Healing 1: Caring for Individuals Experiencing Common Health Challenges

Suggested Learning Strategies

Strategies that Focus on Caring

1. Contributing to a Broadened Understanding of Common Health Challenges

Using the health wheel from Health 2: Lifestyle and Choices as a guide, invite students, working in small groups, to discuss how common health challenges might affect all areas of health and healing.

Each group may be assigned a specific health challenge and given the task of identifying the primary components of the health challenge (e.g., pain, loss of function, immobility, fatigue, confusion, stress, etc.).

With this information, the group will identify how these changes might affect all other aspects of the person’s health (e.g., how fatigue might affect social, cognitive, emotional, and spiritual health).

The group will then discuss how changes in each dimension of health might positively contribute to healing. Each group will report back to the whole class.

2. Contributing to Person-Centred Care

The above process could be undertaken using scenarios of real or fictitious individuals who are struggling with one or more of the common health challenges studied in this course. Students, in small groups, will discuss how the changes in health brought about by the health challenge(s) are affecting all dimensions of the person’s health and healing and how each level of needs (as described by Maslow) is affected. The group will then discuss how changes in each dimension of health might positively contribute to healing. Each group will report back to the whole class.

3. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, ask students to review relevant textbook, online or other course materials describing cerebral vascular accidents (CVAs).

  1. Whole Class Review and Discussion
    • In class, review the risk factors, signs, and symptoms of CVAs. List them on the whiteboard for reference. Following this, have students read the account describing the CVA experienced by Peter Schultz. See STUDENT HANDOUT.
  2. Small Group Discussion
    • Working in small groups, students should apply their knowledge about CVAs to the scenario below by responding to the following discussion questions:
      • What signs and symptoms of CVA did Peter experience?
      • What were the immediate and long-term results of the CVA experienced by Peter?
  3. Whole Class Debrief
    • Come back together as a class and summarize the findings of each group. Highlight any signs, symptoms, and results of CVA that were not identified.

Note: Students could be instructed to add the scenario and session materials to their client portfolio for Peter Schultz.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz
Cerebral Vascular Accidents (CVAs)

DIRECTIONS: Read the following account describing the CVA experienced by Peter Schultz. Working in small groups, apply your knowledge about CVAs to the scenario below by responding to the following discussion questions:

  • What signs and symptoms of CVA did Peter experience?
  • What were the immediate and long-term results of the CVA experienced by Peter?

What I thought was the beginning happened March 3, 1995, when Peter was 77 [years old]. I awoke in the night to hear Peter in the bathroom coughing and hacking as though to rip his throat out. He finally stumbled back to bed and went to sleep. I arose fairly early to prepare breakfast for his sister and her husband who had been visiting us and were leaving that morning for Alberta. We three were sitting at the table waiting for Peter who was slow making an appearance. When he did, we couldn’t understand a word he said as his speech was so confused. He didn’t seem to realize there was anything wrong. We struggled through breakfast trying to persuade him to see a doctor, but he insisted he simply had a little sore throat, so finally our guests left and we began our day.

Peter lay down on the couch and slept. Something was wrong, but I didn’t know what. Later I went to my daughter’s house to give the kids a piano lesson. When I told them what had happened, my son-in-law immediately phoned the doctor who said I must bring Peter into the office. I went home and did that.

“His blood pressure is out of sight,” the doctor said. “He’s had a stroke. I’ll arrange for a brain scan and we’ll see what the damage is.”

The scan showed that he had had several prior strokes that hadn’t been obvious. Medication for high blood pressure was prescribed and I made sure Peter took his pills each day. I had no experience looking after someone who was sick, but Peter didn’t seem sick anyway, just a bit confused sometimes. However, as time went on I began to notice some personality changes. He was often rude to me in front of friends, cried easily, and clung to me almost obsessively; table manners seemed to slip away and he was sometimes extremely impolite.

Metzger, Z.B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Cerebral Vascular Accidents (CVAs) [PDF].

4. Case Study: Creating a Caring Environment for a Patient Who is Dying

The following case study is used with permission of Island Health.[1]

A 61-year-old male is being admitted to the unit by stretcher from Emergency. He was receiving palliative end-of-life care at home, but has been admitted due to a pain crisis. You enter the room with the RN from your unit, and under the direction of the RN, you assist in moving the patient from stretcher to bed. With a gentle touch and a caring smile, you introduce yourself.

As the RN gets the report, you continue to help position the patient. You go for more pillows to help with positioning, get a warm blanket, and retrieve other care items. You ask the RN how you can help (for example, find an IV pole, collect mouth wash supplies, or get ice water.)

Once the patient is settled, you turn your attention to the family. You consider how many chairs they will need in the room and ask if you can get them something to drink. You also show them where the washroom, ice machine, and public telephone are located.

