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Learning checkpoint one
1. What are the aims of palliative care?
2. What are the principles of palliative care?
3. What are the needs of people accessing palliative care services?
4. What are the philosophies of palliative care?
5. When should palliative care service be accessed by a person?
6. What does holistic care mean?
7. Why is communication important between all members of the palliative care team?
8. What people comprise the palliative care team?
9. What is the differences between curative and palliative approaches to care?
Martha Case Study
Martha always appears distant and withdrawn on the infrequent visits to her husband Stephen, who is dying. The palliative care team wants to involve Martha by encouraging her to visit more often and to assist with his care. Martha feels there is an expectation placed upon her. She explains the situation to Jo, the palliative care worker, because she trusts her. ‘I know I may seem uncaring but I’m exhausted from looking after him 24 hours a day at home. I just can’t do it anymore. I haven’t been close with Stephen for many years and I find it such a relief to have some life of my own at last. I appreciate all the care you are giving him.’
Martha feels supported by her husband’s care team and Jo respects that this is how Martha is feeling. When this explanation is conveyed to other members of the palliative care team, it reinforces the importance of communicating with family members.
Questions:
1. How does communication assist in the care planning approach in this example?
2. Where should the personal support worker document this information?
Learning checkpoint two:
1. What communication strategies can be utilized by the support worker to demonstrate an empowerment approach of people accessing palliative care service?
2. What communication strategies can be utilized by the support worker to demonstrate support?
3. What legal and ethical considerations regarding human rights need to be upheld in palliative care? Give two examples of rights people held by who access palliative care services.
4. Why should a personal care worker support religious practices for a person accessing palliative care services?
5. Provide two ways a personal support worker a person’s spiritual needs
6. Why is it important for the personal support worker to obtain information regarding the culture of a person accessing palliative care services?
Narla case study:
Narla is an Aboriginal woman at the terminal stage of her illness. She has progressed to a semi-conscious state while waiting for her family to arrive from an outback community 900 kilometres away. When her family arrive, they are upset as they are unable to communicate with Narla due to her condition. Communication is very important to them at this time. The nurse on duty makes an assessment that Narla is in pain and requires more morphine to relieve the pain. Casey, the palliative care worker, informs the nurse that she doesn’t think that Narla’s restlessness is due to pain but is instead because she wants to communicate with her family and is finding it difficult to do so.
Narla’s family, together with Casey, decide to reduce the dosage of morphine to see if this would allow Narla to communicate with her family. Casey informs the treating doctor of the family’s decision and the dosage is reduced. Narla is then able to sit up, eat a small meal and share stories with her family. She dies the next day.
Questions:
1. Why is it important to use non-judgemental approach to ensure the person’s lifestyle, social, spiritual and cultural needs are supported and documented in the care plan?
2. Provide an example of a legal and ethical consideration regarding work role boundaries, responsibilities and limitations.
Learning checkpoint three
1. What is an advance care directive?
2. What information might advance care directives include?
3. Explain the term dignity of risk in relation to caring for people accessing care service.
4. Explain the legal and ethical considerations regarding privacy.
5. Explain the legal and ethical considerations regarding confidentiality and disclosure.
6. Explain the legal and ethical concepts of the term duty of care.
7. Explain the responsibility of a personal care worker in upholding the rights of an individual to choose the location of their death.
Doris Case Study
Doris lives at home with her older husband who has Alzheimer’s disease. They have a son who has an intellectual disability and is cared for in a hostel. Her eldest son lives in another state. Doris has a history of severe cardiac disease and one day she requires surgery. Following the surgery and after a long, complicated admission to the intensive care unit she is transferred to a long-term ventilation unit for a slow-weaning process. Each day, Doris finds it increasingly difficult to wean from the ventilator. Although her condition appears to be improving, she is weak and reluctant to be removed from the ventilator. Cara, the palliative care worker, speaks to Doris about her feelings, beliefs, values and goals in life. Doris clearly understands the condition of her heart and is clear about her wishes if her heart ever stops. She firmly says that she does not want to be resuscitated. As the conversation continues, she explains what is important to her at this time. She wants:
to be allowed thick drinks
to be always kept clean
to not have to wean off the ventilator anymore or be treated for any more acute episodes
to receive pain medication when she requires it
to be cremated.
Cara knows that Doris is the most appropriate person to make her own decisions. Doris also tells Cara that under no circumstances should her husband be bothered by having to make any decisions, as he also has a bad heart and she wants the medical team to make all decisions for her. A conference is called to discuss the impact of the wishes Doris has expressed about her treatment. As a result, she completes the statement of choices, to reflect her decisions, in the advance care directives in her care plan. Doris is grateful for the opportunity to express her wishes and she dies peacefully three days later with her family and carers by her side.
