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Life and Death Matters Copyright 2020 | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Culture is defined as: “ The ideas, customs and social behaviours of a particular people or society” PSWs: Know that a lack of understanding or appreciation of another person's culture can create barriers for people who need or wish to access care. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PSWs role in providing a culturally safe environment As providers of direct care, PSWs are instrumental in providing and advocating for culturally safe care With cultural safety, a person feels heard and respected We primarily address Indigenous culture in this text, however providing culturally safe care is important when providing care for any person whose culture may be different from yours | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Components of Cultural Safety | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Cultural Humility Empowers the dying person and family Acknowledges that answers from the person and family are as valid as those of the medical team | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Cultural Awareness is... Acknowledges your cultural values, beliefs, and perceptions. Acknowledges that you view every other culture through your cultural lens. Involves asking “Why do we (my family, community) do things this way?” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Cultural Sensitivity Equalizes the power between cultures Acknowledges that all cultures have different values and beliefs, and that no culture is better or worse than another culture | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Cultural Competence Involves: A life-long commitment to honouring and respecting the people you provide care for Acknowledging your biases Gathering information from the person about their cultural values, beliefs and protocols, and incorporating those into caregiving. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Cultural competence is crucial to cultural safety It can prevent miscommunications, misunderstandings and false assumptions | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 With cultural competence “The PSW can effectively and respectfully provide holistic care that meets the physical, mental, emotional, and spiritual needs of the person and their family. ” PSWs Role: Advocate for cultural and religious practices that are important to the person and family Connect with the community as needed for support | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Tools -Indigenous Wellness Framework | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Adopting the Concept of Two-Eyed Seeing “... the urban Indigenous lived experience is often one of variable cultural connections: neither completely in the canoe (representing Indigenous culture) or in the ship (representing Western culture) but in some third space in-between” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Image concept of Two-Eyed Seeing | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Two-Eyed Seeing This art illustrates Medicine Walker by Thomas Anderson | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Addressing Systemic Racism and Bias in Health Care | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Truth and Reconciliation: Calls to Action Education for all health care providers to: Understand the effects of residential schools Develop skills for addressing systemic racism and bias Develop skills in cultural safety, cultural competency and conflict resolution Acknowledge unique health care needs of Indigenous people Value traditional healing and medicine | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Developing Best Practices in Palliative Care | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 What is a best practice? “A way of completing a task that always gives the desired result. ” Examples from your lives? | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Best practices in palliative care These are practices and approaches that enable you and every member of the team to provide excellent care, as determined by the person and family. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Best practices are grouped into 3 categories 1. Expanding your world view 2. Building skills in connecting and communicating 3. Developing best practice ways of being | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 1. Expanding your world view Health care providers who provided excellent palliative care viewed every person as valuable, worthy of honour and respect, and deserving of care. In practice this means: Seeing the person as a human being Hearing the person Interacting with the person | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 “The breast cancer in Room 312 is upset and not eating” vs “Marjorie is the woman in Room 312. She's feeling upset because she didn't feel well enough to go to her son's birthday. I wonder if we could arrange a video conference for her with her son? It might help her to feel connected with him. ” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Supporting every person's dignity The Dignity Question is, “What do I need to know about you as a person to give you the best care possible?” (Chochinov et al, 2016) | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 2. Building Skills in Communicating and Connecting | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Because connecting... Builds trust Communicates value and respect | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Skills for Communicating and Connecting Listening Pausing Asking open-ended questions Being silent Responding with curiousity Avoiding roadblocks to communication | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Listening Listen with the sole intention of hearing the person | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Pausing Take a moment before you respond. Listen and reflect on what the person has said. Pausing may help the person feel validated. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Seeking to understand Asking open ended questions such as, “Hmmm... can you tell me more?” “Can you clarify what you are asking for please?” