Each unit included experiential or attitudinal assignments,
like these letters addressed to death.
"Dying from Alzheimer's is one of my secret fears.
I have taken care of many people with Alzheimer's disease.
I see how sad and lost their family members are…I
pray to not die young. I have two young children who need
their mother. May my death be with a peaceful heart and
spirit. I hope God forgives me for any sins I committed
against others and myself. May our meeting be with mutual
respect and several years away…"
"Death has some evil friends. These friends are
cancer, HIV, Hodgkin's disease…I will fight death
to the end and even though I may lose then I will die
with dignity and peace. Death hates that I love and enjoy
life. This gives it all the more reason to attack…"
"I discovered death in 1994 when I was diagnosed
with a brain tumor on my optic nerve at the age of 14.
It had never occurred to me that I would die at that point
in my life, but suddenly it was a very real possibility….I
felt guilty that my blood counts were always high enough
to get my meds. I would come back the next month for treatment
and a buddy of mine would have passed…As professionals
in end-of-life care, we have the capacity to make the
dying process a meaningful and fulfilling part of one's
life rather than the uncertain, scary end of all that
is good, that most people consider death to be…"
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MOVIE
ANALYSIS DISCUSSION
Each
small group chose a movie to analyze. This group chose
the film, Wit. The movie follows Professor Bearing, the
intellectual, elitist, middle aged main character, from
diagnosis of her ovarian cancer to her death. Her treatment
by health care professionals lacks compassion and never
acknowledges her dying process.
"Throughout the whole movie, I never saw one health
care professional who treated Professor Bearing like a
human being…She was just a task, part of a job…"
"I
remember watching parts of this movie several years ago
and not being interested enough in it to watch it all.
This was before I entered nursing. It's amazing how a
few years will change who we are and what our interests
are. Once I started watching the movie this time, I was
captured by the content and unable to turn it off until
I reached the end. The story line is not what drew my
attention ---I was mortified by the treatment this person
received from those who called themselves healthcare professionals.
I feel there was nothing professional about most of the
behaviors that I saw…I was also so sad for Professor
Bearing and it broke my heart to imagine the pain and
loneliness this woman went through."
"I
think Professor Bearing spent her whole life hiding from
intimacy and connection with others. She was a very lonely
individual who lived and ended her life alone and with
regret. Only when she was near the end did she realize
how important human contact was and how she had been unable
to provide or experience this…"
"As
a nurse, I can say that each pt's case is unique. I develop
a relationship with each person and feel the emotion they
are going through. I care for and about what happens to
each person on a professional and a "human"
level. Each time one of my patient's lives is lost, I
feel a great loss as well. I can't explain it exactly;
it is just a feeling of great emotion and sadness that
stays with me for a while. I think that when you stop
caring this way and experiencing this feeling of loss,
you are at the "burn out" point and it is time
to move on…"
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CASE
STUDY PAPER
Students
in pairs, after choosing a specific chronic illness, describe
its characteristics in a chronic medical
condition essay, to include its: anticipated dying
trajectory; care settings; resources; aspects of suffering;
and plan of care. They then apply the condition to a former
or composite patient in case study format.
Chronic
Medical Condition
"Heart
disease is known to be the number one cause of death in
the United States. It can be caused by various factors
and has co-morbidities that aid in its progression. It
is often difficult to diagnose and targets no specific
age range… When researching palliative care and end-stage
heart diseases, information on chronic or congestive heart
failure (CHF) was found to be the most prominent type.
