Seminar Detail

Nearing the End of Life: Dare to Care
Nearing the End of Life: Dare to Care

Where:   FAIRFAX, VA

When:  Friday, March 9, 2018 at 8:00 AM - 4:00 PM

This event is not currently available for purchase.

For more information: Call (800) 844-8260
Course Description:

Eleanor is an 83-year-old widowed lady with known chronic heart failure and advanced dementia. She is now hospitalized with a significant stroke and dysphagia. She does not have a healthcare directive and had never discussed what she would want, other than staying at home until she dies. She is full code. Her family still wants resuscitation attempted. Her children admit they are concerned about what is best for their mother.

What are options for Eleanor and her family? Would she benefit from artificial hydration and nutrition? How is she going to receive medications? Can some of her medications be discontinued? Who is going to be her caregiver?

In this compelling seminar, multiple case studies like Eleanor's will provide you with examples that you can incorporate when care is more important than cure. To deliver expert, holistic care, healthcare professionals need to have a toolbox full of new interventions to promote quality care at the end of life.

Have you ever been asked, "what would you do if this was your family member?" Learn conversation options to use while staying neutral.

Did you know that a patient might enroll on hospice care and be a full code? We will discuss how this is done.

What can we do for patients seeking euthanasia who see this as the best solution? These situations are becoming more frequent. Anticipate how you will respond.

Strategies regarding comfort, communication, choices and control have unique issues and challenges for patients, families and health professionals. We have an obligation to know how to help provide emotional, spiritual, existential, and physical comfort for those who have life-limiting conditions and to support them through difficult decisions. It’s time to think outside the box.
If there is no CE tab, please refer to the course brochure for continuing education information.
Learner Objectives:

  1. Explain how complementary therapies enhance quality of life for patients.
  2. Evaluate the risks and benefits of medical marijuana.
  3. Acknowledge the eight domains of the National Consensus Project.
  4. Recognize two strategies to overcome fear of death.
  5. Analyze five complications related to artificial hydration and nutrition.
  6. Explore ethical issues often seen at the end of life.
  7. Formulate two strategies to diminish fear of death and dying.
  8. Connect moral resiliency to palliative care.
Program Outline

  • An Inexact Art & Science
    • Illness and dying trajectories
    • Frailty
    • Dementia
    • Prognostication and prognostic scales
    • When to refer to palliative care or hospice (disease specific)
  • Essentials of Care: Comfort, Communication, Choices, Control

  • Comfort Always
    • Morphine: Still the gold standard?
    • Pain during the final hours of life
    • Drug misuse: How to avoid it
    • Opioids for dyspnea
    • Thirst vs. xerostomia
    • Medical marijuana
    • Complementary and alternative therapies
    • Emotional distress interventions
    • The role of spirituality
    • Palliative sedation
  • Communication: Everyone is Involved
    • Advance care planning: More than just a form
    • The terminology matters
    • Your role in these critical conversations
    • How much can we share?
    • Truth vs. hope
    • Code status discussions
    • DNR does not mean do not treat
    • Addressing concerns and needs of the family
    • Thanatophobia: Is it fear of dying or fear of death?
    • Premortem surge
    • Near death awareness
    • The dying process
  • Choices: Shared Decision-Making
    • Nutrition & hydration choices
    • Voluntarily Stopping Eating and Drinking (VSED): Benefits & burdens
    • Life-sustaining treatment
    • Non-beneficial treatment choices
    • Faith-based influences
    • Ventilator support
    • Dialysis or renal palliative care
    • Devices to extend life
    • Hastened death request: Why not humanely euthanize?
  • Allowing Control: Patient-Centered Care
    • Reframing hope
    • What do family members want you to consider
    • Who makes the decision
    • What about family dysfunction…
    • Is the focus quality or quantity?
    • Decision to withhold or withdraw care
    • Challenging decisions: Honoring patients' wishes
  • Cultivating Moral Resiliency
    • Moral resilience – preserving/restoring integrity
    • Personal vs. professional grieving
    • Enabling character and honorable action
    • Ethical Competency


Nancy Joyner is recognized nationally as a palliative care educator, speaker, nurse consultant and author. She is a Palliative Care Clinical Nurse Specialist with over 38 years of nursing experience. Nancy holds certification as an Advance Certified Hospice and Palliative Care Nurse, one of only three in North Dakota. Nancy has gained extensive nursing proficiency from neonatal, pediatric, home care and hospice areas to palliative care provision in almost all departments of hospital and outpatient settings, including the clinic and long-term care. She is the past president of Honoring Choices® North Dakota and active in North Dakota's Palliative Care Task Force. Nancy is the palliative care subject matter expert for UND Center for Rural Health's rural community-based palliative care project. She is a Hospice and Palliative Nurses Association Certified Nurse Educator and Respecting Choices® First Steps Advance Care Planning Instructor. Nancy has developed and taught online palliative care courses for the University of North Dakota and Bemidji State University. She is a nationally certified ELNEC (End-of-Life Nursing Education) trainer as well as a nationally trained POLST trainer.

Speaker Disclosures:

Financial: Nancy E. Joyner is CEO and President of Nancy Joyner Consulting, P.C. She receives a speaking honorarium from PESI, Inc.

Non-financial: Nancy E. Joyner has no relevant non-financial relationships to disclose.
Credits listed below are for full attendance at the live event only. After attendance has been verified, pre-registered attendees will receive an email from PESI Customer Service with the subject line, “Evaluation and Certificate” within one week. This email will contain a link to complete the seminar evaluation and allow attendees to print, email or download a certificate of completion if in full attendance. For those in partial attendance (arrived late or left early), a letter of attendance is available through that link and an adjusted certificate of completion reflecting partial credit will be issued within 30 days (if your board allows). Please see “live seminar schedule” for full attendance start and end times. NOTE: Boards do not allow credit for breaks or lunch.

If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. For other credit inquiries not specified below, or questions on home study credit availability, please contact or 800-844-8260 before the event.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

PESI, Inc. offers continuing education programs and products under the brand names PESI, PESI Healthcare, PESI Rehab and Psychotherapy Networker.

This seminar qualifies for 1.0 hours of general ethics instruction. If ethics is not specified within your licensing board’s approval statement below, please contact your board to determine the applicability and amount of ethics allowed.

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This course has been awarded 6.25 clock hours by the Commission for Case Manager Certification. Full attendance is required.

This activity is designed to qualify for 6.25 continuing education hours.

This intermediate activity consists of 6.25 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from the activity and contact your state board or organization to determine specific filing requirements.

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PESI, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Nurses in full attendance will earn 6.3 contact hours. PARTIAL CONTACT HOURS WILL BE AWARDED FOR PARTIAL ATTENDANCE.

This program has been reviewed and is approved for a maximum of 6.25 hours of clinical Category I CME credit by the American Academy of Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with AAPA’s CME Standards for Live Programs and for Commercial Support of Live Programs.

PESI, Inc. Provider #:1062, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB), through the Approved Continuing Education (ACE) Program. PESI, Inc. maintains responsibility for the program. ASWB Approval Period: January 27, 2017 - January 27, 2020. Social workers should contact their regulatory board to determine course approval for continuing education credits. Social workers participating in this course will receive 5.25 (Clinical) and 1.0 (Ethics) continuing education clock hours for completing this Intermediate course. A certificate of attendance will be awarded at the end of the program to social workers who complete the program evaluation. No more than 6.25 total CE hours may be awarded for this activity. Full attendance is required; no partial credits will be offered for partial attendance.

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