Remember to consider the family in planning the care of your patient. The death of a loved one is an experience that stays with most people forever. It is our job to be supportive during this time. The RN will need to pay attention to eliminating the pain crisis and attend to the other needs while you help to create a caring environment.

Questions for Discussion:

  • Have you ever visited someone who was dying in the hospital?
  • What did staff do to help make your loved one feel better?
  • What could have been done differently that would have helped your loved one?
  • How did staff help you during this time?
  • Empathy – what does it mean to you? How could you demonstrate empathy with the patient?

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

  1. Each group provides a brief introduction to their position on the topic.
  2. In alternating format, the two groups present the two or three reasons identified to support their position.
  3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Healing 1: Caring for Individuals Experiencing Common Health Challenges.

  1. HCAs should respect the rights of a client, who has lung cancer, to smoke.
  2. The family of a client with a developmental disability should be informed of the client’s involvement in a romantic relationship.
  3. HCAs should support the rights of a client to access medical assistance in dying.

2. Developing a Best Practices Tool to Support a Client Who is Dying

Invite students, working alone or in small groups, to develop a tool (for example, a checklist of best practices) that would aid them when they are supporting a client who is dying.

Based on what they have learned about end-of-life care, what regular observations should be made:

  • In respect to physical changes and comfort needs of the client?
  • In respect to mental or emotional changes in the client?

After developing the tool, students will discuss how the information will influence choices they will make about caregiving practice and how they will evaluate the care they provide.

3. Common Patterns of Dying Learning Activity[2]

  1. As a class, watch the Unprecedented – Common Patterns of Dying instructional video available on the Life and Death Matters website.
    Before watching the video, you may wish to use the STUDENT HANDOUT below to assign video review questions to focus viewing. You may elicit answers and other observations from viewing afterwards.
  2. Following this, have students read the case scenario describing the pattern of stuttering decline (“Stuttering Decline – The Roller Coaster”) on the Student Handout below. Students should then form small groups to discuss their responses to the questions provided.
  3. Afterwards, come together as a class and briefly elicit responses from the small group discussion. Next, identify common health challenges reviewed in the course that may result in a prolonged pattern of dying and further consider implications for the provision of care.

STUDENT HANDOUT
Common Patterns of Dying

Video Discussion Questions:

Consider these questions while watching Unprecedented – Common Patterns of Dying instructional video available on the Life and Death Matters website.

  • What key factors have changed the way we die?
  • What are the four common patterns of dying?
  • What information did you find most surprising or interesting?

Small Group Questions:

Read the case scenario below, describing the pattern of stuttering decline (“Stuttering Decline – The Roller Coaster”)

  • In your own words, describe the pattern of dying that is represented in this scenario.
  • What is the impact that this pattern of dying might have on Tom?
  • What is the impact on Sarah and the family?
  • As an HCA, identify ways that you can support Tom, Sarah, and the family.

As a Class:

  • Identify common health challenges that may result in the stuttering decline pattern of dying (e.g., organ failure, such as congestive heart failure, chronic obstructive pulmonary disease, end-stage kidney disease; or chronic progressive illnesses, such as Parkinson’s disease or dementia-related illnesses).
  • HCAs work with clients with chronic disease who may experience a prolonged period of dying that may occur over months or years. How can a palliative approach be integrated into providing care for these clients? How might different work settings (residential, community, or acute care) factor into this approach?

Stuttering Decline – The Roller Coaster

My name is Sarah. I am Tom’s wife and caregiver. Tom has chronic obstructive pulmonary disease, and although we have been dealing with it for over 15 years, the last eight years have been the hardest, with repeat hospital admissions, decreased abilities, and increased needs. I have heard it said that the typical patient with this disease goes to death’s door a number of times before dying. At least five times the children have gathered to say goodbye.

June 9: Last week the doctor came in and, squatting to make eye contact with Tom, asked us what we wanted. Tom said that he was tired – tired of hospitals, emergencies, tests, and more treatments. I very carefully suggested hospice. Tom and the doctor agreed.

June 15: We came home by transport ambulance. All the kids came home to help. In the middle of the night, I wept. I am exhausted. I wonder if he will die soon. I hope he will. I hope he won’t.

July 15: How long will this go on? It has already been eight years! The HCAs come five times a week now. I willingly let them help. Tom seems to enjoy them.

July 18: My, oh my, what a journey! This man of mine has always had a huge appetite. Now he is eating so little. It is hard for him to eat and digest and breathe at the same time. I try to feed him but even with all my effort, he eats very little.

August 9: Tom has been restless for the last three nights. He sits on the edge of the bed, tries to get up, then sits down. Then he wants up. We need to be with him because he is unsafe. He has more difficulty breathing. He is confused, sometimes talking to people who aren’t there. The other day he dreamt of his mom who died several years ago. His sentences are not making sense, his words jumbled. He was like this last year when he was really sick. He recovered then. I don’t think he will recover this time.

