It is my duty

Dawn Butler, RN (Pennsylvania) I walk through those doors with pride, Who's life will i save tonight? Someone is waiting for me, Someone is alive today because of my duty. Sometimes we cry cause we can't save them all, God sometimes won't let us interfere when he calls. A baby's first breath when he looks at me, The joy of my first delivery. The tear i wipe a way with my own hands, The life ending of a gentle old man. The night seems so dark and the morning so bright. Being a nurse you see life in a different light. Who will i save tonight? Who will hold my hand during their last breath with no fright? Who will enter this world on my shift? How many mothers will greet their babies with a kiss? I don't know who these special people are but i will meet them with every call I will hold them tight and help the pain I will hold them up when they feel faint. I will be strong when i am needed That is my job, I am a nurse..that is my duty.

A good nurse works smart, not hard

Providing EDUCATION is an integral component of any professionals role.

Nurses are EDUCATORS!!
RNs should endeavor to find an approach that suits both personality and their skills. When you're a nurse you know that every day you will touch a life or a life will touch yours.

GOAL: Develop in our everyday practice as educators - - as nurses!

Why this topic???
It is important to choose a teaching approach & learning style that suits us/you!
Develop a passion for learning. If you do, you will never cease to grow. Anthony J.

Kolbs LEARNING PROCESS

1.PLANNING 2.EXPLORATION 3.REFLECTION 4.DOING

Nurses dispense comfort, compassion, and caring without even a prescription. ~Val

PERSONALITY has an effect on the learning

approach.

. . . should be considered in designing or planning teaching material.

Panic plays no part in the training of a nurse. ~Elizabeth

4 INGREDIENTS OF SUCCESFUL LEARNING ( Race & Brown 1993) 1. Wanting 2 & 3. Doing and Feedback 4. Digesting

If love can't cure it, nurses can. ~Author Unknown

SURFACE LEARNING vs. DEEP LEARNING

Memorizing important points, students concentrate their efforts on passing the assignments to gain highest possible marks Understands the article, assimilates information based on their experience & evaluated evidence

A nurse will always give us hope, an angel with a stethoscope. ~Carrie

PEER- ASSISTED LEARNING TECHNIQUES

A. DEVT THROUGH REFLECTIVE PRACTICE -- according to Quinn & Johns, REFLECTION is a window through which the practitioner can view and focus self within the context of his own lived experiences in ways that enable her to confront, understand & work to resolve contradictions within her practice between what is desirable & actual practice
Confucius say: "Man who want pretty nurse, must be patient." ~Author

Using a journal of reflection has helped me to structure my thoughts and feelings appropriately. My competence, within this clinical skill, has been further developed and I now feel that my personal and professional development is progressing because of the MSN program of St. Paul University Philippines. Furthermore as a MSN student and at the same time as an educator I have recognized that reflection is an important learning tool in practice. I've learned that nursing is a great metaphor for life. It's rewarding and frustrating, utterly fascinating at times and dull as tombs at others; it's funny, sad, beautiful, ugly, dramatic, and unglamorous.

Nurses are the hospitality of the hospital. ~Carrie Latet

As a Paulinian nurse we know that a little effort can go a long, long way. Investing five or ten minutes in a needy patient at the very beginning of the shift sets the tone for the entire day, and pays dividends in decreased anxiety for them . This principle also works for nightmare-beleaguered toddlers, stymied spouses, and fussy in-laws. =-) And yes, I've found that the Golden Rule is applicable to every possible situation, whether in nursing or in life: Treat everyone you encounter with the same respect you would want for yourself or your loved ones.

"Our job as nurses is to cushion the sorrow and celebrate the joy, everyday, while we are 'just doing our jobs.'"

Everyone who ever lived is, or was, someone's parent, someone's sibling, someone's child, someone's friend. What's more, we are all members of the human race---including the threehundred-pound diabetic who smokes like a chimney and doesn't take her insulin and the homeless alcoholic who hasn't changed his socks in six weeks. We judge them only because we fear, deep inside, that "they" could just as easily be "us" but for the grace of God and perhaps a few strokes of bare good luck. So many lessons.... ....so many opportunities to grow in compassion and wisdom.

