Integrating A Palliative Approach

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Integrating a Palliative Approach
Lab skills PSW (Centennial College)
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Integrating a Palliative
Approach: Essentials for
Personal Support Workers
Workbook
nd
2 Edition
Course Name: Assisting the Dying Person

Student Name: Ronell Endaya

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Chapter 1 – Understanding Dying and a

Palliative Approach
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? What are the benefits of the palliative approach? Do you already
follow some of these principles?
 This is a new concept for me. The benefits of the palliative

approach are it will help you understand the needs of a dying
person and their family. Providing palliative and end-of-life care
means supporting the dying person, their family and their
community.
2. A. Identify two key changes in the way that people die differently now
than they did 100 years ago.
1. The development of hygienic methods, medications, treatments, and
rehabilitation therapies has extended the human life span and the
dying process.
2. People way of living is different from 100 years ago, now there is a lot
of chemical and substances that our body intake from our food and
medications compared to 100n years ago.
B. Considering the aging population and changes to the way people die,
what are two challenges in providing care for dying people now.
 The two challenges in providing care for dying people now are First,
they have the right to refuse to the care regardless how much they
need it. Second, family members are involved in providing care for
dying people.
3. Review the stories of different patterns of decline in Chapter 1 of the

text. Complete the table below.
Pattern of Impacts on the person Impacts on the Ways that you as a

decline family PSW can support the
person and the
family
Steady 1. They may feel too 1.challenging 1. provide person-

decline fast 2. adjust new normal centered, holistic care.
2. They may feel no every week 2. Listen, ask-reflect
time to prepare and respond.
Stuttering 1. Challenging 1. Can feel 1. Collaborate with
decline 2. Adjustment and fear ambiguous the team. Share
2. challenging observations,
discuss needs,
and advocate
when necessary

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2. Observe without
judgement.
Record
observation
Slow decline 1. natural death 1. cannot see 1. collaborate with
2. will not experience declining team, discuss
challenging health slowly needs and
crisis 2. may think advocate when
person is necessary.
close to 2. Provide holistic
death care.
Sudden death 1. no time to say 1. Forced to 1. Comfort
goodbye make 2. Support
2. unexpected death decisions
2. Unprepared
and struggle
4. Using the text, define the following terms:
a. Dementia- are life limiting illnesses that affect a person’s memory,

thinking. Behaviour, and ability to perform everyday activities.
b. End of Life- The last days and weeks of life.
c. Holistic Care- Care that considers all aspects of a person’s being. As well
as attending to physical needs, holistic care considers the psychological,
emotional, spiritual, cultural and social needs of a person and recognizes
that the person is part of the social, environmental and cultural setting of
their family and community.
d. Hospice- A residential or day service facility, a visiting program, an
inpatient unit, or a home care service providing holistic care by a team of
people from a various discipline to a person and their family when the person
is expected to die within six months. Care extends beyond the person’s
death to bereaved.
e. Palliative Care- Holistic, person-centered, supportive care available to
person with a life-limiting illness, and their family, to manage physical,
emotional, spiritual, and psychosocial symptoms associated with a life-
limiting illness and dying. Such care maybe provided at the same time as
acute curative treatments and is beneficial for people from early in the
disease process through death and bereavement.
f. Palliative approach to care- An approach that integrates principles,
practices and philosophy of palliative care into the care of a person with any
life-limiting illness, and their family, early in the disease process, across all
settings. And is provided by all members of the team.
5. List the principles of palliative care in your own words.

 Considers the dying person and family-as determined by the
dying person-to the unit care.
 May positively influence the course of illness but does not
intend to speed or delay death.

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 Acknowledges multiple cultural understandings of dying and

death.
 Support a person to live as fully as possible until death by
helping manage all symptoms and sources of distress.
 Communicate with the person and family and other members
of the team.
6. Circle the best definition: A palliative approach is:

 B. The integration of palliative care principles, practices, and
philosophy into care for people with life-limiting illnesses, early in the
disease process, across all settings.
7. People are holistic beings, which means that they have
 A. Physical, emotional and psychosocial needs
8. A. True
B. True
C. True
D. True
9. What can be learned when HCP asks the “Surprise Question”?
 It can help you remain aware of the reality that the people you are
caring for are also dying. It can gather information about changes in
the person’s health that suggest the person in higher risk of dying next
year.
10. The Interdisciplinary Team (IDT) is designed with the purpose of
supporting the health and well-being of participants in a collaborative,
structured, and person-centered way. An IDT brings together providers from
various specialties with diverse knowledge to respond to the participant’s
physical and clinical.
11. Multiple health care providers from different professional
backgrounds work together and with patients/clients, families,
caregivers and communities to deliver comprehensive health services
across care settings. Effective teamwork is a critical enabler of safe,
high-quality care and supports a patient’s ongoing relationship with
their primary care provider (a family physician or nurse practitioner)
The journey to transition to quality, team-based care with patients and
providers as equal partners means sharing and accessing resources,
events and opportunities to support everyone along the way.

