A Course Study On Competence In Palliative Nursing
Competences are the quantifiable knowledge, skills, and attitudes that professionals should demonstrate in the exercise of safe, consistent, compassionate, modern, evidence based palliative care which is in line with the wishes of the patient and the family of the patient. The following are five key competencies essential in palliative care nursing
The nurse should demonstrate critical thinking and clinical judgment in the care of individuals in palliative care through the use of nursing process to address the bodily, emotional, mental, and religious needs of the patients and families
- The nurse should be able to utilize scientific, humanistic, ethical and personal knowledge as the bases for clinical decision in all aspect of palliative care
- The nurse should be able to assess the needs and goals of both the patient and the family working with other members of the care team.
- The nurse should be able to conduct a holistic assessment (physical, psychological, spiritual) aspect of pain, symptoms, suffering and grief and their possible impact on quality of life.
- The nurse must be able to determine the patient/family challenges, needs, issues and diagnoses based on critical analysis that is based on a comprehensive and thorough holistic assessment of the patient history, symptoms and physical assessment.
- The nurse should be able to collaborate with family, patient and other healthcare practitioners to plan and execute an effective care plan that has specific objectives and outcomes.(Hospice and palliative nurses association)
Advocacy and ethics
The nurse should demonstrate adherence to ethical principles and professional principles in the care of terminally ill and their families
- The nurse should be able to identify and advocate for the rights, wishes and preferences of their patient
- They should be able to ensure that patients have access to care and community care by influencing or developing health and social policies
- They should incorporate ethical principles and professional standards in their practice.
- They should educate patients and their families pertaining their rights and responsibilities, as well as, the available healthcare options
- The nurses should be able to assess the wishes and preferences of the patient as they relate to palliative care
The nurse should be able to demonstrate knowledge, attitude, behavior, and skills that are in line with the nursing standards, codes of ethics, and scope of practice for palliative and hospice practice.
The nurse should be able to demonstrate in-depth knowledge of nursing skill and information
The nurse should portray a clear understanding of the codes of standards that govern the nursing profession.
The nurse should be able to provide palliative care to different patient maintaining the integrity of nursing professional
Course study on communication as a key competence on palliative nursing
The course intends to help a prospect nurse or a practicing nurse understand the importance of communication in palliative care. Course addresses the importance of communication, domains of palliative care and effective communication in palliative care.
Nurses working in hospice and palliative care should demonstrate effective use of verbal, non-verbal and written communication with patients and families, members of the health care team, and the community so as to address the therapeutic and palliative care to patients.
Communication is a key to both health and effective healthcare. Communication in palliative care is complex and threatened by several factors. Communication, however, play a vital role in delivering information and offering emotional support. Communication provides a way in which people relates and is the bases of relationships. Threat of death that is synonymous with terminal illness poses certain challenges to effective communication. It is, therefore, paramount for healthcare practitioners to have effective communication skills to achieve successful palliative care.
Importance of communication
- Effective communication is a powerful therapeutic tool.
- It can be used to empower patients and families with a sense of control.
- It is effective in reducing uncertainty and provides basis for action
- It creates an environment of safety, trust and hope in times of crisis and uncertainty
- It strengthen the relationship between the patient, family and the healthcare provider
- It is essential in developing care plan that is effective and that addresses all aspects of the patient’s life
Effective communication in palliative care is essential in communicating emotional news to the patient and family.
Domain of palliative care
The communication skills to be addressed will be based on domains developed by the national consensus project for quality palliative care of 2009. NCP developed guidelines to be followed in administering palliative care to the terminally ill. Communication is at the heart of eight domains that we developed. We, therefore, have to understand the eight domains so that we can be able to develop effective communication skills.
