Nursing End of Life Care - Course Review

Transcription

1 NEW YORK CITY COLLEGE OF TECHNOLOGY OF THE CITY OF NEW YORK NURSING DEPARTMENT B.S. IN NURSING COURSE OUTLINE Spring 2013 COURSE CODE & TITLE: FACULTY: PREREQUISITE/COREQUISTE: CREDITS NUR 4050 FAMILY CENTERED END-OF-LIFE NURSING CARE ACROSS THE LIFE SPAN PROF. LYNDA M. KONECNY, MSN, RN, CS NUR 3010, NUR 3110, NUR 3130 OR PERMISSION OF NURSING DEPARTMENT COMPUTER LITERACY REQUIRED 3 CREDITS CLASS HOURS: 3 PER WEEK FULLY ONLINE Lecture Viewing Deadline: Wednesdays at 8:30 P.M. OFFICE HOURS: Online By Appointment Only OFFICE TELEPHONE NUMBER lkonecny@citytech.cuny.edu TEXT: Required: Matzo, M.L. & Sherman, D.W. (Eds). (2010). Palliative care nursing: Quality care to the end of life. (3 rd ed) New York, N.Y.: Springer Recommended: Ferrell, B.R., & Coyle, N. (Eds.). (2010). Textbook of palliative nursing. (3 rd ed) New York, N.Y.: Oxford University Press. Zerwekh, Joyce V. (2006). Nursing Care at the End-of Life. Palliative Care for Patients and Families. Philadelphia.: F.A. Davis Company. 1

2 Course Description: This course explores the nurses involvement in family centered end-of-life care. How a health care team approach can address the myriad needs facing individuals and their families at this time of life are discussed. Principles of hospice and palliative care are used as a guide for this curriculum. Factors involved in expert nursing care, which have the potential to greatly reduce the burden and distress of those facing life s end and the ability to offer support for the physical, psychological, social, and spiritual needs of clients and their families are presented. Course Experiences: This fully online course provides the core of knowledge needed by the registered professional nurse to provide clients and families quality end-of-life care they are entitled to receive. The student will examine population demographics, current climate of health care delivery, principles of hospice and palliativecare, pain and symptom management, and ethical and legal issues associated with end-of life care. This course will also address the cultural and spiritual dimensions that influence end-of-life care. Course Objectives: Upon completion of the course, the registered professional nurse student will be able to: 1. Describe the common characteristics of dying in America. 2. Discuss regulations and guidelines employed by federal, state, medical and nursing professional organizations in the delivery of end-of-life care. 3. Explain the leadership role for nurses in end-of-life. 4. Incorporate informational technology in the attainment of quality nursing care at the end-of-life. 5. Incorporate nursing research in the attainment of quality nursing care at the end-of-life. 6. Apply the principles of hospice and palliative-care in the provision of quality end-of-life nursing care to clients and families. 7. Explain the importance of ongoing communication in a caring manner with interdisciplinary team members, clients and families throughout the end-of-life experience. 8. Evaluate the significance of collaboration with significant support people and members of the health care team throughout the end-of-life experience. 9. Examine the importance of critical thinking strategies in the incorporation of knowledge gained from nursing, humanities and the biological and social sciences into end-of-life care. 10. Formulate therapeutic nursing interventions using Watson s Human Caring theory to meet the assessed holistic needs of clients and families throughout the end-of-life experience. 11. Use the nursing process to provide culturally competent care to clients and families throughout the end-of-life experience. 12. Discuss the professional codes and standards of practice that serve to guide and facilitate resolution of end-of-life care dilemmas. 13. Incorporate nursing beliefs, assertions, and personal ideologies on death and dying into nursing practice to meet clients and family needs at the end-of-life. 2

