and share their needs with the team advocate
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dignity is not the most important indicator of well being ANSWER: False all of the following are funconal skills and abilies that care givers observe to understand the declining condion of a dying person, except ANSWER: increase in spiritual conversaon all of these are principals of palliave/hospice care except ANSWER: aims to prolong life which of the following is an issue with boundaries in care giving ANSWER: all of the above being culturally and spiritually competent means that you are aware of your values, beliefs, and prejudices ANSWER: true starng the hospice/palliave care early in the disease process provides symptom management and the person to live ANSWER: true it is usually quite easy to esmate the me remaining before death for people in stutering decline ANSWER: False hospice is about using strategies to prolong life ANSWER: false in Canada hospice and palliave care are oen used together ANSWER: true
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according to Bergclerg the ambiguous dying syndrome, means that people do not get the death benefits or benefits of dying that people get when death is expected ANSWER: true labels and judgments do not prevent you from seeing the person and their need ANSWER: false self awareness is the acknowledgement of our personal baggage and its effects on our behavior ANSWER: true which of the following is not apart of holisc care in addressing the needs of the enre person ANSWER: financial needs the HCA supports the person and their family to live and grow as full as possible ANSWER: true people need to wait unl death is imminent to benefit from HPC ANSWER: false examples of common causes of sudden death include all the following except ANSWER: cancer very few people these days follow the stutering trajectory of decline toward death ANSWER: false healing is different than curing. healing involves all the following, except ANSWER: fixing the underlying cause the term end of life care is well defined
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ANSWER: False by knowing who you are, you are more able to adapt your behavior to meet the needs of a dying person ANSWER: true hospice/palliave care is best when delevired by ANSWER: an interprofessional team personal baggage includes which of the following ANSWER: all of the above your personal baggage always negevly effects the care you provide ANSWER: False a slow decline trajectory is oen the result of dying from all the following, except ANSWER: heart atack which statement is not true of open quesons ANSWER: encourages yes or no quesons which of the following would be an example of a dignity queson ANSWER: what do I need to know about you to give the best quality care meeng the needs of the dying and their family requires self awareness ANSWER: true the stutering decline trajectories is the same as ANSWER: a roller coaster
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a client cannot receive hospice care while receiving acute care ANSWER: False comments such as "it could be worse" is an example of what kind of road block ANSWER: minimizing the problem empathy opens the door to conversaon ANSWER: true maintaining boundaries helps you care for the dying ANSWER: true which of the following will not help improve your ability to maintain boundaries ANSWER: ignore situaons that cause you to have strong emoons you can be a compassionate presence in a dying persons journey without having to do or saying something to fill the silence ANSWER: true all the following are apart of providing compassionate support, except ANSWER: Advising hospice/palliave care promotes ANSWER: holisc care less than 20% of people die in a steady decline trajectory ANSWER: true
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according to Elizabeth coustan, from the edge of the dance floor, you can do which of the following for the client ANSWER: observe and normalize the goal of hospice/palliave care is to ANSWER: improve the person's quality of life
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A dying person determines the goal for pain relief. ANSWER: true Which meds would be helpful in breathlessness and improve the quality of life? ANSWER: opioids providing easy access to toileng is one way to promote comfort. ANSWER: true When a client is experiencing dyspnea, what can you as the support worker do? ANSWER: invesgang triggers that lead to difficulty breathing PAINAD scan assess all of the following behaviors except? ANSWER: acvity and body language (acvity is not on the scale but body language is) when a person has diarrhea, the large intesne absorbs a large amount of water. ANSWER: false people may believe that o2 will fix breathing difficules. ANSWER: true the dying person experiences hunger in the same way a healthy person does. ANSWER: false Mouth discomfort develops when the normal ssues of the oral cavity become very moist. ANSWER: false (become very dry) Delirium is a physical state that the brain cannot send and receive informaon correctly. ANSWER: True The Victoria hospice palliave performance scale is. ANSWER: provides a framework for progressive decline in paents
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Report and record ANSWER: Acut and concise Who determs goal relief ANSWER: Paent What medicaon helps restlessness ANSWER: Opioids Making sure there's easy access to toilet ANSWER: Can help provide comfort How HCA manage symptoms of difficulty breathing ANSWER: Large intesne does not absorb a large amount of water when someone has diarrhoea What do people believe oxygen will do for person or fix ANSWER: Sob When does mouth discomfort occurs ANSWER: Not enough saliva dry mouth What can you observe when someone has anorexia ANSWER: Instead of meals they eat smaller porons or snack or nothing at all Definion of delirium ANSWER: A rapid change in consciousness that occurs over a short me When changing someone's posion ANSWER: It help relieve pain What does "PPS" stand for? ANSWER: Prospecve Payment System
