Virtual Supplementation: Module 6 – Therapeutic Communication at End of Life
Introduction:
This will be an interactive and engaging week in which we will be focusing our learning of the following case studies about end-of-life care/hospice care.
Purpose:
End of life care is an important aspect of nursing care. It requires the ability to develop effective therapeutic relationship and communication skills. It often requires also developing these with the patient’s family as well. There are many aspects of end-of-life care and this learning module will assist you in developing effective therapeutic relationships as well as help you develop an understanding of the differences between hospice care and palliative care.
Your case study:
Mrs. Anderson is a 35 year old female patient with end stage lung cancer that has metastasized to her bone and brain. She requested hospice services last week when she was told she had less than six months to live, but her mother still wants “everything possible done”. Yesterday Mrs. Andersons level of consciousness was noted to have decreased and she was having respiratory distress at home so her mother called 911. Mrs. Anderson is now admitted to the hospital for “comfort care”
Next Steps:
Follow along on this document and complete the required work. Submit this document as well as the post simulation activity into the drobox entitled Module Six – Therapeutic Communication at End of Life.
References:
Chippewa Technical College (n.d) Therapeutic Communication – End of Life. Retrieved from https://cvtc.h5p.com/content/1291009481822683388
Pre-Simulation:
Step 1:
Please indicate and explain what the medical diagnosis of your virtual patient is in the text box below.
What would four assessments would you anticipate to complete
When cancer starts in the lungs, it is called lung cancer. Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the body, such as the brain. Cancer from other organs also may spread to the lungs. When cancer cells spread from one organ to another, they are called metastases. Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body.
Please indicate four nursing interventions that you would complete during your care of Mrs. Anderson.
- Determine and manage pain.
- Monitor vital signs and lab values.
- Assess skin integrity.
- Promote effective coping abilities
What patient teaching would you anticipate Mrs. Anderson might require
Describing the physical and emotional signs of approaching death. A discussion of costs and options available like hospice, palliative ad community service.
Step 2:
Please complete the following short module:
https://www.pallium.ca/eLearning/Taking_Ownership/story.html
Please watch the following two short videos on myths of Palliative Care:
Simulation:
Please complete the following simulation
https://cvtc.h5p.com/content/1291009481822683388
Post Simulation:
- What is one barrier to effective therapeutic communication with family in palliative care? What are ways to overcome this, how can you specifically incorporate this into your future nursing care.
Not allowing for adequate time with the patient/family or Lack of a consensus among involved family members as to the appropriate treatment plan. This can be solved by explaining to the family importance of patient comfort and suggest treatment plans that would make everyone happy to de escalate potential conflict. As well as coming up with a schedule that could allow the family to spend enough time with the patient. I can specifically incorporate this by always keeping in mind what is best for the patient and ways to avoid conflict.
- Within the realm of palliative care, there are a variety of ethical dilemmas that you may face as a nurse. Please choose one of these specific to you and discuss ways to work through the chosen dilemma as a nurse. How do you think you will feel if faced with this dilemma, what are ways to debrief and manage the stress of the situation?
Decision-making when more than one party is involved. For instance, when family attempts to go against the patient’s wishes or what a nurse believes is best, nurses face the issue of trusting the intent of the family members versus respecting the patient’s wishes or nurse’s instincts. This could make me feel overwhelmed or frustrate, I can take a moment to think and do what I need to do then when returning home destress and not allow the situation to affect my life personally.
Please complete either the Self Debrief questions located in the D2L module or attend the debrief session you signed up for.
Virtual Simulation Six – Debrief Questions:
- What did you learn about your own attitudes, feelings, values and expectation about death while participating in this scenario?
I learned the sympathy I felt when seeing the sadness from the family member, the feeling of guilt not being able to do anything and the gratefulness after being thanked by the family member.
- One of the learning objectives was demonstrate respect for the patient’s views and wishes during end-of-life care. In regards to the simulation about Laura;
- Whose decisions should be followed regarding Laura’s care?
Patient wishes should be followed, if patient is not capable then a family member will most likely make the decisions.
- How did you advocate for Laura’s wishes about her end-of-life care?
BY making sure that every measure was done only for comfort purposes only as patient requested.
- What stages of grief are Laura and her mom demonstrating today?
Sadness, depression, and anger.
- Compare palliative care/hospice services.
Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits. Palliative care is comfort care with or without curative intent.
- What are the goals for end-of-life care? Were these goals met for Laura?
physical comfort, mental and emotional needs, spiritual needs, and practical tasks. I believe these goals where met for Laura as they were no complaints from patient or family member.