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Integrating a Palliative Approach:

ESSENTIALS FOR PERSONAL SUPPORT WORKERS
WORKBOOK

Second Edition

Katherine Murray
Edited by Ann-Marie Gilbert
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Integrating a Palliative Approach: Essentials for Personal Support Workers

WORKBOOK · Second Edition

This workbook was created specifically for personal support workers—and anyone who provides direct care.

As a companion workbook to Integrating a Palliative Approach: Essentials for Personal Support Workers, Second
Edition, this book will help you to solidify knowledge and develop skills in providing palliative and end-of-life
care and integrating a palliative approach. You will develop palliative care best practices and learn ways to
provide culturally safe care to support a dying person and their family, including providing care with a trauma
informed approach.

The workbook is filled with creative learning activities designed to develop self-awareness, address bias and
racism, and build palliative care knowledge and skills for supporting physical comfort and providing psycho-
social care for the dying person and family. Examples of activities include reflective writing, short answer and
true/false questions, mind mapping, creating vision boards, small and large group discussions, and role plays.

Prepare yourself to care for the dying and their family by

• Exploring your beliefs and biases through reflective writing and psychosocial exercises
• Developing your understanding of palliative and end-of-life care language, principles, and practices
• Applying your knowledge in case scenarios, role-plays, and group discussion

A companion resource to help you develop your capacity to provide

culturally safe palliative and end-of-life care, and integrate a palliative
approach for any person with a life-limiting illness.

www.lifeanddeathmatters.ca

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Integrating a Palliative Approach:

ESSENTIALS FOR PERSONAL SUPPORT WORKERS
WORKBOOK
Second Edition

Katherine Murray
RN, BSN, MA, CHPCN(C)

Life and Death Matters

Victoria, BC

www.lifeanddeathmatters.ca

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Copyright ©  Life and Death Matters

August 

All rights reserved.

No part of this publication may be reproduced in any form, or by any means,

electronic or mechanical, including photocopying, recording, or any information browsing,
storage, or retrieval system, without permission in writing from the publisher.

Published by Life and Death Matters, Victoria, BC, Canada

www.lifeanddeathmatters.ca

Illustrations by Joanne Thomson

Editing by Ann-Marie Gilbert
Design by Greg Glover

ISBN ---- (pbk.)

Disclaimer
This book is intended only as a resource of general education on the subject matter. Every effort has been made to en-
sure the accuracy of the information it contains; however, there is no guarantee that the information will remain current
beyond the date of publication. The information and techniques provided in this book should be used in consultation
with qualified medical health professionals and should not be considered a replacement, substitute, or alternative for
their guidance, assessment, or treatment. The author and publisher accept no responsibility or liability with respect to
any person or entity for loss or damage or any other problem caused or alleged to be caused directly or indirectly by
information contained in this book.

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Table of Contents
Reflective Writing: A Learning Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1: Understanding Dying and a Palliative Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Chapter 2: Preparing to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Chapter 3: Using Standardized Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Chapter 4: Supporting Physical Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Chapter 5: Providing Psychosocial Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Chapter 6: Caring in the Last Days and Hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Chapter 7: Caring for You! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Instructor’s Marking Sheet for the Role-Play Exercises on Pain . . . . . . . . . . . . . . . . . . . . . . . . 71

Workbook – Contents iii

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Reflective Writing: A Learning Practice

Our “baggage” is made up of the beliefs and values that each of us has learned and accumulated. Our bag-
gage is reflected every day in our actions and words. In order to effectively meet the needs of dying people,
you, as a personal support worker (PSW), must become aware of your own beliefs and values, and learn how
to set them aside so they don’t interfere with your ability to provide person-centred care. When you become
conscious of your beliefs and values, you can acknowledge them without imposing them on others.

Reflective writing is a way to identify and reflect on your own beliefs and values. This workbook will help you
begin writing about them in a non-critical way. When you write, ignore spelling, grammar, and anything else
that distracts you. Avoid analyzing your writing. Your goal is to freely express yourself. Ignore the critic inside.
Include drawings, write in point form or full sentences, and use coloured pens or pencils or anything else
that helps you express yourself. You may need to reflect and write several times when thinking through an
important topic. This is normal. The awareness that you gain from the writing is more important than what
the writing looks like.

When you feel you have exhausted a topic, take a moment to read what you have written and reflect on it.
It is okay to feel surprised, shocked, happy, sad, or any other emotion. These feelings are part of the reflective
writing process. If your feelings are particularly strong, you may want to explore them further. This process of
writing and reflecting will help you become aware of your own beliefs and values.

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Later in the workbook, you are asked to write reflectively. You will be able to identify areas in which your cur-
rent beliefs may get in the way of caregiving. Once you have identified them, you may want to spend time
exploring where the beliefs came from and how they help or interfere with your ability to provide good care.

Choose a quiet and peaceful place for writing. Listen to your inner self, and enter into this practice with an
open mind, prepared for self-discovery.

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Understanding Dying and a 1

Palliative Approach
Understanding Your Beliefs and Baggage
1. One key message in the text is that the principles of palliative care can be integrated into care early in
the dying process. Is this a new concept for you? Write about this idea. What are the benefits of the pal-
liative approach? Do you already follow some of these principles?

Solidifying Concepts
2a. Identify two key changes in the way that people die differently now than they did  years ago.

i.

ii.

2b. Considering the aging population and changes to the way people die, what are two challenges in pro-
viding care for dying people now?

i.

ii.

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3. Review the stories of different patterns of decline in Chapter  of the text. Complete the table below.

Ways that you as a PSW can

Pattern of decline Impacts on the person Impacts on the family
support the person and the family
1. 1. 1.

Steady decline

2. 2. 2.

1. 1. 1.

Stuttering decline

2. 2. 2.

1. 1. 1.

Slow decline

2. 2. 2.

1. 1. 1.

Sudden death

2. 2. 2.

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4. Using the text, define the following terms:

a. Dementia

b. End of life

c. Holistic care

d. Hospice

e. Palliative care

f. Palliative approach to care

5. List the principles of palliative care in your own words.

6. Circle the best definition: A “palliative approach” is:

a. The integration of palliative care principles, practices, and philosophy into care for people with can-
cer, started in the last six months before death

b. The integration of palliative care principles, practices, and philosophy into care for people with all
life-limiting illnesses, early in the disease process, across all care settings

c. The integration of palliative care principles, practices, and philosophy into care for people with all
life-limiting illnesses, for the last six months of life

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7. People are holistic beings, which means that they have

a. Physical, emotional, and psychosocial needs

b. Physical, sexual, and spiritual needs

c. Physical, emotional, psychosocial, sexual, and spiritual needs

8. Circle the correct answer to indicate whether the following statements are true or false. If a statement is
false, provide the reason it is false.

a. Palliative care regards dying as a natural process, considers the person and family as the unit of care,
and continues through death and into bereavement.

