Ways of Knowing
Personal: If you were in Dannie’s shoes, how might you feel if you were discharged without engaging in advance care planning?
Various answers, critical thinking/reflection question.
Collaborator: Name 3 interprofessional team members that could benefit Dannie’s palliative care team?
PT/OT, PSWs, home care, neurologist, dietician, social worker, mental health support, case manager, music therapy, etc.
What is one communication strategy we can use to promote leadership?
“Yes and…”, active listening, effective communication and documentation, etc.
Define palliative care in your own words
“...it means they are living with a life limiting disease and the focus is on relieving symptoms and maintaining their quality of life” - Jenni
Aesthetic: What strategies can we use to engage in difficult conversations with young adults facing life altering chronic illness?
Various answers ex: be direct, use real life examples, use conversation cards, use a workbook, etc.
You check your phone after your shift and notice a coworker has posted on social media, expressing their sympathies for “the young lady on my unit that has MS and cannot hold her bladder”, which role is this action directly in violation of?
Clinician, professional (2.8), leader
How can we be a leader in ACP?
Initiate conversations at appropriate times, provide conversation starters or real life examples to ease conversation and allow time for reflection and consideration.
In which Canadian province are advance requests for medical assistance in dying permitted as part of advance care planning? (3 guesses)
Quebec! (Canadian Medical Protective Association, 2023)
Ethical: Dannie’s father approaches you, upset that Dannie has assigned her husband, Keith, to be her substitute decision maker. He tells you Keith leads with his heart too often, and he wants to make himself the SDM. What can we tell him?
Counsel Dannie’s father that this is her choice; he can speak with Dannie if he feels this is an issue, but it is ultimately up to her, etc.
Dannie was initially approached by a member of the palliative care team who did not effectively explain the purpose of palliative care, causing fear, and left due to ‘awkwardness’ while Dannie was still upset and confused. Name two roles this team member was not displaying in this interaction?
Clinician, communicator, coordinator (wrong time to approach?), educator, etc.
List 2 qualities of a clinical leader?
Ex: integrity, respect, humbleness, humor, good communication, assertive, good at listening, transparency, self- awareness, calmness under pressure, knows when to stand their ground and what battles to fight (Booher et al., 2021, p. 1576)
How often should advanced care planning be reassessed?
Every 1-2 years, or with any major life events or changes (The Canadian Hospice Palliative Care Association & ACP Canada, 2024).
Ethical: When you come on shift, Dannie tells you that last night’s nurse was ‘awful’, and that when she experienced bladder incontinence during the night, the nurse gave her a brief, and told her to “change it yourself, your hands work just fine, and other people need my help”, what can we do about this?
Report Dannie’s stated comments to charge nurse/nurse manager, apologize for Dannie’s experience, show Dannie where/how her feedback can be heard, etc.
Dannie’s father has brought Dannie’s daughter to visit Dannie in the hospital as a surprise, despite Dannie’s wishes. He asks if an exception can be made just this once. What can we do?
We could ask Dannie again today, but ultimately the decision is hers. If she says no we must advocate for her decisions.
How can staff nurses improve their leadership skills?
Practice effective communication skills, practicing collaboration & coordinating teamwork, and increasing understanding of others, develop critical thinking skills, improve competence, empower the team, etc. (Boamah, 2019, p. 1006 & Booher et al., 2021, p. 1574)
What are some barriers to accessing palliative care as a young patient?
High unmet needs, frequent aggressive EOL care, high costs, late ACP, stigma, etc. (Abdelaal et al., 2022)
Empirical: Why is palliative care under-utilized in young people facing chronic illness?
Late referrals to palliative common; one study showed up to 43% of young people experiencing life limited chronic illness had no palliative care involvement prior to death, stigma, need for dedicated, age-appropriate palliative care teams (Abdelaal et al., 2022).
Dannie asks you if her daughter is at risk for developing MS as well, how can you answer as a good educator?
Develop a learning plan together, assist Dannie to understand the information she is seeing online, find evidence for Dannie ourselves
There is ~1.5% chance of passing symptomatic MS from a parent to a child (Multiple Sclerosis Society, n.d.).
How can leadership help Dannie on an individual basis?
Advocate for her needs, coordinate care, address learning gaps, be transparent and empower the team to do the same.
What are 3 concepts or facts you learned about palliative care participating in Dannie’s case?
You've accomplished our SMART goal!