August 17: We celebrated our 60th anniversary two months early.

August 19: Tom is very weak, can manage sips of water. He is confused again.

August 20: It is with a sad heart that I tell you my Tom died this morning. He has been sick for 15 years.

Copyright © 2017, Life and Death Matters. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Common Patterns of Dying [PDF].

4. Critical Thinking Activity: Responding to Clients with Common Health Challenges

Students will use knowledge about communication, common health challenges, and observing and reporting to identify and respond to a variety of health-related situations.

Scenarios are provided below. Included for each scenario are a HCA Role Card, a Client Role Card, and a Client Profile. The Client Profile should be used to inform client care; alternately, it could be used to populate preferred templates in use by the program (e.g., bedside care plan or assignment sheets). The material provided for this activity has been formatted in a way that will facilitate its direct use in the educational setting.

Students may enjoy practising this activity in the lab, with measures taken to simulate a real-life setting. This critical thinking activity could also be adapted for use during the Healing 3: Personal Care and Assistance course.

Depending on program sequencing, scenarios and client profiles could be further adapted to increase the complexity of this activity. This could be accomplished by incorporating additional props and/or equipment or by adding information to the client profile (e.g., medication information).

While not directly indicated, the health-related situations are listed below for instructor reference. Students in the HCA role should be able to identify these situations (using observation and reporting) through the role play and when documenting. The instructor will highlight these during the debrief.

  • Role Play 1: Responding to a client showing signs of hypoglycemia
  • Role Play 2: Responding to a client showing signs of orthostatic hypotension
  • Role Play 3: Responding to a client indicating she is hungry
  • Role Play 4: Responding to a client showing signs of pneumonia
  • Role Play 5: Responding to a client showing signs of a urinary tract infection
  • Role Play 6: Responding to a client showing signs of constipation

Setting Up the Activity

A. Role Play

Have students work in pairs, with one acting as the client and the other as the HCA. Provide role play cards  in such a way that students do not see the card for the alternate role. The student acting as the client will read the Client Role Card and follow the directions provided. The student acting as the HCA will read the HCA Role Card and then use critical thinking skills to respond to the situation they are presented with. The Client Profile for each role play can be provided to both students and/or given to them to share.

Students playing the HCA role should be reminded to respond to the scenario based on their observations, communication with the client, and accompanying client profile (or assignment sheet and/or bedside care plan).

Students should be instructed to report any emergencies to the instructor, who could take on the role of the team leader.

Students should be directed to alternate roles after each role play and get new role cards from the instructor after completing required documentation (see B).

B. Documentation Exercise

After each role play is complete, the two students will prepare a written report describing the situation. If desired, the instructor could request that a specific documentation format is followed, such as the one to be used in the practice education setting. At a minimum, the following should be documented:

  • What the HCA observed, including symptoms the client reported to them.
  • What the HCA did.
  • When the HCA did it.
  • The client’s response, as observed by the HCA.

C. Debrief

After students have completed this activity, convene as a class to review the common health challenges presented. Discuss appropriate response(s) and reporting for each scenario, highlighting which situations would require immediate reporting to the team leader.

ROLE PLAY CARDS

ROLE PLAY 1: HCA ROLE CARD

You are working for a home support agency. Today you are visiting Jenny Smith for the first time. Enter the home, greet your new client and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 1: CLIENT ROLE CARD

Your name is Jenny Smith and you are 72 years old. After the HCA greets you, tell them you feel dizzy and sweaty and that you are hungry because you skipped breakfast today.

ROLE PLAY 2: HCA ROLE CARD

You are working in an assisted living residence. Today you will be escorting Mrs. Kaur to the dining room for lunch. Enter her room, greet her, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 2: CLIENT ROLE CARD

Your name is Mrs. Kaur, and you are 88 years old. After the HCA provides introductions and checks your bedside care plan, they will ask you to walk to the dining room. As you get up from your chair, act dizzy. Sit down again and tell the HCA you feel dizzy.

ROLE PLAY 3: HCA ROLE CARD

You are working in a group home setting. Today you will be assisting Alicia Smith who has ataxic cerebral palsy. Enter her room, greet her, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 3: CLIENT ROLE CARD

Your name is Alicia Smith, and you are 42 years old. You have ataxic cerebral palsy and are unable to speak. When the HCA arrives, use gestures to indicate that you are hungry.

ROLE PLAY 4: HCA ROLE CARD

You are working in an acute care setting. Today you will be providing care to Mr. Dhaliwal who has had hip replacement surgery. Enter his room, greet him, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 4: CLIENT ROLE CARD

Your name is Mr. Dhaliwal. When the HCA enters your room, start coughing. Tell the HCA that you have chest pain and are feeling cold.

ROLE PLAY 5: HCA ROLE CARD

You are working in a residential care home. Today you will be assisting Rosa Martinez with her breakfast. Enter her room and greet her. Respond to the situation you are presented with.

