Unit 2 Palliative Flashcards

1
Q

Nursing Roles
(Professional)

A

Demonstrates caring, respect, deep
listening, authenticity, and trust.

  • Responsible to:
  • Assess own communication ability
  • Continuous improvement of
    communication skills
  • Utilize alternate strategies for
    communication difficulties
  • Convey accurate information
  • Maintain interprofessional team
    communication
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2
Q

Emotional Intelligence

A

Correct identification of emotions in
oneself and others.
* The use of emotion to facilitate
reasoning
* Understanding emotions; and
* Manage emotion

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2
Q

Self Awareness

A

Our knowledge about ourselves, our
motives and how these translate into our behaviour.

  • Become aware of how we are
    interpreting the signals of others.
  • Crucial factor in forming a therapeutic relationship with others.
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3
Q

Nursing Roles
(Behaviour)

A

Valued by patient and family
* Being present
* Connecting
* Affirming and valuing
* Acknowledge vulnerability
* Utilizing intuition
* Providing serenity and silence
(Ferrell & Paice, 2015)

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4
Q

Communication Skills in
Palliative Care

A

Active Listening
* Summarizing
* Paraphrasing
* Empathy
* Clarifying
* Silence
* Acknowledgement
* Encouragement

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5
Q

Active Listening

A

Requires concentration

Allows message to be heard and
acknowledge

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6
Q

Summarizing

A

Stopping at intervals throughout the conversation
(and the end) to summarize what has been
spoken
* To check the patient/loved one and yourself have
shared common understanding and agreement
* Provides additional time to think

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7
Q

Paraphrasing

A

Repeat what patient/loved one has said, using
your own words
* Demonstrates active listening
* Allows patient/loved one to correct any
inaccuracies or misunderstanding.

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8
Q

Empathy

A

To recognise how another person might be feeling.
* “Experience of walking in another person’s shoes

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9
Q

Silent

A

Can be uncomfortable to many of us.

  • Allows quiet reflection and taking stock of the conversation.
  • Make some sense of what is happening and form
    next questions.
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10
Q

Acknowledgement

A

Words, expression and intonation that
demonstrates interest or understanding.

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11
Q

Encouragement

A

Positively encourage patient to continue
talking.

Promote further possibility of disclosure

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12
Q

Forms of non-verbal communication and their use in palliative care

A

Haptics - touch.

Kinesics- body movement

Proxemics- using space.

Physical characteristic.

Environmental factor- surroundings.

Vocalics-paralinguistic aspects.

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13
Q

Haptics - touch.

Positive

Negative

A

To reassure a distress patient.

When the touch is misinterpreted or
inappropriate.

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14
Q

Kinesics- body movement.

Positive

Negative

A

Positive
Head nodding to encourage a patient
to talk about his/her concern.

Negative
Shrugging shoulders in response to a
question

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15
Q

Proxemics- using space

Positive

Negative

A

Coming down to the patient’s level to
talk to them.

Standing at the foot of the bed to
hold a conversation

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16
Q

Physical characteristic.

Positive

Negative

A

Wearing a clean, uniform,
appropriate hair. Nails etc.

Appearing untidy, paying little
attention to physical appearance.

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17
Q

Environmental factor- surroundings.

Positive

Negative

A

A quiet conversation in a private
area.

Having a conversation in an open,
non private space

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18
Q

Vocalics-paralinguistic aspects.

Positive

Negative

A

Using a soft, gentle, slow tone to
break bad news.

Loud, aggressive tones.

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19
Q

SPIKES Protocol and Ask-Tell-Ask

A

SPIKES (setting, patient perception, invitation, knowledge, emotions, summary and strategy).

  • Goals:
  • Gather information from patient and family.
  • Provide medical information.
  • Support patient and family.

Ask-Tell-Ask

Ask patient and family what they know and
understand
* “Tell” the patient medical information.
* Ask about their emotions.

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20
Q

Ask-Tell-Ask

A

Ask patient and family what they know and
understand
* “Tell” the patient medical information.
* Ask about their emotions.

21
Q

Anticipate/Assess emotions and respond with
empathy

A

Observe patient

  • Identify the emotion (vary from shock/disbelief/sad to anger)
  • Eg: “This must be difficult for you”, “I can see you are not expecting to hear
    this, it must be upsetting for you.”
  • Allow patient to cry, talk or silent
  • Do not be in a hurry
22
Q

What is ACP?

