Concepts Flashcards
Remember Concepts
What is Shared mind? Hint: This card has several ways of talking about shared mind, so try to name as many as possible, then see if you are close.
“ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meaning, and intentions among 2 or more people.” 1+1=3
A continuum of patient-centered approaches to patient-clinician interactions: Transactional <—-> Interactional
“promotes relational autonomy, a view…that humans are social beings and that trusting relationships and personal knowledge…enhance autonomy by helping patients to process complex decisions that otherwise overwhelm the cognitive capacity of a single individual
Existential distress is a clinical concern for cancer patients, that can be addressed through relational ethics, how? (General)
(Alleviating Existential Distress of Cancer Patients: Can Relational Ethics Guide Us? Leung & Esplen, 2010)
“Patients and families need empathetic understanding of a shared mortality that honours connections to a greater force, to a higher power, or to others to preserve individual personhood and dignity”
Existential distress is a clinical concern for cancer patients, that can be addressed through relational ethics concept of ENGAGEMENT, how?
(Alleviating Existential Distress of Cancer Patients: Can Relational Ethics Guide Us? Leung & Esplen, 2010)
- Engagement with existential distress: “many clinicians are aware of their lack of knowing what to say and/or to do when patients have existential distress” -Engagement is about human to human connection… a commitment between individuals. -requires understanding the other’s situation, perspective, and vulnerability -ask ourselves “How do we engage with each other?” -Looking at a person as a whole, appropriate vulnerability, conversation, and time management are aspects of engagement. -other communication techniques, such as active listening, eye contact, and touch, and also a capacity to relate and be with one another, as well as create a safe space for self (patient) expression, etc.
Existential distress is a clinical concern for cancer patients, that can be addressed through the relational ethics concept of EMBODIMENT OF PRACTICE, how?
(Alleviating Existential Distress of Cancer Patients: Can Relational Ethics Guide Us? Leung & Esplen, 2010)
Embodiment of practice: “Cultural and social controls and norms are internalized in the body and become unconsciously expressed as the proper way to act in familiar situations” “When we can reflect on our emotions, we can be conscious of [the] ethically relevant aspects of a situation so that our rational judgments can be fully informed”
e.g. if i had a patient who looked like my mother who passed away, I might have a ton of emotions and feelings about the situation, but by reflecting on my emotions, i can seperate rational from irrational (or emotionally/ experienced charged) decisions for better patient outcomes
*i dont now for sure if this is what that means but i think so*
Existential distress is a clinical concern for cancer patients, that can be addressed through the relational ethics concept of ENVIRONMENT OF THE HOSPITAL, how?
(Alleviating Existential Distress of Cancer Patients: Can Relational Ethics Guide Us? Leung & Esplen, 2010)
- Environment of the hospital: “clinicians often face difficulty in hospitals where…they can not construct spaces to be present or talk and listen to patients’ illness experiences” “The unit culture does not fully support psychological care in light of inadequate staffing and little time”
Existential distress is a clinical concern for cancer patients, that can be addressed through the relational ethics concept of MUTUAL RESPECT how?
(Alleviating Existential Distress of Cancer Patients: Can Relational Ethics Guide Us? Leung & Esplen, 2010)
- Mutual respect (valuing patients as persons) “Attitudes…that fundamentally connect us to each other and reveals how we interactively help or are helped by others” “Nurses’ attitudes are shaped by previous experiences, both professional and personal”
What is existential distress? (LONG)
- Dying brings decline in health, withdrawal from social networks, loss of normal roles, and the utter aloneness with the confrontation of the end of one’s existence.
- which leads to feelings of hopelessness, burden to others, loss of sense of dignity, desire for death or loss of will to liveand threats to self identity.
- Existential Loneliness has entered the literature and ‘is understood as an intolerable emptiness, sadness, and longing, that results from the awareness of one’s fundamental separateness as a human being.’ [3]
How do we know if we are breaking bad news? (from breaking bad news article)
WE DON’T!!!!! Some people are afraid to give “bad” news, but whether it is good or bad is subjective to the receiver. Most people prefer “honest, accurate and reliable information and want to receive it as close as possible to the time that the facts are known” Having the full picture does not diminish hope. It provides predictability, greater control, etc. and therefore gives power back to the individual and family… so don’t withhold peeps!!
