Final Flashcards
narrative ethics
framework that helps people tell stories that allows nurses to choose the best way to act
what is narrative ethics interested in
preventing mutual misunderstanding
hx of palliative care
Economic prosperity following the war resulted in hospital coverage to have deaths in hosptial
principals of palliative care
dignity hope comfort QOL relief from suffering
nurses role in palliative care
initiates communication that reflects values and honors patients wishes
what is palliative care
seeks to improve pts QOL once a chronic/life limiting condition is diagnosed
3 theories and models that assist nurses in working with patients and families
shared theory unitary care model transition model
shared theory
nursing competence, self competence, interventions, palliatve care behaviours
unitary care model
uses interpretive reasoning and reflection to inc knowledge
values in unitary care model
pattern, wholeness, consciousness, caring, transformation, relationship meaning
transition model
palliative care approaches are similar to chronic condition management
factors that affect palliative care delivery in transition model
health problems (non ca pateints recieve more life prolonging interventions) policies nurses education in EOL care
pattern
every person is unique
wholeness
each person is greater then and different from the sum of their parts
consciousness
lots of personal growth, nurse helps family express thoughts and become conciouss of experience
transfomration/transcendence
nurse helps transform patients view of illness
relationship
connection and caring through dialogue, negotiation, meaning, creating, sharing
meaning
consists of understanding of illness and dying learned through nurse
primary nursing role when breaking bad news
to provide information and support in response to questions asked by patients and family that is essential to coping
shared minds def
new idea and prespective emerge through sharing of thoughts and feelings between 2+ people
interactional shared mind care
occurs when pt and HCP are engaged in dialogue and actively participating in process
transactional care shared mine
you are going through motions to get the jop done
benefit of interactional shared mine approach
allows nurse to connect with the patient
prognostication
estimates of a patients survival time
what does prognostication mean for the patient
may provide hope or let patient plan
cons of underestimation with prognostication
pt may think they are robbed of time
cons overestimation with prognostication
may cause excessivley aggressive/toxic treatments or delay referral to PC
disease trajectory
pattern in which disease typically follows
disease trajectory helpful
can help w prognostication
disease trajectory unhelpful
not all diseases follow the same pattern, every patient and disease is unique
what does quality of life mean in EOLC
subjective to pt emotionally stable pain controlled hope, dignity
what must the hcp beware of when a patient is making difficult desicions
patients often make medical decisions to fulfill someone elses psychological needs
advanced care planning
process of reflection and communication, lets people know what kind of health and personal care you would like to receive
what does an advanced care plan mean for the pt
that their wishes will be honored
what does advanced care plan mean for the family
it allows the family th know what the patient wants
who is involved in advanced care planning
doctor, loved ones, nurses
Roles and responsibilities of POA
gives someone permission to act on your behalf in legal matters (money business, private affairs)
who is involved in POA process
you, lawyer, two witnessess *cant be spouse or children)
temporary decision maker/representation agreement
someone who makes decisions temporarily when pt is unable to. POA interms of healthcare
what does a representation agreement mean for the pt
someonelse is making their healthcare descisions for a time
who can be involved in representation agreement
guardian, spouse, adult child
advanced directive
MOST/resus guide
what does Advanced directive mean for the patient
lets them choose what degree of intervention they want
who is involved in the AD
doctor
what is the PPS
scale used to measure patients performance at EOL
how does PPS work
based on categories that we score the pt in
when is PPS utilized
to quickly assess the patients fx level
how does PPS inform patient care
prognostic value allows us to assess worklaod
what is MAiD
occurs when an authorized health care provider provides or administers medication that intentionally brings about a person’s death, at that person’s request.
