| Active Listening | Grief and Bereavement | Pain Control and Comfort Measures | Emotiona and Social Care (Psychosocial) | Spiritual Care |
|---|---|---|---|---|
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That the person I'm listening to is NOT ME.
What assumption do we need to begin with if we wish to be active listeners?
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Lots of things including loss of income, loss of role, loss of emotional support; loss of companionship; loss of someone to do certain things with, etc.
A secondary loss is something we lose in addition to the loss of the person him or herself through death. Give an example of a secondary loss.
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Chronic pain has been experienced for greater than six months, a patient is less likely to show outer indications of suffering, and it needs to be treated with round the clock medication.
BONUS POINTS Describe the difference between chronic and acute pain. Points will be awarded for up to three differences that can be identified.
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The INABILITY to accept the reality of a situation
How would you define DENIAL?
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Religion
Does religion or spirituality unite like-minded people, but divide "other minded" people?
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It means we set aside our personal concerns and needs for the time we are spending with the patient or family member.
What does it mean to "bracket" our own concerns in order that we may listen with our full attention?
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Lots of possibilities.
BONUS POINTS After someone dies there are many normal grief reactions. These may be physical, emotional, mental/cognitive, behavioral, spiritual. Name one normal grief reaction and explain which category it falls under. EXTRA POINTS WILL BE AWARDED FOR EXAMPLES OF ADDITIONAL CATEGORIES
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Involvement of nerves, metastasis to organs and interference with function, also incidental pain such as migraines or arthritis, treatment related pain.
Name some causes of pain in cancer patients.
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1) fear of the process of dying; 2) fear of being a burden; 3) fear of being abandoned; 4) fear of the unknown; 5) fear of a loss of dignity, etc.
BONUS POINTS What are the primary fears of a person facing a terminal illness? Points will be awarded for up to three of the common fears.
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What comes after death? What has my life meant? How can I reconcile with an estranged family member? I feel guilt... I feel fear... etc.
BONUS POINTS What are examples of spiritual issues that a grieving or dying person might raise with a trusted companion? Points will be awarded for up to three examples.
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1) pay attention to body language, 2) pick up on feeling words, 3) check our understanding, 4) Talk about specific situations, 5) Allow people to express even "dark" feelings.
BONUS POINTS As active listeners, we strive to "listen to the feelings as well as the words." List one way we "get to the feelings." Extra credit if you can name more than one.
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It takes as long as it takes
BONUS POINTS What is an acceptable length of time for an individual to continue to grieve the death of a beloved family member? EXTRA POINTS WILL BE AWARDED IF YOU USE THE EXACT WORDING
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Constipation
What side effect of narcotics must we ALWAYS pay attention to? This must be an exact answer.
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1) flexibility in roles; 2) ability to accept outside help; 3) Open communication skills
A family which is described as an open family has three attributes that may help them during the time of a terminal illness of one of their members. Points will be awarded for each attribute you can identify.
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1, loss of income and professional status, 2, physical beauty and 3. role in the family. Additional points will be added if you can name what a volunteer should do in this situation.
Our patients have often lost much of what gave them a sense of worth throughout their lives. Name some of the losses people face at the end of life.
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We will never share anything they say outside of the Team, and we will only share what is necessary for safety inside the Team.
In Hospice, what do we promise our patients about confidentiality?
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Difference in relationship before death; personality of the griever; role of the griever in the care of the deceased; the existence of strong denial prior to the death of the mother for one of her children, etc.
Name two reasons why two children of the same mother might grieve her death differently.
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Remind the pt that it's time to take medicine, help them sit up, carry pre-measured medications to the patient, get them a glass of water, even deliver medications to the home... but we can NEVER administer meds.
How may a volunteer help in getting a patient's medications to him or her? What can a volunteer NEVER do in regard to a patient's medications?
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If one has been trained NOT to admit to pain or weakness it may be difficult for that individual to communicate clearly what is needed to caregivers.
How may the military cultural norm of STOICISM impact end of life care.
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It gives the message, "I accept you, I am here with you, you are not alone in this journey."
What role can appropriate touch play in the spiritual care of a dying person?
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1) recounting our own experience; 2) giving advice too freely; 3) Reassuring too soon.
BONUS POINTS Name one of the roadblocks to good listening. Extra points if you can name more than one.
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A history of mental illness or substance abuse; the presence of children in the home; the support group of the one facing loss; physical illness; strong denial; emotional or financial dependency; multiple losses, strong denial prior to the death, etc.
Name two important bereavement risk indicators that the hospice team needs to pay attention to when we admit a new patient and family?
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Fanning the patient's face, raising the head of the bed, helping them get their oxygen on if they're not using it.
What simple measure can relieve the discomfort of someone who is short of breath?
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Triangulation is getting caught up in a conflict between two other people and it can be avoided by not taking sides and by directing the conflicted individuals back toward one another.
What is "triangulation" and how can a volunteer avoid it?
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Never minimize; Additional points will be added for suggestions of what we should do: listen and accept. Offer a visit from a chaplain.
What should we avoid doing when a patient shares feelings of guilt from their past?
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