Course Module. Basic Certificate Course in

Transcription

1 Course Module Basic Certificate Course in Palliative Nursing (BCCPN) Prepared by: Centre for Palliative Care Bangabandhu Sheikh Mujib Medical University Shahbag, Dhaka, Bangladesh BCCPN Module_Page-1

2 Participants of Curriculum Development Committee Sl. Name of participants Designation Remarks 1. Prof. Nezamuddin Ahmad Professor & Project Co-ordinator, CPC, BSMMU. Advisor 2. Md. Nurul Anwar Ph.D Nursing Instructor, Dhaka Nursing College, Dhaka. Resource person 3. Ms. Moniza Khatun Nursing Superintendent, RMCH, Rajshashi Resource person 4. Ms. Shahanara Khatun Instructor, College of Nursing, Mohakhali, Resource person 5. Ms. Probhaboti Roy Nursing Superintendent of Hospital, BSMMU Member 6. Ms. Mabel D Rozario Chairman, Dept. of Graduate Nursing, BSMMU Member 7. Ms. Halima Begum Deputy Nursing Superintendent (Education & Training), BSMMU 8. Ms. Shantana Rani Day Deputy Nursing Superintendent (Admin), BSMMU. Member Member 9. Ms. Habiba Zaman Nursing Officer, BSMMU Member 10. Ms. Mayabini Boiragi Nursing Officer & Nurse co-ordinator, ICU nurses training progam, BSMMU. Member 11. Ms. Magdalina Pandey Nurse Manager, Square Hospital, Dhaka Member 12. Ms. Fatema Akter In-Charge Nurse, Centre for Palliative Care, BSMMU. Member 13. Mst. ShilpiAktar SSN, Centre for Palliative Care, BSMMU. Member 14. Ms. RozinaAkter SSN, Centre for Palliative Care, BSMMU. Member 15. Ms. Rowsan Ara SSN, Centre for Palliative Care, BSMMU. Co-ordinator BCCPN Module_Page-2

3 Course at a Glance Title of the Course Entry Qualification Type of Course Duration Number of Participants Venue : Basic Certificate Course in Palliative Nursing (BCCPN) : Registered Nurse of Bangladesh Nursing Council : Full time (08:30 AM to 2:30 PM) : 6 Weeks (42 days) : 10 (Ten) each batch : Centre for Palliative Care, BSMMU, Shahbag, Dhaka. TIME ALLOCATION Theory sessions Clinical Practice Demonstration Class Review Examination Week End Total : 15 days (15 x6 hours = 90 hours) : 15 days (15x6hours = 90 hours) : 02 days (2 x 6hours = 12 hours) : 02 days : 02 days : 06 days : 42 days BCCPN Module_Page-3

4 Master plan For 6 weeks BCCPN course structure Theory Clinical practice Demonstration Review Examination Week end BCCPN Module_Page-4

5 Rotation plan For Clinical Practice (15 days) IPD- 7 days Counseling-1 day OPD- 3 days Homecare 2 days Procedure Room- 2 days Group- A Group- B BCCPN Module_Page-5

