Unit 3: Knowledge Centred Nursing Service and Support Flashcards
Narrative Competence
The ability to acknowledge, absorb, interpret, and act on the stories we hear
Objectivity in Parentheses in relation to narrative competence
everyone has differing interpretations of reality
Narrative Horizon:
Patient’s subjective experience, showing up with authentic curiosity and seeing a hope for the future
Narrative Construction:
Actively listening to story, understanding of sociocultural context, respecting diversity
Medical Relationship
empathy, patient-centred care, facilitating and empowering
Medical Care
responsive, timed, reflected
4 components of narrative competency
- narrative horizon
- narrative construction
- medical relationship
- medical care
Reduction of suffering can be accomplished through the use of three main techniques:
deconstruction, externalization and re-authoring
Deconstruction
whole story, listen to what they’re not saying
Externalization
put it into context, depersonalize it from defining them, someone experiencing a problem, they are not the problem
re-authoring
rewrite story to create hope
5 Disciplines of Servant Leadership
- Values people
- Develops people
- Builds community
- Provides leadership
- Displays authenticity
Roles of Nurse in Family Centred Rounds
- coach, orient and prepare patient
- advocate and address patient concerns
- speak early to provide critical information
- Speak often to share thoughts or concerns, suggestions, and nursing therapeutics
- Ask questions to create a shared mental model and create opportunities for change (CFIM)
How is caregiving a universal experience?
There are only four kinds of people in this world:
ü those who have been caregivers;
ü those who currently are caregivers;
ü those who will be caregivers and
ü those who will need caregivers.
Define informal caregiver
Someone who cares for and gives unpaid support to a family member, friend, or neighbour who is frail, ill, or disabled and who lives at home or in a care facility.
What is the outpatient medical care setting in family caregiving?
Home
When do the caregiving responsibilities usually intensify
At end of life
Define caregiver strain
difficulty with duties and responsibilities associated with the caregiver role. Juggling with the number of technical tasks.
Define caregiver burden
alterations in caregiver’s emotional and physical health that can occur when care demands outweigh available resources
Can caregiver strain exist without burden
Yes
Caregiver wellbeing is felt when we balance our
demands and resources
Caregiver stress occurs when
demands are not balanced with resources
_____________to resources/supports that are in place can occur with prolonged caregiver status.
Desensitization
_________ Canadians aged 15 and over, are caregivers for someone with a chronic health problem
3 in 10
What gender is most likely to be a caregiver
Women
_____ of caregivers state they are not receiving as much support as they need
42%
39% of family caregivers are caring for their
mother or father
______ canadians are a caregiver ______ will become one
1 in 4
1 in 2
What is the CCCE
Canadian Centre for Caregiving Excellence
Supports caregivers across Canada
Saskatchewan is one of only provinces without caregiver support network
4 Most Prevalent Problems for Caregivers in Canada
- Current supports not meeting needs
- Services for care givers and recipients are insufficient and fragmented
- Leaves of absence and other protections are inadequate
- Financial supports are insufficient and ineffectively designed
Objective Measures of Caregiver Burden
- number of hours providing care
- type of tasks
Subjective Measures of Caregiver Burden
- emotional distress
- depressive symptoms
RAISE caregivers
R - recognize
A - assist
I - include
S- support
E - engage
3 Evidence Based Caregiver Interventions Recommended for Practice
- Cognitive Behavioural Interventions
- Psychoeducation Interventions
- Supportive Interventions
Cognitive Behavioral Interventions for Caregivers
draw on the principles of CBT
The interventions are aimed at helping the caregiver identify negative thoughts, beliefs, and behaviors so that they can be altered in a positive way
Psychoeducational Interventions for Caregivers
a focus on providing education in combination with other activities, such as counseling or support, that are delivered in a variety of methods to the caregiver or the patient–caregiver dyad, as well as individually or in a group setting
Examples of Psychoeducational Interventions for Caregivers
Education
Counselling
Anticipatory Guidance
Supportive Care Interventions for Caregivers
that provide emotional support to caregivers, with the goal to build rapport with them and/or provide a safe space to discuss feelings and learn problem-solving techniques.
