Suffering and Total Pain Partageons nos savoirs: Formation pour les professeurs afin soutenir les étudiant(e)s en soins infirmiers dans leurs interventions de fin de vie Sharing expertise: Enhancing end-of-life care education for nursing students t Susan Brajtman RN, PhD School of Nursing University of Ottawa May 7, 2008
Objectives Identify and discuss ss the different dimensions s of total t pain/suffering i Discuss a holistic model of care and explore the implications of using the model in addressing suffering/total pain. Explore and discuss teaching strategies that allow students to explore and understand the concepts of total pain/suffering Explore and discuss teaching strategies that enhance students ability Explore and discuss teaching strategies that enhance students ability to understand, assess and manage their patient s total pain.
Fear and depression are a part of life. In illness there are no negative emotions, only experiences that have to be lived through. What is needed in these moments is not denial but recognition. The ill person s suffering should be affirmed, whether or not it can be treated. What I wanted when I was most ill was the response, Yes, we see your pain; we accept your fear. Arthur W. Frank, At the will of the body. Houghton-Mifflin, 2001.
Aspects/Domains of Holistic Care lt l Spiritual Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.
Aspects/Domains of Holistic Care, e.g. -Disease management -Pain & other symptoms -Function -Nutrition habits - activity, e.g. -Finances -Relationships -Personal routines -Recreation -Vocation -Rituals -Legal issues -Family caregiver support -Practical, e.g. -Personality - symptoms -Emotions -Control & dignity -Coping responses -Self image/ self esteem -Loss & Grief Spiritual, e.g. -Meaning & values -Existential issues -Beliefs -Spirituality -Rites & rituals -Symbols & icons -Loss & Grief -Life transitions -Religions Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.
Aspects/Domains of Holistic Care Aspects/Domains of Holistic Care l Spiritual Spiritual it Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15. Aspects/Domains of Holistic Care Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15. Aspects/Domains of Holistic Care Spiritual Spiritual Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15. Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.
Holistic Care and Environmental Influences Spiritual Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.
Holistic Care, Environmental Influences and Interprofessional Relationships Formal Care Givers (includes Volunteers) Friends Family Spiritual Family Friends Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.
Holistic Care, Environmental Influences, Interprofessional Relationships, Culture & Society Formal Care Givers (includes Volunteers) Spiritual Friends Family Adapted from: Domains of Issues Associated with Illness and Bereavement in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002,,page 15.
Learning in Action What am I learning about myself when I listen to someone who is suffering? How can I be truly present to someonew ho is suffering?
Dimensions of Total Pain/ Suffering Pain: Comprehensive pain assessment, WHO ladder Pain: fear, anxiety, anguish: Complementary therapies, pharmacological therapy, support, Dignity-Conserving Care (Chocinov, 2002) Social Pain: affect on family and friends, feelings of burden: family dynamics, involvement Spiritual Pain: spiritual needs assessment (Puchalski & Romer, 2000) Meaning and purpose of life events, meaningful relationships, need to give and receive love, hope
Collaborative patient Centred Care (Herbert, 2005) Collaborative interprofessional team approach: no one health care professional can meet all of these patients multiple, complex needs
Teaching Strategies Case studies created and/or of patients students are caring for Narrative Pie - dimensions of holistic care Interprofessional team map The Humanities: books, movies, art, poetry
Your ideas!
References A model to guide hospice palliative care: Based on national principles and norms of practice. (2002). CHPCA From: http://www.chpca.net/marketplace/national_norms/ii.pdf Chochinov, H.(2002). Dignity-conserving care- a new model for palliative care. JAMA,287(17), 2253-2260. Greenstreet, W. (2001). The concept of total pain: a focused patient care study. British Journal of Nursing, 10(19), 1248-1255 Herbert, C. (2005). Changing the culture: Interprofessional education for collaborative patient-centred practice in canada. Journal of Interprofessional Care. 1, 1-4. Puchalski, C., & Romer, A. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. Self learning Module: You the Learner, The Person in Your Care in Palliative Care Unit (PCU) & The Interprofessional Care Team AtSCO Health Service. ( 2007). Interprofessional Education for Collaborative patient Centered Practice in the Humanities. Teamwork in healthcare: promoting effective teamwork in healthcare in Canada. (June, 2006). Report to Canadian Health Services Research Foundation, Canada.