"I can stand out the war with any man. - Florence

GIBBs REFLECTIVE CYCLE

1.DESCRIPTION 2.FEELINGS 3.EVALUATION 4.ANALYSIS 5.CONCLUSION 6.ACTION PLAN

Constant attention by a good nurse may be just as important as a major operation by a

SUPERVISION
-- refer to providing a safe environment to explore issues of concern to the individual practitioner through reflection and selfawareness -- HOW? 1. Supervisee + supervisor agree on same time 2. Supervisee brings issues to the meeting for discussion 3. Using reflection, supervisor facilitates supervisee to come to their own "Good teachers are those who know how little they know. Bad teachers are those who think they conclusions know more than they don't know.-- R. Verdi

C.DEVT THROUGH MENTORSHIP

-- refer to formation of a learning relationship between teacher and learner wherein both parties have responsibilities LEARNER must be honest in discussing personal practice and keeps a record of professional development TEACHER supports the learner by providing safe environment that facilitates reflective practice; provides feedback
It is the nurse that the child first hears, and her words that he will first attempt to imitate.

D. DEVT THROUGH PRECEPTORSHIP

-- BUDD SYSTEM providing informal support and orientation to the work environment -- the PRECEPTOR is shadowed while involved in their normal work; OBSERVER witnesses the experienced practitioner in action

"the character of the nurse is as important as the knowledge she possesses.

PROBLEM-BASED LEARNING
-- student-focused learning -- a stated problem is the stimulus for students to use their cognitive skill to gain knowledge of the concepts and issues identified -- HOW IS IT DONE? 1. Problem is presented before the learners 2. Learners define the nature of the problem, identify additional resources needed and find viable answers 3. Teachers act as facilitators by asking questions and monitor students progresses

Nursing would be a dream job if there were no doctors. ~Gerhard Kocher

PROBLEM: MAY JEAN May Jean, 49 years old female, was admitted to a tertiary hospital in Metro Manila last Feb. 19,2008 with the following presenting symptoms: aural fullness and abdominal pain with enlargement. The patient was placed on low fat, low sodium diet and has undergone CBC. As the admitting nurse, plan for the care of MJ. How do you assure the continuity of your care during the hospitalization of MJ? On Feb. 20, an ultrasound-guided paracentesis of the abdomen was performed; examination of the abdominal fluid was done. A catheter was inserted draining to bag. Patient was referred to Dr. Juco with new orders. Dr. Jucos evaluation noted that MJ is known to be a case of ovarian CA s/p chemotherapy s/p TAHBSO. As the nurse on duty, in the light of this information, what modifications would you do in the NCP designed bu the admitting nurse? How would you involve head nurse and colleagues?
Wives are young mens mistresses; companions for middle age, and old mens

The trained nurse has become one of the great blessings of humanity, taking a place beside the physician and the priest....

Famous Saying by William Osler

WHAT CANCER CANNOT DO

by Kristen Homandberg

Cancer is so limited that: It cannot cripple love It cannot shatter hope It cannot corrode faith It cannot destroy peace It cannot kill friendship It cannot suppress memories It cannot silence courage It cannot invade the soul It cannot steal eternal life It cannot conquer the spirit
Nursing is a work of Heart!

HOLISM Greek word holos which means entire/whole

Why this topic???
Inner resources are as important as external ones
Develop a passion for learning. If you do, you will never cease to grow. Anthony J.

The WHO defined health as

"a state of complete physical, mental,

and social well-being and not merely the absence of disease or infirmity."

HOLISTIC CARE focuses on

healing the whole person through the unity of body, mind, emotion, spirit and Nurses environment. are the heartbeat of health car

Nightingale believed that God had called her to be a nurse.

She was dubbed "The Lady with the Lamp .

Florence Nightingale

The NIGHTINGALE PLEDGE taken by new nurses was named in her honor, and the annual INTERNATIONAL NURSES DAY is celebrated around the world on her birthday.

Florence Nightingale syndrome

Blessed are the nurses, for they help us heal through love and

MACMILLAN GOLD STANDARDS FRAMEWORK (Dr. Keri Thomas)

Work as a team and ensure continuity of care Plan for developments in patients illness Provide patients with the best symptom control Give support to patients and carers

1. Proper use of NURSING

Behind every good doctor is a great nurs

ONE MAJOR POINT!

Look at the PATIENT as a UNIQUE individual so that we, NURSES, can create an ENVIRONMENT that facilitates INNER HEALING thus reducing suffering.

SYMPTOM MANAGEMENT
KEY PRINCIPLES 1. In implementing any intervention or tx r/t the management of symptoms, the preferred choice of the patient should be the forefront of the minds of the carers. This includes to nontreatment as an option 2. Open communication decision-making. Pt & fy 3. Listen to patients own story. Including past & present life experiened

PROCESS OF SYMPTOM MANAGEMENT

1.