Situations that require less disclosure (breaking bad news):
→ Some patients prefer not to receive some or all of the facts, because not knowing the truth is their way of coping with their illness → Cultural differences have been identified with regard to preferences and behaviours around information relating to particular diagnoses, such as cancer, and prognosis and end of life decisions ** important to ascertain individual patients’ preferences about the information they want to receive and allow these preferences to guide the content, timing and delivery of information**
Tips for breaking bad news (prep, giving information, responding to reactions and answering questions, planning for the next step, debriefing / develop and use supports)
Preparation -Identify who needs to be present -Find a setting that is private, where interruptions will be minimised; ensure chairs are available so everyone can be seated. -Ensure those being given the information know beforehand that they are going to receive significant news by alerting them to the seriousness of what they will be told. -Ensure there is time available for explanation, questions and emotional reactions so that the patient does not feel rushed. -Familiarise yourself with the relevant information — if you do not have the opportunity to do this because the situation is unplanned then listen, find the information and take it back within an agreed time frame. -Think beforehand how you will deliver the news and also the words and phrases that you are comfortable to use -Use open questions to find out what the patient knows and is expecting to hear; determine preferences for what and how much the patient wants to know -Do not make assumptions about what the patient or relatives know or what they want to know; seek their clarification. **Giving the information** -Provide the information accurately and clearly, getting a balance between being honest while at the same time being encouraging, supportive and hopeful. -Do not use jargon or medical terms without a thorough explanation. If patients do not understand they may feel confused or stupid and reluctant to ask questions. -Use words and phrases that have a clear meaning to prevent misunderstanding or multiple interpretations. -Do not use euphemisms such as ‘growth’ instead of ‘cancer’, ‘they didn’t make it’ instead of ‘they have died’, and ‘they are better’ when they have improved a little but there is no significant change. -Break the information into chunks, giving one piece of information and then moving on once you are sure the recipient has understood. -Continually assess preferences for additional information; confirm this with the patient and follow the patient’s lead. -Repeat key information; be aware that those receiving the news may not take in further information once the bad news has been given. -Respond to reactions and answer questions -Expect an emotional reaction. -Allow time and opportunity for expressing emotions — as Gauthier (2008) suggested, ‘listen more and talk less’. -Acknowledge the emotions being expressed and name them to give them legitimacy — for example, ‘I can see you are sad/angry/ overwhelmed by this news’. -Provide frequent opportunities for questions. **Plan the next step** -Agree a plan about what will happen next so patients and relatives have a sense of control and know what to expect. -Offer hope and encouragement about the options that are available. -Inform the patient and relatives that you will be available to discuss and listen to concerns in the future (if you will continue to be involved in their care) and/or provide information about support services that are available and the contact details of those involved in the next stage of their care. -Provide written information where this is available and appropriate. ***Debrief: develop and use support systems** -Managers should be aware that breaking bad news is time consuming and demanding and can have an impact on workload and the emotional wellbeing of staff. -Formal and informal opportunities to reflect and provide support should be made available. -Senior staff should take responsibility for ensuring sources of support are developed and used. Individual practitioners should pay attention to looking after themselves and find effective ways of coping with the stressful consequences that can follow involvement in breaking bad news.
What answers can an advanced care plan give for you when you are unable to answer for yourself?
- Who do you want to make your health care decisions for you?
- what health care treatment(s) do you agree to, or refuse to, if a health care provider recommends them?
- would you accept or refuse life support and life-prolonging medical interventions for certain conditions?
- what are your preferences should you need residential care and not be able to be cared for at home? (my voice)
When can moral distress and conflict of conscience occur?
When nurses experience situations that feel fundamentally wrong to them but also feel powerless to change them
Should nurses document any EOL and MAiD conversations?
Yes! Nurses must carefully document any conversations re: MAiD and EOL.
Should nurses document any EOL and MAiD conversations?
Yes! Nurses must carefully document any conversations re: MAiD and EOL.
When is conscientious objection okay?