True False

b. Palliative care is active, holistic care for older individuals with serious health-related suffering due to
severe illness.

True False

c. Palliative care improves the quality of life of a person through the prevention and relief of suffering.

True False

d. All people with life-limiting conditions can potentially benefit from a palliative approach.

True False

9. What can be learned when an HCP asks the “Surprise Question”?

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10. Consider the members of the interdisciplinary health care team who are responsible for care of a person
dying in a long-term care facility. In the space below, create a mindmap that shows how the different
members of the interdisciplinary health care team participate in integrating a palliative approach. You
are welcome to use a larger page of your own if your mindmap requires more space.

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11. Care teams can be quite different in urban, rural, or remote areas, and in First Nation, Inuit, or Métis
communities. For each location or community listed above, create a mindmap to illustrate the different
people who are available to be on the care team. Include paid and unpaid people.

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Integrating into Practice

12. Working in small groups, consider Figure  on page  in the text. Using Tom’s Experience—a Stuttering
Decline on page , identify principles of palliative care that are used in the story, or that could have been
used in this story as part of integrating a palliative approach for Tom and his family from the time of
diagnosis to the end of bereavement.

13. At work or during your practicum, talk with a member of the team and ask who helps to integrate a
palliative approach in the care setting, and how to access a specialty palliative care provider when the
team is unable to manage the person’s symptoms.

14. In the larger group, consider the barriers to accessing and receiving palliative care (page  in the text)
and discuss whether these barriers exist in your community. If time permits, brainstorm ideas for improv-
ing access to palliative care.

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15. In what ways can the PSW help to integrate a palliative approach into care?

16. In small groups or with a friend or colleague, discuss the following questions:

a. What is a palliative approach to care?

b. What is palliative care?

c. Who is on the care team?

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Preparing to Care 2
Understanding Your Beliefs and Baggage
1. What is self-awareness? Describe it in your own words.

2. Identify an early experience you had related to death, dying, and/or grief.

a. Describe the experience.

b. What support did you receive? What support would you have liked to receive?

c. How did this experience affect you?

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3. Think about the four different patterns (trajectories) of decline, and on the “flip chart” provided draw
them in order of your most preferred (“good death”) to least preferred (“bad death”) way of dying. On the
right-hand side of the chart, write two reasons why you placed them in the order you did.

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4. Reflect on which trajectory or pattern of decline you would hope a loved one would experience when
they are dying.

a. Which trajectory would you choose for them?

b. Did you want something different for your loved one than you wanted for yourself? Explain whether
you found it harder or easier to imagine and choose a path for someone else instead of for yourself.
(Sometimes people have more difficulty making decisions on behalf of another person and may
choose more aggressive treatments for someone else than they would want for themselves.)

5. Circle the faces in the illustration below that reflect some of your feelings about working with people
who are dying.

interested worried afraid ill unsure eager to

learn

meditative concerned glad I can nervous honoured other

offer support

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6. Label the baggage in the illustration below with some of the beliefs and baggage related to death,
dying, and/or grief that you carry with you. What beliefs and baggage will you need to acknowledge and
put aside when caring for dying people?

7. Review pages  to  in Chapter  of the text and identify best practices you already use. Write these
practices down in a journal or notebook. Provide examples if possible. Consider a personal encounter
you had with someone who interacted with you and demonstrated one or more of these practices.
Reflect on your thoughts and feelings during this experience in the space below.

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8. Recall a time when someone shared a painful experience with you and you wanted to help “fix” the
problem. What part of your response suggests that you were in the Fix-It Trap?

9. Answer the reflective questions, listed on page  in the text, under the heading “Strategies for address-
ing systemic bias and racism.”

Solidifying Concepts
10. Provide definitions for the following terms:

a. Culture

b. Cultural safety

c. Cultural humility

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d. Cultural sensitivity

e. Cultural awareness

f. Cultural protocols

11. As discussed in the “Maintaining Therapeutic Boundaries” section on pages  to  in the text, therapeutic
boundaries are necessary when providing care. Maintaining therapeutic boundaries is not always easy.

a. How might you know if you are not maintaining boundaries?

i.

ii.

iii.

b. What steps can you take to establish therapeutic boundaries?

i.

ii.

iii.

12. Review page  in the text and provide examples of four common roadblocks to communication.

a.

b.

c.

d.

13. Describe when a trauma-informed approach to care is important. What are the steps to integrating a
trauma-informed approach into your practice?

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14. Identify whether the following statements express sympathy or empathy (circle your answer):

I feel so sorry for you. Sympathy Empathy

I hope you feel better soon. Sympathy Empathy
I can hear the sadness in your voice even on the telephone.
Sympathy Empathy
I am here for you if you want to talk about it.
I feel so badly that your mother died. Sympathy Empathy
It sounds like you are overwhelmed with things to do.
Sympathy Empathy
How can I help?

15. As a PSW, you help to address the needs of the person and/or their family. Below, circle the activities that
PSWs can and should be involved in.

a. Offer information brochures to the family to clarify services available in your facility.

b. Share your concerns and observations about the person’s level of comfort at their care conference.

c. Suggest that the family write a list of their concerns, questions, and goals of care to share with the
nurse or physician.

d. Advise the family to increase the person’s pain medication.

Integrating into Practice

16. In pairs or small groups, discuss the following:

a. Similarities and differences between your definitions of self-awareness

b. Experiences you have had related to death, dying, and/or grief

c. Feelings you have about working with people who are dying

d. The concept of baggage that you carry and the need to put baggage aside to care for others

17. In small groups, describe ways to incorporate the Indigenous Wellness Framework as you are providing
care.

18. A vision board is a visualization tool which refers to a board (poster board, cardboard and so on) of any
sort used to build a collage of words and pictures that represent your goals and dreams. Create a vision
board identifying best practice interactions. For each best practice, identify the skills or behaviours that
are already a part of who you are and what you bring naturally to the work. Next, identify best practice
skills that you are interested in developing. Work with a colleague or mentor to identify how you can
develop those interactions that are not part of who you are into your practice.