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12. The palliative approach principle in Tom’s text are: Considers the
dying person and family- determined by the dying person – to the unit
care. May positively influence illness but doles not intend to speed or
delay death. Is holistic, person-centered care to help manage all
symptoms and sources of distress-physical, psychological, spiritual and
social.
13. To access a specialty palliative care provider when the team is unable to
manage symptoms is to talk to nurse or to the physician where the client can
get a palliative care provider or specialist. PSW or a family member can
provide a palliative care.
14. Addressing the following barriers to accessing and receiving palliative
care can open the doors to better quality of life for the dying person and
family.
15. Review the palliative competencies identifies for PSWs where you work,
and develop a learning plan to achieve those competencies. Discuss ways
that PSWs can participate in team meetings and collaborate in the
development of the care plans.
16. A. What is a palliative approach to care?
 An approach that integrates the principles, practices and philosophy of
palliative care into the care of a person with any life-limiting illness and
their family early in the disease process, across all setting, and is
provided by all members of the team.
B. What is palliative care?
 Holistic, person-centered, supportive care available to a person with a
life-limiting illness, and their family, to manage physical, emotional.
Spiritual and psychosocial symptoms associated with a life limiting
illness and dying. Such care maybe provided at the same time as acute
curative treatments and is beneficial for people from early in the
disease process through death and bereavement.
C. Who is on the care Team?
 The people who are on the care team are the doctors, nurses. PSW,
physiotherapist, social workers, Occupational therapist.
Chapter 2 – Preparing to Care

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1. Self-awareness is the ability to focus on yourself and how your

actions, thoughts, or emotions do or don’t align with your internal
standards.
2. A. the experienced related to death, dying, and or grief when my

grandparents passed away, my grandparent died in home, where
there are no hospitals accepting them because they are on the end
of life and the hospitals said they can’t do anything for them.
B. I receive my family support, making me understand that it really

happens and everyone will go there, that it is my grandparent time
has come. I did not expect any support that I liked to receive
because I understand that all people will go in the end of their lives.
C. The experience affects me that it makes me sad knowing that

you will not able to get the chance again to see them and accepting
the reality the sadness of losing someone you really love.
My preferences WHY
Steady Decline will be a good death as it is explaining that it is natural
for me death and the fact that as we grow
older our body get weaker to death.
Stuttering Decline is a bad death for it shows that you will be undergoing
me a health crisis or a lot sufferings as
you are fighting for any chronic
diseases slowly weakening your body
to death.
3. Dying
4. A. I will choose Steady Decline trajectory pattern for my love ones

as it is the way of a natural death, without undergoing to any health
crisis and will not get shock and for me that is that proper way to
death.
B. I don’t want something different for my love one or for myself.

Though other people saying that if they experienced death they
would like sudden death, so they will not suffer or something, but as
of what is happening today in every part of the world because of
covid-19 it leaves fear and anxiety to every people, a shock and
loneliness that giving emotional stress to a lot that leads to death.
5. Worried, Afraid, Concerned, Nervous and Other

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6. Feelings and Affected All People will

Emotions in the situation die
The beliefs and baggage that I need to acknowledge and put aside
when caring for dying people is my feelings and emotions. I need to
maintain my professionalism with the client even I got connected
attached to the person.
7. Thoughts and feelings during this experience is listening and being

silent. For me sometimes listening means everything specially for
those people who are grieving and being silent means everything
that a single word might not appropriate for them and not the right
time to talk about what happened.
8. I had a best friend way back in my country who passed away

recently because of covid-19 who messaged me that he needs help.
I wanted to help to fix and do something for him but I don’t know
and I can’t asses the problem since I am here in Canada. My
response since to cheer him up and lessen his over thinking about
the situations and give him strength to fight. It burdens me that my
response I am in the Fix-It trap.
9. - My beliefs about indigenous people, ethnic minorities and people
in underserved population is that they are still part of the
community and they still deserved a proper treatment and proper
benefits from the government and other services. -- Yes, they are
common beliefs in my community.
 My current beliefs help will not hinder my ability to provide

compassionate, respectful, non-judgmental care to everyone I
encounter in my work as long as I respect and understand their beliefs
and listen to what they are coming from and what they believe in.
10. A. Culture- is the ideas, customs and social behavior of a particular

people or society. Culture influences a person’s behaviors and
interactions with other people.
B. Cultural safety- is an outcome reflected by individuals feeling

safe, having their perspectives heard and respected, and sharing in
decision making in their experiences of accessing and receiving
care.

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C. Cultural Humility- involves reflecting on your cultural biases,

acknowledging the biases, and keeping this information present so
that you can learn about another person’s culture and develop
relationships based on trust and respect.
D. Cultural Sensitivity- develops when you recognize differences and

similarities between your culture and other cultures, and
acknowledge that your culture is no better or worse than any other
culture. With this perspective you demonstrate respect for all
cultures.
E. Cultural Awareness- acknowledging your cultural values beliefs

and perceptions and recognizing that you view and experience
other cultures through the lens of your culture. Being culturally
aware could involve asking “Why do we do things this way?
F. Cultural Protocols- refers to customs and standards of behavior for

a culture a d determines for a specific group of people the respectful
ways of communication rituals, traditions, cultural practices and
ways of governing care will enable you to communicate.
11. A. I. Ask for your opinions on treatment issues or to sign documents

II. Ask questions that should be addressed to the physician or nurse.
III. Confide in you rather than in ither members of family or a team.
B. I. Acknowledge the importance of boundaries.