When a specific type of care, treatment or procedure, conflicts with your moral or religious beliefs and values, you may arrange with your employer to refrain from providing the care. e.g. some nurses don’t feel comfortable being involved in MaiD
When is conscientious objection okay?
When a specific type of care, treatment or procedure, conflicts with your moral or religious beliefs and values, you may arrange with your employer to refrain from providing the care. -if you make the objection known to your employer well before a client would require care. -you are still responsible for ensuring that the objection does not impact the continuity of care or compromise the ability of the client to receive high quality, safe, ethical and competent care. e.g. some nurses don’t feel comfortable being involved in MaiD
What are BCCNP’s suggestions on providing high-quality, client-centered end-of-life care?
-advocating for clients -providing information -participating in decision-making -caring for and supporting clients and their families -collaborating with members of the health care team to ensure that clients have their care and information needs met.
When is a person eligible for medical assistance in dying?
-They are eligible for publicly funded health-care services in Canada -they are at least 18 years of age and capable of making decisions with respect to their health. -they have a grievous and irremediable medical condition -they have made a voluntary request in writing for MAiD that, in particular, was not made as a result of external pressure -they have given consent to receive MAiD after having been informed of the means that are available to relieve their suffering including palliative care
Give some points on the First Nations health
-The FN perspective is a Holistic model of health (physical, mental, emotional, and spiritual aspects of a being) -family structure looks different, and extended family is very important so we might see many visitors and must do our best to accommodate -culturally safe care is important -important to be culturally aware (know about history, differences, similarities, etc) -important to be culturally sensitive (understand how history has impacted indigenous health (health disparities), power indifferences, how sim. diffs impact care etc) -be culturally competent- possess tools for providing culturally appropriate care -many other points!!!
What does the FN holistic model of health include?
Center circle– individuals –> starts here with taking responsibility for our own health Second circle- important to focus on mental, emotional, spiritual, and physical facets to create a health, well-balanced life Third circle- respect, wisdom, responsibility and relationships (overarching values that support and uphold wellness) Fourth circle- the people who surround us are critical components of our health and wellbeing (nations, family, community, land etc) Fifth- social, cultural, economic and environmental determinants of our health and well-being outer circle- FHNA vision of strong children, families, elders and people in communities (so health goals i guess
Nurses, especially those with greater empathy are at greater risk of compassion fatigue due to the core values of nurses. What are the signs and symptoms of CF?
-anxiety and intrusive thoughts -apathy -depression -HTN -errors in judgment -trouble sleeping and nightmares
What is compassion fatigue?
‘nurses absorbing and internalising the emotions of clients and sometimes co-workers
Ethical relationships involve which concepts? (hint, there are 6)
Mutuality, engagement, embodiment, environment, non-coercion, freedom of choice
Ethical relationships involve the following key concepts, except: 1)mutuality 2)engagement 3)non-coercion 4)beneficience
beneficience
True or false: mutuality is a relationship that is mutually beneficial, it involves knowing and deeply understanding another person’s goals, values, beliefs
TRUE Mutual respect is inspired by responsibility to the other. “When we respect something [someone], we heed its call, accord it its due, [and] acknowledge its claim to our attention” (Dillon, 1992). Mutual respect is the means to mitigate power differentials. This does not mean that the nurse and the patient have equal power. It means that the nurse and the patient have different power. Within the relational ethic framework mutual respect provides a means of interacting with others that are not equal, through recognition that “our differences complement rather than exclude one another” (Benhabib, 1987, 87). Mutual respect develops from an intersubjective experience arising from a non-oppositional perception of difference. This is achieved by acknowledging the phenomenological experience of the selves in the relationship.
- Moral agency is: a. A nurse’s right to act in the best interest of the patient. b. The ability of a nurse to act in a moral or ethical way, which benefits outcomes. c. An agency who’s goal is to provide ethical and moral guidance. d. Both A and C
B. the ability of a nurse to act in a moral or ethical way, which benefits outcomes From CNA (ethical (or moral) agent. Someone who has the capacity to direct their actions to some ethical end, for example, good outcomes for patients (Storch, Rodney, & Starzomski, 2013). Exercising that capacity would be ethical (or moral) agency.)
