BAYLOR UNIVERSITY SCHOOL OF NURSING

 

Course:

Nursing 4397: Terminal Care and Human Needs
Revised Fall 1996

Description:

The fundamental goals in caring for persons with terminal illness are to relieve suffering and create the opportunity for reconciliation with God, self, and others. Effective care encompasses all spheres of being individuals, social systems, and caregivers. this course provides the opportunity to use the nursing process, human needs model, and personal exploration in learning to provide effective care to individuals and families experiencing terminal illness.

Credit Hours:

3 credit hours

Requisites:

Completion of all Junior II courses or permission of the instructor.

Objectives:

Upon completion of the course the student will be able to:

  1. Apply the nursing process to persons with terminal illness and the social systems of those persons in fulfilling human needs.
  2. Compare selected theoretical approaches to psychological, social, and spiritual interventions with clients and their social systems in terminal situations.
  3. Analyze current concepts in the control of pain and other problems of advanced and terminal disease.
  4. Evaluate selected institutional approaches to terminal care.
  5. Explain selected cultural and spiritual dimensions in dying and death.
  6. Analyze personal attitudes and beliefs about dying, death, and mortality; and how these impact provision of care.

Content Outline Summary

  1. Physiological Needs
    1. Philosophical and Ethical Issues
    2. Understanding Pain
    3. Assessing Pain
    4. Controlling Pain
    5. Symptoms Other then Pain
    6. Synthesis of Physiological Care
  2. Psychological and Social Needs
    1. The Experience of Dying
    2. Human Needs
    3. Theoretical Approaches
    4. Family Dynamics
    5. Common Psychosocial Problems
    6. Delivery of Care (Systems)
  3. Spiritual Needs and Cultural Dimensions
  4. Religious Practices of Specific Faiths
    1. Cultural Characteristics
    2. Nursing Interventions
    3. Exploration of Personal Attitudes and Beliefs
  5. Synthesis of Human Needs and Caring for People Who are Dying
    1. Human Needs, Terminal Care, and Planning
    2. Growth and Healing
    3. Operational Compassion
    4. Spiritual Care

Requirements and Evaluation Methods:

Requirements include (1) case study or related paper, (2) two unit and one final exam, and (3) class discussions.

Case Study or related
+ class participation . . . . . . . . . . . . . . . . . . . . . . 20%
Two Unit Exams @ 25% each  . . . . . . . . . . . . . . 50%
Final Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30%

Attendance, Examination, and Delayed Examinations:

See Policy Manual

Instructional Methods:

Text:

Kemp, C. Terminal Illness: A Guide to Nursing Care


Unit I Physiological Needs

Objectives

  1. Analyze philosophical and ethical issues in symptom control.
  2. Recognize different types and meaning of pain
  3. Explain the assessment of pain in patients with advanced disease.
  4. Relate pharmacological measures in controlling pain.
  5. Summarize non-narcotic therapies for pain control.
  6. Explain therapies for common symptoms (other than pain).
  7. Apply the human needs model to physiological care.
  8. Synthesize knowledge of disease progressions and symptom prevention and control.

Content Outline

  1. Philosophical and Ethical Issues
    1. Suffering
    2. Professional responsibilities
    3. Telling the truth
    4. Euthanasia
    5. DNR orders and "heroic" efforts
    6. Attitudes related to symptom control
  2. Understanding Pain
    1. Types
    2. acute
    3. chronic
    4. Influences on pain
    5. Meanings of pain
    6. Suffering
  3. Assessing pain
    1. Prejudices
    2. Description of pain
    3. Assessment over time
    4. Types (bone, visceral, skin, etc.)
    5. Influencing factors
  4. Controlling Pain
    1. Narcotics
      1. dosages
      2. scheduling
      3. addiction
      4. common misconceptions
    2. Non-narcotic medications
    3. Measures other than medications
      1. radiation
      2. chemotherapy
      3. surgery
      4. prayer and meditation
  5. Symptoms Other than Pain
    1. Nausea and vomiting
    2. Bowel symptoms
    3. Oral problems
    4. Anorexia
    5. Respiratory symptoms
      1. dyspnea
      2. pleural effusion
      3. pneumonia
    6. CNS symptoms
      1. confusion
      2. AIDS dementia
      3. increased intracranial pressure
    7. Oncologic emergencies
      1. hypercalcemia
      2. bleeding
      3. superior vena cava syndrome
      4. spinal cord compression
    8. Skin problems
    9. Odor, cosmetic issues
    10. Imminent death
      1. physical events
      2. psychosocial and spiritual events