II. Be clear about your scope of practice, job description, and any
legal and ethical guidelines relating to the work you do.
III. Ask your employer to clarify your job description, responsibilities
and task as well as related policies and guidelines and to provide
information to staff an to people for whom you provide care.
12. A. Minimizing the problems

B. Offering false reassurance
C. Offering excessive praise
D. Offering platitudes
13. Developing a trauma-informed practice contributes to providing a

safe environment for health care. It is important for PSW to help
provide a physically, psychologically and emotionally safe
environment for any person who may have experienced trauma.
Strategies are:
 Develop your trauma awareness
 Provide safety and build trust with the person
 Provide opportunities for choice, collaboration and connection
 Identify their strength and help build their skills

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14. Sympathy
Sympathy
Bad Death Good Death
Sudden death Natural Death
Death in health crisis Death receives good care
Died alone Died with proper goodbye
Empathy
Sympathy
Empathy
15. C.
16. In pairs or small group discuss the following:
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 board of any
sort use to build a collage words and pictures that represent your
goals.
19. In small groups discuss the story about the homeless woman on
page 32 in the text.
20. Work in pairs or small groups to explore one of the Truth and
reconciliation Commission Canada’s call to action Identified for
health care, summarized on pp. 30-31 of the text.
21. Work in pairs in the role play described.
22. I want my family and the team to know about my perspective in life,
beliefs and my likes and dislikes when it comes to a thing, food and
opinions. I want them to know what are the things that needs to
consider when giving care to a palliative patient.
23.
a. another person list surprised you and why?

b. It might help me adapt to help meet individual preferences by
knowing their beliefs, culture, like and dislikes and goals in
providing care.

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24. I want to be in a care setting where they can monitor my health, my

diet and whatever illness I have to extend my life as much as
possible and be with my family and friends for the few days of my
life.
25. The two eyed seeing will be helpful on providing care without biased
and racism Looking both in views in providing culturally safe and
person-centered care.
26. System bias and racism are present in the health care system.
Option 1: Work in groups
Option 2: Discuss in small groups
Chapter 3 – Using Standardized Tools

Understanding Your Beliefs and Baggage
1. I might feel good because team collaboration is more about creative
problem-solving, communication, knowledge sharing and innovation.
The two strategies I believe will help me feel more confident in
collaborating with the team are: First Lead by an Example, Team
members need to feel respected and that they are free to contribute
ideas. Second is Creating a Collaborative Work Environment where
there is a space for the team members that they will be heard by other
team members and considered that their ideas, opinions and
suggestions are important.
2. A. Ambulation
B. Activity and evidence of disease
C. Self-care
D. Intake
E. Consciousness level or mentation
3. A person who is 20% PPS is Totally Bed bound.

Unable to do any activity and have an extensive disease.
Needs a Total Care
Minimal to sips
He might have full or drowsy confusion.
4. A person who is 10% PPS is Totally Bed bound.

Unable to do any activity and have an extensive disease.

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Needs a Total Care and Mouth care only.

He is in a coma status and no sign of conscience.
5. A. If the Frailty Value from the CHSA Clinical Frailty Scale increases it
means the PPS or Palliative Performance Scale is lower and might
severely ill and completely dependent on others for activities of daily
living.
B. People identified frailty values between 4 and 7 would benefit from a

palliative approach being integrated into their care.
6. Symptom Framework for PSWs uses standardized question prompts to

gather symptom-specific information from the person.
7. The PAINAD Scale is able to identify, if the person is experiencing pain,

but is not able to identify the severity of the pain.
8. The interactions might help me to provide support and space for rituals
and practices from mine is using an open box to make it possible to
write responses to facilitate and gather information and record and
update goals-care-conversations for best practice interactions.
9. Report:
Eileen a 98-year-old woman who has a chronic obstructive pulmonary

disease. She receives oxygen through nasal canula and receives
opioids daily to manage her breathlessness.
She was frowning and moaning. Doesn’t want to get up in bed,

complaining about her tummy is hurting that started this morning in
her abdomen. She describes the pain spasm come and go and rate 8
out of 10 when 0 is being no pain and 10 is severe pain. Last bowel
movement unknown, short breath as she responded to questions and
she thought it may be because of eating too much dinner.
I call the nurse to report about Eileen’s pain and ask is she can come
today to see Eileen.
10. Work in small group.
Chapter 4 – Supporting Physical Comfort


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1. I grow up in a home where my family members are sometimes

comfortable using medications to manage and pain and sometimes,
they are using a home remedy medication to manage pains but not
most of the time that opposed to use medications to manage pains. I
believe some of the medications are compatible to one but not to one
another, it will depend to the respond of the body of individuals. Beliefs
also matters when it comes in receiving care and medications.
2. Opioids are sometimes referred to as narcotics and although they do

relieve pain, they do not fall into the same category as over-the-
counter painkillers such as aspirin and Tylenol. As long as the person
receiving the opioids will be benefited and will abused the drug and will
not bring harm and will follow the proper intake it will be helpful to
people who are experiencing severe pain. It will be depended to the
usage of each individual.
3. Things might have helped me feel comfortable if my love ones are

beside me looking after me. If the person is caring for me, I would like
to have in my caring basket are soft pillows, movies, Gospel songs,
family pictures, fruits and vegetables.
4. B. Individualize comfort measures to meet the needs of the person.

D. Monitor, record, and report the person’s responses to medication
and other comfort measures.
5. 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.
6. True
7. D. nausea/vomiting, constipation, drowsiness, confusion
8. A. Fear of the Symbolism – if he is taking morphine, it means he is
dying
B. Fear of Developing Tolerance- if he becomes used to this dose of
medication, then it will not work for him when his pain increases.
C. Fear of Becoming Dependent – he will become dependent on this
medication.
D. Fear of Developing a substance use disorder – I don’t want to
become addicted.
E. Fear of Being Judge
F. Fear Of developing Respiratory Depression