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19. In small groups, discuss the story about the homeless woman on page  in the text. Think about and
share an experience you had when you judged someone. Describe the feeling you had about the
person. Did your attitude toward them change when you learned more about them? If so, how did it
change? What strategies can you use to help you learn not to judge or label people?

20. Work in pairs or small groups to explore one of the Truth and Reconciliation Commission of Canada’s
Calls to Action identified for health care, summarized on pp. – of the text. Identify ways PSWs can act
on that specific call to action in your community. Share your findings with the larger group.

21. Work in pairs. In the role play described below, one participant will be Person A and the other will be
Person B.

a. Person A talks about a concern or a problem that they have. For example, “I am worried about the
exam next week” or “My mom is sick and she may have cancer. My dad is also not well.”

b. Person B will respond with a roadblock to communication (see page  in the text).

c. Person A will consider their internal reaction to this type of response.

d. Person B will consider how it felt to reply with a roadblock and observe the effect it had on Person A.

e. Reverse your roles and observe your responses to roadblocks.

f. Reverse the roles again, but this time ask open-ended questions. Consider how it felt to ask these
questions, and how it felt to be asked a question that helped to stimulate thinking, rather than a
roadblock.

g. Discuss your experiences in both roles and compare your feelings when faced with a roadblock
versus being asked an open-ended question. Work with your partner to create a list of open-ended
questions that encourage communication.

22. It is important that PSWs share information with the team about the person’s preferences and goals of
care. Reflect on what you would want your family and the team to know about you if they were caring
for you when you were dying.

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23. Create your own list of characteristics of what would be a good death and a bad death for you.

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During class or with a partner, compare lists and answer these questions:

a. What characteristics on another person’s list surprised you and why?

b. How might you adapt care to help meet individual preferences?

24. Refer to the “Dignity Question” on page  in the text. Then imagine that you are dying. What does the
team need to know about you to give you the best care possible?

25. Reflect on the concept of Two-Eyed Seeing on pages  and  of the text. In the large group, discuss
your thoughts about the concept and share ideas on how to integrate this concept into your practice.

26. Systemic bias and racism are present in the health care system.

Option : Work in groups to identify people who experience systemic bias and racism in your area. Brain-
storm with the group to create a list of practical strategies for combatting systemic bias and racism in
your college, workplace, or community. Create a mind map that illustrates your strategies, and share
with the larger group.

Option . Discuss in small groups the unique personal, family, community, and cultural needs that some-
one will learn when caring for you and your family.

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Using Standardized Tools 3

Understanding Your Beliefs and Baggage
1. As a PSW you are a member of the interdisciplinary team. You observe, gather information from the per-
son and the family, and, when needed and as appropriate, you discuss with the team issues that affect
the person’s quality of life. You collaborate to develop or update the care plan. Reflect on how you feel
about collaborating with the team. Write about two strategies you believe will help you to feel more
confident in collaborating with the team.

Solidifying Concepts
2. Caregivers in many countries and in many settings use the Palliative Performance Scale (PPS) to identify
the person’s current level of functioning and needs, changes, and the need to adapt the care plan. What
five things are measured on the scale?

a.

b.

c.

d.

e.

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3. Using words from the PPS, describe a person whose PPS is %

4. Using words from the PPS, describe a person whose PPS is %.

5a. Consider the CSHA Clinical Frailty Scale for the following questions. What does it mean when a person’s
frailty value from the CSHA Clinical Frailty Scale increases?

5b. What might be beneficial for a person when their frailty value is between  and ?

6. When should you use the Symptom Framework for PSWs?

7. The PAINAD Scale is able to identify if the person is experiencing pain, but is not able to identify the
__________________________ of the pain.

8. The Psychosocial Assessment Tool helps to identify psychosocial, spiritual, and cultural values and prac-
tices of a person. One of the roles of the PSW is to be open and sensitive to values and practices that are
different from their own. Reflect on best practice interactions, and which interactions might help you to
provide support and space for rituals and practices different from yours.

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Integrating into Practice

9. Consider the following case. Use the SBAR Communication Tool on page  to record information
about this person, and then write out what you would report in the space titled “Report.”

Eileen is a -year-old woman living in her home. She has chronic obstructive pulmonary disease.
She receives oxygen through a nasal canula and receives opioids daily to manage her breathlessness.
You visit to provide personal care and help her with breakfast.

This morning when you arrived to help her get out of bed, she was frowning and moaning, and she
shook her head and said, “No, not today. I’m staying in bed!” You responded, “You are not your usual
self. What is happening?” She replied, “My tummy is hurting. I don’t want to get up.” She suddenly
pressed her hands to her midsection, called out in pain, groaned loudly, and rolled onto her side. You
asked if a pillow behind her back and between her legs would help make her a bit more comfortable,
and when she agreed, you positioned the pillows. Eileen gave you permission to ask her some more
questions and talk with the nurse.

She said that the pain in her tummy started this morning. You asked her to point to where it hurts,
and she rubbed her hand up and down and back and forth over her abdomen. You asked her to de-
scribe the pain, and she replied, “The spasms come and go.” You asked her to rate her pain on a scale
of  to , with  being the most severe pain that she can imagine and  being no pain. She said that
when it is bad it is an  out of , and when it is not bad her abdomen is just tender. She was not able
to say how often the pain comes and goes. She thought it may be caused by eating too much dinner.
She also did not remember when she had her last bowel movement. She was short of breath as she
responded to the questions. You asked how you can best help, and she said she doesn’t know, but
that she needs something done because the pain is awful. You told her that you will get her some
water and will phone the nurse to let her know about the pain, and to ask if she can see Eileen today.

Report

10. Work in small groups. Each small group practices using one tool and takes notes about the experience
of using the tool, being the person who the tool is gathering information about, and the questions that
arose while using the tool. The group then reports back on their findings to the larger group.

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S SITUATION
My name is ___________________________.
I need to talk with you about ___________________________.
Person’s name
Concern is a
❑ Change in person’s condition
❑ Ongoing issue
❑ Safety issue
❑ Family issue
Is it a good time to talk now? When?

B BACKGROUND
They are experiencing [insert symptoms] _______________________________________________
Relevant information (Include observations from PPS)

A ASSESSMENT
Symptom
(Record information gathered with the Symptom Framework for PSWs)
Onset
Provoking/Palliating
Quality
Region/Radiating
Severity
Treatment
Understanding
Values
What else?
Other concerns:

R REQUEST/RECOMMENDATION
Can you come and see ___________________________?
What do you recommend that I do now?
What is the plan moving forward?

