Unit 2 Palliative

Question 1

Nursing Roles
(Professional)

Answer 1

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

Question 2

Emotional Intelligence

Answer 2

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

Question 2

Self Awareness

Answer 2

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.

Question 3

Nursing Roles
(Behaviour)

Answer 3

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

Question 4

Communication Skills in
Palliative Care

Answer 4

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

Question 5

Active Listening

Answer 5

Requires concentration

Allows message to be heard and
acknowledge

Question 6

Summarizing

Answer 6

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

Question 7

Paraphrasing

Answer 7

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

Question 8

Empathy

Answer 8

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

Question 9

Silent

Answer 9

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.

Question 10

Acknowledgement

Answer 10

Words, expression and intonation that
demonstrates interest or understanding.

Question 11

Encouragement

Answer 11

Positively encourage patient to continue
talking.

Promote further possibility of disclosure

Question 12

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

Answer 12

Haptics - touch.

Kinesics- body movement

Proxemics- using space.

Physical characteristic.

Environmental factor- surroundings.

Vocalics-paralinguistic aspects.

Question 13

Haptics - touch.

Positive

Negative

Answer 13

To reassure a distress patient.

When the touch is misinterpreted or
inappropriate.

Question 14

Kinesics- body movement.

Positive

Negative

Answer 14

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

Negative
Shrugging shoulders in response to a
question

Question 15

Proxemics- using space

Positive

Negative

Answer 15

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

Standing at the foot of the bed to
hold a conversation

Question 16

Physical characteristic.

Positive

Negative

Answer 16

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

Appearing untidy, paying little
attention to physical appearance.

Question 17

Environmental factor- surroundings.

Positive

Negative

Answer 17

A quiet conversation in a private
area.

Having a conversation in an open,
non private space

Question 18

Vocalics-paralinguistic aspects.

Positive

Negative

Answer 18

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

Loud, aggressive tones.

Question 19

SPIKES Protocol and Ask-Tell-Ask

Answer 19

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.

Question 20

Ask-Tell-Ask

Answer 20

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

Question 21

Anticipate/Assess emotions and respond with
empathy

Answer 21

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

Question 22

What is ACP?

Answer 22

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

Question 23

Why ACP?

Answer 23

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.

Question 24

Who is ACP for?

Answer 24

Everybody, regardless of age or health status. *It is not compulsory and not a legal document.

Question 25

Approaches of ACP Discussion

Answer 25

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

Question 26

General ACP

Answer 26

Identify Nominated Healthcare Spokesperson and consider goals of treatment should a serious neurological injury occur Early onset and medically stable patient

Question 27

Disease specific ACP

Answer 27

Determine the goals of treatment as the complication escalate. Patients with progressive, life-limiting illness, and frequent complications

Question 28

Preferred plan of care

Answer 28

Establish a specific plan of care when patient deteriorates Patients with <12 months prognosis and/or requiring long term institutional care

Question 29

Key Components of ACP Discussion

Answer 29

- 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.

Question 30

The importance of ACP Discussions

Answer 30

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.

Question 31

Requirements for ACP Discussions

Answer 31

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.

Question 32

Why Assessing Decision Making Capacity is Important

Answer 32

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.

Question 33

Barriers of initiating ACP

Answer 33

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

Question 34

Patient factor

Answer 34

Denial of diagnosis/unclear diagnosis Inclined to protect family Low health literacy Death topic avoidance

Question 35

Strategies of Denial of diagnosis/unclear diagnosis

Answer 35

Discuss goals of care.

Question 36

Strategies for inclined to protect family.

Answer 36

Include family members in the care discussion.

Question 37

Strategies for Low health literacy

Answer 37

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

Question 38

Strategies for Death topic avoidance

Answer 38

Create more ACP awareness in the community.

Question 39

Clinician factor

Answer 39

No enough time Lack of continuity during care transition Lack of knowledge and confidence. Unclear prognosis Focused on curing of disease

Question 40

Strategy for No enough time

Answer 40

Time management.

Question 41

Strategy for Lack of continuity during care transition

Answer 41

Integrate and enhance continuity of care and communication among stakeholders.

Question 42

Strategy for Lack of knowledge and confidence.

Answer 42

ACP facilitator training.

Question 43

Strategy for Unclear prognosis

Answer 43

Goals of care discussion.

Question 44

Strategy for Focused on curing of disease

Answer 44

Mindset change- focus on quality of life.

Question 45

System Factor

Answer 45

Focus on life sustaining care. Ownership Interpretation Concordance

Question 46

Focus on life sustaining care

Answer 46

Focus on quality of life in the care goal discussion.

Question 47

Ownership

Answer 47

ACP is everyone’s business

Question 48

Interpretation

Answer 48

Interpret correct context.

Question 49

Concordance

Answer 49

Advocate for achieving patient’s goals.