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Assisting the Person Who is Dying and Their Family:

Essentials in Hospice Palliative Care

National Association of Career CollegesRevised Module 14November 3, 2011

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Goals

• Intro new Module 14 & Essentials in HPC resources

• Know how to access: • instructors guide, podcasts, order

forms, LDM

• Q & A• Demo

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Goals

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Your goals

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Why?

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Exciting time to be alive…

• Boomers started turning 65 this year. • Demographics

• 100 years ago • 1/20 people over 65 years• 2026 1/5 people over 65.

• Annual death rate• By 2056 the annual death rate will have nearly

doubled.

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Interesting time to be dying…

Dying is not what we

think it is…

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Pattern of dying has changed…

• 10% unexpected - heart attack/accident…• 20% cancer, often with some warning• 30% chronic organ failure,

•ups and downs •on deaths doorstep numerous times

• 40% dwindling, (>50% with dementia)

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The challenge…

• Decreased length of time requiring care

• Decreased family caregivers• Decreased beds per capita,

• LOS reduced from 43 months twenty years ago, to only 14 months now.

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PSWs….

Provide 80% of care in

long term care

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Hospice Palliative Care

•Gold standard of end of life care

•Less than 25% of dying Canadians access the services of a specialty hospice team

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The good news

Not everyone needs a

specialty team!

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But most people benefit from ….

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A palliative approach

Palliative principles and practices•Anyone with a life limiting illness•Earlier in the disease process• In any setting

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Don’t let “End of Life Care”

become “End of the Road Care” –

Integrate Palliative Education!

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Module 14

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Terminology

Personal Support Worker =Health Care Worker

Assessment =Gathering information

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Module 14

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Module 14 – Assisting the person who is dying and their family: Essentials in HPC

• Time – 22 hours• Learning outcomes• Content guidelines• Resources (Instructors Guide, Text, Study Guide, Podcasts, PPT, DVD) • Evaluation (Study Guide, Group

Assignment, Final Test)

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Content - sessions

• HPC principles, philosophy• “On being up close & personal w/ the

dying”• Physical comfort - common issues• Care in the last days & hours and

following death• Self care

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Evaluation

•Study Guide 35%•Group Assignment 20%•Final Test 45%

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Marking the Study Guide

•Beliefs and Baggage (participation)•Content and Concepts (answer key)

•Based on learning needs, •choose 35 questions, •include B&B, C&C, I&A

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Group Assignment

• Information for the instructor• Information for the students• Marking scheme (give students a copy)• Case Study #1

•Patient role•PSW role

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Module 14 is supported by “Essentials in HPC Resources”

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Essentials Text

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Study Guide

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Beliefs and Baggage

•Following the exercise on breathing with a straw, … write about your experience with difficult breathing. What did this feel like to you?

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Concepts and Content

•List physical behaviours that you might observe with ….

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Integration and Application

•Case Studies•Questions•Apply in

•Lecture•Lab•Clinical setting

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Teaching Presentations: PPTs

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Lecture notes for instructors include:

Links to resources

Key points

Supplemental information for use at instructor’s discretion.

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“Customize”

You can •Personalize for particular needs•Localize for each community

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Videos

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Podcast Library

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Warehouse

•Let’s pull it all together…

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Instructor’s Guide

•pulling it all together!

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Instructors Guide - Outline

• Intro•Page 13-16•Comments? Questions?

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Instructors Guide – see handout

• Intro• Allocated teaching time (22 hours)• Learning Outcomes• Resources at a Glance, supplies• Instructor prep• Student prep• Lesson Plan

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Guide

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Technical details

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Instructor’s Guide – download

• http://lifeanddeathmatters.ca/facilitators-forums/instructors-guide.html

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How to access the podcasts

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Order form

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Life and Death Matters contact info

• info@lifeanddeathmatters.ca

• admin2@lifeanddeathmatters.ca

• kath@lifeanddeathmatters.ca

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PowerPoint posted online:

Shareslide – see online http://

www.slideshare.net/lifeanddeathmatters

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Break

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Group Assignment

• Information for the instructor• Information for the students• Marking scheme (give students a copy)• Case Study #1

•Patient role•PSW role

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Let’s walk through one session -

Dyspnea• Teaching Time: 1.5 hours

• (with Comfort Basket add .5 hours)

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Learning Outcomes

At the end of this unit learners will be able to:• Experience dyspnea through participation in the

exercise.• Identify 5 questions to ask and what to observe.• Identify three comfort measures for preventing or

alleviating discomfort with dyspnea.• Provide a sample report on a patient experiencing

respiratory congestion with dyspnea, including a request for nurse’s help.

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Resources at a glance

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Supplies, Preparing• Bring in three straws…• Instructor Preparation

•Familiarize self with the material•Preview dyspnea video•Comfort basket?•Choose activities, discussion points,

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Videos

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Video Activity

Straw exercise –

See also page 61 text

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Beliefs and Baggage

•Following the exercise on breathing with a straw, … write about your experience with difficult breathing. What did this feel like to you?

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PowerPoints – Dyspnea

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DYSPNEATHE FEELING OF BREATHLESSNESS

pgs. 60-68

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What to look/listen for

• (Respiratory rate)• Breath sounds• Periods of shortness of

breath? • Pauses for breath when

talking?

• Shortness of breath on exertion?• Does it settle with

rest?• Cough/congestion• Skin color• Fever• Anxiety or fear

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Concepts and Content

•What you might observe when someone is having difficulty breathing:

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Assessing Dyspnea

ASK the Patient:

•“Do you ever have difficulty breathing?

•Rate dyspnea with ESAS (text pg.30)•"OPQRSTUV"

pgs. 62-63

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Integration and Application

Study Guide – p.30 Using assessment toolask person about his/her breathing

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Guiding through an acute episode

• Acknowledge patient’s“I can hear that you are

uncomfortable…”• Touch may help ground individual• Provide a focus message

“Look in my eyes…”“Breathe with me…”

pg. 67

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Comfort Basket

• Dyspnea presentation….

• May want to include the

comfort basket here as well

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THE ARBUTUS TREE

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The Arbutus Tree

A symbol of…

• Strength

• surviving and thriving in harsh conditions

• Growth at the edge between land and sea, between life and death

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Click icon to add picture

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Teaching is in invitation to learn

And learning is an invitation

to teach….

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Poem by Deanna Edwards

Teach me to dieHold on to my hands

I have so many questionsThings I don’t understand

Teach me to dieGive all you can give

If you teach me of dyingI will teach you to live

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Thank you!

•Feedback and evaluation

•kath@lifeanddeathmatters.ca

• info@lifeanddeathmatters.ca

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