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Loss of appetite anorexia A rehydration treatment where fluids from an IC bag enter the fatty tissue under the skin through a needle hypodermoclysis Infrequent movement of a person's bowels, having 2 or less BMs per week constipation A person's fluid level in the body is less than what is necessary to maintain normal body functions dehydration Involuntary weight loss of more than 5% of body weight in six months, triggered by the body's inflammatory cachexia Patterns of decline during the dying process trajectories Acknowledging your cultural values, beliefs, and perceptions cultural awareness A physical state in which the brain cannot send and receive information correctly. Can be reversible or irreversible. delirium Key medications for relieving severe pain, by decreasing the number and strength of pain signals reaching the brain opioids The uncomfortable sensation of struggling to breathe the feeling of being unable to get enough air, difficult breathing dyspnea
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Helps you to have a say about the health care you would like to receive if you get very sick and cannot speak for yourself advanced care planning Do not attempt CPR DNACPR Trying to understand another person's feelings and needs empathy Activities or events that are used to create a special moment that honour and respect a person, their traditions or beliefs ritual Ability to speak from a neutral position to clarify care needs and share their needs with the team advocate A healthy and natural adaptive response to loss grief Guiding a person into imagining that they are relaxing in their favourite place guided imagery People or situations that touch us in some deep, conscious place which may make it difficult to stay off of someone else's dance floor hooks Program provided for those whose death is expected in less than six months, or to the bereaved hospice Also known as compassion fatigue burnout
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Life and Death Matters Copyright 2020 Chapter 1 Understanding Dying and Integrating a Palliative Approach
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Life and Death Matters Copyright 2020 Learning Outcomes 1. Identify changes in the way people are dying. 2. Explain the four common patterns of decline and associated challenges for person and family. 3. Define the terms hospice, palliative care, end-of-life care, and a palliative approach. 4. Explain the meanings of terms used in hospice and palliative care and how the terms may be understood differently in different care settings and communities. 5. Explain the principles of palliative care. 6. Identify common barriers to accessing and receiving palliative care and common misunderstandings about palliative care.
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Life and Death Matters Copyright 2020 Learning Outcomes 7. Explain the benefits of integrating a palliative approach to care. 8. Discuss the roles of different team members and understands when and how to access and collaborate with them to integrate a palliative approach. 9. Discuss the PSW's role in addressing the holistic (physical, emotional, cognitive, and spiritual) needs of the dying person by observing and sharing observations and changes with the team. 10. Advanced role: Demonstrate strategies for sharing observations and concerns about people needs in care conferences with the team.
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Life and Death Matters Copyright 2020 Chapter 1 Understanding Dying and Integrating a Palliative Approach
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Life and Death Matters Copyright 2020 Changes in the way people die People are dying: When they are much older With multiple chronic illness(es) Declining over many years
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Life and Death Matters Copyright 2020 Four common patterns of dying Sudden Death <10% Steady Decline <20% Stuttering Decline Slow Decline70%
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Life and Death Matters Copyright 2020 Four common patterns of dying
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Life and Death Matters Copyright 2020 Steady decline < 20% of deaths More common for people dying with certain cancers Decline often occurs in last 6 months
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Life and Death Matters Copyright 2020 Stuttering decline Multiple periods of decline and recovery Organ failure, chronic disease e. g. COPD, CHF, kidney disease
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Life and Death Matters Copyright 2020 Impact of repeatedly nearing death? How might repeated experiences of nearing death, and then recovering affect the dying client? How might this affect the family and significant others?
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Life and Death Matters Copyright 2020 Slow decline Periods of decline and recovery are more subtle Parkinson's disease Dementia-related illness
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Life and Death Matters Copyright 2020 70% of deaths: stuttering or slow declines Stuttering decline Slow decline
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Life and Death Matters Copyright 2020 How does this affect PSWs? How does this affect caregiving?
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Life and Death Matters Copyright 2020 Sudden death 10 % of deaths Heart attack Major stroke Car accident Overdose Pandemic illness
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Life and Death Matters Copyright 2020 "End-of-life care" has different definitions “Can you tell me more about what you mean by end-of-life care?” When someone says, “end-of-life care” you might ask
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Life and Death Matters Copyright 2020 Hospice and palliative care begins “It's not being dead but the dying I fear”
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Life and Death Matters Copyright 2020 Cicely Saunders heard and saw that the needs of the dying were not being met in acute care She took action She earned her MD and worked to create a hospice
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Life and Death Matters Copyright 2020 St Christopher's Hospice Founded in London, 1967, by Dame Cicely Saunders Provided care for the unique needs of the dying
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Life and Death Matters Copyright 2020 Dr. Balfour Mount established “palliative care” in 1974
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Life and Death Matters Copyright 2020 “hospice” and “palliative” In Canada, these terms have been used together and may mean the same thing
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Life and Death Matters Copyright 2020 What is palliative care?