2. 3.

EVALUATION establishing the cause of the symptom involves taking hx, including gen trends and recent changes. effectiveness of interventions that have already been implemented Use of tools- Verbal rating scales Visual analoges scale

1.

EXPLANATION about care and treatment options is vital to the delivery of effective care and empowers patients and carers to be involved as equal partners in decision making process. - info about the disease process and significance of symptoms should be provided - Poor communication skills can give detrimental effect on pt. outcomes

PROCESS OF SYMPTOM MANAGEMENT 3. MANAGEMENT builds on the assx process. - all professional involved in patient care should be working towards same goal 4. MONITORING det hw efective d int.. Cont reassesmnt 5. ATTENTION TO DETAIL

BREATHLESSNESS-DYSPNEA -- management is aimed at treating the cause NON-pharmacological: -- decrease the level of anxiety -- allow rest periods between each stage of any procedure or as necessary --minimize effort required during mealtime -- interactions that require verbal responses should be limited -- correct positioning & posture -- ensure a restful sleep

-- educate patients in coping techniques in advance of the terminal phase of disease -- breathing and relaxation techniques -- oxygen therapy --help them accept the limitations of their disease

PHARMA MNGT -- bronchodilators, steroids, furosemide, nebulized saline, use of sedation, nebulized opoids

COUGH- common wt lung ca ++WET Cough -- bronchodilators, nebulized saline, expectorants, mucolytics, antibiotic therapy ++ DRY Cough --antitussive, nebulized local anesthetics
** Proper coughing technique ** Postural drainage ** steam inhalations

PAIN

-must be a prioprity

-An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or describes in terms of such damage - the unrelenting nature can impact on all aspects of a persons life, including activities of daily living , sexual and social relationships, sleep patterns, thought processes and existential domain

INCIDENCE OF PAIN -2/3s of pt. with cancer suffer pain while 1/3 do not experience any pain at all.
PHYSIOLOGY 1. PHYSIOLOGICAL PAIN is the least intricate and occurs when the nociceptive system warns of impending injury to the body, providing direct pain information to the brain. 2. CHRONIC PAIN long standing pain which can lead to increased pain response. 3. NEUROPATHIC PAIN commonest cause of complex pain is current or past damage to the nerve fibres, which can follow damage to the periprhal nerves or injury to the spinal cord or brain.

- Somatic pain- pain that arises in the skin, muscle, periosteum or fascia. This type of pain is localised - Visceral pain- results from infiltration, compression, distension or strecthing of the thoracic or abdominal viscera. Poorly localised and often accompanied by nausea.

ASSESSMENT OF PAIN -history 1. Site and n0. of pains 2. Intensity and severity of pain 3. Radiation of pain 4. Timing of pain 5. Quality of pain (burning, stabbing) 6. Aggravating or relieving factors 7. Aetilogy of pain 8. Type of pain 9. Analgesic drug history 10.Presence of any clinically significant psychiatric d/o

WHO GUIDELINES for Cancer pain relief 1. By the mouth the oral route remains the least & safest method drug administration and provides a rap id onset of analgesia 2. By the clock- since most oral analgesics act only for 4 hours or less, oral analgesics should be prescribed 4- hourly in order to achieve therapeutic levels of analgesia rather than waiting for the pain to occur 3. By the ladder- pain free with as few side effects of the medication. 3 possible steps dependent upon the severity, type and cause of the pain.

STEP1: mild pain. This involves the use of a non- opioid analgesic e.g paracetamol, NSAIDS, diclofenac or ibuprofen STEP2: mild to moderate pain. Use of weak opioids, most contain codeine wc should be excess of 30 mg to be effective e.g. dihydrocodeine & dextropropoxyphene STEP3: Moderate to severe pain Morphine + non opioids and adjuvants

MONITORING PAIN The site of the particular pain being experienced, using the body chart of the initial assessment, as the patient may have multiple pains and the pains can be labelled a,b,c Whether it is linked to movement or rest The level of pain, and this should be elicited from the patient

NON DRUG INTERVENTION -Aromatherapy -Massage -Hypnosis -Relaxation therapy

GASTROINTESTINAL PROBLEMS Vomiting -Is essentially a protective mechanism to rid the body of any digested poison. NAUSEA - Occurs there is a disturbance in the normally constant contractions and relaxations of the stomach which becomes flaccid in order to prevent further absorption of toxins. ANXIETY INDUCED EMESIS -Is a common experience and patients or their carers may be able to identify anxiety as a trigger for ANTICIPATORY EMESIS

