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

of family PSW can support
decline the person and the
family

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

decline too fast 2. adjust new centered, holistic
2. They may feel no normal every week care.
time to prepare 2. Listen, ask-reflect
 and respond.
Stuttering 1. Challenging 1. Can feel 1. Collaborate
decline 2. Adjustment and fear ambiguous with the team.
2. challenging Share
observations,
discuss needs,
and advocate
when necessary
2. Observe
without
judgement.
Record
observation
Slow decline 3. natural death 3. cannot • collaborate
4. will not see with team,
experience declining discuss needs
challenging slowly and advocate
health crisis 4. may when
think necessary.
person is • Provide
close to holistic care.
death
Sudden 3. no time to 3. Forced 3. Comfort
death say goodbye to make 4. Support
4. unexpected death decision
s
4. Unprepare
d and
struggle

3. Using the text, define the following terms:

• Dementia- are life limiting illnesses that affect a

person’s memory, thinking. Behaviour, and ability to
perform everyday activities.
• End of Life- The last days and weeks of life.
• 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.
• 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.
• 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.
• 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.

3. 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.

5. Acknowledges multiple cultural understandings of

dying and death.
6. Support a person to live as fully as possible until
death by helping manage all symptoms and sources
of distress.
7. 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.
5. People are holistic beings, which means that they have

• A. Physical, emotional and psychosocial needs

8. A. True
B. True

C. True
D. True
• What can be learned when HCP asks the “Surprise Question”?
a. 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.
• 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.
• 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.

8. 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.

9. 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.
10. 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.
11. 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.
12. 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

13. 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.

14. 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 as it is explaining that it is
death for me natural death and the fact
that as we grow
older our body get weaker to
death.
Stuttering Decline is a bad it shows that you will be
death for me undergoing a health crisis or
a lot sufferings as you are
fighting for any chronic
diseases slowly weakening
your body to death.
6. Dying
 7. 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.

8. Worried, Afraid, Concerned, Nervous and Other

15. 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.

16. 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.

17. 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.
18. - 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.
.
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
Bad Death Good Death
Sudden death Natural Death
Death in health crisis Death receives good care
Died alone Died with proper goodbye
14.
Sympathy
Sympathy
Empathy Sympathy
Empathy
13. C.
14. In pairs or small group discuss the following:
15. In small groups, describe ways to incorporate the
indigenous Wellness Framework as you are providing
care.
16. 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.
17. In small groups discuss the story about the homeless woman
on page 32 in the text.
18. 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.
19. Work in pairs in the role play described.
 20. 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.
9. another person list surprised you and why?
10. It might help me adapt to help meet individual preferences by
knowing their beliefs, culture, like and dislikes and goals in
providing care.

21. 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.

22. 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.

23. 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
11. 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.
• A. Ambulation
a. Activity and evidence of disease
b. Self-care
c. Intake
d. Consciousness level or mentation
5. 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.

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

Unable to do any activity and have an extensive disease.

Needs a Total Care and Mouth care only.

He is in a coma status and no sign of conscience.
24. 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.

25. Symptom Framework for PSWs uses standardized question

prompts to gather symptom-specific information from the person.

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

pain, but is not able to identify the severity of the pain.

27. 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 Understanding Your Beliefs
and Baggage
28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. True
34. D. nausea/vomiting, constipation, drowsiness, confusion
35. A. Fear of the Symbolism – if he is taking morphine, it means
he is dying
a. Fear of Developing Tolerance- if he becomes used to this dose
of medication, then it will not work for him when his pain
increases.
b. Fear of Becoming Dependent – he will become dependent on
this medication.
 c. Fear of Developing a substance use disorder – I don’t want
to become addicted.
d. Fear of Being Judge
e. Fear Of developing Respiratory Depression
36. 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.

37. True

38. The consequences of not providing medications regularly for a

person experiencing pain they change their behavior even before
they talk about pain.

39. A. openness to and awareness of traditional healing and medicines

can determine whether a person or family feels comfortable using
them.
a. Avoid judging instead be curious about the person and their
culture.
b. 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.
c. The traditional healing and medicines of indigenous people
vary, depending on the dying person’s community.
d. when a person is interested in receiving traditional healing
and medicines, record and report this within the person’s
community.

40. 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.

41. 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.
42. 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.
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.
43. As a PSW, I will ask Yetta culture and ask her to tell
some stories about her country of origin.
44. I will do research of an alternative way of traditional
healing based on her culture for somehow to give her comfort.
45. I will give her different way of giving comfort until the
end of her life.
46. I will help her to do what she loves to do that is possible to do.

12. 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.

13. A. Encourage fluid intake to help remove medication metabolites

from the body.
B. Prepare and consult a diet plan which will help prevent constipation.

14. Constipated

When What you might Comfort Ways to

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

changes in
bowel and
bladder
function.