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Life and Death Matters Copyright 2020 Principles: Palliative care is care that 1. Affirms life and regards dying as a normal process 2. Considers the dying person and family to be the unit of care 3. Is holistic and person-centred 4. Includes physical, emotional, spiritual psychological and social distress 5. Includes prevention and early detection 6. May positively influence course of illness
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Life and Death Matters Copyright 2020 Principles: Palliative care is care that 7. When possible, it is provided by the interdisciplinary team 8. Can begin anytime and continues through death and bereavement
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Life and Death Matters Copyright 2020 “Palliative” is a type of care Do not refer to a person as “palliative”
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Life and Death Matters Copyright 2020 Consider saying these phrases instead: “He is in his last days and hours” “She is actively dying ”
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Life and Death Matters Copyright 2020 Palliative and acute care or "disease modifying" care can occur together
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Life and Death Matters Copyright 2020 Palliative care is care that 1. Improves quality of life 2. Does not speed or delay death 3. Provides pain relief and manages distressing symptoms 4. Attends to the dying person in a holistic way
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Life and Death Matters Copyright 2020 90% of Canadians support palliative care Because it: Decreases fears (of dying) Reduces family burden Supports family decision making 90%
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Life and Death Matters Copyright 2020 Another interesting fact While cancer accounts for ~20% of deaths, a person dying with cancer is 3 X more likely to access palliative care
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Life and Death Matters Copyright 2020 Barriers to accessing/receiving palliative care Lack of resources and funding Difficult for people in remote/rural locations to access on-site care Lack of awareness Referrals for palliative care Misunderstandings e. g., “Palliative care is only for people dying with cancer” Being a member of an underserved population
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Life and Death Matters Copyright 2020 Underserved populations are: Children, older adults People with disabilities People who identify as LGBTQS2+ People who are vulnerably housed People of Indigenous, African, Asian or immigrant heritage
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Life and Death Matters Copyright 2020 Barrier for underserved population
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Life and Death Matters Copyright 2020 Barrier for underserved population
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Life and Death Matters Copyright 2020 Barrier for underserved population
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Life and Death Matters Copyright 2020 DID YOU KNOW Words for palliative care, death and dying are often absent from Indigenous language. How would a person access palliative care if that type of care was not part of their culture? Barrier for underserved populations
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Life and Death Matters Copyright 2020 Remove Barriers by Integrating a Palliative Approach
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Life and Death Matters Copyright 2020 A palliative approach began in Australia Australia integrated palliative care principles and strategies into primary health care Care is provided by all members of the team What they saw Great increases in the capacity to provide palliative care simply by increasing the number of people able to provide care.
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Life and Death Matters Copyright 2020 Increase access to palliative care by Providing more caregivers.... at more care locations Physician's office In the home Community care Hospice care Assisted living facility Long term care facility Acute care facilit
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Life and Death Matters Copyright 2020 More caregivers at more locations means... That all members of the health care team must be educated in basic palliative care knowledge and skills Because every member of the health care team is responsible for providing palliative care
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Life and Death Matters Copyright 2020 What is a palliative approach A palliative approach means, “Integrating the principles, practices and philosophy of palliative care into the care of people with any or serious illness, early in the disease process, across all care settings”
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Life and Death Matters Copyright 2020 Key points on a palliative approach It is holistic care-includes physical, cultural, psychological, social and spiritual needs, that: Reduces suffering with early identification and adoption of palliative care strategies to meet care needs Is provided at all care settings Is provided by all caregivers
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Life and Death Matters Copyright 2020 Understanding a palliative approach
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Life and Death Matters Copyright 2020 Integrating a palliative approach in LTC Because people enter LTC later in their disease than previously Their care needs are more complex than previously The length of stay is shorter Greater numbers die in LTC each year
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Life and Death Matters Copyright 2020 A palliative approach can improve care for those dying in long term care Increases QOL Reduces number of ED visits Reduces number of aggressive measures
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Life and Death Matters Copyright 2020 A palliative approach works well with dementia care principles
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Life and Death Matters Copyright 2020 A palliative approach can also apply in other care settings: Emergency department Acute medical/surgical care Home and community care
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Life and Death Matters Copyright 2020 PSW's role- a palliative approach PSWs are “the eyes and ears of health care team” Observe, record and report information Provide direct care according to care plan Collaborate with the team
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Life and Death Matters Copyright 2020 PSWs integrate a palliative approach by: Gathering information 01 Considering the needs of the whole person 02 Providing physical and psychosocial support 03 Communicat-ing and advocating 04 Collaborating with the team 05
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Life and Death Matters Copyright 2020 PSW competency