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Supporting Physical Comfort 4

Understanding Your Beliefs and Baggage
1. Reflect on your experiences of pain and on your family’s experiences of pain. Consider your beliefs about
pain management. Did you grow up in a home in which family members were comfortable with using
medications to manage pain, or do you come from a home in which family members opposed the use
of medications? Reflect on and write about this.

2. Reflect on your beliefs about opioids and the use of opioids for managing symptoms. Identify any be-
liefs, values, or biases that you may hold that will influence how you feel about the person you are caring
for receiving opioids.

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3. Consider a time when you were ill or experiencing pain. Reflect on what might have helped you to feel
more comfortable. What would you like someone to have in their comfort basket if that person were
caring for you?

Solidifying Concepts
4. Circle the principles that guide the health care team in supporting physical comfort.

a. Focus on the person’s goals of care.

b. Individualize comfort measures to meet the needs of the person.

c. Use medications to manage symptoms only when death is imminent.

d. Monitor, record, and report the person’s responses to medications and other comfort measures.

e. Provide information and education to help the person and family understand symptom manage-
ment.

5. Circle the principles that guide the team in making decisions about administration of medications for
symptom management.

a. The team determines the goal for pain relief.

b. Medications should be given only after pain occurs, not on a regular schedule.

c. Breakthrough doses are used when a symptom recurs between regularly scheduled doses.

d. A combination of medications may be necessary to control a symptom and side effects.

e. Side effects and fears or concerns about medications should be recorded and reported.

f. Comfort measures may help improve comfort.

6. Opioids are commonly used to help manage pain and difficulty breathing.

True False (circle your answer)

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7. These are the four most common side effects of opioids (circle your answer):

a. Nausea/vomiting, drowsiness, addiction, confusion

b. Nausea/vomiting, drowsiness, confusion, insomnia

c. Constipation, addiction, nausea/vomiting, confusion

d. Nausea/vomiting, constipation, drowsiness, confusion

8. Describe each of the four common fears and misunderstandings about using opioids for symptom
management.

a.

b.

c.

d.

9. Why is it important to provide medications for symptom management regularly, around the clock?

10. The most common concerns people have about using opioids are constipation and addiction.

True False (circle your answer)

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11. What would be the consequences of not providing medications (e.g., opioids) regularly for a person
experiencing pain?

12. Traditional healing and medicines benefit the person spiritually, emotionally, and culturally. How can
you prepare so that a person feels comfortable requesting and accessing traditional medicine and heal-
ing practices?

a.

b.

c.

d.

e.

13. List the reasons why a person might benefit from the inclusion of complementary and alternative ther-
apies in their care.

a.

b.

c.

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Integrating into Practice

Anorexia and Cachexia

14. Read “Profound Truths of Nutrition” on page  in the text. Explain these truths in your own words as if
you were talking with a member of your own family.

15. A dying person often loses weight and loses interest in eating. Refer to the story about Yetta’s experience
on page  in the text.

a. What did Yetta do to address her lack of appetite?

b. Identify five things that you as a PSW could have done to help Yetta and her family adjust to her
decrease in appetite.

i.

ii.

iii.

iv.

v.

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16. What can you and the team do to support the family of a person experiencing anorexia and cachexia?

Changes in Bowel and Bladder Function

17. List two strategies to help prevent constipation.

a.

b.

18. Use pages  to  of the text to complete the table below.

What you might ask a

What you might observe Comfort measures
dying person to better Ways to support family
if a person is constipated that might be helpful
understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

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Dehydration
19. Read pages  to  in the text to complete the table below.

What you might ask a

What you might observe Comfort measures
dying person to better Ways to support family
if a person is dehydrated that might be helpful
understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

Delirium
20.
Mrs. Marsh is a resident at your facility. You are called by Mrs. Marsh’s daughter, who is concerned
about her mother’s recent behaviour changes, including pacing, confusion, inability to carry on a
conversation, and refusing to take medication.

Complete the table below using the case provided and information from pages  to  of the text.

What you might ask a

What you might observe Comfort measures
dying person to better Ways to support family
if a person has delirium that might be helpful
understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

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21. Indicate in the following table the differences between dementia and delirium.

Delirium Dementia

Causes

Time frame of onset

Brain changes—permanent
or reversible?

Caused by body changes

(yes/no)

Presence of anxiety, fear, or

paranoia

22.
You are providing care for an Indigenous person in their home in an isolated community. There is
no physician or nurse available to visit. The health care team supports you through phone calls.
The person is experiencing delirium. You know that the family wants to keep their loved one in the
community and does not want to transfer them to the hospital, which is a four hours drive away.
You need to call the nurse or physician to update them on the changes, and to develop a care plan
that will meet the needs and the goals of the person, family, and community members who are
caring for the person. You know that you need to gather information by observing and interacting
with the person. You also know that you will need to talk with the family and the community
members who are involved to understand their needs and their desire to keep the person at home.

What tools can you use to help you as you prepare to talk with the health care team and develop a care
plan that meets the needs and goals of the person, family and community?

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Depression
23. What are the risk factors for developing depression among people living with life-limiting illness?

24. What are the primary risk factors for developing depression?

a.

b.

c.

d.

e.

25. Complete the table below using information from pages  and  of the text.

What you might What you might ask a

Comfort measures
observe if a person dying person to better Ways to support family
that might be helpful
has depression understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

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Difficult Breathing
26. Complete the exercise below to experience difficult breathing (dyspnea).

Dyspnea Exercise
Materials: A drinking straw
Location: A place with room to walk
Note: People with respiratory or heart problems should not participate in this exercise.

Exercise
a. Pinch your nostrils to cut off airflow through them.
b. Place the straw in your mouth and begin breathing through it.
c. Walk around for two minutes.
d. At the end of two minutes, remove the straw from your mouth and stop plugging your
nose. Take a moment to allow your breathing and sensations to return to normal.

You have just experienced sensations similar to those that people with dyspnea have.

Answer the following questions:

a. What did the experience feel like? Describe it.

b. What were your thoughts as the exercise progressed?

c. How do feel you would respond if that sensation happened to you suddenly? What would you think
was happening?

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27. Complete the table below using pages  to  of the text.

What you might observe What you might ask a

How you might prevent Comfort measures
if a person has difficulty dying person to better
difficulty with breathing that might be helpful
with breathing understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

Fatigue
28. If the person you are caring for has a PPS of % and is very fatigued, what comfort strategies can you
suggest that might help them have the energy to accomplish their priority activities? Complete the
table below using pages  to  of the text.