ROLE PLAY 5: CLIENT ROLE CARD

Your name is Rosa Martinez. After the HCA greets you, act as if you are confused. Indicate that you have pain in your lower abdomen.

ROLE PLAY 6: HCA ROLE CARD

You are working in a residential care home. Today you will be assisting Julie Bates with her breakfast set up. Enter her room, greet her, and let her know that it’s time for breakfast. Respond to the situation you are presented with.

ROLE PLAY 6: CLIENT ROLE CARD

Your name is Julie Bates. After the HCA lets you know that it’s time for breakfast, tell her you don’t feel hungry. When the HCA follows up, tell her that you have a stomach ache.

CLIENT PROFILES

ROLE PLAY 1: CLIENT PROFILE

Jenny Smith is a 76-year-old female who lives alone.

Health Challenges/Diagnosis: Diabetes, neuropathy, significant visual impairment, history of falls, history of depression

ADLs: Partial assist with personal care

Mobility: One person assist with walker, unsteady on feet, history of falls

Nutrition: Diabetic diet, receives Meals on Wheels, family sometimes brings food (sweets), Jenny occasionally skips meals

Communication: English

ROLE PLAY 2: CLIENT PROFILE

Harpreet Kaur is a 92-year-old female living in an assisted living residence.

Health Challenges/Diagnosis: Parkinson’s disease with history of falls, arteriosclerotic heart disease, orthostatic hypotension

ADLs: Supervision in bathroom, requires cueing, appropriate cultural attire, raised toilet seat, meal set up

Mobility: Uses four-wheeled walker

Nutrition: Soft diet with fluids, plate protector, adaptive utensils, cup with lid

Communication: Speaks Punjabi and English

Cultural: Attends temple every Sunday

ROLE PLAY 3: CLIENT PROFILE

Alicia Smith is a 42-year-old female client who lives in a group home.

Health Challenges/Diagnosis: Ataxic cerebral palsy, expressive aphasia

ADLs: Full assist with personal care

Mobility: Risk of falls, assist with range of motion exercises

Nutrition: Soft diet, encourage small snacks throughout the day

Communication: Understands English, uses gestures to communicate when hungry

ROLE PLAY 4: CLIENT PROFILE

Jagdish Dhaliwal is a 73-year-old male in hospital following hip replacement surgery.

Health Challenges/ Diagnosis: Osteoarthritis, history of falls, CVA at age 68, dysphagia

ADLs: Assist client to sit (dangle) at side of bed (Q.I.D), one-person assist for dressing, assist with mouth care, commode for toileting, and deep breathing and coughing exercises

Mobility: Two-person assist to dangle and commode

Nutrition: Thickened fluids, dysphagia diet, cultural food preferences

Communication: Speaks Punjabi and English

ROLE PLAY 5: CLIENT PROFILE

Rosa Martinez is a 79-year-old female who lives in an assisted living residence.

Health Challenges/Diagnosis: Blind due to glaucoma, history of urinary tract infections

ADLs: Requires partial assistance with personal hygiene

Mobility: Uses white cane, assist with walking

Nutrition: Assist with meal set up/eating, record fluid intake, cranberry juice with meals

Communication: Speaks Spanish and English

ROLE PLAY 6: CLIENT PROFILE

Julie Bates is an 88-year-old female who lives in residential care.

Health Challenges/Diagnosis: Arthritis, esophageal reflux, constipation, hemorrhoids

ADLs: Partial bath, set up with meals, assist with hearing aid and glasses

Mobility: Uses four-wheeled walker, assist with mobility

Nutrition: Low fibre diet, small appetite, encourage to drink fluids

Communication: Speaks English, shy and doesn’t like to bother staff

Other: Last recorded bowel movement was four days ago

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download: Role Play Cards [PDF].

5. Case Study: Decision-Making Regarding Reporting Changing Client Condition

The following case study is used with permission of Island Health.

It is not unusual for client status to change quickly in acute care settings; HCAs need to be aware of how to most effectively communicate changes in client conditions in order to ensure their safety and well-being.

For the past few months, Greg, an HCA, has been working full time on a surgical unit. He is getting to know the team members and enjoys the opportunity to work in partnership with the health care team.

For the past few shifts, Greg has been supporting care for Mr. Stark. Mr. Stark is 67 years old and is a retired teacher. He had surgery six days ago to remove a tumour in his small intestine and now has a colostomy bag. He has been progressing well after the surgery and is looking forward to returning home to his wife. Mr. Stark plans to independently manage his colostomy care with assistance from community based nursing as required.

Greg is stopped by Mr. Stark while doing his hourly care rounds. Mr. Stark indicates that he is feeling like he is going to vomit and needs help. Mr. Stark’s RN, Jane, is currently in a family meeting with another patient.

Ask students to consider the “who, what, when, where, why and how” for this situation.

