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E-Learning Module A:
Introduction to CAPCE and the Nurse’s Role in Hospice Palliative Care
This module requires the learner to have read chapter 1 and 2 of the CAPCE Program Guide and the other required readings associated with the topic. See the CAPCE Program Guide required and recommended reading list for more information.
Revised: January 2017
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Contents of this e-Learning Module may be reproduced in whole or in part provided the intended use is for non-commercial purposes and full acknowledgement is given to the Southwestern Ontario Hospice Palliative Care Education Program and St. Joseph’s Health Care London.
Please reference as follows:
Southwestern Ontario Hospice Palliative Care Education Program. Comprehensive Advanced Palliative Care Education e-Learning Modules. London: Southwestern Ontario Hospice Palliative Care Education Program, St. Joseph’s Health Care London; 2013; second edition 2017.
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GETTING STARTED
This e-Learning Module has been designed to consolidate key concepts from the required readings and provide an opportunity to begin applying these concepts through self-directed reflection and scenario-based work, in preparation for the case-based discussions, in-person, with other learners.
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GETTING STARTED
In this module, you will review the content highlights associated with the CAPCE program, and the Nurse’s Role in Hospice Palliative Care.
You may be asked to write down your thoughts or ideas during this module. You can do so in the Notes section at the end of Chapter 1 and 2 in your Program Guide. Have your Program Guide with you as you complete this module.
These notes are just for you; you won’t be required to submit them. However, you may be prompted to use your notes for discussion in your Peer-to-Peer Exchange and Coaching Sessions. Please be respectful of confidentiality.
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TOPICS COVERED
✓ Introduction to CAPCE: Critical Concepts
✓ CAPCE Performance Objectives
✓ Leadership
✓ Nurses Role in Hospice Palliative Care
✓ The National Model to Guide Hospice Palliative Care
✓ Foundational concepts of Hospice Palliative Care
✓ Effective Communication
✓ Effective Group Function
✓ Ability to Facilitate Change
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TOPICS COVERED
✓ Foundational Concepts of Hospice Palliative Care
✓ Therapeutic Relationships
✓ Therapeutic Use of Self
✓ Phases of Therapeutic Relationships
✓ Self-Care
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INTRODUCTION TO CAPCE: CRITICAL CONCEPTS
Key concepts associated with Introduction to CAPCE include:
✓ Personal learning goals will help you measure your progress throughout the program and ensure this experience meets your unique needs
✓ The Palliative Care Nurse is an advocate, a change agent, and a nurse skilled in, not only the science, but the art of hospice palliative care
✓ The National Model to Guide HPC is the framework for the CAPCE program and enables nurses to identify issues faced by the person and family, provide palliative care based on best practice guidelines, and effectively assess and document outcomes.
✓ Building, maintaining and ending therapeutic relationships is central to the practice of a nurse.
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CAPCE PERFORMANCE OBJECTIVES
Becoming a resource in HPC is much more than successfully completing the CAPCE course. As a resource, you must be committed to continually developing your knowledge and skills in both the art and science of hospice palliative care.
Review the performance objectives for the CAPCE program in your Program Guide. As you review them, reflect on where you currently are in your practice and how that compares to the CAPCE objectives. What gaps or learning opportunities do you see for yourself?
Write your observations down in the Notes section following Chapter 1 in your program guide.
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LEADERSHIP
According to the College of Nurses of Ontario, leadership is one of the seven professional standards. It is defined as: ‘a relational process in which an individual seeks to influence others toward a mutually desirable goal” (RNAO, 2006)
Nurses emerge as leaders when they:
✓ Role model professional values, beliefs and attributes
✓ Provide coaching and mentoring to novice nurses
✓ Advocate for the person and family
✓ Collaborate with the health care team
✓ Develop therapeutic relationships with persons and families
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LEADERSHIP
Think about a colleague who, in your opinion, has embodied the definition of leadership.
What characteristics or qualities did or does that person possess? How did he or she influence you?
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A NURSE IN HOSPICE PALLIATIVE CARE
As a nurse, you will accompany the person and family, providing support and care, throughout the illness trajectory. You will collaborate with members of the health care team and help coordinate care for the person and family members. When fully present in the illness journey, you will be able to engage in therapeutic encounters that, over time, build therapeutic relationships based on mutual trust.