What you might ask a dying person Comfort measures that

How you might prevent fatigue
to better understand their needs might be helpful
1. 1. 1.

2. 2. 2.

3. 3. 3.

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Mouth Discomfort
29. Complete the table below with information from pages  to  of the text.

What you might observe if What you might ask a dying person Comfort measures that
a person has a dry mouth to better understand their needs might be helpful
1. 1. 1.

2. 2. 2.

3. 3. 3.

Nausea and Vomiting

30. Consider this scenario.

She was crying on the bed when I entered her room.

She said, “I’m so tired of this nausea; I wish I could just die.”

I sat with her and held her hand. It was the only way I thought I could be helpful at that moment.

When she was less distressed, we talked. I used the Symptom Framework for PSWs to better under-
stand what was happening, and then I phoned the nurse to report.

a. Remember a time when you or a friend or family member were nauseated. Using the Symptom
Framework for PSWs adapted for nausea and vomiting on page , consider possible answers that
a nauseous person might give you when you ask the questions. Write what you “heard” as though
you were recording for a person experiencing nausea.

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Symptom Framework adapted for nausea and vomiting

When did the symptom begin?

Is this new, or has this happened before?
Did it start suddenly or slowly?
O Onset

What makes the symptom feel better? Worse?

P Provoking/Palliating

Can you describe the discomfort? How does this symptom affect you?

Q Quality

Where are you feeling the symptom?

R Region/Radiating

How severe is the symptom?

 = no symptom and  = the worst imaginable
Small, medium, large
S Severity
Mild, moderate, severe

What do you think might be helpful?

T Treatment

What do you think might be happening?

U Understanding

What are your goals for the symptom?

V Values

What else do you want me to know or do?

For the PSW: Consider your knowledge of this person—what do you see?
What do you believe would be helpful?

W What else?

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b. Using the SBAR Communication Tool and the notes you wrote about the previous scenario, write out
the verbal report you would provide to the nurse.

S SITUATION
My name is ___________________________.
I need to talk with you about ___________________________.
Person’s name
Concern is a
❑ Change in person’s condition
❑ Ongoing issue
❑ Safety issue
❑ Family issue
Is it a good time to talk now? When?

B BACKGROUND
They are experiencing nausea and vomiting.
Relevant information (Include observations from PPS)

A ASSESSMENT
Symptom
(Record information gathered with the Symptom Framework for PSWs)
Onset
Provoking/Palliating
Quality
Region/Radiating
Severity
Treatment
Understanding
Values
What else?
Other concerns:

R REQUEST/RECOMMENDATION
Can you come and see ___________________________?
What do you recommend that I do now?
What is the plan moving forward?

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Pain
31. Role-Play Exercises: Parts A and B

There are three roles in each part of the role-play exercises:

• Role of the PSW, who gathers, records, and reports information

• Role of the person who is in pain

• Role of the nurse to whom the PSW reports (ideally the instructor plays this role)

In each role-play exercise, the PSW gathers information from the person who is experiencing pain, using
the information provided below for that role. After completing Exercise A, the participants playing the
role of the PSW and the person in pain switch roles and complete Exercise B. The participant playing the
nurse, preferably the instructor if available, does so in both exercises.

Marking sheets for the instructor are provided on pages  and  at the end of this workbook. The
participants playing the roles of the PSW and the person in pain may find that the marking sheets will
help them in playing their part.

For Role-Play Exercise A, the PSW role starts below and Mr. J’s role appears on page .

Role-Play Exercise A: PSW Role

Mr. J is  years old. He has prostate cancer and is dying. He lives alone. You visit Mr. J in his home daily
to assist him with personal care, remind him to take his medications, and set out a meal.

Usually he is very happy to see you and he loves to talk. Today he acknowledges your arrival but only
mutters a response when you greet him. His dinner plate from last night is on the table, and the food
was not eaten. When you ask him how he is, he says he did not sleep last night, is in pain, and can
hardly move because his left hip is so sore. He says he is tired of being sick. When you suggest a bath,
he says that there is no way that he can even get to the bathroom.

You realize Mr. J’s condition has changed and that you need to record your observations of his pain,
report to the nurse, and ask the nurse for help to develop a new plan for his care today. You remember
that you can use the System Framework for PSWs adapted for pain to gather information. You proceed
to gather information from Mr. J.

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Mr. J. is able to answer all of your questions. Complete the following:

a. Gather information about Mr. J’s pain using the Symptom Framework for PSWs on page .

b. Record your observations in Mr. J’s “chart” (below).

c. Use the SBAR on page  to prepare an oral report. Deliver the oral report to the nurse.

d. Discuss what you learned in this exercise with your role-play partner.

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Symptom Framework for PSWs adapted for pain

When did the pain begin?

Is this new, or has this happened before?
Did it start suddenly or slowly?
O Onset

What makes the pain feel better? Worse?

P Provoking/Palliating

Can you describe the discomfort? How does this symptom affect you?

Q Quality

Where are you feeling the pain?

R Region/Radiating

How severe is the pain?

 = no symptom and  = the worst imaginable
Small, medium, large
S Severity
Mild, moderate, severe

What do you think might be helpful?

T Treatment

What do you think might be happening?

U Understanding

What are your goals for your pain?

V Values

What else do you want me to know or do?

For the PSW: Consider your knowledge of this person—what do you see?
What do you believe would be helpful?

W What else?

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S SITUATION
My name is ___________________________.
I need to talk with you about ___________________________.
Person’s name
Concern is a
❑ Change in person’s condition
❑ Ongoing issue
❑ Safety issue
❑ Family issue
Is it a good time to talk now? When?

B BACKGROUND
They are experiencing pain.
Relevant information (Include observations from PPS)

A ASSESSMENT
Symptom
(Record information gathered with the Symptom Framework for PSWs)
Onset
Provoking/Palliating
Quality
Region/Radiating
Severity
Treatment
Understanding
Values
What else?
Other concerns:

R REQUEST/RECOMMENDATION
Can you come and see ___________________________?
What do you recommend that I do now?
What is the plan moving forward?

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Role-Play Exercise A: Mr. J’s Role

A PSW comes to see you every day. Today you are particularly pleased to see the PSW because you are
really in a lot of pain and need help.

When the PSW asks you about your pain, you provide information as described below.

Do not volunteer information unless the PSW asks you for it.