Examples of Supportive Care Interventions for Caregivers
structured/unstructured support, counselling, active listening, presence
6 Necessities for Canada Meeting the Needs of Family Caregivers
- safeguard caregiver health and wellbeing
- increased respite
- increased caregiver assessment to sustain their contributions
- financial support
- access to info and training
- job protection and income support
Caregiver Resilience
Ability to adapt or to improve one’s own conditions following experiences of adversity
Define watershed moment
an important event that changes the direction of history.
Crossroads of past and future
Advanced Care Planning
The goal of an advance care planning discussion is to ensure that clinical care is consistent with the person’s expressed preferences and wishes.
Bereavement
the experience of losing someone important to us. It is characterised by grief, which is the process and the range of emotions we go through as we gradually adjust to the loss.
Hospice Palliative Care
Hospice is comfort care without curative intent
Instructional Directive
a document you use to tell your physician and family about the kinds of situations you would want or not want to have life-sustaining treatment in the event you are unable to make your own healthcare decisions.
Proxy/Substitute Decision Maker
a designated person authorized to make decisions on behalf of a patient who is unable to make important decisions about their own personal care
How does the palliative approach refer to the family
As the unit of care
Those closest to the patient in knowledge, care, and affection
What does palliative care seek to do?
improve a person’s quality of life once a chronic, life-limiting condition is diagnosed.
When does palliative care continue into?
until death and into family bereavement and care of the body.
Where is palliative care provided?
in all primary care settings, including homes, ambulatory clinics and other community settings, and in all tertiary care settings, including hospitals, hospices and long-term care facilities.
5 Palliative Care Principles
- dignity
- hope
- comfort
- quality of life
- relief of suffering
Define palliative approach
The use of palliative care principles with people facing life limiting conditions at ALL stages - not just end of life
What does a palliative approach reinforce?
- personal autonomy
- right for persons to be actively involved in care
- greater sense of control for individuals and family
The palliative approach does not link the provision of care with
Prognosis
Specialized Palliative Care
involves a specialist palliative care team or health professional to augment palliative care
In what 2 ways does specialized palliative care augment palliative care?
- assessing and treating complex symptoms
- providing information and advice to staff about complex issues
Palliative care provides relief from:
pain and other distressing symptoms
Palliative care affirms _____ and regards dying as a _______
affirms life and regards dying as a normal process;
Palliative care provides a ________ to help the family cope during the patient’s illness and in their own _________
support system
bereavement
Palliative care is applicable _____ in the course of illness, in conjunction with other _________________, such as chemotherapy or radiation therapy, and includes those investigations needed to better ________________
Early
therapies that are intended to prolong life
understand and manage distressing clinical complications
Describe the Canadian Hospice Palliative Care Association model from the time of diagnosis to patient’s death
Presentation: as many therapies as possible
Illness progress: curative therapies decreases and therapies to relieve suffering/increase quality of life increase
Focus of care movement in Canadian Hospice Palliative Care Association model
Focus of care moves toward family for anticipation of death
A lack of what can lead to complex grief?
Anticipation
True or False: palliative care includes physician assisted death
False
What is a good death
Variations in which individuals perceive as good
Trends toward death midwifery, death cafes, dignity and comfort with death
6 Components of Palliative Performance Scale
- Ambulation
- Activity level/evidence of disease
- Self-care
- Intake
- Level of Consciousness
- Estimated median survival in days
6 Guiding Principles for Conducting Palliative Family Meetings
- goals of care
- sharing of information
- based on need
- be resource effective/triage of priorities
- preventative approach to avoid crisis and conflict
- are offered routinely on admission and prn
What 4 things do families want out of family meetings?
- process attributes
- information content
- hope and control
- information divergency
What process attributes do families want from palliative family meetings?
o Process matters more than content
o Well-paced
o Active Listening
What information content do families want from palliative family meetings?
o Specifics about what lies ahead (estimated time)
What hope and control do families want from palliative family meetings?
o Sense that family can contribute in some way ex) hold his hand
o Maintain professional honesty
o Reasonable and respectful family involvement
What information divergency do families want from palliative family meetings?
o Cannot just have family meeting and let it go
o Increased updates to family as new information comes forth
o Meeting needs of each family member
Current Palliative Trends in Society
- Death-phobic
- Families under a lot of stress
- Demand for euthanasia and new legislation
- Dying not well-understood or accepted
- Variable responses across cultures
- CHPCA and CNA position statement: A “palliative approach” in any setting/situation
Bereavement Definition
Used to describe having lost someone important or significant through death
The objective loss