The domains includes
- Structure and processes of acre
- Physical aspects of care
- Psychological and psychiatric aspect of acre
- Social aspect of care
- Spiritual, religious, and existential aspect of care
- Cultural aspects of acre
- Care of the imminently dying patient
- Ethical and legal aspect of care
Structure and processes of care
- Successful palliative care is highly dependent on the structure and the processes of care. The establishment of these structures is hinged on effective communication. It is essential for nurses to realize the multidisciplinary nature of palliative care. They should, therefore, work toward developing effective communication between the different stakeholders of palliative care. Nurses should not assume that effective communication will be automatically realized. It is built on effective supportive structures. Nurses should be ready to employ the use of technology such EHR, mobile phones, electronic mails and other modern communication gadget to facilitate effective communication. Nurses should be able to adjust communication methods to suit different circumstances. They should effective communication to establish a collaborative environment between the patient, family and other care provider. Nurses should be at the forefront of establishing structures and processes that support effective communication.
Physical aspect of healthcare
The complexity of communication pertaining physical aspect of palliative care involves the experience of symptoms. Nurses requires effective communication skills in order to assess the level of patient pain, mitigating factors that influence tolerance to pain, administration of pain relieving medication and deciding on the medication choices. Communication about physical care involves learning to recognize the effect of stoicism and its impact on managing pain. Nurses should be able to identify what triggers pain and the connection between physical pain and existential suffering.
Psychological and psychiatric aspect of care
Nurses in the palliative care must be ready to work with patient portraying psychological needs. Nurses need to have excellent listening skills to offer solutions to psychological needs of the patient. Nurses are expected to assess for anxiety, depression, and other psychiatric responses. They should give attentive voice to fears, uncertainty, anger, and sadness. It is important to know that nurses play a crucial role in the last days of life as a confidant and friend of the patient.
Social aspects of care
The social aspect of palliative care involves the relationship between the patient’s life and other people related to them. They include issues such as financial impacts of the illness, family dynamics, culture and sexuality. It is paramount for the nurse to understand that treatment decision should be arrived through collective communication between among all stakeholders. Nurses are expected to communicate with respect for the family system, honoring the dignity of the patient, and facilitate bereavement support for the loved ones.
Spiritual, religious, and existential aspect of care
Nurses need to know that spiritual care, which encompasses religious and secular beliefs, is essential in palliative care. At this point in life, families and patients are faced with a sense of hopelessness, meaning and purpose of life, faith, forgiveness and abandonment from deity. Most nurses fill ill-prepared for religious communication. However, they should realize that communication skills are essential in communication the appropriate interventions such as inviting religious leaders.
Culture has an eminent influence on palliative care. This culture influences how patient communicate how families interact and communication. it is paramount for nurses to understand the culture of the client for them to develop effective communication.
Care of the eminently dying patient
The nurses must realize the importance of the final hours of dying. This moment poses a great communication challenge to many nurses. The family and the care givers are emotionally exhausted grief is intense, and the healthcare provider has to confront the emotion burden of witnessing death. The nurse must stand out and support the family by giving information through effective communication (Wittenberg, goldsmith, Ragan, 2013)
Students are required to research and write a report on standards of nursing in palliative acre
Effective communication skills
Communication is the mutual creating of meaning by both communicators. In palliative care, there is a multidisciplinary communication between the different care providers and the patient. It is important for nurses to understand that communicators influence other parties’ actions and response. The mutual model of communication implies that both parties (patient & nurse), are simultaneously encoding, delivering and interpreting messages. It is, therefore, imperative to note that, the parties are using both the listening and speaking skills simultaneously. In order to effective understand communication in palliative care, you will need to under standard the central law of communication.
Central law of communication
The central law of communication involves the following.
One cannot not communicate
In our every daily activity, we are constantly communicating and interacting with others through our words, expressions, looks, touch or voices. Nurses are, therefore, expected to be cautious of all their aspect of life while interacting with patients. A simple action, sign or voice, can be interpreted in different ways.