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Offering silence Support can be: Offering silence | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Being there with a person “Good communication that includes silence is an art” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Responding with curiousity Being curious is essential to providing person-centred, culturally safe palliative care | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Being curious means... Asking questions only if the answers will enhance the therapeutic relationship Curiosity for curiosity's sake is unethical | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Responding, by avoiding roadblocks Avoid roadblocks that: Minimize the problem Offer false reassurance Offer excessive praise Offer platitudes | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Developing Best Practice Ways of Being | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Focusing on strengths and not judging Look for the strengths in the person and the family | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Maintaining hope Hope changes through different life experiences PSWs can foster hope | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Being empathic and compassionate Empathy —the ability to see the perspective of, and feel the emotions of, another person | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 A few characteristics of offering empathy Seeing the world as others do Staying out of judgement | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 3. Building a Professional and Ethical Practice | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Strategies for building a professional and ethical practice 1. Maintaining therapeutic boundaries 2. Collaborating with the team 3. Committing to advocacy 4. Committing to learning 5. Committing to leadership | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 1. Maintaining Therapeutic Boundaries | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 A Caregiver without Boundaries I love my work, but I am overwhelmed. I work five days a week, and on my days off, I still have to go to work and care for the people who don't have family to check in on them. I know I shouldn't, but I just have to go. The other caregivers don't remember to provide some of the care that she needs. ” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 What are boundaries? “Invisible edges of a relationship” The space between people in a relationship that we do not cross | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Types of boundaries Personal boundaries-identify how physically close you can be with another person and feel comfortable Emotional boundaries-identify how emotionally close you can be with another person and feel comfortable For this presentation: Boundaries = therapeutic boundaries | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Boundaries support emotional availability Therapeutic boundaries allow you to be available emotionally while remembering that their story is not your story. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Boundaries help you respect family relationships... "I want you to treat my mom like she is your mom, but remember that she is my mom" | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Boundaries are important Because PSWs provide the majority of direct care. May develop very close relationships with person and family | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 When providing direct care You will often: Say hello and then goodbye to many people Be referred to as “family” by person and family Feel like family Be asked to perform tasks not assigned | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 With unclear boundaries You may Feel extreme emotions Feel ownership Try to take control Try to fix “unfixable” problems | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 The Fix-it Trap When people are dying, they may suffer with emotional pain and grief- this pain is unfixable. PSWs: Know that as a care provider, you will need to learn strategies for “being with” suffering without needing to fix-it | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Strategies for Avoiding the Fix-it Trap PSWs Role: Learn how to distinguish between providing comfort and responding to grief Learn how to be with the person, bear witness to their pain, hear what they say and validate it, but not to take it on. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 How to maintain boundaries 1. Acknowledge the importance of boundaries 2. Know the scope of your job 3. Take time to reflect on situations where you experienced strong emotions 4. Engage regularly in self-care | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Maintaining Boundaries When Working in Small Communities | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 The Family Dance The image of the dance can help us understand how to work from a therapeutic distance | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 On the edge of the dance floor, you can 1. Observe and learn about family interactions 2. Explore to understand what to ask 3. Normalize -what would a healing response look like? 4. Preserve the integrity of the family dance | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Collaborating with the team | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Committing to: Advocacy Learning Leadership | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 What is an advocate? Someone who speaks up for or on behalf of another person | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PSWs can advocate for the person, the family, or help them to advocate for themselves | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Ways that PSWs advocate 1. Clarify information to clear up misconceptions 2. Connect the person with assistance 3. Identify people or resources needed when people advocate for themselves | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PSWs advocate for the person and family when they help to gatekeep as the person's energy declines | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Strategies for Advocating Be confident Be professional Be prepared Be clear Be descriptive Be positive Be thankful for assistance | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Chapter 3 Using Standardized Tools | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Learning Outcomes 1. Explain the rationale for using standardized tools. 2. Demonstrate how to gather and communicate information using the standardized tools PPS, ESAS, Symptom Framework for PSWs, PAINAD and SBAR. 3. Demonstrate how to effectively record and report information to the team. 4. Discuss communication strategies that facilitate collaboration with the team. