Part 2 Simulation Workbook 2021 PDF

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S20 Adult Nursing Year 1 Simulation Practice Handbook 2 Student Name: Alison Phelan Personal Tutor: Karen Lumsden Group: C3b Faculty of Health and Wellbeing

Adult Nursing

Title of Event: Mrs. Harini Kapoor 1 Therapeutic Communication at EoL

All learning outcomes have been mapped to: The NMC (2018) Standards for Proficiency for Registered Nurses; Annexe A: Communication and relationship management skills & Annexe B: Nursing procedures Aim(s) of Event: Session Learning Outcomes: To enable the students to gain knowledge and • Students will demonstrate an ability to analyse skills that will enable them to practice different styles of communication and their therapeutic communication in EoL care impact on care. • Students will gain greater understanding of the skills required for therapeutic communication in EoL care. • Students will begin to put into practice these skills within a safe learning environment. • Students will be supported to assess each other communication skills and give sensitive and constructive feedback. Pre-simulation preparation –2 hours: Prior to attendance at the simulation practical students must complete ALL the pre-session activities. • Read the article Brighton LJ & Bristowe K (2016) Communication in palliative care: talking about the EoL, before the EoL. Postgrad Med J (92):466–470: A link to this article is available on BB • Access the RCN web material (link via BB) and explore the guidance on communicating with patients in EoL care • Read introductory information on the PALLIUM communication framework • Watch both videos of the nurse's interactions with Mrs. Kapoor (you may need to do this 2-3 times) Using the template table (provided below) write up your answers to the questions related to the PALLIUM criteria. Pre-simulation Requirements- provide Pre-simulation Requirementsprovide evidence that you have: Read the introductory evidence that you have read the article by information on the PALLIUM communication Brighton LJ & Bristowe K (2016) framework and have watched both videos of the nurse's interactions with Mrs. Kapoor (This Write a summary of the key points you have learned from your reading of this journal article will be your completed table - attached) Palliative care derives from the Latin term Palliative care helps patients with a life-threatening PALLIUM. In ancient times, a pallium was a illness and their families live better (World Health heavy cloak. In palliative care, the image is of Organisation (2015), cited in Brighton & Bristowe someone wrapping a thick, warm cloak around (2016). Some of the most challenging another person to shield them from the conversations in palliative care are those about elements. This is an excellent illustration of end-of-life issues. This could include discussing what palliative care is all about. Palliative care prognosis, desires, and objectives such as life-

is supplied to a vulnerable individual as a helpful and protective companionship. Communication is a necessary component of this process. The term PALLIUM will be used here to refer to a method of efficiently and therapeutically engaging with individuals, particularly when they are feeling vulnerable. It is a valuable framework for deconstructing therapeutic communication into its several components, each of which requires a distinct set of abilities. P = Presence AL = Ask and Learn LI = LIsten U = Understand M = Make a difference Presence To communicate therapeutically with another person, you must be fully present. To put it another way, you must focus entirely on them, and make sure nothing else takes your attention away. A private and quiet area may be required. Focusing on the person, without letting yourself be distracted by your next duty or service customer, is essential. Focus on the person and their task becomes secondary. Ask and Learn Be curious and attentive to the other person as they are talking. Ask open and probing questions in order to allow the individual to speak freely. By knowing more about the other person, you can react more effectively. Listen Unless you genuinely listen, all questions will be of no benefit. This is not as simple as it seems; it takes focus and effort. Listening is an active conscious behaviour that is a crucial element of being fully present to the other. To truly listen, you must mute your own thoughts, preconceptions, pre-judgments, and possible answers. Pay attention to the other person. To listen, you must have the appropriate body language and facial expressions, which allow the other person to feel at ease and be honest with you. You should maintain a comfortable and open posture, retaining natural eye