Questions:
1. Describe the changing needs that Doris communicates to cara. Where should this information be documented?
2. Who should Cara report Dori’s decisions to?
Learning checkpoint four:
1. List and explain two common misconceptions regarding pain- relieving medication.
2. Who should the personal support worker report to when they observe a person they are supporting is in pair?
3. What actions should the personal support worker take if a person accessing refuses food?
4. If a person who is at the end of their life is unable to take fluids orally, what care strategies should be implemented?
Katie Case Study
Katie is in the final stages of her life. She has returned home and is being looked after by her family. Family members have been actively involved in all aspects of Katie’s care and understand the approach being taken by the palliative care team.
Katie’s granddaughter Molly is a registered nurse and acts as the communication link between the palliative care team and the family. Molly participates in care plan discussions about her grandmother and informs the family of changes to Katie’s care.
At the latest meeting, Molly expresses her father’s concern that Katie seems to be experiencing severe pain as she regularly moans and appears restless. Molly’s father is concerned that increasing the morphine will hasten Katie’s death. The care nurse, Val, agrees that the family needs additional information about Katie’s condition and reassures the family that, although Katie’s condition is deteriorating, the care team regularly monitor and review pain and symptom management.
Val advises the family that she will perform a comprehensive pain assessment, and discuss the outcome with Katie’s doctor. As a result, Katie’s doctor prescribes the appropriate medication to help reduce her pain. At the next assessment, Katie’s pain has reduced from severe to mild and she has become more interactive with family members and the care team.
Questions:
1. List three care strategies that the personal care worker implement Katie to assist in managing her pain.
2. Explain three evaluations the personal care worker can undertake to assess the effectiveness of pain and comfort interventions.
Learning checkpoint five:
1. Identify two common signs of grief a person their family or carer might exhibit on diagnosis of a life threatening or life limiting illness.
2. Identify and explain the five stages of grief.
3. What actions can a personal support worker take to support a person’s culture when providing end of life care?
4. List four care strategies a personal care worker can undertake to promote dignity ofr the person after death.
5. It is important to regularly check the care plan for any changes to the care delivery for a person accessing palliative care services. List two things that a person might change.
6. What does a supportive environment mean for people accessing palliative care services?
7. Identify two care strategies to support the family/carer after death has occured .
Rhonda Case Study
Rhonda is a care worker in an aged care facility. Penny, a client, is admitted there after being discharged from hospital. An assessment prior to her discharge identified the following end-of-life symptoms:
Loss of appetite
Weight loss
Profound weakness
Changes in breathing patterns
Hypertension
Mental anguish
Blood pooling along the skin
Day-to-day deterioration
Penny is also bed-bound and over the coming weeks her condition deteriorates rapidly. She appears agitated and restless and begins to talk about her mother, who died many years before. Rhonda contacts the local hospital’s palliative care service for support.
Two days later, on one of her care rounds, Rhonda finds that Penny is no longer responsive. Her breathing is irregular and, as Rhonda is watching, Penny lapses into unconsciousness. Penny’s body temperature also appears cooler than the previous day. Rhonda immediately notifies Gemma, her team leader.
Gemma then informs the care nurse on duty and Penny’s doctor. The nurse confirms that Penny is falling into a coma. Gemma asks Rhonda to sit with Penny, hold her hand and talk to her until she passes away. Gemma notifies Penny’s family who live in the country and tells Rhonda she has done a good job. ‘I don’t know if it was any help but she seemed calmer while I was there,’ Rhonda says.
Questions:
1. List three signs of imminent death that Rhonda might have observed when caring for penny.
2. Who should Rhonda report these signs to?
Learning checkpoint six:
1. List and explain two areas that organisational policies and procedures cover to manage emotional responses and ethical issues a personal care worker may experience.
2. Identify two reactions a palliative care worker may have after death of a person .
3. Explain what bereavement care includes.
Sophie Case Study
Joan is in palliative care and her support worker is Sophie. Joan’s condition deteriorates and her daughter Marilyn becomes increasingly anxious about her mother’s impending death. Marilyn constantly asks Sophie if Joan is experiencing any pain and is worried as her mother is unable to take more than a few spoonfuls of soft food and sips of fluid. Marilyn stays at the facility with her mother for the last two days of Joan’s life and is not sleeping or eating a great deal herself. Sophie becomes concerned for Marilyn and reports these concerns to the supervisor. The supervisor organises the pastoral care team worker to spend time with Marilyn and Marilyn reports that she finds comfort in these visits.
Questions:
1. Identify an emotional issue or concern that Sophie is experiencing in caring for Joan.
2. Identify two self care strategies the Sophie can implement to address the emotional impact of providing support.

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