what does maid mean for the patient
that they may be assisted with death if they meet the requirements
nurses role in maid
duty to provide care that is safe, competent and ethical
what if you are a nurse providing care for maid and you do not agree with it
you provide care until somebody is able to relieve you because you cannot abandon pt
Grief
primarily emotional/affecive process of reacting to significant loss
bowlby 4 phases of greif
shock and disbelief searching and yearning disorganization/despair rebuilding and healing
how does worden view mourning
adaptation to loss
wordens 4 tasks of mourning
accept reality of loss experience , pain and greif , adjust to enviro in which deceased is missing ,withdraw emotional injury/energy and invert into other relationships
what is wordens most difficult task
Withdraw emotional injury/energy and invert in other relationships (most difficult task)
cross cultural sensitivity 4 qs to ask
type of death r/t culture bereavement rituals after death ritual/practice appropriate emotional response
bereavement
objective situation one faces after having lost an important person via death
mourning
public display or eternal expression of greif
sibling bereavement
maintain connections w deceased sibling by engaging in specific actions to keep them in touch
ongoing attachement categories in sibling bereavement
regretting trying to understand catching up reaffirming influencing reuniting
compassion fatigue
debilitating weariness brought on by repetitive response to the pain and suffering of others
burnout
r/t stress in work environment
3 characteristics of burnout
emotional exhaustion alientation from job related activities reduced performance
difference between burnout and compassion fatigue
burnout springs from where you work, compassion fatigue is associated with the work you do
othering
how we engage w those percieved different from oneself
exclusionary othering
uses power within relationships for domination and subordination
danger with exclusionary othering
uses power within relationship for domination and subordination
inclusionary othering
uses power within relationships for transformation and relation building recognize respect, value abilities and strengths of others
marginalization
individuals and groups who are ostrasized and excluded as a result of societal structures around dominat identities and idiologies
what does marginalization do in healthcare
creates division between HCP and pt l/t suboptimal care
racism
prejudice or discrimination based on belief that one group is superior
oppression
situation where ppl are governed in an unfairwait preventing them from having equitable opportunities and freedom
healthy immigration effect
immigrant comes to canada healtheir then canadians, then health declines
stigma
set of negative/unfair beliefs that a society or group gave about something
disease stigma
when groups are blamed for their illness bc they are viewed as lazy or unclean
colonialsism
invasion, dispossesion, subjucation of ppl
social justice
fair distrubution of resources and responsibilities among members of populations
equity
quality of being fair and impartion
eqaulity
state of being equal, especially in rights and oppurtunities
truth and reconcilliation comission
desire to put events of the past behind us so we can work towards stronger/healthier future
eg of truth and reconcilliation commission
response to residential school legacy in as incere indication and acknowledgement of injustices
how does truth and reconcilliation commission establish new relationships
mutual recognition and respect
standard temp descion maker/representation agreement
permits representative to make daily living descsions/healthcare, but not decision to refuse healthcare to preserve life
non standard descion maker
expands representatives authority to include decsisions like refusing/giving conset for life supporting care/tx
phase 1 bowbly and parkes
shock and disbelief
shock and disbelief
human does what it needs to do to cope with reality. adaptive need to withdraw
phase 2 bowbly and parkes
searching and yearning
searching and yearning
attempt to undo or retract distressful reality, why us why now
phase 3 bowlby and parkes
disorganization and despair
disorganization and despair
full penetration of distress and of facing the loss ‘my life is over’
phase 4 bowbly and parkes
rebuilding and healing
rebuilding and healing
being restructing to proceed
worden task 1 of mourning
accept reality of loss
worden phase 2 of mourning
experience the pain of greif
worden phase 3 of mourning
adjust to an environment in which the deceased is missing
worden phase 4 of mourning
withdraw emotional energy and invest it into another relationship
schubert and schultz dual process model
states that coping and predicting good versus poor adaption to a stressful life event in order to better understand how individuals . come to terms with bereavement
treatment for compassion fatigue
practice self care
treatment for burnout
managable workload
risk factors for compassion fatigue/burnout
being in high acuity areas
caring role
poor self acare
exposure over time
age- old and have had enough
self care practices to avoid or mitigate compassion fatigue
awareness
balance
connection
cultural competence
set of congruent behaviours/attitudes and policies that come together in a system agency or among professionals