- True or False Ethical / moral distress occurs when a nurse is unable act according to their moral judgement. This can lead to feelings of frustration, guilt and anger but it can also lead to reflection.
TRUE
- Hospice Palliative care is: a. A place where people go to die b. An approach to care c. An approach that seeks to improve quality of life d. B and C
D
- Which of the following factors impact the morbidity and mortality rates of indigenous communities both historically and currently: a. Residential schools b. Loss of traditional land - living on reserves c. Loss of culture – ways of being d. All of the above
D
- True or False Palliative care patients that stop eating die of starvation.
FALSE People with advanced illnesses don’t experience hunger or thirst as healthy people do. People who stop eating die of their illness, not starvation.
True or false: Palliative care is only for people dying of cancer.
False: Palliative care can benefit patients and their families from the time of diagnosis of any illness that may shorten life.
True or false: We need to protect children from being exposed to death and dying.
False- Allowing children to talk about death and dying can help them develop healthy attitudes that can benefit them as adults. Like adults, children also need time to say goodbye to people who are important to them.
True or false: Palliative care means my doctor has given up and there is no hope for me.
Palliative care ensures the best quality of life for those who have been diagnosed with an advanced illness. Hope becomes less about cure and more about living life as fully as possible.
True or False Opioid addiction is a concern for palliative patients who are being treated for pain.
FALSE: Keeping people comfortable often requires increased doses of pain medication. This is a result of tolerance to medication as the body adjusts, not addiction.
True or false: Morphine is administered to hasten death.
Appropriate doses of morphine keep patients comfortable but do not hasten death.
True or false: palliative care hastens death?
FALSE: Palliative care does not hasten death. It provides comfort and the best quality of life from diagnosis of an advanced illness until end of life.
- All of the following are common trajectories of illness except a. Terminal illness b. Violent death c. Frailty d. Organ failure
b. violent death
- Which statement (s) is correct - Prognostication a. Is not always accurate b. Provides information for patients, families and healthcare providers. c. May involve assessment tools such as the Victoria Hospice Palliative Performance Scale. d. All of the above.
*******D***** more info: → pt’s and families usually recognise that physicians cannot accurately give an answer but mostly they want an educated guess and willingness to discuss end of life topics. → when pt’s ask “how long have I got” clarify what they are asking, are they asking how long until the next exam/dx test? How long until they can leave hospital? → also you need to determine the reasoning behind the question: pt may have things to complete before death (paperwork, family visits etc) or they have a trip planned, family may be wondering if they should come visit now or if they can come later. Many different tools exist for prognosticating disease course: most important factor is the patient’s level of function, usually referred to as his/her performance status. Measuring the rate of decline of performance status will demonstrate a momentum that can be used to estimate further decline. In other words, in palliative care, conditions that deteriorate week by week usually continue to do so, day by day etc. Measuring performance: → palliative performance scale: useful in documenting performance status & therefore monitoring decline in performance to gain an estimate of prognostication. Also useful tool for communication of illness. → Karnofsky performance scale: similar to palliative. Measures performance in oncolog. Pt’s rate on scale of 100 - 10 based on status in 4 areas (activity & evidence of disease, self-care, intake, and LOC) Predicting performance: 2 tools are identified in this paper for prognostication. Bothe are designed for oncology but can be used for other diseases. However: many progressive, life-threatening non-cancer diseases have more unpredictable courses and prognosticating is more difficult → palliative prognostic score 30-day survival probability is less than 30% with a score greater than 11, and more than 70% with a score of 0 to 5.5. → Palliative prognostic index Scoring greater than 6 on the palliative prognostic index predicts a survival of less than 3 weeks (sensitivity 80%, specificity 85%).
What are the 2 components of prognosticating?
→ The 2 components of prognosticating are formulating an accurate prediction and communicating it to the patient and family. Together, these components are a mix of art and science.
What are risks of prognostication?
→ Underestimation: (pt live longer than expected) family members believe they have been robbed of “usable” time. → Overestimating: (pt dies earlier than expected) might delay referral to palliative care services or delay aggressive analgesia use. might also increase the use of potentially toxic and difficult treatments, which will have little effect on the patient’s time and might result in lower quality of life. Family may delay visiting, proper documents may not be in place when death occurs.