Who to communicate with. It is important to get the assistance of nursing staff with this as there may be a variety of factors contributing to the nausea. If unable to interrupt Jane, contact the RN covering for Jane, or the team leader.

What to communicate. Tell the RN what you saw (observations), when you saw it and what Mr. Stark reported to you regarding his nausea. Determine if the RN wants you to record this on any special forms. Be prepared to answer some questions from the RN.

When. This nausea is a change for Mr. Stark. Because of this, it is important that you verbally communicate this information immediately.

Where. It may be that you are asked to record this information on a special form or chart. Depending on the outcome, this may be a topic that is addressed in a team huddle as well. Collaborate with the RN to determine who will report this information and where. Ensure patient confidentiality and privacy is respected during verbal communication.

Why. It is critical that this information is shared in a timely way as Mr. Stark will require the assessment of his condition and possible treatment. Timely communication will also reassure Mr. Stark that his care needs are being addressed.

How. You may be able to use the nurse call bell system, pager, or voice-activated devices to alert team members that you require assistance.

Consider what forms and meetings you can use to share information once immediate needs are addressed.

Strategies that Focus on Professional Approaches to Practice

1. The Dance: Maintaining Professional Boundaries

Maintaining professional boundaries when caring for a dying person can sometimes be particularly challenging. Elizabeth Causton, in her writings on the “The Dance” (See STUDENT HANDOUT), provides caregivers with a metaphor that may be helpful as they work closely with clients and families.

Have students read the description of “The Dance” and ask them to discuss the following:

  • Does the metaphor of the dance make sense in relation to professional practice when caring for dying individuals?
  • What does the author mean by “hooks” in this context? Can you think of any hooks that might affect you in an end-of-life context?
  • Have you seen or could you envision caregiver behaviours, such as those described, that reflect lack of perspective? How would a caregiver behave who is kind, compassionate, and caring yet maintains professional boundaries – who is able to “feel deeply and to act wisely”?
  • How might the ideas in this reading apply to other caregiving contexts (e.g., with clients who are vulnerable but not necessarily dying)?

STUDENT HANDOUT
The Dance by Elizabeth Causton

When we work with a conscious awareness of where we stand in relationship to patients and families, respecting their unique “dance” in response to grief and loss, we are less likely to become over involved or to get lost in our work.

The idea of a family dance is not new, but it works particularly well as an image that reminds us of the importance of paying attention to boundaries as we work with people who are “vulnerable and broken.” The image can also be used to describe the sense of continuity of the family dance, which has evolved over generations. It reminds us that every family dance has its own history and that every step taken on the family dance floor has a reason in the context of that shared history.

So, when one member of the family either sits down or lies down on the dance floor because of terminal illness, the dance may look quite clumsy as the family tries to modify their routine to accommodate the changes, but the new steps are not random. They, too, have meaning in the context of what has gone on before.

Still, as we watch families struggle with a difficult dance, to music that always gets faster and louder in a crisis, we may be tempted to get onto their dance floor to try and teach them a new dance, with steps from the dance that we are most familiar with – our own. Of course, this rarely works, for the obvious reason that our dance steps do not have a history or a reason in the context of another family’s particular dance. Our valuable and unique perspective is lost the moment we step out onto someone else’s dance floor. Regardless of our good intentions, we truly become lost in our work.

The greater value of our role is to stay on the edge of the dance floor and from that vantage point, to observe, comment on, and normalize the process that the family is going through. We may suggest options, new dance steps that the family hasn’t thought of, but we do so with the recognition that they can only consider new ideas in the context of their own history. This is what it means to work from a “therapeutic distance,” to work with an awareness of where we stand in relation to the people with whom we are working.

However, whereas working with this kind of clarity and respect for boundaries may be our goal, experience tells us that it is not easy to achieve. The edge of the family dance floor is often, in fact, a fluid border as difficult to define as it is to say exactly where the sea meets the sand. In addition, each of us has “hooks” – people or situations that may touch us in some deep, unconscious place. Because we have an obligation to do this work with awareness, it is important that we do our “homework”, seeking to identify our “hooks” and paying attention to signs that we may have stepped over the line.

The signs that we are losing our perspective are: 1) experiencing an extreme emotional reaction to a person or situation that (perhaps without our knowing it) resonates with an unresolved issue or a difficult relationship on our own dance floor; 2) feeling a sense of ownership as reflected in language such as “my patients” or “my families,” or difficulty in letting go or sharing individuals with other team members; and/or 3) experiencing a need to influence or control patients and families by directing their options and choices or by making ourselves indispensable to them.

Despite having identified signs of over-involvement, it is also important to understand the challenges inherent in our work and be gentle with ourselves as we strive to be “good enough.” We need to remember that maintaining a therapeutic distance does not preclude strong emotions and deep caring. Two of the great advantages of knowing where we stand and being clear about what we bring to our work are being able both to feel deeply and to act wisely.

