WEEK 3 Palliative Care Nursing

Question 1

What is palliative care?

Answer 1

An approach that improves the quality of life of patients and their families when facing life threatening illness

Question 2

Describe what is meant by a palliative care approach

Answer 2

Early identification, Impeccable assessment, Treatment of pain and other physical/psychological issues

Question 3

List 5 places where palliative care is provided

Answer 3

Peoples homes
Aged care facilities
Inpatient units
Outpatient services
Emergency departments

Question 4

What is the legal framework used for when a person no longer hold capacity to make medical decisions?

Answer 4

Medical Treatment and Planning and Decisions Act 2016

Question 5

Describe the Medical Treatment and Planning and Decisions Act 2016

Answer 5

Framework for decision making used only when a person does not have the capacity to make treatment decisions for themselves

Question 5

What happens in the absence of an appointed substitute decision maker (SDM)?

Answer 5

The law sets out an order to determine the SDM with whomever has a close or continuing relationship with:
- Spouse or domestic partner
- Primary unpaid carer
- Oldest adult child
- Oldest parent
- Oldest adult sibling

Question 6

Do health practitioners require consent to administer palliative care to a patient?

Answer 6

Health practitioners do not require consent to administer palliative care to a patient who does not have capacity to do so regardless of SDM

Question 7

Can patients refuse palliative care?

Answer 7

A person cannot refuse palliative care in an instructional directive and nor can the SDM. A person can include statements about palliative care in their values directive

Question 8

Define advanced care planning

Answer 8

Planning for future health and personal care, whereby the persons values and preferences are made known so that they can guide decision making at a future time when they do not have capacity

Question 9

Identify the 4 principles of advanced care planning

Answer 9

Person centred
Ongoing process (Early intervention)
Goals, values and beliefs clarification
Legal framework

Question 10

Identify the 6 components of advanced care planning

Answer 10

Reflection
Discussion
Decision making
Documentation
Review
Activation

Question 11

Identify the 2 forms of advanced care directives in victoria

Answer 11

Instructional ACD
Values based ACD

Question 12

Describe an instructional ACD

Answer 12

A legally binding statement in which you consent to, or refuse future medical treatment

Question 13

Describe a values based ACD

Answer 13

Is a statement of you values, beliefs and preferences to be able to guide future medical treatment

Question 14

Describe voluntary assisted dying

Answer 14

The Voluntary Assisted Dying Act 2017 is a law intended to limit suffering only for those who are clearly dying

Question 15

What is the main criterion you have to meet for voluntary assisted dying

Answer 15

Must be diagnosed with an incurable disease, illness or medical condition that is advanced and progressive, that will cause death within weeks or months, but no longer than 12 months

Question 16

What are the 5 criteria you have to meet for voluntary assisted dying?

Answer 16

• Over 18
• Victorian resident
• Australian citizen
• Must have decision making capacity
• Must be diagnosed with an incurable disease, illness or medical condition that is advanced and progressive, that will cause death within weeks or months, but no longer than 12 months

Question 17

Identify the 3 theories used to describe grief

Answer 17

1. Worden 1977
2. Kubler-Ross
3. Stroebe and Schut

Question 18

Describe Worden’s grief theory

Answer 18

4 tasks of mourning that a person needs to complete in order to make an adjustment to their loss
1. To accept the reality of the loss
2. To work through the pain and grief of the loss
3. To adjust to an environment in which the deceased is missing
4. To relocate the deceased and move on

Question 19

Describe Kubler-Ross’s model for grief

Answer 19

Stage 1: Denial
Stage 2: Anger
Stage 3: Bargaining
Stage 4: Depression
Stage 5: Acceptance

Question 20

Describe Stroebe and Schuts model for grief

Answer 20

Dual process model of coping accepts that grief can be both helpful and detrimental depending on circumstances

Question 21

Identify the 2 stages of the Stroebe and Schut model

Answer 21

1. Loss Orientation: Grief work, intrusion of grief, denial/avoidance of restoration changes
2. Restoration Orientation: Attending to life changes, doing new things, distraction from grief, avoidance of grief

Question 22

Identify the 4 main impacts of patient deaths

Answer 22

1. Emotional impact of a patient death on healthcare staff
2. Impact of culture on the work environment
3. Impact of personal situations and life experience
4. Grief support and education

Question 23

Describe the emotional impact of a patient death on healthcare staff

Answer 23

Symptoms and work performance may be effected by the quality and quantity of the relationship, age etc.

Question 24

Describe the impact of culture on work environment

Answer 24

Patterns of behaviour, customs and beliefs of a group

Question 25

Describe the impact of personal situations and life experience

Answer 25

Socio-cultural, personal, role expectation, previous losses that may impact responses to the death

Question 26

Describe grief support and education

Answer 26

Debriefing, education, formal and individual support systems contributed to professional wellbeing

Question 27

Describe the aspects of a communicative palliative approach

Answer 27

Positive attitude to death and dying
Open discussion about death and dying
Not confined to end stage care
Active comfort care - Positive approach to reducing symptoms
Facilitates understanding through active support

Question 28

Define grief

Answer 28

An expected response to a painful life event, where the symptoms and duration of which can vary from person to person e.g. death of a loved one

Question 29

What is uncomplicated grief?

Answer 29

When a person is processing their feelings in a typical way in the following days, weeks and months

Question 30

What are 5 symptoms of uncomplicated grief

Answer 30

Crying/sobbing
Sleep problems
Persistent lack of energy
Changes in appetite
Difficulty concentrating

Question 31

What is complicated grief?

Answer 31

Occurs when the response to a loss or death does not fade over time and keeps a person from getting back to their normal lives

Question 32

Identify 5 symptoms of complicated grief

Answer 32

Includes the symptoms of uncomplicated grief, along with:
Persistent anger
Inability to focus on anything but the loss
Problems accepting the reality of the loss
Excessive avoidance of reminders
Intense feelings of sadness/pain/hopelessness
Sucicidal thoughts/actions