- True or False– Care that emphasizes knowing the patient and family and is based upon sharing thoughts, perceptions and ideas, with a focus on relational autonomy in decision making, is transactional care. (Reference, Epstein and Street, 2011 – Shared Mind)
False- it’s transactional…..
Shared Mind includes talk of interactional and transactional interactions (it’s a continuum) which are described as: At one end of the continuum, an interactional approach promotes knowing the patient as a person, tailoring information, constructing preferences, achieving consensus, and promoting relational autonomy. At the other end, a transactional approach focuses on knowledge about the patient, information-as-commodity, negotiation, consent, and individual autonomy
What is shared mind?
ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among 2 or more people.
Existential Distress is the distress that occurs when we contemplate our existence and / or death. This type of distress is commonly seen with cancer patients or others facing a terminal diagnosis. Which of the following can help healthcare providers navigate existential distress with their patients. a. Transactional care b. Moral agency c. Relational ethics d. Biomedical ethics
Relational ethics
Bad news can come in many forms, healthcare providers may not always know what a patient and family consider to be bad news. Which of the following communication techniques are helpful when potentially delivering bad news to patients and / or families. a. Use open ended questions to determine - what the patient knows, preferences for how much they want to know, or what they are expecting you will say. b. Use closed ended questions to get to the point. c. Use clarification to avoid making assumptions. d. Avoid euphemisms, medical terms and / or jargon. e. A, C and D
********E******* The other tips on BBN: Preparation -Identify who needs to be present -Find a setting that is private, where interruptions will be minimized; ensure chairs are available so everyone can be seated. -Ensure those being given the information know beforehand that they are going to receive significant news by alerting them to the seriousness of what they will be told. -Ensure there is time available for explanation, questions and emotional reactions so that the patient does not feel rushed. -Familiarise yourself with the relevant information — if you do not have the opportunity to do this because the situation is unplanned then listen, find the information and take it back within an agreed time frame. -Think beforehand how you will deliver the news and also the words and phrases that you are comfortable to use -Use open questions to find out what the patient knows and is expecting to hear; determine preferences for what and how much the patient wants to know -Do not make assumptions about what the patient or relatives know or what they want to know; seek their clarification. **Giving the information** -Provide the information accurately and clearly, getting a balance between being honest while at the same time being encouraging, supportive and hopeful. -Do not use jargon or medical terms without a thorough explanation. If patients do not understand they may feel confused or stupid and reluctant to ask questions. -Use words and phrases that have a clear meaning to prevent misunderstanding or multiple interpretations. -Do not use euphemisms such as ‘growth’ instead of ‘cancer’, ‘they didn’t make it’ instead of ‘they have died’, and ‘they are better’ when they have improved a little but there is no significant change. -Break the information into chunks, giving one piece of information and then moving on once you are sure the recipient has understood. -Continually assess preferences for additional information; confirm this with the patient and follow the patient’s lead. -Repeat key information; be aware that those receiving the news may not take in further information once the bad news has been given. -Respond to reactions and answer questions -Expect an emotional reaction. -Allow time and opportunity for expressing emotions — as Gauthier (2008) suggested, ‘listen more and talk less’. -Acknowledge the emotions being expressed and name them to give them legitimacy — for example, ‘I can see you are sad/angry/ overwhelmed by this news’. -Provide frequent opportunities for questions. **Plan the next step** -Agree a plan about what will happen next so patients and relatives have a sense of control and know what to expect. -Offer hope and encouragement about the options that are available. -Inform the patient and relatives that you will be available to discuss and listen to concerns in the future (if you will continue to be involved in their care) and/or provide information about support services that are available and the contact details of those involved in the next stage of their care. -Provide written information where this is available and appropriate. ***Debrief: develop and use support systems** -Managers should be aware that breaking bad news is time consuming and demanding and can have an impact on workload and the emotional wellbeing of staff. -Formal and informal opportunities to reflect and provide support should be made available. -Senior staff should take responsibility for ensuring sources of support are developed and used. Individual practitioners should pay attention to looking after themselves and find effective ways of coping with the stressful consequences that can follow involvement in breaking bad news.