Reprinted with permission of the author

Elizabeth Causton

elizabeth@caustonsonbeach.ca

Causton, Elizabeth. (2003). The Dance. In M. Cairns; M. Thompson; W. Wainwright (Eds.), Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. (p. 202–203) Baltimore, MD: Health Professions Press.

Download Student Handout: The Dance by Elizabeth Causton [PDF].

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

  1. One or more quizzes or examinations that pertain to knowledge of human anatomy and physiology, normal changes of aging, nutrition in healing, and common challenges to health and healing (Learning Outcomes #1, #2, and #3).
  2. An assignment in which students, working in small groups, research a common health challenge and present their findings to the class. Each group should be prepared to discuss the physical, social, emotional, and cognitive changes that a person dealing with a particular health challenge might face. Each group should also identify community resources and discuss the HCA role in caring for and supporting individuals experiencing the health challenge (Learning Outcomes #2 and #4).
  3. A written assignment in which each student identifies what they would want in a care provider for themselves or a close family member who is dying. Each student will discuss this fictitious “perfect” caregiver in terms of the person’s:
    • Comfort with the death and the dying process.
    • Knowledge of and ability to provide palliative care.
    • Ability to communicate with the dying individual.
    • Relationship with other health team members.
    • Relationship with family members.
    • Ability to communicate with family members during the dying process and immediately after the death of the client.
    • Ability to adapt to cultural, religious, or other person-centred care requirements.

Each student should reflect on their strengths as a caregiver as these relate to end-of-life care and identify areas of personal or professional development that would assist them to become more effective or confident in providing end-of-life care (Learning Outcomes #4 and #5).

Resources for Healing 1: Caring for Individuals Experiencing Common Health Challenges

Online Resources

ALS Canada. https://www.als.ca/

American Psychological Association. (2019). Culturally diverse communities and palliative and end-of-life care [Fact sheet]. https://www.apa.org/pi/aging/programs/eol/end-of-life-diversity.pdf

Arthritis Canada. https://arthritis.ca/

Association of Canadian Community Colleges and Canadian Association of Continuing Care Educators. (2012, June 28). Canadian educational standards for personal care providers. https://www.collegesinstitutes.ca/wp-content/uploads/2014/05/Reference-Guide_Canadian-Educational-Standards-for-Personal-Care-Providers_ACCC.pdf

British Columbia Hospice Palliative Care Association. https://bchpca.org/

Canadian Cancer Society. https://www.cancer.ca/

Canadian Hospice Palliative Care Association. https://www.chpca.ca/

Canadian Liver Foundation. https://www.liver.ca/

Canadian Lung Association. https://www.lung.ca/

Challacombe, L. (2021). The epidemiology of HIV in Canada [Fact sheet]. CATIE. https://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hiv-canada

Diabetes Canada. https://www.diabetes.ca/

Diabetes Canada. (2021). Basic meal planning [Blog post]. http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/basic-meal-planning

Dodd, K. (2020). End of life nutrition [Blog post]. The Geriatric Dietitian. https://www.thegeriatricdietitian.com/embracing-hospice-end-of-life-nutrition/

Dying with Dignity Canada. https://www.dyingwithdignity.ca/

Elsevier. (2015). Body spectrum [Illustrations]. Elsevier, Inc. http://sites.elseviermultimedia.us/common/HP/bodyspectrum/

Emedicinehealth. (2017). HIV and AIDS quiz: HIV testing and symptoms [Online quiz]. http://www.emedicinehealth.com/hiv-aids_quiz_iq/quiz.htm

Government of British Columbia. (n.d.). Advance care planning. https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/advance-care-planning

Government of Canada. (2016). End of life care. https://www.canada.ca/en/health-canada/topics/end-life-care.html

HealthLinkBC. https:k//www.healthlinkbc.ca/

HealthLinkBC. (n.d.). Seniors’ health. https://www.healthlinkbc.ca/health-topics/common-health-concerns/seniors

Heart and Stroke Foundation. https://www.heartandstroke.ca/

Interior Health Authority. (2021). Palliative and end of life care to relieve suffering and improve quality of life. https://www.interiorhealth.ca/YourCare/PalliativeCare/Pages/default.aspx

Kidney Foundation of Canada. https://kidney.ca/

Mayo Clinic. (2017). Diseases and conditions [Index]. https://www.mayoclinic.org/diseases-conditions/index?letter=A

Medical News Today. (2017). What causes difficulty swallowing (dysphagia)? http://www.medicalnewstoday.com/articles/177473.php

MS Society. https://mssociety.ca/

Muscular Dystrophy Association. https://www.mda.org/

Osteoporosis Canada. https://osteoporosis.ca/

Pacific AIDS Network. https://pacificaidsnetwork.org/

Pain B.C. https://www.painbc.ca/

Parkinson Society British Columbia. https://www.parkinson.bc.ca/

Quizlet Inc. [Mobile app]. https://quizlet.com/

Victoria Hospice. https://victoriahospice.org/

WebMD. (2019). What is constipation? http://www.webmd.com/digestive-disorders/digestive-diseases-constipation