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9. Its important to provide medications for symptoms regularly around

the clock because if you ignore each symptom it may lead to worse
situation of each client or even to death.
10. True
11. The consequences of not providing medications regularly for a

person experiencing pain they change their behavior even before they
talk about pain.
12. A. openness to and awareness of traditional healing and

medicines can determine whether a person or family feels comfortable
using them.
B. Avoid judging instead be curious about the person and their culture.
C. learn about their traditional practices and with the person’s
permission share information about these practices with the team to
consider including as a component of providing care.
D. The traditional healing and medicines of indigenous people vary,
depending on the dying person’s community.
E. when a person is interested in receiving traditional healing and
medicines, record and report this within the person’s community.
13. A. Massages reportedly increase relaxation, decrease anxiety and

promote feelings of well-being.
B. Reflexology is based on Chinese concept of qu, massaging reflex
points helps qu to flow freely and reportedly reduces tension and
improves circulation and healing.
C. Music can improve a person’s quality of living as well as their dying,
by helping manage anxiety, pain and depression.
14. Eating nutritious foods can help the body regain strength and
improves health, but you need to take a look to each food that
concerning to your health. In some health issues there are foods that is
needed to avoid like people with hyperthyroidism they need to avoid
foods that rich in iodine. Some food might help you to get in good
condition but some of it will make your condition more worsts. You
need to be careful and take a look to each food if it is good to your
health or not.
15. A. Yetta ate whipping cream. She decided to eat and drink only
what she loved, nibbling small bits of anything she felt eating and
nothing else.

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B. I. As a PSW, I will ask Yetta what she loves to eat and select what is
best for her health and prepare it for her.
II. As a PSW, I will ask Yetta culture and ask her to tell some stories
about her country of origin.
III. I will do research of an alternative way of traditional healing based
on her culture for somehow to give her comfort.
IV. I will give her different way of giving comfort until the end of her
life.
V. I will help her to do what she loves to do that is possible to do.
16. The things that I can do for the family of a person experiencing
anorexia and cachexia is educate them first about the disease and
condition of their family member so they are going to be aware of it.
Then make a care plan for the person ADL with the team and the
family to e courage the client to eat and gain weight as possible.
17. A. Encourage fluid intake to help remove medication metabolites

from the body.
B. Prepare and consult a diet plan which will help prevent constipation.
18. Constipated
When you might What you might Comfort Ways to support

observe if a ask a dying measures that Family
person is person to better might be helpful
constipated understand their
needs
1. observe 1. what 1. As a person 1. Arranging the
changes in treatment do you moves less and room so that the
consistency of think might be takes in less, person has
the BMs of the helpful? their bowel and enough privacy
person in your bladder function when using
care. will decrease. commodes
2. Describe the 2. How does it 2. Supporting a 2. providing
presence of the feel? Can you person with information
stool in the describe it? limited mobility about the
rectum, oozing to maintain their person’s culture
liquid stool on muscle activity that will help the
pads under can help prevent team to
garments or problems understand
soiled garments. cultural aspects
that relate to

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changes in bowel
and bladder
function.
3. may 3. when did 3. involve the 3. recording the
experience constipation person in chair date and a
vomiting, incontinence exercises that description of the
nausea, begin? use abdominal person’s BMs.
abdominal pain muscles and PSWs should
and distention exercises that proceed in a
and generalized move the legs to culturally
pain. encourage sensitive manner
intestinal when
mobility. approaching
topic with family.
19. Dehydrated
person is person to better might be helpful
dehydrated understand their
needs
1. dry mouth, 1. How frequent 1. make sure 1. You can invite
tongue and lips is your urinating? person’s favorite family to
drinks are within participate in
reach to providing
encourage comfort to the
frequent person who is
drinking. experiencing
dehydration and
show the to do
so.
2. Dry skin 2. How do you 2. encourage 2. the person or
feel? Can you person to avoid their family
describe it? dehydrating maybe
liquids. concerned that
dehydration is
causing or will
cause
discomfort.
3. loss of skin 3. which do you 3. provide 3. encourage
firmness prepare to drink? excellent mouth them to walk
care to prevent with the nurse or
discomfort to the physician to
mouth. learn some
options

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managing or
preventing
dehydration.
20. Delirium
person has person to better might be helpful
delirium understand their
needs
1. Refusing to 1. when did you 1. provide a 1. Listening to
take medication first notice the quiet, familiar, their concerns
change? safe environment and reporting
with adequate these to the
lightning. nurse
2. inability to 2. How severe is 2. maintain the 2. providing
carry on a this experience person’s daily reassurance that
conversation with delirium? routine as much the loved one’s
as possible delirium does not
mean they are
crazy.
3. Confusion 3. what do you 3. be alert of 3. Providing a
think might be signs of delirium. space for the
helpful? Report delirium family to nap and
as soon as regain their
possible. strength during
the delirium or
after settles.
21.
Delirium Dementia
causes Metabolic problems, Damage to braincells
medication related
Time frame of onset temporary Life time
Brain changes- Reversible Permanent
permanent or
reversible
Cause by body Yes No
changes (yes/No)
Presence of anxiety, Yes Yes
fear or paranoia
22. Tools can be help as I prepare to talk to a health care team are
the SBAR form to gather information and the OPQRSTUVW form to

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Assess the person to develop a care plan for the person, family and the
community.
23. The risk factors for developing depression are living with life-
limiting illness, chronic pain, or declining abilities as well as living in
long-term or residential care.
24. A. Life-limiting illness

B. Chronic pain
C. Declining Abilities
D. Living in a long-term care
E. Low self-esteem
25. Depression
person has person to better might be helpful
depression understand their
needs
1. are 1. when did you 1. help the 1. educate family
uninterested in first notice the person and about depression
their usual change? family to
activities understand that
depression is a
symptom that
can be treated
even in a
terminally ill
person.
2. Frequently 2. How do you 2. ask the person 2. teach the
express sadness, feel? Can you what they feel family for the
anger and describe it? would be helpful medication
frustration at this time and treatment for
record their depression.
response.
3. are socially 3. what do you 3. are present 3. ask the family
withdrawn think might be when the person to support and
helpful? needs a listening always be with
ear. the person in
times of
problems.