prolonging or palliative therapies and expectations and fears around dying and death, which is known as anticipatory or advance care planning (ACP). With an increasing and ageing global population, palliative care services cannot be met by professionals alone (Hughes et al 2015: World Health Organisation 2004; Quill & Abernethy 2013, cited in Brighton & Bristowe (2016). As a result, specialists as well as generalists are expected to communicate with persons with life-threatening illness and their loved ones regarding end-of-life care. Over the years, communication has been widely accepted as being vital in healthcare. Open and honest interactions with patients, and those close to them, continue to be highlighted as a necessity (Francis 2013; Neuberger 2014, cited in Brighton & Bristowe (2016). Nonetheless, around 60-90% of patients with life-threatening illness have not discussed end-of-life care matters with their provider (World Health Organisation 2015; Temel et al 2000, cited in Brighton & Bristowe (2016). Patients with COPD who had end-of-life care discussions were twice as likely to assess the quality of their care as "the finest imaginable" (Leung et al (2012), cited in Brighton & Bristowe (2016). A prospective research of over 1,000 cancer patients indicated that the number of aggressive medical procedures were dramatically reduced when endof-life care discussions occurred before the last 30 days of life (Mack et al (2012), cited in Brighton & Bristowe (2016). On the contrary, those receiving aggressive medical interventions report much improved quality of life and relative adjustment when provided with fewer aggressive therapies near the end-of-life (Wright et al (2008), cited in Brighton & Bristowe (2016). Study findings are in agreement with a previous systematic review, which included 100 studies. The study revealed evidence of a beneficial impact in the form of lower hospitalisations, increased use of hospice and palliative care services, and a better degree of compliance with patients' desires (Brinkman et al (2015), cited in Brighton & Bristowe

contact, but without being too near to the person, nodding your head and giving positive feedback. Understand First, listen carefully to the other person to comprehend their thoughts and feelings. Reflecting on what you heard is a way to better clarify your comprehension and then letting the other person know that you've been heard correctly. You use your body language and facial emotions to show knowledge as well. The right use of touch can convey a deeper level of empathy and understanding. Keep in mind that "I understand how you feel" rather than "I know how you feel." Make a difference Once you comprehend the other person's problem, you will be able to reply correctly. However, even by being here and giving someone the opportunity to unload, you have made a difference. Sometimes you can do things to improve the problem, and frequently you'll have to direct the person to others who can assist and help. Everything is vital; just be supportive in whatever manner you can.

(2016). Patients are reported to have a greater quality of life, and families are reported to experience better grief adjustment when patients undergo fewer intensive medical treatments at the EoL (Wright et al (2000), cited in Brighton & Bristowe (2016). These findings are consistent with a recent systematic analysis of the impact of ACP on end-oflife care. Indicating the beneficial effect through fewer hospitalisations, increased use of hospice and palliative care services, and less use of lifesustaining therapies (Brinkman et al (2014), cited in Brighton & Bristowe (2016). Additionally, research has established the necessity of talking about end-of-life care issues earlier rather than later. Among physicians, residents, and nurses, the leading impediment to 'goals of care dialogues' was observed to be patients' incapacity. A recent analysis of patients' medical records from the US showed that while around 79% of patients had capacity when brought to the hospital, 40% of these individuals lost capacity before they had an end-of-life talk. For every 20 patients who had lost capacity, there was a marked increase in the use of intensive life-sustaining treatments by surrogate decision-makers. Early interactions with patients might affect those close to them and result in mourning. Based on an examination of qualitative research in the US, family members reported that timely dialogues about death allow them to use the time they have to benefit from hospice and palliative care services (Park et al (2015), cited in Brighton & Bristowe (2016). Also, having these dialogues before the illness has deteriorated would help families to prepare while also preserving optimism (Shirado et al (2015), cited in Brighton & Bristowe (2016). Fewer than 40% of patients with cancer, 14% of patients with COPD, and 10% of patients with chronic renal illness have discussed end-of-life care problems with their physician and only when their doctor brings up the subject (Clayton et al (2005), cited in Brighton & Bristowe (2016). Concern about the impact of end-of-life care