The pain started yesterday, after you fell on the way to the kitchen. The neighbour was there and
helped you back to bed. You figure that you hurt your hip when you fell; it has been aching ever since.
The aching will not stop. It is the worst pain you have had since getting sick and is almost as bad as
when you broke your leg  years ago.

The medications that you take five times a day help you feel a bit better but only for an hour or so. Your
neighbour gave you a cold pack, but you can’t get out of bed to get it. Rubbing your hip helps a bit.

Rating your pain, you figure it is a  out of  on a scale of  to , on which  is no pain and  is the
worst pain you can imagine. You couldn’t sleep last night and feel exhausted. You are miserable and
just want some help.

You are so glad that the PSW came and is so helpful.

Role-Play Exercise B: PSW Role

Mr. K has lived on the unit where you work for two years. He is  years old and has osteoporosis and a
history of multiple fractures. Mr. K. is cognitively able and alert but is very frail and slow moving.

Today when you help him get up he is really hesitant to move and gets out of bed very carefully. When
you comment on his slow movements and his apparent stiffness, he says that he is in pain and that
he can hardly move because his back is so sore. He says he did not sleep much last night. He is willing
to get up to sit in the chair by the bed but does not want to go to the dining room for breakfast. He is
very worried about his back.

You realize Mr. K’s condition has changed and that you need to record your observations of his pain,
report to the nurse, and ask the nurse for help to develop a new plan for his care today. You remember
that you can use the System Framework for PSWs adapted for pain to gather information. You proceed
to gather information from Mr. K.

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Mr. K. is able to answer all of your questions. Complete the following:

a. Gather information about Mr. K’s pain using the Symptom Framework for PSWs on page .

b. Record your observations in Mr. K’s “chart” (below).

c. Use the SBAR on page  to prepare an oral report. Deliver the oral report to the nurse.

d. Discuss what you learned in this exercise with your role-play partner.

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Symptom Framework for PSWs adapted for pain

When did the pain begin?

Is this new, or has this happened before?
Did it start suddenly or slowly?
O Onset

What makes the pain feel better? Worse?

P Provoking/Palliating

Can you describe the discomfort? How does this symptom affect you?

Q Quality

Where are you feeling the pain?

R Region/Radiating

How severe is the pain?

 = no symptom and  = the worst imaginable
Small, medium, large
S Severity
Mild, moderate, severe

What do you think might be helpful?

T Treatment

What do you think might be happening?

U Understanding

What are your goals for your pain?

V Values

What else do you want me to know or do?

For the PSW: Consider your knowledge of this person—what do you see?
What do you believe would be helpful?

W What else?

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S SITUATION
My name is ___________________________.
I need to talk with you about ___________________________.
Person’s name
Concern is a
❑ Change in person’s condition
❑ Ongoing issue
❑ Safety issue
❑ Family issue
Is it a good time to talk now? When?

B BACKGROUND
They are experiencing pain.
Relevant information (Include observations from PPS)

A ASSESSMENT
Symptom
(Record information gathered with the Symptom Framework for PSWs)
Onset
Provoking/Palliating
Quality
Region/Radiating
Severity
Treatment
Understanding
Values
What else?
Other concerns:

R REQUEST/RECOMMENDATION
Can you come and see ___________________________?
What do you recommend that I do now?
What is the plan moving forward?

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Role-Play Exercise B: Mr. K’s Role

Your PSW comes to help you get out of bed today. You wish the PSW would take care of everyone else
first, because you are so sore! Your back hurts worse than it has for ages!

When the PSW asks you questions about your pain, provide the information as described below.

Do not volunteer information unless the PSW asks you for it.

The pain really increased during the night. You don’t know what happened to cause it to get so bad.
You are worried that you have another fracture. You hope the doctor will come see you and check it
out.

The pain is worse than the other pains you have had before. This one is terrible! In fact, if they ask you
to rate the pain, you might even say this pain rates  out of  on a scale of  to , on which  is no
pain and  is the worst pain you can imagine. It hurts in your upper and lower back, and the sharp and
shooting pain goes down your legs.

You take only the regular medications that the nurse gives you every morning and at lunch and
suppertime.

You wish your wife were alive, because she would help you by giving you a warm flannel blanket. You
wish you could just stay in bed and not get up, and you definitely do not want to go to breakfast.

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32. Refer to the story about Annette on page  in the text.

a. How did the PSW identify Annette’s pain?

b. What did the PSW do to help address Annette’s pain?

c. Write a verbal report to share information with the nurse about Annette.

d. Follow-up after giving medication is as important as the original charting to report pain. Write a
sample chart entry following up on Annette.

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Providing Psychosocial Care 5

Understanding Your Beliefs and Baggage
1. This exercise is designed to help you understand the importance of helping people with life-limiting
illnesses determine their priorities and maintain their choices.

a. In the large box below, list the things that are important to you in your life (e.g., people, activities,
events, foods).

b. In the medium-sized box, write about what you would do if you had only three months to live.

c. In the small circle, write about what you would do if you had only three days to live.

Note: If you are feeling vulnerable and think that this exercise will be too much for you, work with a col-
league or the instructor to adapt this activity to meet your needs. If this exercise triggers strong responses,
consider debriefing with a colleague or the instructor.

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Now think about your responses to the exercise and do some reflective writing guided by the questions
below:

d. What were your feelings as you wrote in the large box? The medium box? The small circle? What
thoughts do you associate with these feelings?

e. Write about your decision-making process for what to write in the shapes. How did the items differ as
you moved to smaller shapes? How did you decide what to include in the small circle?

f. How would you feel if you were not able or not allowed to do what you identified in the circle? Con-
sider how dying during the COVID- pandemic affected the ability of the person to do what they
wanted in their last weeks and days and hours. If you had been dying and unable to see family or
friends in the last days, how would that be for you? What might have been helpful?

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2. Reflect on this story and answer the questions below it.

You have been assisting a person with their personal care regularly for several months. You have
become very fond of them and their partner and enjoy providing care. When you arrive today, the
partner informs you that the person has decided not to continue with kidney dialysis. The doctors
suggest that without dialysis they might have a few weeks to live. You realize that this will shorten
their life significantly.

a. What feelings, thoughts, and questions might you have?

b. With whom is it appropriate to discuss your questions and feelings?

c. If you do not agree with the person’s choice to discontinue dialysis, what best practice interactions
can help you withhold judgment and show respect?

d. What might you say to or do for the person and the partner to show compassion?

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Solidifying Concepts
3. Describe why psychosocial care is considered holistic.