6 Introduction: People with life-limiting diseases including cancer suffer a lot in their last days. Pain, other difficult symptoms and psychosocial and spiritual problems dramatically decrease the quality of life, place a burden on the family and on the health care system. This is the same for most of the elderly also towards the end of their life. Palliative care improves the quality of life of people with life-threatening or debilitating illness by providing relief from pain and other physical symptoms and addressing psychosocial and spiritual needs. To ensure the most effective care for patients, palliative care begins at the point of diagnosis, continues throughout treatment, and extends to bereavement support to the family after the patient s death. In situations where cure is possible, palliative care can provide essential supportive care to provide pain relief, control symptoms, and minimize suffering. Palliative Care has not found a proper place in undergraduate or post graduate medical education in the country. There have been a few developments in delivery of services for the incurably ill, bedridden and dying patients in the country over the last 3-4 years. But these initiatives have been able to address only a minor fraction of patients in need of care. Universal nature of the problem and the potential for addressing most of it at the Primary Health Care level demands necessary skills for health care professionals in the community. One of the major areas which need urgent attention is capacity building among nurses who are the key professionals at the point of delivery of care. This needs to be done through a organized, structured regular training program in palliative care in the country so that quality and uniformity of training is maintained. Bangabandhu Sheikh Mujib Medical University (BSMMU), the only medical university in the country has introduced and incorporated Palliative Care in its services in The university has decided to address the knowledge and skill gap in palliative care in the country through a series of training programs and courses starting with Six Weeks Basic Certificate Course in Palliative Medicine and Basic Certificate Course in Palliative Nursing. Most of the patients at the end of their lives are looked after by health care professionals working in hospitals and in the community. Basic Certificate Course in Palliative Nursing is aimed at helping nursess to consolidate and develop their confidence and expertise in palliative care. Interactive theory session and clinical exposure in the background of availability of rich background material makes the course productive and useful for all clinicians. Successful candidates will be awarded Basic Certificate in Palliative Nursing at the end of the six weeks course. The course is jointly organized, run and evaluated by the palliative care service of BSMMU and the WHO Collaborating Centre at the Institute of Palliative Medicine of Calicut, Kerala, India. Curriculum for the course was finalized in 2012 following three pilot courses and a feedback, evaluation and consensus workshop supported by Bangladesh University Grants Commission. Course Outline:? The Basic Certificate Course in Palliative Nursing has 6 weeks of direct interactive tutorials, bed side clinical sessions, written assignments and skill development in nursing procedures related to palliative care.? There will be clinical placement for fifteen days both in out-patient service and in patient ward. BCCPN Module_Page-6

7 ? As part of the course, the candidate must submit 10 case histories, 6 written assignments and 1 project proposal for evaluation.? The course material provided will contain modules, which will cover essential information on principles and practice of palliative nursing.? There will be an evaluation at the end of the course. Successful candidates will be awarded the Basic Certificate in Palliative Nursing BCCPN Module_Page-7

8 Aim of the course: The course aims to:? Provide the candidate with an opportunity to demonstrate the ability to develop clinical practice by integrating this with up-to-date and relevant theoretical palliative care knowledge. Particular attention will be paid to the holistic, patient and family centered nature of palliative care, including grief and bereavement.? Provide opportunities to develop personal and professional reflection about the management of a patient with palliative care needs.? Develop the ability to evidence-based clinical practice in the light of increased knowledge, newer skills and personal reflection. Learning Objectives: At the end of the course, the participants will be able to: Patient Care: o Demonstrate knowledge and proficiency in evaluation of (a) patients with incurable and life limiting illnesses and (b) patients with specific symptom palliation needs o Perform a careful and complete history and physical examination, with emphasis on communication with the patient and/or his/her family about end-of-life issues such as advance directives and prognosis o Develop a basic treatment plan for patients with common symptoms associated with lifelimiting illnesses o Identify indications for transferring patients to the inpatient Palliative Care service Medical Knowledge: o Acquire basic knowledge of the following topics: Symptom evaluation and management: The trainee should demonstrate advanced and sophisticated knowledge of evaluation and management, of patients with advanced diseases Pain: Dyspnoea Constipation and diarrhea Nausea and vomiting Anorexia and weight loss, abdominal distension, lymphedema Urinary incontinence, frequency, retention Spinal cord compression, management of unconscious patients Delirium and agitation, including terminal delirium Anxiety and depression? End of life issues: ethics and communication Breaking bad news Advance directives Resuscitation status Artificial nutrition and hydration The family meeting? Prognosis Chronic medical conditions Patients near the end of life BCCPN Module_Page-8