3 14. Identify opportunities for continuing education and new initiatives in end-of-life care. NUR 4050 Totally Online Course This fully online course uses Wimba Classroom instruction. Wimba lectures are archived each week for 24/7 viewing. Students meet in the traditional classroom on the first day of class where they receive orientation and Wimba Classroom instruction. Below are the supported operating systems and recommended computer system specifications for using Wimba Classroom. Student Computer Minimum Requirements: Windows vista latest version, Windows 2000+, Mac OSX Internet Browsers: Mozilla Firefox 3.6 +, Safari MB RAM (256 MB recommended) External speakers This totally online course requires students to login a minimum of 3 days out of 7 days a week on Bb. It is students responsibility to check the following areas on Bb: Announcements, Course Information, Course Documents, Communications, Grade Book, and respond to their College Campus within 48 hours of receiving faculty . Online Class Participation Online class participation is a course requirement. It is essential that students respond in a timely manner (due dates are strictly observed) to discussion board questions or Blogs on Blackboard (Bb). To be considered as participating in a discussion, students must first post a personal comment on the assigned discussion topic and then remark on TWO separate student statements on the same topic. Students who do not post individual comments or do not remark on TWO separate student assignments on the assigned discussion questions or Blogs will be considered as NOT participating in class. Students who fail to participate in class will be given an incomplete course grade. Discussion Board: When responding to a faculty posed question or issue placed on the discussion board on Bb, students must satisfactorily complete all components of the question or issue to be considered as fully participating. Incomplete or unsatisfactory student statements result in the student being given no credit for participation and an incomplete course grade is given until the student satisfactorily completes the assigned discussion. In addition to a student s personal comments on a discussion question, a student MUST remark on TWO separate peer statements. This action keeps the discussion alive, and is an important part of class participation. Students who do not satisfactorily remark on TWO separate student statements will be considered as not participating in class and will be given an incomplete course grade. Blogs: When responding to a faculty assigned Blog on Bb, students will be asked to share their personal experiences on a related topic or issue. Students need to respond to the topic and satisfactorily complete all the components of the Blog item to be given credit for participation. Students are also required to comment on TWO separate student Blogs on the same topic. Students who post an incomplete Blog or do not comment on TWO separate student Blogs will be considered as not participating in class and will be given an incomplete course grade. 3

4 Online Class Attendance It is important that students know how online class attendance is taken. Class attendance is recorded the moment a student logs in to the Wimba archived lecture on Bb. The length of time a student spends in an archived lecture is documented. Wimba allows faculty to track students online class attendance in each Wimba archived lecture. The Wimba archived lecture must be viewed, in its entirety, for a student to receive attendance credit for that week. Students will NOT receive attendance credit if the total number of online lecture viewing does not coincide with the total number of hours and minutes for that specific archived lecture or if the online lecture viewing time exceeds (for one viewing period) the archived lecture by 60 minutes (i.e. the online lecture is 1 hour 30 minutes and 32 seconds, the student s viewing time is 6 hours and 30 minutes and 15 seconds). Students have up to seven days (from Wednesday 8:30 p.m. of the lecture week until the following Wednesday at 8:29 p.m.) to complete the assigned weekly archived lectures (i.e. online lecture viewing for Week #1 is from January 30, 2013 at 8:30 P.M. ((when Week#1 begins)) and ends February 6, 2013 at 8:29 P.M. ((for attendance credit for Week#1viewing)). As per college policy no more than two absences are permitted for a course, which lectures weekly. Archived online Wimba lectures are regularly monitored by faculty for attendance purposes. POSTING OF REQUIRED ASSIGNMENTS ON BLACKBOARD All due dates for required assignments in NUR 4050 are noted in the course schedule and strictly adhered. All required assignments and papers are to be submitted electronically to SafeAssign on Bb. For an assignment or paper to be considered on time, it must be electronically submitted to SafeAssign before Wednesday at 8:30 p.m. on the day it is due. 5 grade points will be deducted for each day (24 hours) the assignment or paper is past due (excluding Saturday and Sunday) The maximum number of grade point deductions taken is 50 points. Academic Integrity Standards: The Baccalaureate Program in Nursing adheres to the New York City College of Technology/CUNY Policy on Academic Integrity. This policy specifically states, in detail, what constitutes Academic Dishonesty. All students are responsible for abiding by this policy. This detailed policy can be found in the College Catalog or on the College Website HYPERLINK: New York City College of Technology Policy on Academic Integrity; Students and all others who work with information, ideas, texts, images, music, inventions, and other intellectual property owe their audience and sources accuracy and honesty in using, crediting, and citing sources. As a community of intellectual and professional workers, the College recognizes its responsibility for providing instruction in information literacy and academic integrity, offering models of good practice, and responding vigilantly and appropriately to infractions of academic integrity. Accordingly, academic dishonesty is prohibited in The City University of New York and at New York City College of Technology and is punishable by penalties, including failing grades, suspension, and expulsion. The complete text of the College policy on Academic Integrity may be found in the College Catalog. Technology Requirements: Many NUB students have been using Bb at New York City College of Technology or in other Educational Institutions and are familiar with this educational online tool. If you are new to Bb, use the beginners guide to Bb located on the home page. You can also attend one of the many Bb introduction workshops offered to students at the beginning of the semester in G-600. Bb introduction workshop schedules are posted on the College website and in G-600. The telephone number for G-600 computer lab is:

5 This course utilizes Bb extensively and it is required that you have one of the following Internet Browsers: Mozilla Firefox or Safari. You will need your current College address on Bb to receive important faculty related notices during the semester or to communicate with your Professor. (Student College s were updated in January 2010, please refer to this example: To update your College address on Bb, select update from menu bar located on the LEFT side of the Bb home page. Type in your updated College address in the textbox following the example above. Retype your updated address in the second textbox to verify the change. This will update your College address on Bb. If you have a question about your College account, the Help Desk is a good resource to use. Lastly, you will need a COMPUTER with at least 256 MB of RAM and an Internet connection via a 56K modem or higher in order to take this totally online course. Net Etiquette: All students will follow the Rules of Netiquette listed below with web site addresses for additional detailed information: The Rules of Netiquette (accessed from: The Rules of Netiquette websites at HYPERLINK Rule 1. Remember you are dealing with people. It is not nice to hurt other people s feelings Never mail or post anything you wouldn t say to someone s face Never be offensive online Rule 2. Adhere to the same standards of behavior online that you follow in real life. Be ethical Act within the laws of society and cyberspace Rule 3. Know where you are in cyberspace. Netiquette varies from domain to domain Lurk before you leap Rule 4. Respect other people s time and bandwidth. Remember you are not the center of cyberspace Post messages to the appropriate discussion group If you disagree with the premise of a particular discussion, don t waste time and bandwidth of the members by telling them your personal opinions or by making personal attacks Rule 5. Make yourself look good online. Check grammar and spelling before you post Avoid using all caps (it looks like you re shouting) Know what you re talking about and make sense Be pleasant and polite Rule 6. Share expert knowledge. Offer answers and help to people who ask questions on discussion groups Summarize and think through your responses before posting a summary to the discussion group Rule 7. Help keep flame wars under control. Don t respond to flame-bait Don t post spelling or grammar flames If you ve posted flame-bait or perpetuated a flame-war, apologize Rule 8. Respect other people s privacy. 5

6 Don t post any personal information about yourself or about others Rule 9. Don t abuse your power. The more power you have, the more important it is that you use it well Rule 10. Be forgiving of other people s mistakes. Remember you were a network newbie once too! Additional considerations for online discussions: For private communication, comments are best shared with the faculty through College , not on the discussion board or in a Blog. Remember to use formal rules of English when communicating online. Instructional Methods: Asynchronous Lecture Blackboard Assignments Case Studies Online Instruction using Wimba Online Platform Internet website resources PowerPoint presentations Discussion Board Blogs Evaluation 2 Assignments on a variety of topics 20% (Each assignment is 10% of the course grade.) 2 Case Studies based upon unit topics 40% (Each case study is 20% of the course grade.) 1 Paper 40% Unit Objectives Unit I End-of-life Demographics Recognize changes in population demographics, health care economics, and service delivery that necessitate improved professional preparation for end-of-life care. Describe the philosophy and principles of hospice and palliative-care that can be integrated across settings to effect quality care at the end-of-life. Discuss aspects of suffering, clients and families experience, when facing a life-threatening illness or event. Describe the role of the nurse in providing quality end-of-life care. Explain the importance of knowing who you are, as a professional nurse, in order to practice healthy caring behaviors. Identify the sources of stress as a result of working with dying clients and their family members. Utilize strategies to create a healthy working environment when working with clients and family members throughout the end-of-life experience. Unit II Pain Management Identify barriers to adequate pain relief at end-of-life. List components of a thorough pain assessment. Describe pharmacological and non-pharmacological therapies used in pain management. 6

