Lawrence S. Bloomberg Faculty of Nursing

A Palliative Approach to Care for Clients with Progressive and Life-Limiting Illnesses

Fall 2020

6 week course

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Delivery Format: Online

Course Description
Course Outline
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  • Course Description

    Palliative care is defined as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (World Health Organization 2018)”. This is in contrast to the prior understanding that palliative care was a specialty service reserved for only those closest to end of life. Through the development of advanced communication, assessment and complex symptom management skills, explored in this course, health care practitioners may effectively and confidently apply a general palliative care approach to care for adult clients and their families with deteriorating health statuses across all health care settings.  Along with the core knowledge and skills in palliative and end of life care, nurses and other healthcare practitioners require strong self-awareness and self-care practices to authentically and effectively assist clients during highly complex and emotional life transitions. This course is grounded in evidence and competencies for palliative care that can be applied across the continuum of care and in any clinical setting, for adult clients as their health status declines.

    Course Objectives

    By the end of this course participants will be able to:

    1. Apply foundational knowledge and principles of palliative care to their approach to care for client’s and families experiencing progressive and life-limiting illness.
    2. Describe communication skills/strategies specific to difficult conversations associated with progressive disease and life-limiting illnesses such as Advance Care Planning and Goals of Care.
    3. Describe key components of a comprehensive health assessment including appropriate use of screening and diagnostics tools to gather information about clinical symptoms and disease progression.
    4. Articulate a plan of care, including pharmacologic and non-pharmacologic strategies, to manage complex symptoms of progressive disease and declining health status.
    5. Recall how to identify transition into the last days and hours of life.
    6. Describe interventions for end of life care including planning for death, family psychosocial support, grief, and symptom management.

    This is a 6 week on-line course delivered through the University of Toronto’s learning management system. It is estimated that up to 6 hours of study per week is required for successful completion. In each of the 6 weeks of the course participants are expected to view a one-hour e-learning module, review required readings, actively engage with the course material by responding to questions related to the readings, and contribute to the discussion board with fellow participants.  Participants can progress through the course at their own pace each week, however the modules must be completed in order and there are 2 short assignments with specific due dates.  On-line discussion activities provide opportunity for participants to learn from the varied experiences, roles and perspectives of other healthcare providers. Grading for this course is on a pass /fail basis. In order for participants to receive a grade of “pass” they must obtain a final cumulative minimum average of 70% in the course based on all evaluation methods (Discussion board participation and assignments). Successful participants will receive a certificate of completion for the course.

    Audience

    This course has been designed to provide a comprehensive, evidence-based education experience for Nurses, Clinical Nurse Specialists, Nurse Practitioners, and other health care professionals for whom palliative care is not the main focus of their clinical practice.  This course is not intended to prepare practitioners for a specialty practice in palliative care but rather to enhance skill and knowledge so they may employ a general palliative care approach in their current area of practice, and further support clients and their families through transitions associated with progressive and life-limiting illnesses of any etiology.

  • Schedule of Weekly Topics/Evaluation Components

    Please note for this course the week runs from the Monday to the Sunday evening following.

    Date Topic Evaluative Components
    Week 1: Introduction to course and online details A Palliative Approach to Care in Progressive Disease

    • Foundational knowledge for a palliative approach to care across the continuum of progressive disease or life-limiting illness
    • Overview of competencies for palliative care

    Course theme introduction: Clinical and ethical decision-making, caring for the health practitioner, caring for the caregiver & application to practice

    Discussion Board Post
    Week 2: Communication and Care Planning in Palliative Care

    • Overview of communication strategies for managing difficult conversations (Advanced Care Planning; Goals of Care)

    Complex planning and  care co-ordination

    Discussion Board Post
    Week 3: Complex Clinical Symptom Management in Palliative Care