discussions on patients and people close to them can impede discussions among healthcare providers. Many therapists avoid these discussions, fearful of either killing hope or creating injury (Almack et al (2005); Hancock et al 2007; Pfeil et al 2015, cited in Brighton & Bristowe (2016). Maintaining hope has been found to be critical to patients and relatives (Clayton et al (2008), cited in Brighton & Bristowe (2016). Hope can coexist with knowledge of life-threatening disease or prognosis. It does not only mean survival, though Abdul Razzak (2014, cited in Brighton & Bristowe 2016). Patients may keep optimism while still admitting their terminal prognoses, whether they hope for a cure, live longer than expected, enjoy a decent quality of life and live it to the full. Additionally, 73% of the study's participants were able to both preserve hope and prepare for their patient' death Clayton et al (2008, cited in Brighton & Bristowe 2016). 22 Death-related conversations are not linked to poorer psychosocial patient outcomes, and the majority of terminally ill patients and their relatives find discussing death, dying, and grieving to be non-stressful (Emmanuel et al (2004), cited in Brighton & Bristowe (2016). This is not to say that every patient will be open to having a dialogue about their mental health. Many patients want to learn about end-of-life care, but the timing of the information is critical—when they are ready and not earlier (Friedrichson et al (2011); Hudak et al (2008), cited in Brighton & Bristowe (2016). This may make it more difficult for healthcare providers to assess the proper moment. Patients have suggested that it may be useful to ask directly about readiness. Likewise, it is beneficial to inquire about patients' and family' information and decision-making involvement preferences. Clinicians lack a great deal of ability to gauge their preferences; nonetheless, interviewing patients about their preferences yields significant benefits, particularly for clinicians' confidence (Murtagh et al (2006), cited in Brighton & Bristowe (2016). Decisions, involvement, type and amount of information, as well as preferences. The process

must be about offering opportunity for patients and relatives to communicate intentions and concerns, as well as the chance to be revisited and amended (Parker et al (2007), cited in Brighton & Bristowe (2016). With this presentation, the possibilities and options are shown as fluid and open to modification (Pollack et al (2015), cited in Brighton & Bristowe (2016). When patients are provided with the proper tools, the level of participation is still a choice. Indeed, this literature may look conflicting and opaque to follow. Although information must be honest, sustaining optimism does not lead to unreasonable expectations (Park et al (2015), cited in Brighton & Bristowe (2016) information should be given in a way that displays empathy, but not pity. When it comes to terminology, research indicates that explicit language can lead to anxiety for some family members. In contrast, for others it might contribute to confusion (Karlsson et al (2015), cited in Brighton & Bristowe (2016). When discussing end-of-life care, while these factors are necessary to be aware of, we believe equally important are the non-specialist communication qualities that patients and families name as critical to developing pleasant communication experiences. Patients prefer to be treated as individuals, and when possible, they demand empathetic treatment providers. They want to be heard, form relationships with their providers, and receive holistic care in a comfortable setting (Abdul Razzak et al (2014), cited in Brighton & Bristowe (2016). Better communication with patients and family members on end-of-life care problems is necessary. Supporting doctors with this essential obligation should be a focus for practitioners, researchers, and policy makers. While there are challenges to having an open dialogue about end-of-life care, the most crucial attributes patients and families value— empathy and compassion, provided within holistic, individualised treatment—are essential in all areas of medicine. Palliative care discussions described in the literature should not prevent doctors from offering palliative care options. Work is now on to