WebMD. (2016). What is edema? http://www.webmd.com/heart-disease/heart-failure/edema-overview

Wedro, B. (2021). Blood clots (in the leg). MedicineNet. https://www.medicinenet.com/blood_clots/article.htm

Online Videos

9News. (2016, July 3). Storytellers: The ALS death ride [Video]. YouTube. https://www.youtube.com/watch?v=2TkXt_hRfY0

Alilia Medical Media. (2018, November 5). The endocrine system, overview, animation [Video]. YouTube. https://www.youtube.com/watch?v=vLdNX5Te1Xo

Alilia Medical Media. (2018, November 20). The lymphatic system, overview, animation [Video]. YouTube. https://youtu.be/cCPyWFK0IKs

Alilia Medical Media. (2019, September 3). Overview of the nervous system, animation [Video]. YouTube. https://youtu.be/R1_B5_ytWSc

American Foundation for the Blind. (2008, October 16). Visual simulations [Video]. YouTube. https://www.youtube.com/watch?v=DwtH1mO4eE0

BioDigital, Inc. (2008, October 14). 3D medical animation – What is cancer? [Video]. YouTube. http://youtu.be/LEpTTolebqo

Brown, G. (2009, July 15). Jenny’s Huntington’s story [Video]. YouTube. https://www.youtube.com/watch?v=rleVDQ-4MsY

CTE Skills.com. (2015, November 31). The urinary system in 7 minutes [Video]. YouTube. https://www.youtube.com/watch?v=CkGqp5tr-Qk

Diabetes UK. (2013, September 3). Diabetes and the body: Diabetes UK [Video]. YouTube. https://youtu.be/X9ivR4y03DE

Diseases Simplified. (2020, January 16). Must know causes of edema/swelling [Video]. YouTube. https://www.youtube.com/watch?v=jyoaxSbwFTM

DocMikeEvans. (2014, March 13). Failing kidneys and different treatment options [Video]. YouTube. https://youtu.be/mi34xCfmLhw

DrDrewLCTV. (2011, October 31). What alcohol can do to your liver [Video]. YouTube. https://www.youtube.com/watch?v=l-SBR7p7K-M

End of Life Project. (2012, November 29). Completing the circle: End of life care with Aboriginal families [Video]. YouTube. https://www.youtube.com/watch?v=XbUGMIKId0c

FilmSpawn. (2012, June 12). World elder abuse awareness day [Video]. YouTube. https://www.youtube.com/watch?v=mSFnDe6A2Ww

Geriatric Dietitian. (2019, July 20). Embracing hospice end of life nutrition [Video]. YouTube. https://www.youtube.com/watch?v=suj_EXYHhGI

Gilbert, D. (2014, February 18). Loss of independence within the elderly [Video]. YouTube. https://www.youtube.com/watch?v=up7rGG0ytoE

Halton Healthcare. (2020, February 20). Pressure injury prevention 2020 [Video]. YouTube. https://www.youtube.com/watch?v=qcyhJuNhPG4

Healthguru. (2008, February 8). Understanding epilepsy. (Epilepsy #1) [Video]. YouTube. https://www.youtube.com/watch?v=MNQlq004FkE

Heat Inc., Health Education and Training. (2017, September 11). The nursing assistant: pressure ulcer prevention [Video]. YouTube. https://www.youtube.com/watch?v=6OGSkxlr9-c

HeistheStud. (2014, December 14). Emphysema & bronchitis [Video]. YouTube. https://www.youtube.com/watch?v=S-tryBgTBBk

Human Biology Explained. (2014, March 8). Anatomical terms – drawn and defined (updated) [Video]. YouTube. https://www.youtube.com/watch?v=kvHWnJwBkmo&app=desktop

Innovative Hearing Solutions, Inc. (2015, July 14). Inserting and removing RIC’s, CIC’s and BTE’s hearing aids [Video]. YouTube. https://www.youtube.com/watch?v=K4BK-ohwhoI

Janux. (2015, January 10). Human physiology – Introduction to the immune system [Video]. YouTube. https://youtu.be/CG931UYMbN0

Los Angeles Times. (2013, July 3). The singing nurse at Valencia hospital soothes the suffering [Video]. YouTube. https://www.youtube.com/watch?v=ODok6eNtA9c

Lee Health. (2012, January 6). Recognizing lymphedema [Video]. YouTube. https://www.youtube.com/watch?v=ruDdySPgt4k

Life and Death Matters. (2015, March 21). My tribute to PSWs [Video]. YouTube. https://www.youtube.com/watch?v=7nvHOawDX8M