7 Unit III Symptom Management Identify common symptoms associated with life-threatening illnesses and end-of-life process. Identify potential causes of symptoms at end-of-life. Describe assessment of symptoms at end-of-life. Describe interventions that can be used to prevent or diminish symptoms at end-of-life. Unit IV Cultural Considerations in End-of-Life Care Identify dimensions of culture and the influence of culture on end-of-life care. Conduct a cultural assessment of clients facing the end-of-life. Discuss beliefs regarding death and dying held by various groups. Recognize the value of interdisciplinary care in respecting cultural diversity. Unit V Ethical / legal Issues in End-Of-Life Care Define the role of the nurse in supporting ethical practices in end-of-life care. Explain ethical issues and dilemmas that may arise in end-of-life care. Describe advance directives and how they relate to end-of-life care. Apply ethical practices in decision-making regarding end-of-life dilemmas. Unit VI Communication Define the importance of ongoing communication with interdisciplinary team, clients and family members throughout the end-of-life experience. Identify factors that influence communication in the palliative-care setting. Describe the important factors association with communication of bad news. Identify the characteristics that the client and the family expect from health care professionals. Unit VII Meeting Human Responses in the Spiritual Domain Discuss the differences and similarities between spirituality and religiosity. Enhance the understanding of the perspectives of spirituality. Conduct a spiritual assessment as part of end-of-life care. Develop a plan of interventions to provide appropriate spiritual care considering culture and religious preferences of client and family. Use opportunities in the end-of-life experience to enhance spiritual growth of client and family. Unit VIII Grief, Loss, and Bereavement Define loss, mourning, grief and bereavement. Distinguish between anticipatory grief, normal grief, complicated grief and disenfranchised grief. Distinguish three tasks of grief and list five factors that may facilitate normal grief. Provide personal death awareness and cumulative loss associated with professional care giving. Identify four systems of support nurses can access to assist in coping with death anxiety and loss. Unit IX Preparation and Care for the Time of Death Assess an actively dying client, list five physical signs and symptoms associated with the dying process and identify three signs of death. Assess physical, psychological, social, and spiritual care needs and interventions for the actively dying client and their family. Identify one culturally diverse population in the nurse s community and discuss death and dying belief systems for that group. Discuss five responsibilities of the nurse following the death of a client. Identify personal experiences with death. 7

8 Unit X Achieving Quality Care at the End-Of-Life Describe the multiple roles for nursing in improving the quality care for the client and family at the endof-life. Discuss cost considerations in providing quality care at the end-of-life. Recognize opportunities for change within health care systems and how to participate and effect change. Describe opportunities for personal growth at the end-of-life. Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Topical Outline Orientation and Horizon WIMBA Live Classroom training Traditional Class Day for Orientation and training purposes Need for Improved Care at the End-Of-Life 1. Death and dying in America: Changes over the last century 2. Demographics and social trends 3. Disease / dying trajectories Principles of Hospice and Palliative-Care 1. Hospice a. Definition b. History 2. Palliative-care a. Definition b. History 3. Philosophy and principles of hospice and palliative-care Individual Assessment of Care at the End-Of-Life Based on a Model for Quality of Life 1. Quality of Life Model 2. Addressing multiple dimensions of care 3. Concept of suffering The Role of the Nurse 1. Extending palliative-care principles across practice settings 2. Improved quality of end-of-life care 3. Healthy practices for end-of-life care Current Status of Pain Relief 1. Barriers to pain relief 2. Pain assessment 3. Pharmacological therapies 4. Non-pharmacological therapies 5. Complimentary therapies 6. Other pain relieving therapies Essential Elements of Symptom Management 1. Common symptoms 2. Comfort measures 8