Every message has two level of meaning (task and relationship level)
Communication serves different purposes such instructing, diagnosing, supporting or encouraging. This constitutes the task level. The relationship level involves how the receiver of the message interprets the message. The content level is determined by the content of the message while the relationship is determined by how the words are phrased. The relationship level is greatly influenced by nonverbal communication. It is, therefore, essential for nurses to have information on nonverbal codes that are relevant in communication
Kinesics- this involves body movement such as gestures, eye contact and body position. Body movements express emotion.
Hepatics are the use of touch, which may be context related or relationship related. Hepatics convey as sense of warmth.
Proxemics- this constitutes how we use space and distance. Nurses are allowed to invade the “space” of patient
Physical appearance- this includes types of body and clothing. Physical appearance influence perception. It is crucial for nurses to maintain a professional appearance.
Vocalic- this includes all aspects of the voice such as volume, tone, accent, pause or rate of speech. Nurses should moderate their voices to be similar to or be different from the voices of the patient.
Chronemics- this involves how we use and perceive time. A nurse should demonstrate a balanced use of time between administrating medications and listening to patients
Artifacts- this comprises of the physical objects that stand between the nurse and the patient. Physical objects have the potential of creating an emotional distance.
Students should explain the connection between the five role of nursing and communication.
The following chapter explains two practical protocols that are essential in palliative care
Context listening acknowledgement strategy summary (CLASS)
This protocol is efficient in conducting interviews. The context of the interview involves the physical surrounding within which the interview will be conducted. The five component of context includes, space, body language, eye contact, introduction and touch. For effective communication, the nurse should ensure the privacy of the patient. S/he should maintain a relaxed state and maintain eye contact with the client. The nurse should touch non-threatening area to comfort or instill confidence in patients (Seymour et al, 2008).
The care provider should demonstrate effective listening skills in order to sustain a dialogue with the patient. There are four fundamental skills for effective listening. They include the use of open questions, using facilitating techniques, clarifying, and time management and handling interruptions
Acknowledgement of emotions
Nurses should show empathic responses in emotional interviews. In order to acknowledge emotions, the nurse should identify the emotion of the patient and the cause of the emotion. They should use the information as the basis of responding to the emotions of the client.
The following guidelines are essential in selecting an effective management plan.
- Always determine the optimum care plan
- Assess what is the expectation of the patient toward the plan
- Assess the response of the patient
The end of the interview provides the care provider to establish a long relationship with the patient. Most patients in palliative acre spend a prolonged period of time with the care giver. As a nurse, you are expected to build the foundation of that relationship by stating your expectations.
B. setting perception invitation knowledge and emotions
This is protocol for breaking bad news. The protocol involves six components that include setting, patient perception, and invitation to share, giving knowledge, acknowledging emotions, and designing management strategy. The nurse must create an effective physical environment for breaking the news. S/he should consider the perceptions of the patient before communicating the facts about her/his condition. The communication of the outcome should consider the emotion status of the patient (Buckman, 2001)
Practical practice for the students
Mrs. Wilss is a 72 years old lady with a 20 years history of complex illness including diabetes, obesity, hypertension and CHF. Due to diabetes, Wilss has developed renal failure and is on dialysis. Her family and healthcare provider have recently discussed her deteriorating health condition. Over the weekend, Wilss informed her family that she is done with the suffering and want to terminate her dialysis, knowing that her action will end her life. Her daughter is okay with the decision, but her husband is opposed to the decision. The family decides to visit your facility for assistance.
Explain the communication skills that you will require while conducting the interview.
What communication behaviors will be of use to you when communicating the decision?
Communication skills in palliative care: A practical Guide. Retrieved from http://www.cornellcares.org/
E. Wittenberg, J. Goldsmith, B. Ferrell & S. Ragan (2013) Communication in palliative nursing. Oxford University Press. New York.
Professional competencies for generalist hospice and palliative nurses. Hospice and palliative nurses association
S. Payne, J. Seymour & C. Ingleton (2008) Palliative care nursing: principles and evidence for practice. Open University press.