End-of-life Care

Objectives

This subject is part of the compulsory basic training of the Bachelor's degree in Nursing curriculum of the Faculty of Health and Welfare Sciences. The purpose of this End of Life Care (ELC) program is to offer Nursing students elements for reflection on the situation of advanced and terminal illness and provide them with tools that allow them to provide a professional response to the needs of patients and their families in the situation of advanced and terminal illness.

At the end of the subject, the student must be able to:

• Analyze the role of the nurse in caring for people with advanced illness and at the end of life and their families.
• Develop teamwork skills.
• Analyze the situation of advanced illness or end of life.
• Analyze the phases of adaptation to the situation of advanced illness and end of life, the reactions and responses of the patient, the family, the environment and the team itself.
• Value the family and the environment as social and natural support systems.
• Value and treat people holistically, respecting their right to participate in making decisions about their care.
• Categorize the symptoms presented by people with an advanced and terminal illness and the control strategies.
• Develop skills and attitudes to care for patients with advanced illness or at the end of life and their families.
• Develop communication skills.
• Implement effective communication with the people being treated and with the work team.
• Apply skills to deal with difficult situations.
• Practice nursing care that allows providing quality care to the patient and their families.
• Reflect on the idea of dying and death in our sociocultural environment.
• Discuss the principles of bioethics involved in making decisions at the end of life.
• Experiment with the grieving process to be able to provide support to people who are immersed in it.
• Synthesize information and communicate in writing and orally.

Learning outcomes

• LO1. Develop skills to accompany the end-of-life process.
• LO2. Collects and interprets data and information on which to base their conclusions, which may include, where appropriate, reflections on social, scientific or ethical issues in the field of nursing.
• LO3. Demonstrates skills for critical reflection in processes linked to the exercise of the profession.
• LO4. Communicates knowledge and ideas from the field of health sciences clearly and precisely in Catalan, Spanish or English to all types of audiences, whether specialized or not.

Competencies

Specific skills

• Develop and implement strategies for easing and controlling symptoms that contribute to alleviating end-of-life situations of care receivers and significant others.

Basic skills

• Students have the ability to gather and interpret relevant data (usually within their field of study) in order to make judgments that include reflection on relevant social, scientific and ethical issues.

Core skills

• Communicate orally, in writing and audiovisually, in one's own language and in foreign languages, with proficiency in form, content and use.
• Reflect critically on knowledge of all kinds, with a commitment to professional rigor and quality.

Content

1. Advanced chronic illness and palliative care
   1. History of palliative care
   2. Situation of advanced or terminal illness
   3. Palliative care
   4. The care team
   5. The complexity attention model
2. Communication and information
   1. Purpose/objective of the communication/information
   2. Basic principles of communication/information
   3. The knowledge of the truth
   4. How to give bad news
   5. Listen professionally
   6. Facing and addressing difficult situations
3. Emotional impact of the situation of advanced and terminal illness
   1. Respond to the reactions of the patient, the family and the environment, and the team
   2. Mechanisms of adaptation to the new situation. Models for the analysis of the process of adaptation to the situation of terminal illness
   3. Palliative care in children and adolescents
4. Symptom control
   1. General principles of symptom control
   2. Symptom control
   3. Emergencies in palliative care
   4. Situation of agony
5. Dying and death
   1. Death from a cultural point of view
   2. Ethical and legal aspects of dying and death
   3. Advanced will planning
6. The grieving process
   1. Bond formation
   2. The loss
   3. The grieving process
   4. Mutual aid groups

Evaluation

In accordance with the Academic Regulations for undergraduate studies at UVic-UCC, this subject can be passed through a continuous summative assessment.

The activities that serve to collect evidence for the evaluation are the following:

• Registration and monitoring of reflection activities in the classroom and independently, through individual or group reflection. These activities allow you to organize the knowledge acquired from classroom and independent work and from reading the bibliographic material provided (25% of the final grade for the subject; non-recoverable). These activities must be submitted in the same classroom once the session has ended or through "Assignments" on the Moodle platform.
• Bibliographic review work as a research, analysis and synthesis activity, carried out in a small group (50% of the final grade for the subject; non-retrievable). This activity must be submitted through a Moodle assignment.
• Public defense of the bibliographic review work, based on a poster, as a communication activity (20% of the course; non-retrievable)
• Participation observation (5% of the course)

Evaluation conditions

• None of the assessment activities are recoverable.
• To be eligible for the summative continuous assessment, a minimum attendance of 80% of the sessions is required.
• To obtain the final grade, you must have completed all the activities and passed them with a grade of 5.

Important

Plagiarism or copying someone else's work is penalized in all universities and, according to the UVic-UCC coexistence rules, constitute serious or very serious faults. Therefore, during the course of this subject, plagiarism or the improper appropriation of texts or ideas from other people (see What is considered plagiarism?) and the improper or undeclared use of artificial intelligence in an activity automatically result in a suspension or other disciplinary measures.

To cite texts and materials appropriately, you must consult the academic citation guidelines and guidelines available on the UVic Library website.

Methodology

The subject is designed so that students actively participate in their teaching/learning process. Specific teaching techniques and methodologies derived from the proposals emerging from the European Higher Education Area are applied: reflective dialogue, individual work, group work, analysis of audiovisual material and others.

In each session, some central points of each of the topics are discussed based on the bibliographic material available for the subject and related to the topic being developed. Based on the reflective dialogue, the bibliographical material and the proposed exercises, knowledge is built, which must allow for meaningful learning for the student.

The teacher provides articles and complementary readings, recommendations, and links to web pages related to the subject content that are useful to the student.

Face-to-face sessions, in contact with the teacher, alternate with exercises based on the methodologies mentioned above.

The bibliographical material for the subject is found in the virtual classroom.

The subject is organized to be taught in person and requires regular class attendance (minimum attendance at 80% of sessions). In the event that you are exceptionally unable to attend class regularly due to work reasons, you must always discuss it with the teacher beforehand to assess the possibility of establishing a different work plan and assessment.

Bibliography

Key references

• Grupo de planes de cuidados de la AECPAL (2014). Planes de cuidados estandarizados de enfermería dirigidos a pacientes y família en procesos avanzados y terminales (2 ed.). Sanidad y Ediciones SL.
• Martínez Cruz, M.B., Montleón, M., Carretero, Y. i García, M.L. (2022). Enfermería en cuidados paliativos y al final de la vida (2 ed.). Elsevier.
• Mendiueta, W., Astudillo, C., Astudillo, E. (2018). Cuidados del enfermo en el final de la vida y atención a su familia (6 ed.). EUNSA.
• Murray, K., Thomson, J., & Helguera, A. (2019). Lo Esencial en Cuidados Paliativos Cuaderno de Trabajo: Un recurso práctico en enfermería. Life and Death Matters.
• Watson, M., Campbell, R., Vallath, N., Ward, S., Wells, J. (2020). Manual Oxford de cuidados paliativos (3 ed.). Aula Médica.

Further reading

Teachers will provide complementary bibliography and compulsory reading throughout the course via the Virtual Campus.