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26. Exercise. (Sorry miss I didn’t do this exercised as I am currently

taking medication for heart).
27. Difficulty Breathing
How you might What you might What you might Comfort
prevent difficulty observe if a ask a dying measures that
with breathing person has person to better might be helpful.
difficulty understand their
breathing needs.
1. do not over 1. gasp for air 1. How do you 1. gathering
worked yourself when moving or feel? Can you information
at rest describe it? about possible
triggers that lead
to difficulty
breathing
2. remover 2. open their 2. when do you 2. planning ways
covers in air mouth wide to notice feeling to avoid these
ways when doing get more air. breathless. triggers as much
exercise or as possible.
physical activity
3.Limit extreme 3. reduce to 3. how severe is 3. making sure
activities when participate in this experience the unnecessary
having a heart activities to with airway irritants
problem. avoid or reduce breathlessness? are not used
breathlessness. around the
person.
28. Fatigue
How you might What you might ask a Comfort measure that
prevent fatigue dying person to better might be helpful
understand their
needs
1. Get right 1. How do you 1. discuss about
amount of sleep feel? Can you fatigue to the person.
describe it?
2. Eat properly 2. When did you 2. you may want to
notice feeling be quiet, gentle and
tired? positive rather than
energetic and
enthusiastic in
conversation.
3. Exercise 3. what do you 3. support a person by

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regularly think might be listening with them

helpful? and their family.
29. Mouth Discomfort

What might if a person What you might ask a Comfort measure that
has a dry mouth dying person to better might be helpful
understand their
needs
1. Visibly dry 1. How do you 1. offer water or
lips, gums or feel? Can you drinks frequently.
tongue describe it?
2. Fresh blood or 2. When did you 2. club soda to loosen
dry blood in notice change in materials on oral
the mouth your mouth? mucosa and teeth.
3. An unpleasant 3. what do you 3. moisten their oral
smell in the think might be mucosa gently.
mouth. helpful?
30. Nausea and Vomiting

a. Scenario OPQRSTUVW
b. SBAR
31. Pain (Role-Play Exercise)
32. A. The PSW Identify Annette’s pain by PSW observation on

change on her behavior and routine.
B. The PSW notice she was sitting in her room, rocking and a deep
frown in face and asked if she is having pain.
C. Notice changes in routine and behavior of the client and said
that having pain in the back as she rubbed it.
D. Annette client that has a new compression fracture in the back.
The fracture causing pain and cannot stand up and walk around.
Giving increase medications and visibly relaxed and soon was able
to get up and walk around with assistance.
Chapter 5 – Providing Psychosocial Care

1. A. List the things that are important to you in your life.
 Family
 Love & Self-Love
 Friends
 Good Health

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 Passion
 Food, Water and Sleep
B. Write about what you would do if you only have three months to live.
 If I only have 3 months to live, I will “live each day like as it is the
last” day of my life. I always thank GOD for each day for the
blessing of life he gave me.
 I will call my parents and family regularly and make sure that I
always tell them that I love them. I will spend time cooking for
friends and family and take time to go to almost every party,
wedding, and funeral I am asked to attend. People are important
and I want them to know it.
 Thinking with only the 3 months that I only have left to live will
be very frustrating and stress at first, I don’t know what I am
going to think or do but I decided to live life with good and happy
moments with my love ones and giving happiness to them as
well and to the people around me.
C. Write about what you would do if you had only three days to live.
 If I only have three days to live. I will spend those three days with
my family and friends in a very relaxing place like the most
beautiful beach resort where I will live for 3 days with no stress
and not thinking any problems. I will live life to its best with
them. Telling stories, talking about life eating the best food we
could ever had and have fun with them until my 3 days ended.
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?
 While writing my answers It makes me feel sad and make me

think that I can do those things even I don’t know when I am
going to live. Make me to have thoughts to live a happy and
healthy life to the fullest. Life is short we didn’t know when we
are capable to do the things we wanted to do. Live each day as it
is your last day.
E. Write about the decision-making process for what to write in the shapes.
How did the items differ as you move to smaller shapes? How did you decide
what to include in the small circle?
 The decision- making process I made what to write is how will I

use the time I have left in a way it will be worth it and

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meaningful. The items differ as I move to each question is how

long your life will be going and how important the things you will
consider. I decided to include the things that I really wanted to do
and what I really value the most.
F. How would you feel if you were not able or not allowed to do what you
identified in the circle? Consider how dying during the Covid-19 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?
 I will feel very sad and frustrated if I will not be allowed to do

those things I mentioned on the circle. Covid-19 pandemic it
affects the ability of the person to do what they wanted to do in
their last weeks, days and hours because they got restricted to
go outside and held any parties or gatherings with family. Covid-
19 pandemic also affected their emotional feelings because of
the fear of getting exposed to the virus and spread it out with
your love ones. I am dying and unable to see my family and
friends in my last days it would be very sad, frustrating and very
stressful if I will not get the chance to see my loves before I die.
Things might be helpful, doing things as alternative to boredom
and longingness with love ones, videocall conference with family,
friends and relatives once in a while to get some talk and
bonding through online. Letters from friends and doing some of
the client’s hobbies indoor.
2. Reflect on the story provided on the workbook.

a. What feelings, thoughts, and questions might you have?
 FEELINGS: I will be very sad since the doctor said without the
dialysis it will shortens client life and live for a few weeks only.
 THOUGHTS: I might find a way for the client to continue his
dialysis or have an alternative way that will help the client for his
kidney failure.
 QUESTIONS: Client’s thought and feelings why he discontinued
the dialysis? What can I do to help the clients realize the
consequences about discontinuing dialysis in a gentle manner?
b. With whom is it appropriate to discuss your question and feelings?