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A NURSE IN HOSPICE PALLIATIVE CARE
The Nurse in palliative care:
1. Collaborates with the person and his or her family and other colleagues in problem solving and develops individualized care plans
2. Identifies gaps in care delivery both at the bedside and within the organization
3. Considers strategies in response to identified gaps and needs
4. Communicates organizational gaps and issues and possible problem solving strategies to management in an effort to enhance delivery of hospice palliative care within the organization
5. Advocates for improved delivery of hospice palliative care within the organization.
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A NURSE IN HOSPICE PALLIATIVE CARE
Consider the role of the nurse in palliative care and your place of work. Think about your response to the following questions, and then write down your answers in the Notes section at the end of Chapter 1 in your program guide:
1. Provide and example of how you have collaborated with a health care team to develop individualized plans of care for a person and his or her family.
2. Identify one specific way you can advocate for improved delivery of hospice palliative care within your organization.
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A NURSE IN HOSPICE PALLIATIVE CARE
Goal setting is a powerful process for thinking about your ideal future, and for motivating yourself to turn your vision into reality.
What are your personal goals related to becoming a nurse in hospice palliative care?
Identify three specific goals for your self and write them in the Notes section following Chapter 1 in your program guide. Be prepared to share and explain these goals with your CAPCE Coach (coaching session one).
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THE NATIONAL MODEL TO GUIDE HOSPICE PALLIATIVE CARE
Developed by the Canadian Hospice Palliative Care Association (CHPCA) in 2002, following ten years of collaborative effort, the hope for this model of care was to change the understanding of hospice and palliative care from “care of the dying” towards “ care that aims to relieve the suffering and improve quality of life throughout the illness and bereavement experience.”
One tool contained within the Model is The Square of Care. Turn to the Square of Carein the Model document now and review. The Model is a required reading for the program. See the reading list for how to access this resource if you haven’t done so already.
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THE NATIONAL MODEL TO GUIDE HOSPICE PALLIATIVE CARE
When a carpenter sets about to solve a problem, build something new, or enhance an existing object, he or she uses a carpenter's square.
The Square of Care is a tool just like a carpenter’s square. Every time an issue is identified, the nurse will work through the steps of the Therapeutic Encounter (discussed more fully in Module B: Assessment).
The steps of the Therapeutic Encounter will be familiar to you because they closely resemble the steps of a Nursing Process.
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FOUNDATIONAL CONCEPTS OF HOSPICE PALLIATIVE CARE
According to the Model, there are three foundational concepts of hospice palliative care:
1. Effective Communication
2. Effective Group Function
3. Ability to Facilitate Change
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EFFECTIVE COMMUNICATION
Effective communication within your organization, your team, as well as, with the person and family is a skill that takes time and practice.
To be an effective communicator, you must:
1. Share a common language with others
2. Engage in verbal/non-verbal communication, active listening, and appropriate response
3. Collect data from the team, person, and family and document
4. Provide education for the person and family that is appropriate to respond to their need
Being a skilled communicator means taking risks, making mistakes, and learning from each encounter.
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EFFECTIVE GROUP FUNCTION
Effective group function is dependent on effective communication, as well as negotiation and discussion.
Each member of the team must be willing to consider the viewpoints of others an work together to provide care for the person and family.
[Teamwork is] that work which is done by a group of people who possess individual expertise, who are responsible for making individual decisions, who hold a common purpose, and who meet together to communicate, share and consolidate knowledge from which plans are made, future decisions are influenced, and actions determined. –RNAO, 2006.
Within effective group function, the person and family, together, are the center of care.
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ABILITY TO FACILITATE CHANGE
Although the nurse cannot directly change the experience of illness for the person and family, he or she can, through ongoing therapeutic encounters, promote a positive experience in the illness journey.
On an organizational level, the nurse has many opportunities to influence change in the workplace and be a catalyst for enhancement of palliative care delivery.
On a local and regional level, the nurse can facilitate change by serving on committees and working groups
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FOUNDATIONAL CONCEPTS OF HOSPICE PALLIATIVE CARE
Identify a case where you had the opportunity to facilitate a positive change in the illness experience for the person and family:
▪ How did you influence the change?
▪ What challenges did you encounter along the way?
▪ What did you learn from the experience?
Write your answers to thee questions in your Notes section following Chapter 2 in your Program Guide.
