Teaching and learning strategies are influenced through observations, experiences, emotions, attitudes, and reactions from others (Bandura, 1977). Through this process, individual form opinions and behaviors within their lives. These opinions and behaviors impact the type of care they provide to individuals. Knowles (1984), describes the adult learner as self-directed and responsible for decisions. Other motivating factors for adult learners are: they need to know why they need to learn something, they learn through experience, they problem-solve and the need for the learning must be of immediate value (Knowles, 1984). Learning has been described though Bloom's Taxonomy but has been revised by Overbaugh & Schultz, (n.d.) to a newer process containing six criterion:
Remembering: Can the student recall the information?
Understanding: Can the student explain ideas or concepts?
Applying: Can the student use the information in a new way?
Analyzing: Can the student distinguish between the different parts?
Evaluating: Can the student justify a stand or decision?
Creating: Can the student create new product or point of view?
Meeting this criterion, the full circle of learning has become complete.
The AACN in it's creation of the Recommended Competencies for Peaceful Death hopes to achieve the above learning principles. I will provide the link to this website for review and also list the 16 competencies that are now recommended for all student nurses.
http://www.aacn.nche.edu/elnec/publications/peaceful-death
1. Recognize dynamic
changes in population demographics, health care
economics, and service delivery that necessitate improved
professional preparation for end-of-life care.
2. Promote the provision
of comfort care to the dying as an active,
desirable, and important skill, and an integral component
of nursing care.
3. Communicate
effectively and compassionately with the patient, family,
and health care team members about end-of-life issues.
4. Recognize one's own
attitudes, feelings, values, and expectations
about death and the individual, cultural, and spiritual
diversity existing in these beliefs and customs.
5. Demonstrate respect
for the patient's views and wishes during end-of-life
care.
6. Collaborate with
interdisciplinary team members while implementing
the nursing role in end-of-life care.
7. Use scientifically
based standardized tools to assess symptoms
(e.g., pain, dyspnea [breathlessness] constipation, anxiety,
fatigue, nausea/vomiting, and altered cognition)
experienced by patients at the end of life.
8. Use data from symptom
assessment to plan and intervene in symptom
management using state-of-the-art traditional
and complementary approaches.
9. Evaluate the impact
of traditional, complementary, and technological
therapies on patient- centered outcomes.
10. Assess and treat
multiple dimensions, including physical, psychological,
social and spiritual needs, to improve quality at the
end of life.
11. Assist the patient,
family, colleagues, and one's self to cope with
suffering, grief, loss, and bereavement in end-of-life
care.
12. Apply legal and
ethical principles in the analysis of complex
issues in end-of-life care, recognizing the influence
of personal values, professional codes, and patient preferences.
13. Identify barriers
and facilitators to patients' and caregivers'
effective use of resources.
14. Demonstrate skill at
implementing a plan for improved end-of-life
care within a dynamic and complex health care delivery
system.
15. Apply
knowledge gained from palliative care research to
end-of-life education and care.
16. The purpose of the
competency statements is to assist nurse
educators in incorporating end-of-life content into nursing
curricula. This document is developed with the understanding
that few schools of nursing would offer a
discrete course in end-of-life care. Thus, this
document offers an approach to incorporating
end-of-life content throughout the currently
existing curriculum.
Additionally,There are four components of a "natural death" in the ICU described by Cronquist, Theorell, Burns & Lutzem (2004). These are:
1. The process of dying is not prolonged or rushed (timing).
2. Technical death is aligned with bodily death.
3. The family has accepted the death.
4. Careful planning of withdrawal of treatment is made to enable control of the situation so the family can witness a gradual, quiet and dignified death.
Thinking about such care, it becomes obvious of the need for all nurses to become educated and explore their own feelings about death and dying to better assist patients and families with this process.
Your thoughts?
References
Cronquist, Al, Theorell, T., Burns, T., & Lutzem, K. (2004). Caring about-caring for: Moral obligations and work responsibilities in intensive care nursing. Nursing Ethics, 11(1), 63-76. Retrieved from CINAHL Plus with full text.
Knowles, M. (1984). Andragogy. Retrieved from http://www.instructionaldesign.org/theories/andragogy.html
Overbaugh, R.C., & Schultz, L. (n.d.). Blooms Taxonomy. Retrieved from http://www.odu.edueducrpverbau/Bloom/blooms_taxonomy.htm
Peaceful death: recommended competencies and curricular guidelines for end-of-life nursing care. (2012). Retrieved from http://www.aacn.nche.edu/elnec/publications/peaceful-death
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