 It is appropriate to discuss my questions and feelings with the
supervisor, nurse and physician in charge with the client.

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c. If you do not agree with the person’s choice to discontinue dialysis,

what best practice interactions can help you withhold judgement and
show respect?
 The best practice interactions that might help me is show my
care to my client’s condition and I will make him feel that I
respect his decision to discontinue his dialysis. I will let him know
what will happen if he discontinues his dialysis.
d. What might you say to or do for the person and the partner to show
compassion?
 What I am going to do is show my compassion to my job and that
I am willing to do whatever I can do to give him comfort. I will
make them feel that I am always here if they need me.
3. Describe why psychosocial care is considered holistic.

 Psychosocial care is the culturally sensitive provision of
psychological, social, and spiritual care through therapeutic
communication. It is considered holistic because it shows that
effective psychosocial care improves patients' health outcomes
and quality of life.
4. Describe what can you do to support a person through transitions

when their disease is advancing and the person has been told that a
cure is not possible.
 I will support a person through transitioning, I will be
encouraging, Phrases like, "I'm with you no matter what," and "I
support you,” I will be more patient, make them feel that I am
concern and helpful.
5. Identify four key points about dying with dementia.

a. Increase fatigue
b. Reliance on others
c. Communication Troubles
d. Memory Loss
6. What principles of providing culturally safe care will help you and the
team share information in a most helpful way?
 Listening to the person and empathizing with them about their
concerns and questions and connecting them with the
appropriate team member for support.
 Communicating with the team when the person or family do not
understand the information that has been shared with them.
 Identifying and working to share information in line with the
person’s and family members preferences for receiving and
sharing information.

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 Ensuring that the person and family know how to contact the
team any time of the day or week.
 Working with the team to identify other people who can provide
support to the person and family if the health care team is not
available at night.
7. As a PSW you support a person’s psychosocial needs when you:

a. Advocate by communicating the persons choices and goals.
b. Support their preferences
c. Invite the person to determine their priorities
d. Respect the person’s right to choose or refuse treatment, to eat
or not to eat. To bathe or not to bathe.
e. Provide choices whenever possible.
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.
Using assessment techniques and professionals from other disciplines can
widen the assessment process. Professionals that could be utilized include:
a. Speech therapists, physical therapists, and occupational therapists to
determine functional issues
b. Social workers, case managers, and vocational rehabilitation specialists
for lifestyle and practical issues
c. Other specialists, such as audiologists, other medical specialists,
religious and spiritual influences, and so forth
9. Identify eight ways that PSW’s can support advance care planning
a. Validate their desire to talk about their personal wishes and hopes.
b. Acknowledge the lack of interest in discussing end-of-life issues, and at
the same time share a healthy attitude toward advance care planning
conversations.
c. Encourage them to discuss their goal of care.
d. Help the person learn about medical procedures.
e. Help the person think what is right for them.
f. Help the person talk with their health care professionals about
medication or treatment concerns.
g. Help the person record conversations. You might say.
h. Encourage the person to talk with their health care professionals and
provide them with the relevant contact information. You might say.
10. As a PSW you can sign legal documents including wills, legal
forms, and documents.
 FALSE

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11. Write five things you learned about grief that you did not know
before reading the text.
1. Grief is a whole-person experience.
2. Grief is a natural, healthy response to loss that helps people adapt
to living in a change world.
3. Grief is a hope wish for something that is important to the person.
4. People grieve in a different unique way.
5. People grieve differently over time.
12. Describe ways to support children who’s loved one is dying.
 Prepare children for what they will see.
 Be honest
 Use correct language
 Invite children to participate in caregiving
 Include children when possible.
 Recognize children’s grief and grief together
13. EXERCISE
-Extreme Activities - Limit foods that I like
 I will feel sad, need to do something for myself to get back on
track and help my self to get well and live healthy as I can.
 If the doctors tell me that I should no longer do the activities at

first, I will feel empty, blank about these losses. I will feel better
knowing that I still have activities left and still I will be grateful to
know what will be the best for me according to my doctor.
 I am no longer to do that activity I will feel sad because part of

me has been taken. I am going to be limited to enjoyment that I
want to explore and experience and it will not be the same as
before.
14. In a small group, discuss ways to support a person’s relationship

with their family and community. Include options for a person who is
not able to be with their home community, family or culture.
 To support a person’s relationship with their family and community
encourage them to reach out with their family and friends make them
know that what ever their going through they are not alone, a lot of
people is on their side whenever they need someone to be with and
talk to.
15. Review pages 167 to 167 text about grief being a whole person
experience.
a. Mark illustration
 whole
b. Reflect on how grief is a whole person experience.

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 Grief is a whole person experience that can affect every part of a

grieving person’s life physically, socially, emotionally, spiritually,
mentally and culturally response towards to others and life
everyday living that can take a longer time to heal and move on
to recover.
c.
 Brain
 Headache
 Tears
 Chest pain
 No appetite
 Tummy ache
 Fatigue
 Pushing people away
16. Reflect the ways to support a grieving person.