    • Review of health assessment including appropriate use of screening and diagnostics tools to gather information about clinical symptoms and disease progression.
    • Specific symptom assessment for:
      • Pain
      • Nausea and Vomiting
      • Constipation
    • Explore the etiology and mechanisms of each symptom
    • Apply clinical decision making to formulate a plan of care for each symptom including appropriate pharmacological and non-pharmacological interventions
    • Explore the impact of symptoms on clients and caregivers
    • Support for clients and caregivers to educate and empower them in managing symptoms in palliative care
    Assignment #1: Complex Symptom Assessment and Management Case Study
    Week 4: Complex Clinical Symptom Management in Palliative Care (Continued)

    • Specific symptom assessment for:
      • Delirium/Dementia/Depression
      • Dyspnea
      • Appetite
      • Anxiety
    • Explore the etiology and mechanisms of each symptom
    • Apply clinical decision making to formulate a plan of care for each symptom including appropriate pharmacological and non-pharmacological interventions
    • Explore the impact of symptoms on clients and caregivers
    • Support for clients and caregivers to educate and empower them in managing symptoms in palliative care
    Discussion Board Post
    Week 5: End-of-Life Care

    • Explore the concept of a “good death”
    • Specific symptom presentation and management at end of life including, comprehensive assessment and interventions (pharmacological and non-pharmacological) for:
      • Pain
      • Respiratory changes
      • Neurological changes – myoclonus, seizures, delirium
      • GI and GU changes
      • Emotional alterations – anxiety, depression, hopelessness
    • Review decision making process regarding interventions at end of life
    Assignment #2: End-Of –Life Reflective Paper
    Week 6: End-of-Life Care (Continued)

    • Planning for the death including:
      • Management of symptoms
      • Use of palliative sedation for refractory symptoms
      • Medical assistance in dying
      • Place of death – home, hospital, hospice, etc.
    • Review the psychosocial support for families
    • Review types of grief and potential nursing interventions
    Discussion Board Post
  • Faculty

    Allyson Nowell RN, BScN, MSc, CON(C)

    Allyson Nowell is an Advanced Practice Nurse at Sunnybrook Health Sciences Centre in Palliative Care and supporting a Toronto Central LHIN initiative as a Clinical Coach for Long Term Care homes implementing a palliative approach to care. Most recently she held the position of Senior Professional Practice Leader at Princess Margaret Cancer Centre where she also established the McCain Centre for Pancreatic Cancer. Allyson did her Master’s of Nursing at McGill University. She has worked as a Clinical Nurse Specialist for more than 15 years in palliative care and oncology, including spending 5 years in the United Kingdom as a Clinical Nurse Specialist for a Hospice where she was a Team Leader and a Lecturer Researcher. Allyson sits on many local, provincial and national committees and is currently the Director-at-Large, Professional Practice for Canadian Association of Nurses in Oncology (CANO).  Allyson is your course coordinator.

    Patricia Murphy-Kane Clinical Nurse Specialist (CNS) Palliative Care, RN, BA, BScN, MN, CHPCN (c)

    Trish is a graduate of the University of Ottawa and the University of Toronto. She holds a clinical appointment with the Bloomberg Faculty of Nursing at the University of Toronto. Her nursing experience has been in many different clinical areas both in hospital and the community. Over the last nineteen years Trish has focused her practice in oncology where she has worked in the areas of surgery, medicine and palliative care.  Presently she works as a Clinical Nurse Specialist in palliative care at the Princess Margaret Cancer Centre. In addition to her role in palliative care, Trish is involved as an Advance Practice Nurse with the Medical Assistance in Dying Team at the University Health Network. In her roles Trish is committed to supporting and advancing nursing practice through mentorship, education, research and interprofessional collaboration.