Life Before Death. (2013, December 7). Life before death – Roger’s story [Video]. YouTube. https://www.youtube.com/watch?v=eQRHrgCiEzI

LivingHealthyChicago. (2016, March 7). Living with arthritis [Video]. YouTube. https://www.youtube.com/watch?v=D6HtMELddcg

Magic Spangle Studios. (2012, July 11). 3D medical animation – central nervous system [Video]. YouTube. https://youtu.be/-s8yEhRZgvw

Markivmedcom. (2009, July 15). Acute myocardial infarction – heart attack [Video]. YouTube. http://youtu.be/zeS-0au8ij4

Marwaha, S. (2016, October 28). Wash your hands. It just makes sense [Video]. YouTube. https://youtu.be/BJStsvWPz7k

Miller, B. (2015, March). What really matters at the end of life [Video]. TED2015. https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life

MooMooMath and Science. (2017, May 18). Types of human body tissues [Video]. YouTube. https://www.youtube.com/watch?v=O0ZvbPak4ck

Moovly. (2014, September 22). What is ALS? [Video]. YouTube. https://www.youtube.com/watch?v=Q2Xt4noBVws

NPT Reports. (2013, September 13). End of life. Aging matters NPT reports. [Video]. YouTube. https://www.youtube.com/watch?v=uzfcvptgJ2c

PBS Digital Studios. (2013, March 25). You are mainly microbe! [Video]. YouTube. https://youtu.be/4BZME8H7-KU

Seet, J. (2006, April 12). UTI [Video]. YouTube. https://www.youtube.com/watch?v=I9fJHLSw4Og

St. Michael’s Hospital. (2018, August 2). What is hypoglycemia? – DiaBiteSize [Video]. YouTube. https://www.youtube.com/watch?v=e0XN_hjfQiA&feature=youtu.be

Sunnybrook Hospital. (2018, March 13). Quality dying – Let’s talk about it [Video]. YouTube. https://www.youtube.com/watch?v=9CYl12mBluA

TED-Ed. (2014, November 10). How a wound heals itself – Sarthak Sinha [Video]. YouTube. https://www.youtube.com/watch?v=TLVwELDMDWs

TED-Ed. (2014, November 24). How do lungs work? – Emma Bryce [Video]. YouTube. https://youtu.be/8NUxvJS-_0k

TED-Ed. (2017, December 14). How your digestive system works – Emma Bryce [Video]. YouTube. https://www.youtube.com/watch?v=Og5xAdC8EUI

TED-Ed. (2018, March 12). The science of skin – Emma Bryce [Video]. YouTube. https://youtu.be/OxPlCkTKhzY

Teepa Snow’s Positive Approach to Care. (2017, December 21). How dementia affects language skills [Video]. YouTube. https://www.youtube.com/watch?v=0BlZF_4EKp4

ThePenguinProf. (2011, July 29). Medical terminology [Video]. YouTube. https://www.youtube.com/watch?v=3fiEszFPRE8

University of Bristol. (2010, March 3). How the human brain works [Video]. YouTube. https://www.youtube.com/watch?v=9UukcdU258A

USMLE pass. (2019, November 18). Sounds of breathing patterns (Cheyne-Stokes, Kussmauls, Biots) [Video]. YouTube. https://www.youtube.com/watch?v=ViGjOiPE2mY

WebMD. (2019). The basics: Diarrhea [Video]. http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea

Whitford, B. and Paskievich, J. (Directors). (2005). The gift of diabetes [Film]. National Film Board. https://www.nfb.ca/film/gift_of_diabetes/

YourRenalCare. (2011, December 15). Kidney stones [Video]. YouTube. https://www.youtube.com/watch?v=LngbrHJkXoE

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

SuperTeacherTools: https://www.superteachertools.us/#.

  • Instructors can use this site to create customized games for classroom use. Styles include Jeopardy, Who Wants to be a Millionaire, and Speed Match.

Canadian Virtual Hospice. (2016). Livingmyculture.ca. http://livingmyculture.ca/culture/

  • A series of online videos discussing quality palliative care for people from the following cultures: First Nations, Inuit, Métis, Chinese, Ethiopian, Filipino, Indian, Iranian, Italian, Pakistani, Somali. Videos range from 2 to 25 minutes.

Joyce, S. & Grainger, J. (2021). NHA-CL-Palliative care awareness. LearningHub. https://learninghub.phsa.ca/Courses/7491/nha-cl-palliative-care-awareness

  • An e-learning course that takes 1 hour 30 minutes to complete.

Life and Death Matters. (2015). Boundaries and self-care in hospice palliative care. https://www.youtube.com/watch?v=wSb_O6_E7_A&feature=em-share_video_user

  • Author Elizabeth Causton discusses the importance of boundaries and self-care for those working in palliative care (25 minutes for review and discussion).

  1. Island Health (2012).
  2. Copyright © 2017, Life and Death Matters. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0)