 Supporting a grieving person.
 Empathize and reflect
 Leave a room for silence
 Individualize care
 Make room for tears
 Identify what support needed
17. Complete reflective activity on Medical Assistance Drying.

Understanding your beliefs and values is essential to providing
person-centered palliative care. Know that your beliefs, values
and ethical assumptions will affect your desire and willingness to
participate in discussions about MAID. Because MAID addresses
our feelings about the value of life, it is possible that you may
experience strong emotions when talking with a person who
expresses a desire to die.
Chapter 6 – Caring in the Last Days and

Hours
1. Caring for someone in their last days and hours at the time of death for
me will be important as it is the most important days of their lives. As
much as I want to give them comfort and unexceptional care before
they leave this world.
2. Caring for the body after death is one of the most important part in
some traditions and cultures like mine. They held a burial that last for 9

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days to grieve 24 hours in a day. Some of them reminiscing the last

days and hours that they are going to be with their family member,
they are buying good clothes for the death body to wear. Others may
not be comfortable of it but to understand each culture, beliefs and
baggage will help to give the nest care for the dying person and family.
3.
Physical Changes Comfort for the Dying Comfort measures for
Person the family.
Decreases physical Sleeping may be more Acknowledge that it is
strength and increased important than a daily common for people to
drowsiness bed bath, and visiting sleep more as death
with family may be nears. You might say, it
more important than is normal for dying
visiting with friends. person to sleep more
and more as time
passes. If the family
expresses concern that
medications may be
causing their loved
one’s drowsiness,
encourage them to talk
to the nurse or
physician.
Reduced intake and Give the person Encourage the family to
difficulty swallowing thickened fluids if talk or ask questions of
directed by the nurse the nurse, physician, or
or dietitian. Remind the dietician when they
person to swallow if have concerns about
they forget. the effects od
decreased intake on
their loved one and
what the experience
may be like for that
person.
Delirium or confusion Promptly report early Encourage family
signs of delirium to the members who are
nurse. Consider caring for a dying loved
whether it would be one to try to find ways
helpful to reorient this to care for themselves,
person, given their for example, by having
cultural perspective a nap or going for a
about delirium. Allow walk, while are in the
the person to be in home.
their delirium

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orientation if they
appear to be
comfortable.
Agitation or Report agitation and Encourage the family to
restlessness restlessness promptly discuss their concerns
to the nurse so that this with the nurse and
symptom can be physician. Share
manage quickly. information. Explain
that restlessness is a
common experience
that you will experience
in the last days and
hours,
Unresponsiveness You support the person You can help family
when you reposition members ex[lore ways
them regularly to to connect with their
protect their skin and loved one by using
increase their comfort. touch or music, by
It maybe comforting to simply being a quiet
person if you continue presence, or by
talk with them as reminiscing and
though they were able recalling family stories
to hear you. in the presence of the
dying person.
Irregular breathing You can help by Show the family how to
positioning the person freshen and moisten a
in a way that supports dry mouth if the person
their breathing and by is breathing through
providing verbal their mouth. If the
assurance. family is interested in
helping with care, show
them how to used
atomizer and apply lip
balm.
Congested breathing Provide a calm and Encourage the family to
reassuring presence. contact the nurse if
Use pillows to support congestion increases of
the person to help open if the person shows
airways. signs of discomfort. The
Help the person into a nurse can address
semi-supine position if questions about the
they are very use of suctioning to
congested relieve the congestion.
Changes in skin color If the person is Consult with the nurse
and temperature sweating, you can about the person’s
provide clean clothing physical need to be

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and bedding. If the washed. More frequent

person is cold, you can washing maybe
offer another blanket, necessary if the person
but it is important to be is sweating or is
aware that the person’s incontinent. Full baths
skin temperature might may not be necessary if
change again and the person remains
should be checked clean and dry.
regularly.
Dry eyes You can provide Help the family know
comfort by moistening that seeing a person
the eyes with artificial with only the whites of
tears. Talk with the their eyes is normal
nurse if the person’s and encourage them to
eyes appear to be dry. talk with the nurse or
physician for a support.
Decrease Urinary Increase Fluid intake. Speak with the family
Output Use catheter or which option they is
incontinence pads most consistent with
the person preferences.
Bowel or bladder Provide a sense of Teach the family for
incontinence comfort for the person some procedures how
and family to have an they will change
incontinence pad in incontinence pads
place properly.
4. A. Preparing Yourself
B. Preparing the family and other staff.
C. Developing a Plan for the time of death and Providing compassion
5. A. Acknowledge and validate the family’s questions.

B. Connect the family with a nurse or counsellor or social worker, who
can answer their questions.
C. Share agency or facility educational brochures about what to expect
as death nears, which the family can review while waiting to meet the
nurse.
D. Ensure that the family knows how to access the team.
6.
 Decreased physical strength and increase drowsiness
 Reduce intake and difficulty swallowing
 Delirium or confusion
 Agitation or restlessness
 Irregular breathing
 Congested breathing
 Changes in skin color and temperature

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 Muscle twitching
 Dry eyes
 Lack of urinary output or bowel and bladder incontinence
7.
Care of the body Ways to support family
Home setting Long-term care At all locations
facility
a. place and a. place and Make sure the family has easy access
incontinence pad incontinence pad to the contact information of the
under the buttocks under the buttocks nurse.
in case of further in case of further
incontinence incontinence
b. change soiled b. change soiled Prepare the body as respectfully as
linen linen you would if the family is present.
c. dresses the c. dress the person Put in the person dentures as this is
person in a fresh in a fresh gown or important to the family.
gown or clothing clothing as
as appropriate appropriate
d. position the d. position the Infor the nurse and the family as
person lying flat person lying flat soon as possible.
with a pillow under with a pillow under
their head their head
e. Close their e. Close their Gather person’s things as it is
eyelids if their eyelids if their eyes important to the family.
eyes are open. are open.
f. Follow the f. Follow the Do as the family wish with respect.
procedures set out procedures set out
for. for.
8. True – As this will help you to provide the best care and understanding
for the client.
9. A. offer nourishment
B. invite individual people to sit beside with their loved ones.
C. Consider the needs of people who are not present
D. caring for the body.
10. A. Provide culturally self- care and support when you identify
whether your facility has a policy regarding the length of time a person
can remain in their room.
B. Support the family whether your facility has a special space to
which the person and their family might move.