3. may 3. when did 3. involve 3.

experien constipation the recording
ce incontinence person in the date
vomiting, begin? chair and a
nausea, exercises descriptio
abdomin that use n of the
al pain abdomina person’s
and l muscles BMs.
distentio and PSWs
n and exercises should
generaliz that move proceed in
ed pain. the legs to a
encourage culturally
intestinal sensitive
mobility. manner
when
approachi
ng topic
 with
family.

19. Dehydrated
When What you Comfort Ways to
you might ask a measures support
might dying person to that Family
observe if better might be
a person understand helpful
is their needs
dehydrat
ed
1. dry 1. How frequent 1. make 1. You
mouth, is your sure can invite
tongue and urinating? person’s family to
lips favorite participat
drinks e in
are within providing
reach to comfort
encourage to the
frequent person
drinking. who is
experienci
ng
dehydrati
on and
show the
to do
so.
2. Dry skin 2. How do you 2. 2. the
feel? Can you encourage person
describe it? person to or their
avoid family
dehydrati maybe
ng liquids. concerne
d that
dehydrat
ion is
causing
or will
cause
discomfort.
3. loss 3. which do you 3. provide 3.
of skin prepare to excellent encourage
firmne drink? mouth them to
ss care to walk with
 prevent the nurse
discomfort or
to the physician
mouth. to
learn
some
options

managing
or
preventing
dehydratio
n.

20. Delirium
When What you Comfort Ways to
you might ask a measures support
might dying person to that Family
observe better might be
if a understand helpful
person their needs
has
delirium
1. 1. when did you 1. provide 1.
Refusing first notice the a quiet, Listening
to take change? familiar, to their
medicatio safe concerns
n environme and
nt with reporting
adequate these to
lightning. the
nurse
2. 2. How severe 2. 2.
inability is this maintain providing
to carry experience the reassuranc
on a with delirium? person’s e that the
conversat daily loved one’s
ion routine as delirium
much as does not
possible mean they
are
crazy.
3. 3. what do 3. be alert 3.
Confusion you think of signs of Providing
might be delirium. a space for
 helpful? Report the family
delirium to nap and
as soon as regain
possible. their
strength
during
the
deliriu
m or
after
settles.

21.
Delirium Dementia
causes Metabolic Damage to braincells
problems,
medication
related
Time frame of temporary Life time
onset
Brain changes- Reversible Permanent
permanent or
reversible
Cause by body Yes No
changes
(yes/No)
Presence of Yes Yes
anxiety,
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

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
a. Chronic pain
b. Declining Abilities
c. Living in a long-term care
d. Low self esteem
25. Depression
When What you Comfort Ways to
you might ask a measures support
might dying person to that Family
observe better might be
if a understand helpful
person their
has needs
depressio
n
1. are 1. when did 1. help 1. educate
unintere you first notice the family
sted in the change? person about
their and depression
usual family to
activitie understa
s nd that
depressio
n is a
symptom
that can
be
treated
even in a
terminall
y ill
person.
2. 2. How do you 2. ask the 2.
Frequently feel? Can you person teach
express describe it? what they the
sadness, feel would family
anger and be helpful for the
frustration at this time medica
and record tion
their treatm
response. ent for
depres
sion.
3. are 3. what do 3. are 3. ask the
socially you think present family to
withdraw might be when the support
n helpful? person and
needs a always be
listening with the
 ear. person in
times of
problems.

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

currently taking medication for heart).
26. Difficulty Breathing

How you What you might What you Comfort

might observe if a might ask measures
prevent person has a dying that might
difficulty difficulty person to be helpful.
with breathing better
breathing understan
d their
needs.
1. do not 1. gasp for air 1. How do 1.
over worked when moving you feel? gathering
yourself or at rest Can you informatio
describe n about
it? possible
triggers
that lead
to
difficulty
breathing
2. remover 2. open their 2. when 2.
covers in mouth wide to do you planning
air ways get more air. notice ways to
when feeling avoid
doing breathless. these

27. Difficulty Breathing

28. Fatigue
How What you might ask Comfort
you a dying person to measure that
might better might be
prevent understand helpful
fatigue their needs
1. Get right 1. How do you 1. discuss
amount of feel? Can you about fatigue
sleep describe it? to the person.
 2. Eat properly 2. When did 2. you may
you notice want to be
feeling quiet, gentle
tired? and positive
rather than
energetic and
enthusiastic in
conversation.
3. Exercise 3. what do you 3. support a person
by
regularly think might be listening with them
helpful? and their family.

