Palliative Part 2 Flashcards
What are some of the roles of palliative nurses?
- Comfort care
- Working with family
- Education
- Pain control
- Chronic illness/Ca patients common
What is the supportive care model?
- 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
Under the supportive care model, what is valuing?
- Provides context for supportive care
- Involves respect for a particular individual
- Primarily an attitude which underlies action
Under the supportive care model, what is connecting?
- 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
Under the supportive care model, what is empowering?
- 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!)
Under the supportive care model, what is “doing for”?
- 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
Under the supportive care model, what is finding meaning?
- 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
Under the supportive care model, what is preserving integrity (wholeness)?
- 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
How do we perform self care?
- Learning to receive as well as give
- Learning to grieve
- Replenishing oneself
- Staying healthy
- Being able to let go of personal agendas
What are some challenges in providing palliative care?
- Time and resource management
- Communication (e.g. end of life situations)
- Family scenarios
What did the iPANEL (Initiative for Palliative Approach in Nursing: evidence and leadership) discuss?
- 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)
What is grief?
- Normal response, unique to individuals, with no timetable or structure
- Process of experiencing a variety of physical, social, and behavioral reactions
What is anticipatory grief?
- 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
What is mourning?
- 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
What is shadow grief?
- 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)
What is disenfranchised grief?
Grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publically mourned or socially supported
What is companion-ing?
- 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
What is complicated/abnormal grieving?
- Failure to return to an individual’s pre-loss level of emotional well-being and functioning
- Can involve unresolved issues, avoidance of loss, etc.
What is involved in the journey of grief?
- Loss
- Protest
- Despair
- Reorganization
- Reinvestment
What are the needs of people who are grieving?
- 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
What influences the way a person grieves?
- 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
What are some signs of unhealthy grieving?
- 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)
How do we set professional boundaries in patient care?
- Use common sense
- Discuss your feelings
- Develop other interests
- Take care of physical needs
- Learn to relax
- Incorporate humor
What is the six “R” process of mourning?
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
What are some facts about children and grief?
- 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