provide sources of support. Better knowledge of our definition and measurement of effective communication is critical for future advancement. • Pre-simulation Requirements- provide evidence that you have accessed the RCN web material on communicating with patients in end-of-life care Write a summary of how you will apply this information in caring for Mrs. Kapoor Communication is a vital component in providing end-of-life care. Mrs Kapoor may feel uncomfortable discussing death, but it is vital and useful to open the dialogues when you are caring for a dying patient. Good communication supports staff in determining the priorities and wishes of everyone. Identifying any worries or gaps in understanding gives Mrs Kapoor and her family a sense of reassurance and eases anxiety and discomfort. Check if Mrs Kapoor has designated someone to make decisions for her if they can no longer make their own decisions. However, in this case, Mrs Kapoor is still psychologically well. In holistic EoL treatment, "the small things matter", and allowing Mrs Kapoor the option to sit and converse will support her during this difficult time. There will undoubtedly be numerous personal and delicate discussions during the delivery of EoL care, and it is vital to be able to reply sensitively when given a chance. On a constant basis, Mrs Kapoor's changing requirements must be monitored. Therefore, it is essential as a nurse to keep everyone in the loop by being in constant communication. The first few times the nursing staff encounters this, they may find it challenging and have trouble deciding what to say. Family members will become increasingly important to Mrs Kapoor's overall well-being, and nurses must regularly include opportunities for the family member to learn about the patient's condition, treatment, and/or care. Therefore, it is vital that you consider how quickly relatives want to know about changes and how they will be handled as a nurse. Make the family feel welcome and arrange for them to have a place to rest and eat and drink close by. Some family members may want to stay with Mrs Kapoor or be recalled in the event of impending death. Some would like to provide direct care. Help where you are needed. Pre-bereavement assistance for families from the nurse contributes considerably to the experience of relatives, both in recognising the situation as it grows and caring for them with intelligence, insight, and understanding. Sensitive chats have an immeasurable benefit, particularly as the condition of Mrs Kapoor gets worse. This is typically seen to be missing in conversations toward the EoL. Informal interactions aid grief preparation Most care towards the EoL is provided by multidisciplinary teams working together to fulfil the requirements of patients as they travel between health and social care services. Communication is necessary in order to promote Mrs Kapoor and family well-being. Everyone involved in Mrs Kapoor's care must know how to respond if something worsens. Anticipated decline should always be planned. Key stages on Mrs Kapoor's journey have a greater likelihood of communication breakdown. Transitions such as moving from one care setting to another are where changes occur most frequently. To help avert breakdowns, teams use electronic communication in addition to the phone conversation and writing communication. As communication capabilities diminish, you should give time to family togetherness. When Mrs Kapoor is unable to speak with loved ones, families are naturally troubled. During the latter moments of their life, people desire to contact their loved ones.

It appears that time spent preparing families before a difficult event impacts the level of family suffering. Assume that all unconscious patients can hear everything. Experience reveals that in some instances, patients' awareness is greater than their ability to respond. It is necessary to suppose that the patient may be in distress if we have no way of gauging comprehension. Communicate with Mrs Kapoor as though he or she is conscious and welcoming families for positive and positive environments. Surround Mrs Kapoor with the people, things, music, and sounds they enjoy, and have regular talks with them. Encourage families to be direct as Mrs Kapoor may believe that they must ask permission to die. Encourage family members to let Mrs Kapoor die in the manner that is most comfortable to them. Suggest alternative words to your relatives: "I know that you're dying. Please do so when you're ready". I love you too." I will miss you. Never forget you. When you are ready, do whatever you must. We adore you too." You will be missed, but we will be OK. Emphasise familiar methods of affection with family members. It is possible to connect with people and comfort them when you touch. Ask family and friends to take basic, intimate actions like touching hands. An overwhelming question for everyone is "Am I dying?" Every scenario needs to be dealt with depending on the circumstances and context. Here are a few possible responses. That must be tough to ask me Why did you ask that question? Is that what you believe? "What makes you think that?" These kinds of responses will allow Mrs Kapoor to explore the subject further while giving you time to collect your thoughts. You should also ask what the doctor or any other healthcare practitioner has previously said about the topic. Ignoring or being dismissive are poor tactics, so if you do not feel you can manage the conversation, just admit you are finding it tough and seek advice from a more senior member of staff. Talking about death can be considered taboo because it just heightens our fear of dying. The taboo of talking about death is founded on fear, and you must become proficient at dealing with terminally ill patients. Make sure everyone, primarily those close to Mrs Kapoor, discusses death using words they can comprehend. We know, or rather we fear, dying in pain and misery. Fears about the quality of care that has been provided recently may only increase these issues. "Don't let him/her suffer." Talking freely about mortality can make it easier to confront de...