4. Describe what you can do to support a person through transitions when their disease is advancing and
the person has been told that a cure is not possible.

5. Identify four key points about dying with dementia.

a.

b.

c.

d.

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6.
You are caring for a person whose culture is different from yours. The person has just been ad-
mitted to your facility. The person’s health has declined recently and they are dying imminently.
The team needs to talk with the family to provide an update and prepare them for the person’s
imminent death.

What principles of providing culturally safe care will help you and the team share information in a most
helpful and supportive way?

7. As a PSW you support a person’s psychosocial needs when you:

a.

b.

c.

d.

e.

8. List three formal assessment processes that the physician, nurse and social worker might use to gather
information about a person’s values, beliefs and preferences for care.

a.

b.

c.

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9. Identify eight ways that PSWs can support advance care planning.

a.

b.

c.

d.

e.

f.

g.

h.

10. As a PSW you can sign legal documents including wills, legal forms, and contracts.

True False (circle your answer)

11. Write five things you learned about grief that you did not know before reading the text.

a.

b.

c.

d.

e.

12. Describe ways to support children whose loved one is dying.

a.

b.

c.

d.

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Integrating into Practice

13. Complete the exercise below to learn about your personal responses to loss.

Multiple Losses Exercise

On each of six pieces of paper, write down one activity that you enjoy (writ-
ing lightly with the pencil will decrease the chance of the writing being
legible from the reverse side of the paper when it is turned over). Lay the
papers writing side down on the table in front of you. Shuffle them around
such that you no longer know which is which. Line them up in a row.

Turn over the middle two pieces of paper and imagine that because of
declining health you are no longer able to do these activities. What is your
immediate response to having these two activities removed from your life?
What do you feel? What do you think?

Resist the urge to change an activity that you lost to a different one. This exercise is designed to help
you imagine the multiple losses that dying people experience.

Now imagine it is two weeks later and the doctor tells you that you should no longer do two more of
the activities. What do you feel about these new losses? Do you feel better knowing that you still have
two activities left?

Now imagine that you wake one morning a month later and are unable to do the remaining two ac-
tivities. What do you feel? What do you want to do or say?

Discuss your experience with a colleague.

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14. In small groups, discuss ways to support a person’s relationships with their family and community. In-
clude options for a person who is not able to be with their home community, family or culture.

15. Review pages  to  in the text about grief being a whole-person experience.

a. Mark the illustration below using words, colours, and shapes to indicate how you experience grief
and how it affects you physically, emotionally, spiritually, and socially.

b. Reflect on how grief is a whole person experience.

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c. Think about a friend or family member who has experienced loss and grief in their life. Use the illus-
tration below to create a picture of grief as you saw your friend or family member experience it.

16. Reflect on the ways to support a grieving person (pages  to ). In small groups, discuss support
strategies you would be comfortable providing, and brainstorm ways to become comfortable with strat-
egies that you feel uncomfortable with.

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17. Complete the reflective activity on Medical Assistance in Dying (MAID) on page . Then work in pairs
or small groups to share your experiences. Acknowledge the different views of your colleagues. Identify
follow-up actions for yourself.

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Caring in the Last Days and Hours 6

Understanding Your Beliefs and Baggage
1. Reflect on and write about your feelings regarding caring for someone in their last days and hours and at
the time of death. Compare this reflection to the feelings you identified, in exercise  and  in Chapter 
of this workbook, about working with people who are dying. Your feelings today may be similar to those
you identified before or may have changed.

2. PSWs often provide care for a person’s body after death has occurred. For some people this is a sacred
ritual; others are not comfortable doing this. Reflect on how you feel about caring for the body after
death. If you feel uncomfortable, consider asking a colleague or supervisor to mentor you and help you
become more comfortable. You may want to ask for additional opportunities at work to gain experience
providing care for the body. Reflect on and write about caring for the body after death.

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Solidifying Concepts
3. Refer to pages  to  in the text and complete the following chart.

Physical changes in the Comfort measures for

Comfort measures for the family
last days and hours the dying person

Decreased physical
strength and increased
drowsiness

Reduced intake and

difficulty swallowing

Delirium or confusion

Agitation or restlessness

Unresponsiveness

Irregular breathing

Congested breathing

Changes in skin colour

and temperature

Dry eyes

Decreased urinary
output

Bowel or bladder
incontinence

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4. Identify three things the team can do to prepare to provide best care in the last days and hours.

a.

b.

c.

5. The family asks you, “What changes can I expect in the last days and hours?” What are four appropriate
ways for you as a PSW to respond?

a.

b.

c.

d.

6. What physical changes in a person suggest that death is very close?

7. You enter a person’s room and notice that the person is not breathing. Create a list of tasks to complete
if this occurred in a home setting and in a long-term care facility.

Care of the body Ways to support family

Home setting Long-term care facility At all locations
a. a. a.

b. b. b.

c. c. c.

d. d. d.

e. e. e.

f. f. f.

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8. It is always important to know what a person’s DNR status is before entering their home.

True False (circle your answer)

Explain your answer.

9. Describe four ways you can support the family after the death of their loved one.

a.

b.

c.

d.

10. List three ways you can you show respect and support for people whose cultural traditions or spiritual
practices are different from yours.

a.

b.

c.

11. Review page  in the text and fill in the blanks in the paragraph below.

When a person’s death is sudden, unexpected, or occurs within  hours of admission to a hospital, the

coroner is notified. The role of the coroner is to confirm the _______________________ of the person

who died and the probable _______________________ and _______________________ of death.

The coroner classifies the death as natural, accidental, suicide, homicide, or undetermined.

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Integrating into Practice

12. Describe two reasons why it is important to explore the family’s understanding when they are asking
how long the person might live.

a.

b.

13. Discuss the topics below in small groups or with a colleague.

a. Supporting a family whose traditions and practices in caring for the body after death are different
from what you know

b. Ways to support the family when they participate in a cultural practice that does not have meaning
for you or seems unnecessary

14. Reflect on the following scenario:

You have been providing care for an Indigenous person (or a person from a culture different from
yours) for almost seven months, and they are nearing their last days and hours. Because the family
knows you and is comfortable with you, they ask you to find space for rituals and traditional cere-
monies, and for many members of the community to meet as the person dies and after death.

In small groups, discuss how you would respond to this request in a culturally safe manner. Consider
different care locations (e.g., long-term care, acute care, hospice, home), and brainstorm ways to create
space and privacy in these locations for the person, their family, and their community as they provide rit-
uals and ceremonies for their dying loved one. If you do not have personal experience in these locations,
ask your instructor to provide a brief overview of the different caregiving spaces in your community.

