NRSG374 - Principles of Nursing: a Palliative Approach

Year

Credit points

Campus offering

Prerequisites

NRSG265 Principles of Nursing: Medical

Unit rationale, description and aim

The Registered Nurse plays a central role in the provision of health care for people who experience health alterations which result in progressive decline in health and ultimately death. Health alterations occur across a range of settings and it is a requirement that the nurse is able to provide care for people experiencing these alterations. This unit is required by students to assist their ongoing development of theoretical knowledge underpinning nursing care for the person requiring a palliative approach in the end stage of their illness.

This unit will enable students to develop knowledge and skills for person–centred, evidence–based nursing care of the person with a life limiting illness to ensure the best possible quality of life for the person and their family. Key principles that underpin best practice will be demonstrated by the use of evidence –based case studies. The nurse’s role in the provision of a palliative approach will be explored across a variety of settings and patient journeys within a context of multi–disciplinary care. The content contained within this unit is instrumental in informing nursing students’ future clinical practice across a variety of settings.

The aim of this unit is to support students to develop an understanding of an evidence based palliative approach within a range of care settings and across the lifespan.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - demonstrate advanced understanding of developmental, lifespan, social, spiritual and cultural factors that impact on the quality of life for people receiving palliative care; (GA1, GA4)

LO2 - demonstrate advanced pathophysiology knowledge to manage common symptoms in the palliative context; (GA4, GA5)

LO3 - critically apply the Roper-Logan-Tierney Model of Nursing across the lifespan, to the principles of a palliative care approach; (GA1, GA4, GA5, GA9)

LO4 - implement the Levett-Jones’ Clinical Reasoning Cycle across a range of settings, to plan safe, evidence-based, culturally sensitive, person-centred palliative care; (GA3, GA4, GA5, GA8, GA9)

LO5 - critically reflect on the lived experiences of the dying, their families and communities; (GA1, GA2)

LO6 - critically evaluate the quality use of medicines, non-pharmacological therapeutic interventions and complementary therapies in the palliative context; (GA1, GA3, GA4, GA5, GA7, GA8)

LO7 - critically apply legal and ethical principles related to the palliation experience. (GA3)  

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity 

GA2 - recognise their responsibility to the common good, the environment and society 

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

NMBA Standards for Practice

The Nursing and Midwifery Board of Australia’s Registered Nurse Standards for Practice developed in this unit are:

Content

Topics will include:

• Principles of a palliative approach
• Philosophy and definition of palliation
• National Palliative Care Standards
• Community perceptions about death, dying and bereavement in contemporary society across cultures
• Values and beliefs about death and dying and impact on care interactions
• Dying trajectories and impact of differing diagnosis e.g., cancer; chronic disease
• Promoting dignity in care relations
• Role of the family in palliative approaches
• Role of the nurse and multidisciplinary team in a variety of settings
• Caring for self and others including the impact of personal stressors; the experience of loss and grief and bereavement care
• Communication in a palliative approach
• Skills of effective communication
• Respect for the diverse human and clinical responses of each person and their family
• End of life discussions and issues including advanced care planning, organ donation and the role of family conferences
• Role of culture and the impact on the interpersonal relationships between the person, family and nurse
• Principles for practice
• Concept of promoting comfort and alleviating suffering
• Assessment and evidence-based management of common symptoms
• Treatment options
• Pharmacology
• Complementary therapies
• Supportive interventions (spiritual, social, psychological)
• Person centredness in caring
• Role of multidisciplinary team and sectorial partnerships
• Applying the clinical reasoning cycle in palliative practice

Optimising function in a person with a life limiting illness

• Identification of needs
• Concept of promoting independence across the dying trajectory
• Role of rehabilitation
• Interventions (physical, psychological and social) to promote function

Learning and teaching strategy and rationale

Modes of delivery in this unit include lectures, tutorials, online activities and self-directed study. Consistent with adult learning principles, the teaching and learning strategies used within these modes of delivery will provide students with foundational knowledge and skills relevant to professional nursing practice. These strategies will also support students in meeting the aim, learning outcomes and graduate attributes of the unit and the broader course learning outcomes. Learning and teaching strategies will reflect respect for the individual as an independent learner. Students will be expected to take responsibility for their learning and to participate actively with peers.

Students exiting university need significant life-long learning skills to deliver sound, ongoing, evidence-based graduate practice as a member of the professional workforce. To embed life-long learning skills students must demonstrate increasing reflective capacity to identify what is being done well and what requires additional work in progressing toward required learning outcomes. Located in the third year of the programme, this theory unit includes some face-to-face teaching hours and an increased online component of learning. Lectures are utilised to convey content and central principles while tutorials deliver interactive and student-driven learning sessions to extend the community of learners, and increase their self-reliance, critical reflection and debate. Online materials provide students with the opportunity to undertake directed, self-motivated study and continue to transition to  independent study and life-long learning.

Assessment strategy and rationale

A range of assessment items consistent with University assessment requirements and policy will be used to ensure students achieve the unit learning outcomes and attain the graduate attributes.

Third year sees students continue their transition towards independent learning. In this unit, there are two 50% assessment items, therefore the importance of each item is higher in terms of achievement of unit learning outcomes and graduate attributes. The professional development resource is aimed at new graduate level nurses working in a palliative care setting. Using palliative care content, the students adopt the level of expectation and knowledge of the new graduate in considering their practice. The written critique requires students to demonstrate an understanding of how theory translates into care and how evidence underpins best practice. Skills necessary for graduate practice include critically appraising and synthesising evidence to drive best practice. An understanding of graduate knowledge and expectations will assist with the transition for student to graduate practitioner. 

These assessments are required to build student knowledge and skills which, by the conclusion of this programme, will enable the student to graduate as a safe and effective nurse. 

Overview of assessments

Representative texts and references

Becker, R. (2016). Fundamental aspects of palliative care nursing: An evidence-based handbook for student nurses (2nd ed.). London, U.K.: Mark Allen Group.

Brown, M. (2016). Palliative care in nursing and health care. London: SAGE.

Ferrell, B.R., & Coyle, N. (Eds.). (2015). Oxford textbook for palliative nursing (4th ed.). New York, NY: Oxford University Press.

Holland, K., Jenkins, J., Solomon, J., & Whittam, S. (Eds.). (2008). Dying. In D. Roberts, Applying the Roper-Logan-Tierney Model in practice (2nd ed.). (Ch.14., pp.453-476). Churchill Livingstone Elsevier.

Johnson, A., & Chang, E. (Eds.). (2014). A palliative approach. In A. Johnson,  & E. Chang (Eds.), Caring for older people in Australia: Principles for nursing practice (Ch.12., pp.377-421). John Wiley & Sons Australia, Ltd.

Johnson, A., & Chang, E. (2014). Bereavement care. In A. Johnson,  & E. Chang (Eds.), Caring for older people in Australia: Principles for nursing practice (Ch.18., pp.377-421). John Wiley & Sons Australia, Ltd.

Larkin, P. (2015). Compassion: The essence of palliative and end-of-life care. Oxford, England: Oxford University Press.

Levett-Jones, T. (2013) Clinical reasoning: Learning to think like a nurse, Frenchs Forest, NSW: Pearson.

Wittenberg, E. (2016). Textbook of palliative care communication. Oxford, NY: Oxford University Press.