9 Total Timing of the theory sessions in the course will be 90 hrs organised as six modules Module 1: Introduction to Palliative Care: 5hrs? Introduction to palliative care 2 hr? Organizing Palliative care services 1hr? Introduction to home care 1 hr? Nurses home care protocol 1 hr Module 2: Communication Skills: 14hrs? Introduction to communication skills 1 hr? Basic principles of communication 1 hr? Effective communication & barriers of communications 2 hr? Breaking bad news 2 hr? Collusion, denial & handling difficult reactions 1 hr? Communicating with other professionals 1 hr? Communication with oneself 6hr Module 3: Symptom Assessment and Management: 19 hrs? Pain management- definition, general principles, causes & assessment 2 hr? Pathophysiology & classification of pain 1 hr? Management of pain 2 hr? WHO analgesic ladder & non pharmacological measures 2 hr? Gastrointestinal symptoms: o Symptoms-nausea, vomiting & intestinal obstructions 1 hr o Dysphagia, constipation, diarrhea, hiccoughs & anorexia 1 hr? Respiratory symptoms- Dyspnea, cough & haemoptysis 1 hr? Old age problems 2 hr? Geriatric care- management 3 hr? Dementia Prevalence, Etiology, Pathophysiology and social issues 1 hr? Dementia - clinical manifestations, diagnosis & management 3 hr Module 4: Palliative Nursing: 29 hrs? Terminal care 1 hr? Ethical issues 1 hr? Nutrition in advanced diseases 1 hr? Pressure sore-definition, causes, stages and sites 1 hr? Prevention and management of pressure sore 1 hr? Wound management- 3hr? Oral problems in palliative care 3hr o ( Oral candidiasis and dry mouth (xerostomia).. Oral ulcer, Halitosis and painful mouth, Coated tongue? Bladder care- ( Common problems and urinary retention, 2hr? Urinary incontinence and catheter care)? Bowel care- (Constipation,Diarrhea, over flow diarrhea,enema. 12hr? Artificial Feeding- ( Definition-Indication for tube feeding. 1hr? General instruction & Nurses responsibility in tube feeding) BCCPN Module_Page-9

10 ? Ostomy care- (Definition, colostomy care and colostomy Irrigation 3hr Tracheostomy and ileostomy care).? Lymphoedema- (Definition, causes, Lymphoedema, skin care & bandaging 6hr Massage and exercise)? Home care kit 1 hr? Interventions at home care 1 hr? Documenting case notes 1 hr? Assessments of patients 1 hr Module 5: Pharmacology : 12 hrs? Introduction- (drugs & medication, classification Drugs forms, source of information about medication, Medication order & abbreviations, Hours of administration, weights and measures) 2 hr? Principles of drugs action and effect of drugs on the body 1 hr? Dosage, absorption and excretion of drugs 1 hr? Rules and time of administrations 1 hr? Storing of medicines 1 hr? Common drugs used in Palliative Care 3hr? Stocking and dispensing of opioids 1 hr? Drug compliance 1 hr? Rules of administration of medication and safety measures 1 hr Module 6: Other topics: 11hrs? HIV/ AIDS- ( introduction & symptoms, Management and stigma) 2 hr? Psycho Social issues in advanced disease 4 hrs? Social mobilizations in health care & Rehabilitation 2hrs? Community participation in palliative care 1 hr? Strategies for mobilizing local community 2 hr BCCPN Module_Page-10

11 Module Contents: Module 1: PALLIATIVE CARE 1. INTRODUCTION TO PALLIATIVE CARE Learning objectives By the end of the section, the students will be able to:? Discuss the history, philosophy, definitions of palliative care, its role in present health care delivery system and its social relevance? Demonstrate that this knowledge understanding informs clinical practice decision making management and teaching? Incorporate concept of total care in clinical practice Content History of palliative care Philosophy & goals of palliative care Definition of palliative care, total care Components of palliative care programme Scope of Palliative care? Physical? Social? Psychological? Spiritual Principles of Palliative care - Who, When & where needed 2. HOME CARE Learning objectives By the end of the section, the students will be able to: Discuss the types of home care & how to organize a home care Understand the importance of nurses home care protocol & home care kit Understand how to assess the symptoms and chart in the case sheet Content Introduction to home care Types of home care Selection of patients in home care Nurses home care protocol Home care kit Interventions done at home care Symptom assessment Assessment of patient in home care Case sheet charting Module 2: COMMUNICATION SKILLS Learning objectives By the end of the section, the students will be able to: Explain the principles of communication Understand the importance of effective communication & banners of communication Understand the steps of breaking bad news & handing difficult situation Be aware of one s strengths and weaknesses in intervening in issues related to palliative care Content Definition of communication Professionals potions problems in communicating with each other BCCPN Module_Page-11