    Meredith Muscat RN, BScN, MN, NP (Adult)

    Meredith is a Nurse Practitioner at the Toronto Central Local Health Integration Network (TC LHIN).  She is a member of the palliative care team which offers specialized palliative care in a homebased setting within a unique collaboration between the TC LHIN, homebased palliative physicians and registered nurses.  During this time at the TC LHIN she has been involved with many local committees looking at the delivery of homebased palliative care and various quality improvement initiatives.   Before her transition to the community, Meredith worked as a Nurse Practitioner in the acute care setting for 10 years where her clinical focus was acute and chronic pain management.  Most recently, she transitioned into the role of clinical management and managed the perioperative department in a downtown academic hospital for 3 years.  In each role Meredith’s commitment has been to mentorship, education and collaboration amongst all members of the interprofessional team.

  • Registration Information

    Fees

    Early Bird price (ends August 23, 2019) $630 + HST
    Regular price (starting August 24, 2019) $700 + HST
    U of T Nursing Alumni save 15%* $595 + HST
    U of T Nursing Adjunct and Status Faculty save 15%*** $595 + HST

    Site Groups

    A group discount rate is available for site groups of three or more people. For details please contact pd.nursing@utoronto.ca.

    Please Note

    • Refund Policy – To withdraw from the course and receive a refund, your written request must be emailed to pd.nursing@utoronto.ca by August 23, 2019. No refunds will be given after this date. All refunds are subject to an administration fee of $100 + tax. As an alternative, a colleague may attend in your place. Please send your substitution request at least 7 days before the course.
    • Advanced registration is required. Registration deadline: September 16, 2019.
    • U of T Nursing Alumni discount is available to BScN, MN, PMNP Diploma, MScN or PhD graduates of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.
    • U of T Nursing Faculty discount is available to individuals with a faculty position, adjunct or status appointment, or are a Clinical Instructor (current academic year only) at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.
    • Applicable taxes (13% HST) will be added to the registration fees.
    • Course Cancellation Policy – The University reserves the right to cancel courses due to unavailability of instructors, facilities or insufficient enrolment. Decisions on course cancellations are made at least 15 calendar days prior to the course starting date, so early registration is recommended. If you enroll in a course that is subsequently cancelled, you may transfer to another section of that course if an alternative is available; or you may receive a full refund. We are not responsible for travel fees or any expenses incurred by you.

    Payment method options

    Individuals

    You have two payment options if you are an individual registering for this course:

    1. Register online with a credit card.
    2. Register by mail with a certified cheque or money order.

    Site Groups

    If you are registering on behalf of a site group of three or more people and want to take advantage of the special discounted price please contact pd.nursing@utoronto.ca.


    Credit Card:

    You can register and pay online with a credit card.


    Certified cheque or money order:

    You can register and pay by mail.

    Step 1: Type your information onto the online form and then print the page (i.e. don’t click “Confirmation and Payment”. Don’t pay by online credit card).
    Step 2: Obtain a certified cheque or money order payable to “University of Toronto” for the registration fee plus 13% HST. No personal cheques. No debit cards.

    Fees (including HST)

    Early Bird price (ends August 23, 2019) $711.90 incl HST
    Regular price (starting August 24, 2019) $791.00 incl HST
    U of T Nursing Alumni save 15%** $672.35 incl HST
    U of T Nursing Adjunct and Status Faculty save 15%*** $672.35 incl HST
    Step 3: Mail the paper registration form with payment (no personal cheques, no cash, no credit cards, no debit cards) to:

    Centre for Professional Development
    Lawrence S. Bloomberg Faculty of Nursing
    University of Toronto
    Suite 130
    155 College Street
    Toronto, ON M5T 1P8

    Step 4: When we receive your registration form we will email a confirmation notice.

     

  • Date and Location

    Spring 2019

    6 week online course

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  • Contact Us

    Email: pd.nursing@utoronto.ca
    Website: bloomberg.nursing.utoronto.ca/pd
    Phone: (416) 978-7688
    Address: Centre for Professional Development
    Lawrence S. Bloomberg Faculty of Nursing
    University of Toronto
    Suite 130
    155 College Street
    Toronto, ON
    Canada M5T 1P8

     

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