A

A process of discussion
regarding decision on future
health and personal care in the
contexts of individual’s values
and beliefs.

23
Q

Why ACP?

A

Identify and clarify own personal values and goals about future health and personal care.

  • Determine substitute decision maker.
  • Build trust.
  • Reduce uncertainty.
  • Avoids conflict and confusion.
  • Enhance peace of mind.
  • Exercise autonomy.

Be considered by medical team as
part of decision for patient best
interest of care during acute crisis
and patient unable to participate
in care process by reason of
impaired consciousness.

24
Q

Who is ACP for?

A

Everybody, regardless of age or
health status.

*It is not compulsory and not a
legal document.

25
Q

Approaches of ACP Discussion

A
  1. General ACP
  2. Disease specific ACP
  3. Preferred plan of care
26
Q

General ACP

A

Identify Nominated

Healthcare Spokesperson
and consider goals of
treatment should a serious neurological
injury occur

Early onset and medically
stable patient

27
Q

Disease specific ACP

A

Determine the goals of
treatment as the
complication escalate.

Patients with progressive,
life-limiting illness, and
frequent complications

28
Q

Preferred plan of care

A

Establish a specific plan of care when patient deteriorates

Patients with <12 months
prognosis and/or requiring
long term institutional care

29
Q

Key Components of ACP Discussion

A
  • Understanding of health condition.
  • Understanding of “Living Well”.
  • Identify Substitute decision maker.
  • Religious or spiritual belief.
  • Resuscitation or life support measure.
  • Preferred place of care.
  • Preferred place of death.
30
Q

The importance of ACP Discussions

A

Encourage expression of end-of-life
preferences.

Allow family and medical team to know patient’s preferences and to prepare in advance.

Provide opportunity to clarify expectations, choices between individual and loved ones.

Empower patient autonomy.

Promote quality of life.

31
Q

Requirements for ACP Discussions

A

The patient has adequate mental capacity for discussions and with no mood disorders.

Patient’s comfort is optimized (mentally and physically).

Patient’s sensory impairment is optimized.

ACP facilitator has good communication skills and
exhibits sensitivity (verbal and non-verbal).

Optimal time allocation.

32
Q

Why Assessing Decision Making Capacity is Important

A

Adults with decision-making capacity always make their own decisions; it is not their documents that
make decisions.

An ACP document is valid only if completed by an adult
who has the decision-making capacity.

An ACP document becomes relevant only if patients
are determined to have lost the ability to make their
own decisions.

33
Q

Barriers of initiating ACP

A

Patient factor
* Clinician factor (example:
doctors/nurses)

  • System factor
34
Q

Patient factor

A

Denial of diagnosis/unclear
diagnosis

Inclined to protect family

Low health literacy

Death topic avoidance

35
Q

Strategies of Denial of diagnosis/unclear
diagnosis

A

Discuss goals of care.

36
Q

Strategies for inclined to protect family.

A

Include family members in the care
discussion.

37
Q

Strategies for Low health literacy

A

Avoid jargons, use simple medical
information, integrated explanation
with pictorials or diagrams.

38
Q

Strategies for Death topic avoidance

A

Create more ACP awareness in the
community.

39
Q

Clinician factor

A

No enough time

Lack of continuity during
care transition

Lack of knowledge and
confidence.

Unclear prognosis

Focused on curing of disease

40
Q

Strategy for No enough time

A

Time management.

41
Q

Strategy for Lack of continuity during
care transition

A

Integrate and enhance continuity of
care and communication among
stakeholders.

42
Q

Strategy for Lack of knowledge and
confidence.

A

ACP facilitator training.

43
Q

Strategy for Unclear prognosis

A

Goals of care discussion.

44
Q

Strategy for Focused on curing of disease

A

Mindset change- focus on quality of
life.

45
Q

System Factor

A

Focus on life sustaining care.

Ownership

Interpretation

Concordance

46
Q

Focus on life sustaining care

A

Focus on quality of life in the care
goal discussion.

47
Q

Ownership

A

ACP is everyone’s business

48
Q

Interpretation

A

Interpret correct context.

49
Q

Concordance

A

Advocate for achieving patient’s
goals.

50
Q
A