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THERAPEUTIC RELATIONSHIPS
Therapeutic relationships are the foundation on which hospice palliative care is established and delivered. According to the RNAO, therapeutic relationships are:
✓ An interpersonal process between the nurse, person and family
✓ Purposeful
✓ Goal directed
✓ Aimed at advancing the best interest and outcome of the client.
The development of successful therapeutic relationships requires continuity; relationships build and grow over a period of successful encounters, and are based on mutual trust
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THERAPEUTIC RELATIONSHIPS
The core concepts central to therapeutic relationships include:
✓ Reciprocity
✓ Self-awareness
✓ Awareness and respect of boundaries
✓ Empathy and validation
✓ Trust
✓ Confidentiality
✓ Therapeutic use of self
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THERAPEUTIC USE OF SELF
We operate in a very task-oriented health care system; however, in hospice palliative care, a paradigm shift is required in which the relationship becomes the focus of our care, instead of the individual tasks.
Hospice Palliative care involves both the art and science of care, and therapeutic use of self implies we stop the doing and concentrate on the being. This includes relationship building with the team, as well as with the person and family.
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THERAPEUTIC USE OF SELF
Is it challenging for you, as a nurse, to stop the doing and focus on the being?
How can you become more relationship-oriented and less task-oriented? Name two specific ways in your Notes.
What do the core concepts of therapeutic relationships mean to you? Take two of the core concepts in therapeutic relationships and, in your Notes, define them briefly in your own words.
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PHASES OF THERAPEUTIC RELATIONSHIPS
Every human relationship has a sequence; there is a beginning, a middle, and an end. Therapeutic relationships are no different.
Your program guide defines and describes the three phases:
▪ Orientation: Initiating and Developing Therapeutic Relationships
▪ Working: Maintaining Therapeutic Relationships
▪ Resolution: Ending Therapeutic Relationships
Before considering the scenario that follows, refer to your Program Guide and review the three phases of the therapeutic relationship, including the what and how for each phase.
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PHASES OF THERAPEUTIC RELATIONSHIPS
Review the following scenario, answer the questions in your Notes section and be prepared to discuss at your next Peer-to-Peer discussion.
You are working the night shift at your local hospital, and Mr. Johnson is admitted during the night with a diagnosis of metastatic lung disease. His PPS is 30%.
Considering what you’ve reviewed about the orientation phase of therapeutic relationship, what will you do initially to establish a therapeutic relationship with Mr. Johnson and his family? Briefly explain in your Notes.
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PHASES OF THERAPEUTIC RELATIONSHIPS
You work the next two nights, as well, and Mr. Johnson is one of you patients both nights. The nights are quiet and you have time to sit with Mr. Johnson’s family and find them to be open and talkative.
What are the importance of recognizing and maintaining professional boundaries?
How can you be personable and still maintain your professional role?
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PHASES OF THERAPEUTIC RELATIONSHIPS
After two days off, you return to wok on a day shift, Mr. Johnson’s PPS is 10%, and he dies in early afternoon.
Think about resolving a therapeutic relationship. Are you comfortable saying goodbye to the family after a person’s death? What are some ways you can bring closure to the relationship and care for yourself?
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SELF CARE
As a nurse, you’ve likely been inundated by self-care education, reminders, and literature. In CAPCE, we will challenge you to think critically about your self-care needs in a hospice palliative care setting.
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SELF CARE
To do this, you will need to leverage your current understanding of the importance of setting personal boundaries, establishing a health lifestyle outside of work, and caring for yourself as much as you care for others.
Remember to:
✓ Set your own limits and stick to them
✓ Build time into your routine that allows you to decompress
✓ Not confuse what you do with who you are
✓ Be open to change
✓ See challenges and mistakes as opportunities for growth and knowledge.
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BRINGING IT TOGETHER
As you finish Module A of your e-Learning, we (your Coaches) would like to take another opportunity to welcome you to CAPCE.
We are excited to have this opportunity to work with you and enhance your practice as a hospice palliative care nurse by providing you with opportunities to gain knowledge and practice with tools and resources.
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WHAT HAPPENS NEXT
To prepare for the next e-Learning Module, you will need to read the associated Program Guide chapter in advance.
In order to complete the next e-Learning Module, you will need to have the Program Guide and the Pallium Palliative Pocketbook with you.
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This e-Learning resource is the property of:
The Palliative Pain & Symptom Management Consultation Program - Southwestern Ontario St. Joseph’s Health Care, London ON
www.palliativecareswo.ca
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