Palliative Part 2

Question 1

What are some of the roles of palliative nurses?

Answer 1

• Comfort care
• Working with family
• Education
• Pain control
• Chronic illness/Ca patients common

Question 2

What is the supportive care model?

Answer 2

• Based on observing the nursing practice in a pain and symptom control clinic
• Model consists of six interwoven dimensions (empowering, doing for, etc.)
• Dimensions are directed towards emotional aspects of dying and practical concerns of patients and carers

Question 3

Under the supportive care model, what is valuing?

Answer 3

• Provides context for supportive care
• Involves respect for a particular individual
• Primarily an attitude which underlies action

Question 4

Under the supportive care model, what is connecting?

Answer 4

• Establishing a trusting relationship with patient and family
• Sustaining connection requires nurse to spend time with the patient and family and to give of oneself
• After the patient dies connection continues for a time in the form of bereavement support
• Eventually connection will be broken

Question 5

Under the supportive care model, what is empowering?

Answer 5

• Building on strengths of patient and family
• Assess for and support effective coping techniques
• Assist with decision making; support choices; providing information
• Letting them vent (listen!)

Question 6

Under the supportive care model, what is “doing for”?

Answer 6

• Goal is to free up person and family so energy can be focused on really important areas for them
• Includes pain and symptom management, co-ordination of care, and advocating
• Collaboration with pt/fam to establish goals and care plan

Question 7

Under the supportive care model, what is finding meaning?

Answer 7

• Involves focusing on living, making best use of time remaining
• People need to be able to make sense of what’s happening to them
• Important to support realistic hope
• Care for spiritual needs

Question 8

Under the supportive care model, what is preserving integrity (wholeness)?

Answer 8

• Core of model
• Refers to integrity of both patient and nurse; must be maintained through balanced attention to all dimensions
• Nurse needs to be able to maintain sense of self-worth and take care of self
• Holistic approach to providing care to person and family

Question 9

How do we perform self care?

Answer 9

• Learning to receive as well as give
• Learning to grieve
• Replenishing oneself
• Staying healthy
• Being able to let go of personal agendas

Question 10

What are some challenges in providing palliative care?

Answer 10

• Time and resource management
• Communication (e.g. end of life situations)
• Family scenarios

Question 11

What did the iPANEL (Initiative for Palliative Approach in Nursing: evidence and leadership) discuss?

Answer 11

• 70% of Canadian’s do not have access to palliative care
• Whilst specialist palliative care units are essential, they are not appropriate for everyone with a life-limiting condition
• By offering a palliative approach in settings such as long term care, acute med units and home, better care can be given to pt/families experiencing multiple transitions of chronic and life-limiting illness
• Goal to further advance integration of a palliative approach to nursing practice in every care setting
• Study informed by nursing practice
• Partnerships are essential (health authority, academic institutions, individuals)

Question 12

What is grief?

Answer 12

• Normal response, unique to individuals, with no timetable or structure
• Process of experiencing a variety of physical, social, and behavioral reactions

Question 13

What is anticipatory grief?

Answer 13

• Aka. Preparatory grief
• Grief reaction occurring in anticipation of an impending loss
• Grieving in the present, relative to a process of loss currently being experienced and projected into the future

Question 14

What is mourning?

Answer 14

• Critical expression of grief to outside world
• Publicly exposed, externalized from within the heart to without
• May include wakes, funerals, cultural practices, etc.
• Needs to run its course as an expression of grief in order that healing may occur

Question 15

What is shadow grief?

Answer 15

• Renewed sense of loss experienced around anniversary of loss, special occasions, etc.
• ‘triggers’ may cause same feelings of grief as time of bereavement (e.g. specific location, piece of music)

Question 16

What is disenfranchised grief?

Answer 16

Grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publically mourned or socially supported

Question 17

What is companion-ing?

Answer 17

• to ‘walk with’
• Most people with uncomplicated grief will recover with help of understanding friends/family but do not carry the burden
• E.g. facilitate not ‘fix’, professional help may be needed

Question 18

What is complicated/abnormal grieving?

Answer 18

• Failure to return to an individual’s pre-loss level of emotional well-being and functioning
• Can involve unresolved issues, avoidance of loss, etc.

Question 19

What is involved in the journey of grief?

Answer 19

• Loss
• Protest
• Despair
• Reorganization
• Reinvestment

Question 20

What are the needs of people who are grieving?

Answer 20

• Uniqueness of grief responses
• Expectations one can have of oneself in grief
• Needs of people who are grieving
• Signs that may indicate unhealthy grief
• Need a safe place
• Need to share pain with others
• Find ways to be in control in time of confusion and lost independence
• People who are dying need to be given permission to die, to let go
• Self-care (e.g. of caregiver)
• To say goodbye to loved ones
• To be asked specific questions re: needs and not have them assumed

Question 21

What influences the way a person grieves?

Answer 21

• Nature of relationship with person who died
• Age of decreased
• Nature of death
• Unique characteristics of decreased and survivors
• Ability of person to make use of social support systems
• Person’s religious and cultural history
• Other crises and/or stress in the person’s life
• Previous experiences with death

Question 22

What are some signs of unhealthy grieving?

Answer 22

• Avoiding any thoughts or feelings about loved one’s death
• Alcohol/drugs to prevent experience of pain
• Avoiding all relationships for fear another loss will occur
• Talking about suicide
• Significant detachment and withdrawal from SO’s
• Suppression of feelings/emotions
• Denied any meaningful participation in rites/rituals of death
• Preoccupation with one’s own health (e.g. cancer phobia)

Question 23

How do we set professional boundaries in patient care?

Answer 23

• Use common sense
• Discuss your feelings
• Develop other interests
• Take care of physical needs
• Learn to relax
• Incorporate humor

Question 24

What is the six “R” process of mourning?

Answer 24

1) Recognize the loss
2) React to the separation (experience pain; give it form; identify secondary losses)
3) Recollect and re-experience deceased and relationship (review/remember realistically)
4) Relinquish old attachments to decreased and old assumptive world
5) Readjust to move adaptively into new world without forgetting old (new relationship with decreased; adopt new ways of being in world; form a new identify)
6) Reinvest

Question 25

What are some facts about children and grief?

Answer 25

- There are several misconceptions about children and loss (e.g. children don't feel grief, they don't understand, funerals would upset them, etc.) - The young know when others are upset; not being involved can be more upsetting; children grieve in their own ways - Developmental levels must be accounted for - There are no right answers, only honest ones; acknowledgement helps dispel fear and misunderstandings - They may not be able to understand everything, or be able to handle intensity of situation; but they will set the pace if allowed to