Meet with the larger group and share your ideas for providing space.

15. When you are at work or during a practicum, refer to the agency’s or facility’s policy and procedures
manual and look up care of the body following death.

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Caring for You! 7

Just as the team needs to individualize care to meet the needs of dying people they care for, each member
of the team needs to personalize self-care strategies.

1. List, mind map, or draw activities that help you to refuel and re-energize.

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2. Reflect on the term “self-care.” Write freely for five minutes about the topic of self-care. What did you
learn? Where did your reflections take you?

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3. Review the information about compassion fatigue in Chapter  of the text.

a. Write freely for five minutes about compassion fatigue.

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b. Review the chart on pages  and  in the text. What zone are you in?

Red Green Yellow (circle your answer)

c. Respond to the reflection questions in the table on Compassion Fatigue that relate to the zone you
are in.

4. Drawing upon the information on pages  to  of the text, create a maintenance self-care plan using
the strategies from each of the categories.

After completing your maintenance self-care plan, meet in pairs or small groups and discuss your self-
care plans. Be open to feedback and provide constructive support to your colleagues.

Consider how you will know if your maintenance self-care plan is working for you. When would you
want to evaluate this plan and assess its successes? Reflect on whether you are open to trying new strat-
egies if the chosen strategies are not working well. Consider arranging a time to meet with your group
in the future to check in with one another about self-care, and to evaluate and adjust your self-care plans
as needed.

5. Create an emergency self-care plan. Share this plan with a colleague, describing why the strategies in
your plan will be most useful for you in an emergency or crisis situation.

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6. Education is one of the finest forms of self-care! The books, movies, and websites listed below are about
dying, death, palliative care, and caregiving. They were chosen because they are classics, thought-pro-
voking, or just plain good.

a. Circle titles that interest you.

Albom, M. Tuesdays with Morrie: An Old Man, a Young Man, and Life’s Greatest Lesson. New York:
Random House, .

Buckman, R. I Don’t Know What to Say: How to Help and Support Someone Who Is Dying. Toronto: Key
Porter Books, .

Callanan, M., and P. Kelley. Final Gifts: Understanding the Special Awareness, Needs, and Communica-
tions of the Dying. Toronto: Bantam Books, .

Joseph, E. In the Slender Margin: The Intimate Strangeness of Dying. Toronto: HarperCollins, . (This
book is a journey into the land of death and dying seen through the lens of art and the imagination.)

Mathieu, F. The Compassion Fatigue Workbook. New York: Routledge, .

O’Rourke, M., and E. Dufour. Embracing the End of Life: Help for Those Who Accompany the Dying.
Toronto: Novalis, .

Schwalbe, W. The End of Your Life Book Club. New York: First Vintage Books, .

b. Circle movies that you want to see.

A Story about Care (-minute video, available on Vimeo at http://vimeo.com/, or Canadian

Virtual Hospice, www.virtualhospice.ca).

Empathy: The Human Connection to Patient Care

(-minute video, available on YouTube at http://youtu.be/cDDWvj_q-o)

The Bucket List (), Jack Nicholson, Morgan Freeman. Two terminally ill men who meet as patients
in a hospital head off with a list of things they want to do before they die.

Wit (), Emma Thompson. A professor reassesses her life when she finds out she has terminal
ovarian cancer.

Five People You Meet in Heaven (), Jon Voight, Ellen Burstyn and Jeff Daniels. Eddie is an
-year-old war vet working as a maintenance man in an amusement park. When he dies while sav-
ing a young girl in harm’s way from a falling ride, he enters the afterlife and meets five people who
will explain the meaning of his life.

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c. Circle websites that you want to explore.

Canadian Hospice Palliative Care Association, www.chpca.net

Canadian Virtual Hospice, www.virtualhospice.ca

Life and Death Matters, www.lifeanddeathmatters.ca

Speak Up: Advance Care Planning in Canada, www.advancecareplanning.ca

The Way Forward: An Integrated Palliative Approach to Care, www.hpcintegration.ca

Your provincial hospice palliative care association

Health Canada: Framework on Palliative Care in Canada,

https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications
/palliative-care/framework-palliative-care-canada.html

Ontario Palliative Care Network, Palliative care competencies for PSWs in Ontario,
https://www.ontariopalliativecarenetwork.ca/en/competencyframework

British Columbia Centre for Palliative Care: Inter-professional Palliative Competency Framework:
Health-care Assistants, https://bc-cpc.ca/cpc/publications/competency-framework/

Health Canada: Medical Assistance in Dying,

https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

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Instructor’s Marking Sheet for the Role-Play Exercises on Pain*

* The group, not individual students, will be marked.

Students in group:

Exercise (circle letter): A B

Possible
Role-Play Comments
Marks

Student playing the person in pain 

Student playing the person in pain

describes it using the information 
provided
Student playing the PSW uses the

Symptom Framework for PSWs

Onset 

Provoking/Palliating 

Quality 

Region/Radiating 

Severity 

Treatment 

Understanding 

Values 

What else? 

Nurse receives a clear and complete


report from the PSW.
Record/documentation is clear, con-
cise, and accurately reflects the verbal 
report.
The reporting is free of judgments and

focuses on key information.
The students reflect on their learning
experience and how they can apply it 
in practice.

TOTAL MARKS GIVEN /21

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Instructor’s Marking Sheet for the Role-Play Exercises on Pain*

* The group, not individual students, will be marked.

Students in group:

Exercise (circle letter): A B

Possible
Role-Play Comments
Marks

Student playing the person in pain 

Student playing the person in pain

describes it using the information 
provided
Student playing the PSW uses the

Symptom Framework for PSWs

Onset 

Provoking/Palliating 

Quality 

Region/Radiating 

Severity 

Treatment 

Understanding 

Values 

What else? 

Nurse receives a clear and complete


report from the PSW.
Record/documentation is clear, con-
cise, and accurately reflects the verbal 
report.
The reporting is free of judgments and

focuses on key information.
The students reflect on their learning
experience and how they can apply it 
in practice.

TOTAL MARKS GIVEN /21

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Please feel free to email me your re昀氀ections. I so

appreciate receiving feedback and stories.

May you feel more comfortable, be more

competent, and provide excellent care for the dying
and their families. And may your work enrich and
bless your life.

Warm regards,
Kath Murray

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