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1. Identify the trajectory for advanced cancer treatment and complications.
2. Summarize the four interventions for dyspnea.
3. List three components of a comprehensive pain assessment.
4. Explain the use of adjuvant medications as part of a pain management plan.
5. Describe the four vomiting centers of the brain.
6. Assess goals of any patient presenting with these emergencies to align treatment.
7. Distinguish the differences between grief and depression.
8. Investigate the various signs of complicated grief.
9. Discuss the differences between palliative care as an adjunct to disease treatments, and palliative care under hospice.
10. Formulate a plan of care that includes components necessary to ensure cultural sensitivity.
11. State the basic requirements for a patient to elect the Medicare Hospice Benefit.
12. Recognize the signs and symptoms of the active dying process.
13. Establish a priority list for the dying patient incorporating shared decision making.
14. Define the stages of grief and loss according to the Kubler Ross Model.

Day One

Life Limiting Conditions in Adult Patients

• Cancers
• Disease Progression
• Sites of Metastases
• Treatment Side Effects
• Neurologic disorders
• Poor Outcomes with Stroke
• Interventions for Dementia Symptoms
• Using Feeding Tubes
• Amyotrophic Lateral Sclerosis (ALS)
• Medications
• Symptom Burdens
• Cardiopulmonary Diseases
• Management of CHF
• Devices to Prolong Life & Complications of Use
• COPD
• Spirometry Progression
• Concerns with Opioids
• End Stage Renal Disease
• Medical Management of Dialysis
• Combining Transplant Hope with Hospice Care

Pain Management

• Correcting Misconceptions
• WHO Ladder
• Pain Scales
• Psychosocial Effects
• Principles of the American Pain Society
• Barriers to Pain management
• Complementary Interventions
• Spiritual & Cultural Components of Pain
• Adjuvant Meds
• Tolerance
• Dependence & Addiction Issues
• Side Effects
• Dysesthesia
• Allodynia
• Hyperalgesia
• Hyperesthesia

Symptom Management Strategies

• Interventions for Dyspnea
• The “4” Vomiting Centers of the Brain
• Choosing “Wisely” Protocols
• Bowel Obstruction
• Mental Status Changes
• Anxiety, Agitation, Confusion, Delirium
• The Confusion Assessment Method

Depression in End of Life Care

• Depression Risk Factors
• Suicidal Ideation
• Pharmacologic Interventions
• Antipsychotics
• Black Box Warnings
• Non-Pharmacologic Interventions
• Terminal Restlessness

Hospice and Palliative Care Emergencies

• Interventions & Options For:
• Spinal Cord Compression
• Superior Vena Cava Syndrome
• Hypercalcemia
• Cardiac Tamponade
• Acute Hemorrhage
• DIC
• Beck’s Triade

OUTLINE DAY TWO

Grief and Loss

• Grief Theories
• Kubler Ross’s Model
• Commonalities: Stages/Tasks
• Doka’s Manifestations of Grief
• Bereavement
• Worden’s Four Tasks of Mourning
• Rando’s Process of Bereavement
• Risks of Complicated Grief
• Grief Support
• Supporting Grieving Children
• Bereavement Camps

Palliative Care

• Differences Between:
• Adjunct to Disease Treatment
• Palliative Care in Hospice
• Patient-Centered Goals
• Advanced Care Planning
• Shared Decision-Making

Medicare Requirements

• Conditions of Participation
• Rules/Regulations
• Services & Therapies
• Volunteer Services
• Levels of Care
• Reimbursement

Ensuring Cultural Sensitivity

• Education & Advocacy
• Religion Components
• Language Differences
• Food Preferences
• Spiritual & Family Values
• Teaching Components

Needs of the Dying Patient

• Symptom Management
• Delirium & Near Death Awareness
• Standards of Practice

The National Consensus Project

• Eight Domains of Care
• Ethical & Legal Aspects

Interdisciplinary/Collaborative Practice

• Professional Issues
• Professional Development

Judy Dobson is employed as a hospice and palliative care nurse educator. Judy has gained extensive experience caring for patients with end stage disease through her time working as a hospice director; Judy organized the first local bereavement camp for children and teens in her area. She earned her MSN as a Clinical Nurse Specialist and also holds certifications as a Hospice and Palliative Care Nurse and as a Hospice Trainer. Judy remains a strong advocate for excellence in the field of hospice and palliative care and prepares nurses to sit for the NBCHPN certification examination.

In addition to Judy's expertise caring for end stage disease hospice patients, she will draw from her invaluable experiences in acute care departments caring for this specialized patient population as well, including: emergency departments, medical/surgical, end stage renal disease, pediatric oncology, gastroenterology, and flight nursing. She has also encountered many of these end stage diseases through personal family experiences as well, which adds another important perspective to the discussion.

She is a sought-after end-of-life presenter, having shared her keen insights at the local, state, and national levels. Judy is an ELNEC (End-of-Life Nursing Education Consortium) trained presenter in Core and Geriatric Education. She recognizes that caring for persons with end stage disease requires extreme sensitivity, deep compassion, and extraordinary knowledge. Attend this seminar to learn from Judy's passion and expertise to provide optimal care for patients confronting the progression of an end stage disease.

Speaker Disclosures

Financial Judith A. Dobson is a Hospice/Palliative Care Educator. She receives a speaking honorarium from PESI, Inc.

Nonfinancial: Judith A. Dobson has no relevant nonfinancial relationships to disclose.

For U.S. and Canadian customers, a CE test is available for $19.99 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion may be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**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.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 11/11/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 14.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 14.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 17.0 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Other Professions
This self-study activity qualifies for 14.0 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.