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Life and Death Matters Copyright 2020 The Surprise Question “Would I be surprised if this [person] died in the next 12 months”
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Life and Death Matters Copyright 2020 Key strategies for providing palliative care and integrating a palliative approach
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Life and Death Matters Copyright 2020 The Health Care Team
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Life and Death Matters Copyright 2020 Care teams vary greatly Depending on 1. Location-urban vs rural 2. Care facility or home care 3. Preferences of dying person and family
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Life and Death Matters Copyright 2020 Dying person and family are the focus of care PSW holds the family in a safe warm embrace
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Life and Death Matters Copyright 2020 PSWs are important members of the team 1. Dying person and family are the unit of care 2. PSW holds and supports the person and family 3. PSW is supported by colleagues 4. PSW provides care and gathers/records/reports information
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Life and Death Matters Copyright 2020 PSWs are important members... cont'd 5. Team may only hear of person's needs from PSW 6. Regardless of care location, team is available for support
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Life and Death Matters Copyright 2020 PSWs gather crucial information for the team
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Life and Death Matters Copyright 2020 Learning Outcomes 1. Practice self-reflection to identify beliefs and baggage about dying and death. 2. Identify how personal baggage can interfere with providing person centred care 3. Reflect and write about personal and systemic biases and racism. 4. Demonstrate how to provide culturally safe care, that is free ofsystemic bias and racism. 5. Advocate for culturally safe practices that are free of systemic racism and discrimination. 6. Explain the reason for integrating a trauma-informed approach to care and identify ways to develop a trauma-informed practice.
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Life and Death Matters Copyright 2020 ... continued 7. Explain the components of a world view that communicates respect and supports dignity for all people. 8. Demonstrate ways to connect and communicate to provide emotional and spiritual support to the person and family. 9. Provide empathetic and compassionate ways of being to provide emotional and spiritual support to the person and family. 10. Identify the benefits of maintaining professional boundaries and explain the challenges and strategies for maintaining boundaries when providing palliative care.
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Life and Death Matters Copyright 2020 What are your thoughts? What do you want to learn, feel and experience about caring for the dying?What do you know and feel about caring for the dying?
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Life and Death Matters Copyright 2020 Living is a journey Dying is a journey
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Life and Death Matters Copyright 2020 Why “prepare to care? ” Preparing to care means:Consciously acknowledging your beliefs, values and experiences Consciously working to provide care that aligns with the beliefs, values and experiences of the person.
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Life and Death Matters Copyright 2020 Preparing to care by packing for a trip
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Life and Death Matters Copyright 2020 You bring who you are with you on any journey
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Life and Death Matters Copyright 2020 These are referred to as “your personal baggage”You bring your values, ideas, hopes, fears, dreams, biases and beliefs wherever you go
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Life and Death Matters Copyright 2020 PSWs : Know that baggage is neither good or bad Carrying baggage means you are human
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Life and Death Matters Copyright 2020 We start today by inviting you to reflect on what you bring with you to caregiving
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Life and Death Matters Copyright 2020 Beliefs and Baggage The baggage we carry can get in the way of providing excellent care
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Life and Death Matters Copyright 2020 Applying the Idea of Baggage to Caregiving
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Life and Death Matters Copyright 2020 1. Pack light 2. Reflect on: Where you are going Who you are going with What does this mean in caregiving?
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Life and Death Matters Copyright 2020 Developing self-awareness will help you to Sort your baggage Recognize and acknowledge your values and beliefs Decide what might interfere with your ability to provide excellent care
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Life and Death Matters Copyright 2020 When you have reflected, You will be more able to hear the words and the feelings behind the words of the dying person You will be able to be more present to the needs of the dying person and family
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Life and Death Matters Copyright 2020 With self-awareness you can: 1. Respect other people, and their spiritual and cultural practices 2. Provide emotional support for the dying person and their family
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Life and Death Matters Copyright 2020 Develop self-awareness with reflective activities
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Life and Death Matters Copyright 2020 Supporting an Appropriate Death
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Life and Death Matters Copyright 2020 What is an appropriate death? PSWs: Know that “good” and “bad” are subjective terms and that they reflect personal preferences. When referring to someone else's preferences, use the term “appropriate death. ”
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Life and Death Matters Copyright 2020 My preferences for dying
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Life and Death Matters Copyright 2020 My preferences for a loved one
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Life and Death Matters Copyright 2020 Collaborating with the Team to Build a Safe Environment for Health Care
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Life and Death Matters Copyright 2020 Providing a safe environment for health care includes Supporting cultural safety Addressing systemic bias and racism Developing a trauma-informed approach for providing care
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Life and Death Matters Copyright 2020
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