29. Mouth Discomfort

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

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

7. A. List the things that are important to you in your life.

• Family
• Love & Self-Love
• Friends
• Good Health
• 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.

a. 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?

a. 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?

a. 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

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.
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.
a. 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. memory lost d,.Communication
Troubles

6
What principles of providing culturally safe care
will help you and the team share information in a
most helpful way?
a. Listening to the person and empathizing with them about
their concerns and questions and connecting them with the
appropriate team member for support.
b. Communicating with the team when the person or family do
not understand the information that has been shared with
them.
c. Identifying and working to share information in line with
the person’s and family members preferences for
receiving and
sharing information
d. Ensuring that the person and family know how to contact the team any
time of the day or week.
e. 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:

• Advocate by communicating the persons choices and goals.

• Support their preferences
• Invite the person to determine their priorities
• Respect the person’s right to choose or refuse treatment, to
eat or not to eat. To bathe or not to bathe.
• 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:
• Speech therapists, physical therapists, and occupational
therapists to determine functional issues
• Social workers, case managers, and vocational rehabilitation
specialists for lifestyle and practical issues
• Other specialists, such as audiologists, other medical
specialists, religious and spiritual influences, and so
forth

8.Identify eight ways that PSW’s can support advance care planning

• Validate their desire to talk about their personal wishes and hopes.
• 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.
• Encourage them to discuss their goal of care.
• Help the person learn about medical procedures.
• Help the person think what is right for them.
• Help the person talk with their health care professionals
about medication or treatment concerns.
• Help the person record conversations. You might say.
• Encourage the person to talk with their health care
professionals and provide them with the relevant contact
information. You might say.

9. As a PSW you can sign legal documents including wills,

legal forms, and documents.
• FALSE
10.Write five things you learned about grief that you did not
know before reading the text.

e. Grief is a whole-person experience.

f. Grief is a natural, healthy response to loss that helps people
adapt to living in a change world.
g. Grief is a hope wish for something that is important to the person.
h. People grieve in a different unique way.
i. People grieve differently over time.
11.Describe ways to support children who’s loved one is dying.

1.Prepare children for what they will see.

2.Be honest

3.Use correct language

  Invite children to participate in caregiving
 Include children when possible.
 Recognize children’s grief and grief together

• EXERCISE
-Extreme Activities - Limit foods that I like
a. 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.

b. 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.

c. 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.

• 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.
a. 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
10. whole
how grief is a whole person experience.
•
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

12.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

13.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
Understanding Your Beliefs and
Baggage
• 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.

• Caring for the body after death is one of the most important
part in itions and cultures like mine.

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.
Physical Changes Comfort for the Dying Comfort
Person measures for
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,
more important than it 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
difficulty swallowing thickened fluids if to talk or ask questions
directed by the nurse or of the nurse, physician,
dietitian. Remind the or 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 members who are
the nurse. Consider caring for a dying
whether it would be loved one to try to find
helpful to reorient this ways to care for
person, given their themselves, for
cultural perspective example, by having a
about delirium. Allow nap or going for a
the person to be in walk, while are in the
their delirium home.
orientation if they
appear to be
comfortable.
Agitation or Report agitation and Encourage the family
restlessness restlessness promptly to discuss their
to the nurse so that concerns with the
this symptom can be nurse and physician.
manage quickly. Share information.
 Explain that
restlessness is a
common experience
that you will
experience in the last
days and
hours,
Unresponsiveness You support the You can help family
person when you members ex[lore
reposition them ways to connect with
regularly to protect their loved one by
their skin and using touch or music,
increase their by simply being a
comfort. quiet presence, or by
It maybe comforting reminiscing and
to person if you recalling family
continue talk with stories
them as though they in the presence of the
were able to hear dying person.
you.
Irregular breathing You can help by Show the family how
positioning the to freshen and
person in a way that moisten a dry mouth
supports their if the person is
breathing and by 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
reassuring presence. to contact the nurse if
Use pillows to support congestion increases
the person to help of if the person shows
open airways. signs of discomfort.
Help the person into The nurse can
a semi-supine address questions
position if about the use of
they are suctioning to
very relieve the congestion.
congested
Changes in skin color If the person is Consult with the nurse
and temperature sweating, you can about the
provide clean person’s physical
 clothing need to be

and bedding. If the washed. More

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

 Preparing Yourself
B. Preparing the family and other staff.
C. Developing a Plan for the time of death and Providing compassion

 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
15. Irregular breathing
16. Congested breathing
17. Changes in skin color and temperature

 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
incontinence pad incontinence access to the contact
under the buttocks pad under the information of the nurse.
in case of further buttocks
incontinence in case of
further
incontinence
b. change soiled b. change Prepare the body as respectfully
linen soiled as
linen you would if the family is
present.
c. dresses the c. dress the Put in the person dentures as
person in a fresh person in a this is important to the family.
gown or fresh gown or
clothing clothing as
as appropriate appropriate
d. position the d. position Inform the nurse and the
person lying flat the person family as soon as possible.
with a pillow lying flat
under with a
their head pillow under
their head
e. Close their e. Close their Gather person’s things as it is
eyelids if their eyelids if important to the family.

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.

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

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