9 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14 Definitions of Culture 1. Cultural assessment 2. Cultural considerations 3. Beliefs regarding death and dying, after life and bereavement 4. Stereotyping 5. Specific cultural groups and death and dying practices Responding to Ethical Issues in End-Of-Life Care 1. Ethical issues and dilemmas in end-of-life care 2. Facilitating ethical and legal practices 3. When ethical dilemmas occur Myths / Realities of Communication 1. The communication process 2. Factors influencing communication 3. Health care professional s communication style Differentiating the Concepts Spirituality and Religiosity 1. Perspective on spirituality 2. Spiritual assessment tools 3. Interventions for spiritual care at end-of-life 4. Opportunities for spiritual growth The Nurse: Death Anxiety, Cumulative Loss and Grief 1. Death anxiety 2. Defense mechanisms 3. Personal death awareness 4. Cumulative loss 5. Stages of adaptation for the nurse The Grief Process 1. Grief assessment 2. Bereavement interventions The Actively Dying Client: Signs, Symptoms and Nursing Interventions 1. Death 2. Care immediately following death 3. The challenge for nurses to delivery quality end-of-life care 4. The nurse s role in improving health care practices in caring for the dying client and family 5. Opportunities for growth at end-of-life Nurses: Integral to Spiritual Care at End-Of-Life 9

10 1. The nurse, dying and death 2. Dying is a unique experience 3. Dying as a physical, psychological, social, and spiritual event Week 15 Tying it all up. Discussion Board Resource List Cassell, E.J. (1991). Recognizing suffering. Hastings Center Report, 21(3), Elkins, M., & Cavendish, R. (2004). Developing a plan for pediatric spiritual care. Holistic Nursing Practice, 18(4), Ersek, M. (2003). Artificial nutrition and hydration: Clinical issues. Journal of Hospice and Palliative Care, 5(4), Ferrell, B.R, & Coye, N. (Eds.). (2001). Textbook of palliative nursing. New York, N.Y.: Oxford University Press. Glannon, W. (2005) Biomedical ethics. New York: Oxford University Press. Glaser, B., & Straus, A. Awareness of dying. Chicago: Aldine Publishing. Kemp, C. & Bhungalia, S. (2002). Culture and the end of life: A review of major world religions. Journal of hospice and palliative nursing, 4(4), Kubler-Ross, E. (1969). On death and dying. New York: Macmillan. Matzo, M.L., & Sherman, D.W. (Eds.). (2006). Palliative care nursing: Quality care to the end of life. (2 nd ed) New York, N.Y.: Springer Publishing Company. Oregon Department of Human Services (2005). Physician assisted suicide: summaries, annual reports, press releases. Retrieved from Oregon Nurses Association (1995). Assisted suicide. ONA provides guidance on nurses dilemma. Retrieved from Parkes, C. M. (2001) A historical overview of the scientific study of bereavement. In M. Stroebe, R. Hannson, W. Stroebe & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping and care pp.25-45). Washington, D.C.: American Psychological Association. Post, S., Pulchalski, C. & Larson, D. (2000). Physicians and client spirituality: Professional boundaries, competency, and ethics. Annals of Internal Medicine, 132(7), Volbrecht, R. (2002). Nursing ethics: Communities in dialogue. Upper Saddle River, NJ: Prentice Hall. Zerwekh, C. (2006). Nursing Care at the End of Life: Palliative Care for Clients and Families. Philadelphia. F.A. Davis Company. Revised Spring 2013 LMK 10