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C. Provide support when you advocate on behalf of families to stay in

the person’s room or create a special space for rituals and traditions.
11. When a person’s death is sudden, unexpected, or occurs within

24 hours of admission to a hospital, the coroner is notified. The role of
the coroner is to confirm the identity of the person who died and the
probable cause and time of death. The coroner classifies the death as
natural, accidental, suicide, homicide, or undetermined.
12. A. it will help the family’s understanding about the situation of

the client.
B. To help the person’s family to accept the dying person’s few days
and hours to live.
13. Discuss in small Groups.

14. Discuss in groups.
15. Meet with larger group.
Chapter 7 – Caring for You!

1. Vacation or break from work.
Massage to relax and meditate
Exercise.
Hang out with friends and happy conversations
2. Self-care is important to maintaining a healthy relationship with

yourself. It means doing things to take care of our minds, bodies, and
souls by engaging in activities that promote well-being and reduce
stress. Doing so enhances our ability to live fully, vibrantly, and
effectively. The practice of self-care also reminds both you and others
that your needs are valid and a priority. I learn that self-care is
important to be able to take care of others and understand others
preferences. My reflections take me to have a better understanding
about self-care.
3. A. “Compassion fatigue is basically draining of emotional energy for

those of us who deal with others pain. “Typically, it has a tendency to
be progressive and sneak up on people and often times we
characterize this as burnout.”
B. Yellow

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C. Things are not as smooth as they were. I feel more tired working
full-time in the morning and studying at night. I am sad when
people tell me their problems. I ignore problems for a while that I
cannot fix right away. But I am still doing my best to things that I
needed to do.
4. Drawing
5. Emergency self-care plan.
- Emergency funds to take a break that will cover my bills, and

expenses if I cannot work for certain days or weeks.
- Consult my family doctor for more advice or information that will
help me to have a self-care plan.
- List of things that I might do for my self while on break and taking
care of self.
- Emergency contact provided in my trusted friends and family.
- Insurances for health or accident as well as for critical illness.
6. A. Embracing the End of life: Help for those Who Accompany the Dying
The End of Your Life Book.
B. A story About Care

The bucket List
Five People You Meet in Heaven
C. Speak Up: Advance Care Planning in Canada

The way Forward: An integrated Palliative Approach to Care

Integrating A Palliative Approach

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Integrating a Palliative Approach

Lab skills PSW (Centennial College)

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Course Name: Assisting the Dying Person

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Chapter 1 – Understanding Dying and a

 This is a new concept for me. The benefits of the palliative

3. Review the stories of different patterns of decline in Chapter 1 of the

Pattern of Impacts on the person Impacts on the Ways that you as a

Steady 1. They may feel too 1.challenging 1. provide person-

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4. Using the text, define the following terms:

a. Dementia- are life limiting illnesses that affect a person’s memory,

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

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 Acknowledges multiple cultural understandings of dying and

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

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Chapter 2 – Preparing to Care

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1. Self-awareness is the ability to focus on yourself and how your

2. A. the experienced related to death, dying, and or grief when my

B. I receive my family support, making me understand that it really

C. The experience affects me that it makes me sad knowing that

4. A. I will choose Steady Decline trajectory pattern for my love ones

B. I don’t want something different for my love one or for myself.

5. Worried, Afraid, Concerned, Nervous and Other

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6. Feelings and Affected All People will

7. Thoughts and feelings during this experience is listening and being

8. I had a best friend way back in my country who passed away

 My current beliefs help will not hinder my ability to provide

10. A. Culture- is the ideas, customs and social behavior of a particular

B. Cultural safety- is an outcome reflected by individuals feeling

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C. Cultural Humility- involves reflecting on your cultural biases,

D. Cultural Sensitivity- develops when you recognize differences and

E. Cultural Awareness- acknowledging your cultural values beliefs

F. Cultural Protocols- refers to customs and standards of behavior for

11. A. I. Ask for your opinions on treatment issues or to sign documents

B. I. Acknowledge the importance of boundaries.

12. A. Minimizing the problems

13. Developing a trauma-informed practice contributes to providing a

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a. another person list surprised you and why?

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24. I want to be in a care setting where they can monitor my health, my

Chapter 3 – Using Standardized Tools

3. A person who is 20% PPS is Totally Bed bound.

4. A person who is 10% PPS is Totally Bed bound.

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Needs a Total Care and Mouth care only.

B. People identified frailty values between 4 and 7 would benefit from a

6. Symptom Framework for PSWs uses standardized question prompts to

7. The PAINAD Scale is able to identify, if the person is experiencing pain,

Eileen a 98-year-old woman who has a chronic obstructive pulmonary

She was frowning and moaning. Doesn’t want to get up in bed,

10. Work in small group.

Chapter 4 – Supporting Physical Comfort

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1. I grow up in a home where my family members are sometimes