“Communication at End-of-Life”
for Personal Support Workers in
Long-Term Care
Module 1
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GOAL FOR MODULE 1
BEST PRACTICE at the Bedside
1. Beliefs, Ideas, Biases, and Stored Knowledge
2. Concepts and Content
3. Integration
4. Application
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WHAT IS HOSPICE PALLIATIVE CARE?
• Review working definitions of:
– Hospice Palliative Care (HPC)
– End of Life (EOL) Care
• Review the CHPCA Model to Guide Palliative
Care.
• Reflect on the Philosophy of Hospice Palliative
Care and End of Life Care.
• Discuss myths and misconceptions about care.
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WHAT IS HOSPICE PALLIATIVE CARE?
1. Hospice Palliative Care means providing comfort when
someone is actively dying.
2. Hospice Palliative Care starts when someone is close
to dying and ends at death.
3. Hospice Palliative Care is for people dying with cancer.
4. Telling residents they are dying takes away their hopes.
5. Receiving Hospice Palliative Care means you will die
sooner.
6. Hospice Palliative Care begins with a doctor’s order.
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PERSONAL DEFINITIONS
DYING
DEATH
DEAD
LIVING
Small Group Activity: On a post-it note, create a
definition for each of these words. Share your
definitions with others at your table, come to an
agreement on a definition with your group, and
post it on the wall.
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http://www.youtube.com/watch?v=-SzA-kWB8-s
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NOT JUST THE DYING!
The philosophy and principles of Hospice
Palliative Care may apply to patient
populations other than the dying. Hospice
Palliative Care programs may play a secondary
role in addressing the needs of these groups.
http://www.chpca.net/norms
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WHEN IS IT APPROPRIATE?
Anyone living with or at risk of developing a life –
threatening situation:
– Due to any diagnosis
– With any prognosis
– Regardless of age
– At any time that they have unmet expectations
or needs and are prepared to accept care
http://www.chpca.net/norms
HOSPICE PALLIATIVE CARE…
Aims to address:
– Physical, psychological, social, spiritual, and
practical expectations and needs
– Loss, grief, and bereavement
– Preparation for, and management of self–
determined life closure and the dying process.
Canadian Hospice Palliative Care Association (2013). A Model to Guide Hospice
Palliative Care. Ottawa, ON: Canadian Hospice Palliative Care Association.
Also available at: http://www.chpca.net/media/319547/norms-of-practice-eng-web.pdf
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HOSPICE PALLIATIVE CARE…
Aims to address:
– Suffering, a state of distress associated with
events that threaten the intactness of a
person and are accompanied by a perceived
lack of options for coping.
Cassell (1991)
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HOSPICE PALLIATIVE CARE…
Aims to address:
– The quality of living and dying – sense of
individual well being, experiences that are
meaningful and valuable to the individual and
their ability to have such experiences.
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MEET BETTY – DOMAIN GAME
Our residents play with the cards they are dealt
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DAILY CARE ACTIVITIES…
What PSW activities
would support a resident
experiencing needs in
the various domains of
holistic care needs?
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ASSESSMENT FOR THE PALLIATIVE CARE PHILOSOPHY
• Would you be surprised if this resident died in
the next 3 months? 6 months?
• Have there been hospital admissions recently?
• Are there distressing physical and psychological
symptoms?
• What are the goals of care? What is the
resident’s/family’s understanding of the disease
processes, prognosis, and treatment options?
Quality Palliative Care in Long Term Care Alliance
www.palliativealliance.ca
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ASSESSMENT FOR THE PALLIATIVE CARE PHILOSOPHY
• Are there significant social and spiritual
concerns affecting daily life?
• Has the resident and their family participated in
advance care planning?
• Has resuscitation been discussed recently?
Quality Palliative Care in Long Term Care Alliance
www.palliativealliance.ca
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WHAT IS HOSPICE PALLIATIVE CARE?
1. Hospice Palliative Care means providing comfort when
someone is actively dying.
2. Hospice Palliative Care starts when someone is close
to dying and ends at death.
3. Hospice Palliative Care is for people dying with cancer.
4. Telling residents they are dying takes away their hopes.
5. Receiving Hospice Palliative Care means you will die
sooner.
6. Hospice Palliative Care begins with a doctor’s order.
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HOSPICE PALLIATIVE CARE IS:
• NOT a person/resident/patient
• NOT a place
• NOT a program
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HOSPICE PALLIATIVE CARE IS:
• Provided to a person/resident/patient
• Provided in a place
• Provided by health care practitioners, program,
service etc.
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HOSPICE PALLIATIVE CARE IS:
A philosophy of care
People are not palliative!
The CARE they would benefit from is PALLIATIVE!
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PALLIATIVE CARE IS COMMITTED TO:
“…healing, and that is something different
from curing. Healing is to make a
person whole, to relieve suffering and
to give the individual a sense of who he
or she is as a person.”
“Palliative care is person-centered,
not disease-centered.”
Dr. Larry Librach