  • Synthesis of Physiological Are

    1. Metastasis and predictable problems
    2. Prevention and early intervention
    3. Planning care


    Unit II. Psychological and Social Needs

    Objectives

    1. Describe a psychosocial model of the dying process.
    2. Review BUSON Human Needs Model.
    3. Explain Biren's tasks of the person who is dying.
    4. Summarize Weisman's characteristics of appropriate death.
    5. Summarize Shneidman's principles, goals, and beliefs.
    6. Explain Kubler-Ross' stages.
    7. Apply Erikson's developmental stages to the care of people who are dying.
    8. Relate theories of family dynamics to the care of people who are dying.
    9. Analyze common psychosocial problems of patients and families.
    10. Apply the human needs model to psychosocial care.
    11. Apply the nursing process to providing nursing care for psychosocial problems.
    12. Analyze delivery systems of care for persons with terminal illness.

    Content Outline

    1. The experience of dying, from diagnosis to death.
    2. Human Needs
    3. Theoretical Approaches
      1. Tasks in Dying
        1. Physiological
        2. Psychological
        3. Social
        4. Spiritual
      2. Weisman's Appropriate Death
        1. Physiological
        2. Psychological
        3. Spiritual
      3. Shneidman's Principles, Goals and Beliefs
        1. Styles of living and dying
        2. Common wishes
      4. Kubler-Ross' Stages
      5. Developmental Stages
    4. Family Dynamics
      1. Systems theory
      2. Communication
      3. Rules and power
      4. Relationship to society
    5. Common Psychosocial Problems
      1. Understanding
      2. Helplessness
      3. Health of caregivers
      4. Children & their perception of death
      5. Grief
      6. Depression
      7. Despair
      8. Anger
      9. Anxiety and fear
      10. Family disintegration
    6. Delivery of Care (systems)
      1. Acute care
      2. Hospice
      3. Home care
      4. Case management


    Unit III: Spiritual Needs and Cultural Dimensions

    Objective

    1. Explain dying and death -- related practices of major faiths or belief systems.
    2. Recognize dying and death -- related practices common to major American cultural groups.
    3. Discuss nursing interventions to meet varied religious practices and cultural characteristics.
    4. Apply the human needs model to spiritual care.

    Content Outline

    1. Religious Practices of Specific Faith and Belief Systems
      1. Christian
      2. Protestant
      3. Catholic
      4. Jewish
      5. Buddhist
      6. Muslim
      7. "New Age"
    2. Cultural Characteristics
      1. Anglo-American
      2. African-American
      3. Hispanic-American
      4. Asian-American
    3. Nursing Interventions
      1. Application of human needs model


    Unit IV: Exploration of Personal Attitudes and Beliefs

    Objectives

    1. Integrate feelings and attitudes toward dying and death with professional practice.

    Content Outline

    1. Basis of personal attitudes and beliefs
    2. Feelings and attitudes and professional practice


    Unit V: Synthesis of Human Needs and Terminal Care

    Objectives

    1. Develop a plan of care for a terminally ill individual using the human needs framework.
    2. Integrate concepts of human needs, caring and professional practice.
    3. Determine means of healing in caring for people who are dying.
    4. Develop a personal strategy for operationizing the concept of spiritual care.

    Content Outline

    1. Human Needs, Terminal Care and Planning
    2. Growth and Healing
      1. Hope
      2. Growth
      3. The people involved
        1. patient
        2. family
        3. caregiver
    3. Operational Compassion
      1. Clinical competence
      2. Human aspects of theory
      3. Being present
      4. Honesty
      5. Caring for oneself and one's family
    4. Spiritual Care
      1. Faith, fears, doubts and strengths
      2. Tensions among faiths; religious and secular factors


    Schedule

    Wednesday, 1:00 - 4:00 PM

    Week

    Date

    Content

     1

    8/27

    Introduction to Course, Experience of Dying

     2

    9/3

    Physiological Needs

     3

    9/10

    Physiological Needs

     4

    9/17

    Physiological Needs

     5

    9/24

    NCLEX Exam

     6

    10/1

    Exam I

     7

    10/8

    Experiential Exercise

     8

    10/15

    Psychosocial Needs: Individual

     9

    10/22

    Psychosocial Needs: Individual

    10

    10/29

    Psychosocial Needs: Family

    11

    11/5

    Exam II

    12

    11/12

    Cultural Issues

    13

    11/19

    Spiritual Care

    14

    12/3

    Experiential Exercise

    15

    12/10

    Synthesis