EVALUATION Assessment of: 1.A detailed hx, including tumor histology and spread and previous tx 2.Onset of symptoms 3.Physical examination 4.Evaluation of biochemical status 5.Factors that exacerbate or relieve symptoms 6.Effects on activities of living 7.Further investigations if necessary eg. Radiological investigation

MONITORING The vomitus should be observed and its characteristics recorded: amount, colour, odor, presence of blood, undigested foodstuffs or fecal fluid

CONSTIPATION -The effect of the illness can also lead to dehydration poor food and fiber intake, lack of exercise, weakness and confusion -Patients taking strong opioids require laxatives EVALUATION -The appearance of the stool often gives indication of the nature of the problem :small, hard stools may mean a slowing of the transit time through the bowel : ribbon-like stools may point out stenosis :blood in stool may indicate tumor or hemmorrhoids

MANAGEMENT 1. Contact stimulant agents 2. Bulk forming drugs provide fiber and need to be taken with adequate water 3. Osmotic laxatives 4. Combination of surface wetting agent and contact stimulant NON PHARMA: 1. Dignity and privacy in toileting 2. Ensure adequate fluid intake 3. Accurate daily recordings of stool consistency, ease of defecation 4. Encourage use of fruit cocktails and increase fiber intake 5. Make sure food looks as attractive as possible

DEPRESSION -Coexists with other physical symptoms in a palliative care patients -Frequently reported psychiatric symptoms in patients with advanced cancer

CHAPTER FIVE COMMUNICATION AND SUPPORT

EFFECTS OF ADVANCED ILLNESS ON IDEN

THE THREAT OF ILLNESS TO FUTURE LIFE AND PLANS

If a person become aware that they have a potentially fatal disease, they are stopped in their tracks. It is a threat to the very core of self and can undermine their sense of security and ability to plan for the future

THE THREAT OF ILLNESS TO PHYSICAL AND PSYCHOSOCIAL INDEPENDENCE

A stressful situation could lead to depression if the individual believed that it was impossible to control the situation -Loss of independence can be shattering to selfesteem. -They lack understanding of their bodies, undermining their sense of power and control. - no longer being able to trust their abilities and

THE THREAT TO BODY IMAGE AND SEXUALITY

THE THREAT TO SOCIAL ROLES AND STATUS

As disease progresses people are likely to feel less confident in their roles as partners, friends and workers -Many found themselves temporarily unable to do so and a few were permanently unable to cope - serious illness and its treatment impose physical limitations

THE THREAT TO RELATIONSHIPS Close relationships form a part of a persons identity and give feelings of security and competence - As the seriousness of their illness becomes manifest, people often go through a period of feeling less confidant in their relationships

THE THREAT OF STIGMA AND ISOLATION

Serious illness can make them feel powerless and unsure of their status, especially if they are subjected to others negative expectations and labelling

THE THREAT TO FAITH AND HOPE A life threatening illness may cause a person to grow spiritually or fall into doubt and despair - Its a n important part of identity

SUPPORTING PERSONHOOD IN ADVANCED ILLNESS

-Normalizing the distressing symptoms, making an effort to maintain eye contact with patients experiencing distressing or embarrassing symptoms -Acknowledging the delicate balance between providing total care for patients and promoting their independence, and respecting their decisions about personal and medical care -Helping patients to have control over their personal appearance and environment ( pts. Were allowed to decorate their bedsides with photos and items from

Caring for the unconscious patientnurses talked to and touched patients and encouraged the family to do the same as they might still be able to hear.

DEVELOPING THERAPEUTIC RELATIONSHIPS IN PALLIATIVE CARE -Authoritative interventions 1. Prescriptive- the helper seeks to direct the behavior of the ct. 2. Informative- the helper give the client information 3. Confronting- the helper tries to raise the clients consciousness about an attitude or behaviour -Facilitative interventions 1. Cathartic the helper encourages the client to release painful emotions such as fear 2. Catalytic- the helper elicits self-discovery and problem solving in the client 3. Supportive- the helper affirms the worth of the clients attitudes, qualities and actions

NONVERBAL COMMUNICATION -SUCH AS JOINT GAZE AND THE USE OF gesture have been found important in the construction of meaning -It has been estimated that non verbal communication carries four times the weight of verbal communication -Perrys 2 importance of NVC 1. Dialogue in silence 2. Mutual touch Humour- perrys 3rd encompassing NV and V

A human being is not attaining his full heights until he is

"Learning is what most adults will do for a living in the 21st century.-- Perelman