12 Needs of communication Basic principles of communication Effective communication Burners of communication Breaking and news Handing collections & denial Handing difficult questions & reactions Reflection on self Module 3: Symptom Assessment and Management Pain Learning objectives At the end of the section, the students will be able to:? Define pain & develop skills in assessment of pain? Understand the general principles pathophysiology of pain? Describe the classification of pain & management of pain? Explain WHO analgesic ladder Content Definition General principles of pain & causes of pain Patho physiology Classification of pain Assessment of pain Management of pain WHO analgesic ladder Non pharmacological measures to relieve pain Other Symptoms: Learning Objectives By the end of the section the student will be able to:? Discuss various methods of assessment of symptoms? Describe method of management of symptoms Content Gastro intestinal symptoms? Nausea & vomiting - Causes & management? Intestinal obstruction - Causes & management? Dysphasia - Causes & management? Constipation & diamboea - Causes & management? Hiccoups - Causes & management? Anorexia - Causes & management Respiratory Symptoms? Dyspnoea - Causes & management? Cough - Causes & management? Haemoptysis - Causes & management Module 4: Palliative Nursing Learning objectives: By the end of the session, the candidate should have knowledge and skills for professional nuring care of the incurably ill and dying patients Content: BCCPN Module_Page-12

13 Terminal care Ethical issues Nutrition in advanced diseases Pressure sore-definition, causes, stages and sites Prevention and management of pressure sore Wound management- Oral problems in palliative care o ( Oral candidiasis and dry mouth (xerostomia).. Oral ulcer, Halitosis and painful mouth, Coated tongue Bladder care- ( Common problems and urinary retention, Urinary incontinence and catheter care) Bowel care- (Constipation,Diarrhea, over flow diarrhea,enema. Artificial Feeding- ( Definition-Indication for tube feeding. General instruction & Nurses responsibility in tube feeding) Ostomy care- (Definition, colostomy care and colostomy Irrigation Tracheostomy and ileostomy care). Lymphoedema- (Definition, causes, Lymphoedema, skin care & bandaging Massage and exercise) Geriatric care - Old age problems - Managements Dementia - causes, pathophysiology, clinical manifestations, Management Characteristic changes in Alzheimer s disease, - Clinical manifestation & Diagnosis - Management Home care kit Interventions at home care Documenting case notes Assessments of patients Module 5: Pharmacology Learning objectives By the end of the section, the candidate should be able to? Understand the routes of administration, mode of action and side effects of drugs commonly used in palliative care? Know the requirements, procedure and documentation of storage and dispensing of opioids Content: Introduction- (drugs & medication, classification Drugs forms, source of information about medication, Medication order & abbreviations, Hours of administration, weights and measures) Principles of drugs action and effect of drugs on the body Dosage, absorption and excretion of drugs Rules and time of administrations Storing of medicines Common drugs used in Palliative Care Stocking and dispensing of opioids BCCPN Module_Page-13

14 Drug compliance Rules of administration of medication and safety measures Module 6: Other Topics HIV/AIDS Learning objectives By the end of the section, the student will be able to: Discuss the clinical features and management of HIV/AIDS Discuss the psycho-social issues of Retro-positive patients. Content Introduction What is HIV/AIDS? Clinical features, causes, investigators Medical and Nursing management Psycho-social issues. Psycho Social issues Learning objectives At the end of the section, the student will be able to understand? The psycho-social issues related to chronic diseases.? Distress related advanced disease? Adjustment disorders Content? Psyho social issues in adavanced and chronic disease? Tools to assess psychological morbidity? Distress Thermometer? Adjustment disorders? Major Psychiatric disorders Social mobilization in health care and Rehabilitation. Learning Objectives : At the end of the section, the candidate should be able to understand? Strategies for ensuring community participation in health care projects? Basic principles of social rehabilitation of the chronically ill and bedridden people Content: Community participation models Social and vocational rehabilitation projects BCCPN Module_Page-14

15 Evaluation Evaluation will be based on theory examination, evaluation of case histories, and written assignments. By the completion of the six weeks, each candidate has to submit 10 case histories, 6 written assignments and 1 project proposal. Pass mark is 60%. The candidate has to score 60% for theory examination, case histories, written assignments and project proposal separately. The total marks of the examination will be 300. Types of exam Total Marks Category Written (Descriptive) 50 Short answered questions (10 out of 12) (10 x 5 ) MCQ questions (50 x 1) OSCE 50 4 spotting (4 x 5) Viva 50 Project 30 6 station (6 x 5) Assignment 30 6 Assignments (6 x 5) Log Book case sheet (10 x 3) Attendance 10 Per class = Marks Distribution Grading Criteria Grade E Excellent (Score of 80% and above) Grade G Good (Score between 70% and 79%) Grade P Pass (Score between 60% and 69%) Grade F Fail (Score below 60%) BCCPN Module_Page-15