Chronic heart failure is a disease of the "old old"
with the greatest percentage seen above the ages of 70
…
…CHF
is a chronic debilitating disease that often goes undiagnosed
in the elderly until it has progressed to the advanced
stages…An anticipated dying trajectory is difficult
to predict, as CHF is a chronic condition. The 5-year
survival rate, in the mild to moderate CHF group is reported
to be approximately 50%...Modern treatments for CHF slow,
but do not arrest the progression of the disease…Despite
the wealth of therapeutic advances, quality of life in
CHF is poor, and discomfort with distress is often worse
than cancer or other malignant diseases…
…The
projected care setting for end-stage heart disease thus
far has been the hospital setting. Very few patients with
non-malignant conditions are referred for specialist palliative
care…CHF is the most common cause of hospital admissions
in the elderly population, with patients subject to frequent
readmissions…
…Since
CHF is a chronic condition, there are few potential resources
available for treatment and end-of-life care…Better
education in the principles of palliative care is needed
for all health professionals that work with heart failure
patients. A common theme of misconceptions found in the
literature was that palliative care was specifically for
the management of the terminal stages of malignant diseases
such as cancer and HIV/AIDS. Palliative care teams have
managed patients with heart failure successfully using
the same approaches that have helped cancer sufferers
for years…
Case
Study
…The
following case study will discuss further multidimensional
aspects, symptoms and a plan for a patient with end-stage
heart disease.
…Virginia
is a 75-year old African American female that presented
to her annual medical appointment for a general checkup.
She had been experiencing dizzy spells but felt this was
attributed to her blood pressure problems…
…Virginia
was admitted to the local hospital and diagnosed with
CHF. Her closest relative, a niece, Tammy, was notified
and came to visit Virginia did not take her medications
as ordered because she had to urinate more frequently
and always had a dry mouth from the diuretics. Since no
other family was involved in her daily care, Virginia
made Tammy her legal and healthcare power of attorney,
so that all of her matters could be taken care of…
…After
three months had passed, Tammy noticed that Virginia had
an increase in incidences of confusion, coughing spells
at night and more frequent bouts of depression and hopelessness.
She had begun complaining of constipation, and Tammy could
see her nausea and vomiting, pain and frequent bouts of
breathlessness without any exertion. Virginia was taken
to see a physician in Winston-Salem, Dr. W. He was shocked
to learn of her advanced stages of heart failure…
…Dr.
W referred Virginia to an outpatient palliative care specialist
team. She was able to make several visits to their clinic,
but when she became unable to ambulate and lost most of
her mobility, a hospice care team was introduced through
the palliative care team, and made home visits…
…In
the month following, a chaplain, social worker, nurses,
and personal care assistants visited Virginia. She had
become incontinent and had a foley catheter. She subsequently
died peacefully at home…"
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END
OF COURSE LETTERS
At
the end of the course, students write letters to their
group members.
…I
am thankful to my group for actively participating in
group discussions and other activities. I would say there
was healthy competition and everybody respected each other's
feelings…I must say this course was unique…it
gave me an opportunity to tell my feelings to my colleagues…
...Doing
this online has worked out well, because we have been
able to sign on around our work schedules and other demands
and still get an increased awareness of the issues related
to palliative care as well as a look at ourselves and
how we feel and react to death and grief…
…I
know we are to include some negative comments, but I don't
have any. I think everyone has worked hard, submitted
great material, been responsive and in general, done their
job to the best of their ability. We are adult students
and things come into our lives that affect what we do,
but we also know how to set our priorities and get things
done the best we can. Great job…
…You
are the group leader. You had no difficulty starting first
and jumping right in. I also appreciated the questions
you asked as part of your answers, many times it furthered
our discussion by inviting a new part of the problem,
or a new solution, to be expanded on. I also liked the
way you attempted to answer each group member individually
and by name. It was good to know someone had something
to say personally back to you, that they had read what
you had to say and were responding to it. I tried to do
that after the good effect it had on me…
…Thank
you for a great group experience. Congratulations to all
those graduating, I hope I will be among you. I personally
will be applying to graduate school, should everything
turn out well. If there is anyone who has more time to
go, congratulations for moving one step further. When
I started the RN-BSN program I really felt as if I was
jumping hoops for a piece of paper. I have changed my
mind along the way and realize I do think differently
and view my profession in a new light…
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