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 As PSWs, you often provide the majority of direct care for the dying person | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PSW's role 1. Gather information 2. Record and report information 3. Collaborate with the team | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Preparing to gather information Sort your baggage Adopt a trauma-informed approach Be mindful of providing culturally safe care. Use open-ended questions and gather information about values, beliefs and practices | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Best practices for gathering information Become familiar with the person's and family's preferences Ask open-ended questions Include a translator when needed | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 What needs to be considered before gathering information? | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Using Standardized Tools | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 A standardized tool is one that has been tested by multiple different researchers, where the testing indicates the tool provides consistent results when used by different people at different locations. What is a Standardized Tool? | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Standardized Tools used in the text Palliative Performance Scale (PPSv2) CHSA Clinical Frailty Scale ESAS Symptom Framework for PSWs PAINAD PACSLAC II Psychosocial Assessment Tool | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Palliative Performance Scale (Version 2) Used across Canada in many care settings Can be used by all members of the health care team | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Palliative Performance Scale (PPS) looks at: Ambulation Activity Level/Evidence of Disease Self-Care Intake Conscious Level Provides a “snapshot” of the person's health at that time | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 What is a PPS level? | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Using the PPS regularly will help identify Changes in the person's health status Changes in the person's care needs | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Example of a PPS Report “I am with Mr. M. He is totally bed bound, is unable to do any of his normal activities, requires total care, is taking only sips of fluids and is drowsy and awake for only short periods. ” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 When you notice the PPS value declining If change is slow and gradual-the team may update the PPS weekly If decline is abrupt and changes are occurring daily, the team may update the PPS daily If the PPS has changed overnight (e. g. from 40% to 20%) the PSW will need to notify the team | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Using the PPS Example of a PPS score Hal spends the majority of hisdaysitting orlying down due tofatigue from advanced disease. He require sconsiderable assistance to walk even for short distances but isother wise fully conscious with good intake. Their PPS score would be 50%. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 CSHA Clinical Frailty Scale Each level of the scale has a descriptor “Very fit” to “Severely frail” “Very fit” is level 1“Severely frail” is level 7 | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 CSHA Clinical Frailty Scale and the PPS Both these tools provide “snapshots” of the person's health and abilities, for that moment. Can be used to identify changes in health when used regularly Check to see which of these tools are in use in the facility where you work | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Using both the PPS and the CSHA Frailty Scale Both tools provide information on the person's status and changes in status Scores using one tool can be converted to the other tool | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Edmonton Symptom Assessment Scale (ESAS) Gathers information from the person about 10 specific symptoms 10 point scale: zero = no symptom Quick to use Visually easy Must be answered by the person Cannot be used if the person cannot self-evaluate | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 ESAS-a “snap-shot” view Provides a “snap-shot” of the person's current or new symptoms Body map can be used in conjunction with ESAS to help the person to show the location of a symptom Record and report | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Symptom Framework for PSWs Adapted from Fraser Health Symptom Assessment Acronym OPQRSTUV Use as a guide to gather information-not every question needs to be asked of every person Adapt questions and use the language that the person uses | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Symptom Framework for PSWs Adapt the questions Include the person's words in the report Record and report | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Text includes symptom specific frameworks e. g. Symptom Framework for PSWs adapted for difficult breathing Symptom Framework for PSWs adapted for pain | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PAINAD Scale and PACSLAC II PSWs will use these tools when caring for people who are cognitively impaired or unable to respond verbally PAINAD-Pain Assessment INAdvanced Dementia PACSLAC II-Pain Assessment Checklist for Seniors with Limited Ability to Communicate | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 PAINAD-Pain Assessment in Advanced Dementia | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Sometimes I hear the practical nurse say “The RN doesn't listen to me”Sometimes I hear the PSW say “The practical nurse doesn't listen to me. ” Sometimes I hear the person and family say “No one listens to me”Sometimes I hear the nurses say “The physician doesn't listen to me. ” | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Successful communication Start by clearly recording information Proceed by clearly reporting information | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Communicating with team When recording Write clearly, briefly and legibly Provide only necessary information-do not include judgement Clearly state the assistance you are asking for | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Communicating with team-how to be heard When reporting Organize information using the SBAR Include info from tools Level of detail may differ when working in a facility (where the nurse can easily see the person) versus in community (where the nurse must rely on information from the PSW) | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 SBAR Communication Tool A framework that facilitates clear, concise and accurate communication of information within the health care team S = situation B = background A = assessment R = recommendation | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Summary 1. Explain the rationale for using standardized tools. 2. Demonstrate how to gather and communicate information using the standardized tools PPS, ESAS, Symptom Framework for PSWs, PAINAD and SBAR. 3. Demonstrate how to effectively record and report information to the team. 4. Discuss communication strategies that facilitate collaboration with the team. | HCA204-Chapter1-7-FP2.pdf |
Life and Death Matters Copyright 2020 Chapter 4 Supporting Physical Comfort 4A: Principles and Practices | HCA204-Chapter1-7-FP2.pdf |