Curriculum Design

Working with a patient who has been diagnosed with terminal cancer can be difficult for nurses. They must manage not only the patient’s symptoms but also the emotional state of a person who has just learned that they may die soon. The nurse must carefully manage her role in the care of terminally ill patients. The nurse must maintain appropriate boundaries with the patient. Working with someone who has a terminal illness may make the nurse sympathize with the patient in that they may go out of the way to meet the needs of the patient. However, this could be emotionally draining for the nurse. In order to provide the best quality care for the patients a set of core cultural competencies need to be developed so that they are able to care for these patients and their families. 

The following competencies and objective will need to be utilized in the care of the terminally ill patient. The first competency and objective will address making the patient comfortable through evidence-based practices using pain management despite the symptoms they are experiencing (Board of Nursing, nd np).

1. The nurse utilizes appropriate and reasonable pain management techniques to ease the patient's pain and improve their quality of life. 

a. The nurse will utilize a standardized pain measurement tool to determine the patients level of pain. 

b. The nurse will utilize behavioral observations to assess the patients level of pain if they are incapable of communicating. 

c. The nurse must collaborate with the physician to recommend pain medication which will be beneficial for the patient.

d. The nurse will monitor the administration of pain medication to ensure the medication is at the right level. 

E. The nurse must provide education to the patient regarding side effects and potential addiction potential of the pain medication.

The second competency will focus on assisting the patient with managing the effects of the cancer care and treatment that is occurring to either stall the end of the patient's life or possibly cure the cancer.

2.  The nurse must manage late and continuing effects of the cancer and cancer treatment. (C-Change, nd np).

a. The nurse must provide compassionate and supportive care as the patient goes through the cancer treatment.

b. The nurse must provide education about the side effects of the cancer treatments and progress of cancer.

c. The nurse must assess the quality of life for the patient as a cost-benefit analysis of the need to continue treatment.

d. The nurse must collaborate with the cancer team members to discuss viable treatment options for the client.

e. The nurse must provide support to the patients family as they go through the cancer treatment process.

The third competency would work on addressing the mental health needs of a patient who has received a terminal illness diagnosis.

3. The nurse must assess and refer the client to services to address the feelings surrounding the feelings of the cancer diagnosis. 

a. The nurse must monitor the mood and anxiety levels through standardized comprehensive assessments and patients self-report. 

b. The nurse must refer the patient to social work or a mental health agency so the client can process the diagnosis.

c. The nurse must collaborate with the mental health professionals to discuss the mental health and medical needs of the patient.

d. The nurse must develop a safety plan with the family in case the patient becomes suicidal.  

e. The nurse must provide mental health support group information to the family so that they can adjust to the mental illness.

The final competency needs to address the fact that the patient may not survive the cancer treatment. 

1. The nurse must refer patients to community palliative and end-of-life care and support resources in order to prepare for the cancer to be terminal. (C-Change, nd np).

a. The nurse must prepare the patient by providing information and resources to the client and family regarding palliative care.

b. The nurse must assist the family and patient attend support groups which other families going through a similar situation.

c. The nurse must assist the family with pre-planning for a funeral for the patient after they pass away.

d. The nurse must provide quality services to ensure that the patient is comfortable in their final stage of life. 

e. The nurse must follow up with the family after the patient has passed away to monitor how they are coping with the loss. 

A case concept would involve an elderly man who has been recently diagnosed with terminal lung cancer. The man is a 62-year-old smoker who is a widower. He has children who live in the same city however they are unable to care for him on a regular basis. The client has become depressed and withdrawn since receiving the diagnosis of terminal lung cancer. He has refused any cancer treatment and has been making stating that he wants to die in peace. The client has begun making plans for his death by giving away his belongings. The client’s family is concerned that he may be suicidal and is seeking the assistance of the nurse to help him through this difficult time.

The third competency addressing the mental health of the patient needs to be utilized in providing services to this client. The nurse must make a referral for the patient to be seen by a therapist to assess his mental stability and the need for further services. The nurse must monitor the mood of the patient through frequent visits to the home or appointments in which the patient can come into the office. The nurse must also collaborate regularly with the other professionals who will be working with the patient in order to keep them updated regarding the treatment and also how the mental health services are progressing. The nurse must also develop a safety plan with the family. This is crucial as in his vulnerable state the patient may commit suicide in an effort to end the pain early. The family and team must ensure that the patient has constant supervision so that he does not hurt himself. The family must also ensure that the patient does not have access to guns, knives or pills. The nurse must then refer the client to a support group who can be of assistance to the patient and his family in their time of need especially in dealing with the mental illness.

The GEM model (Guideline Elements Model) is useful in developing concepts and guidelines for treating the patient. “The major concepts in the model hierarchy below the upper category level are identity, developer, purpose, intended audience, target population, development method, testing, knowledge, and appendix.” (Park, 2004 147). The identity, in this case, is the identified patient, the developer of the program would be the nurse and the team, the purpose of the concepts would be to address the mental health symptoms that have occurred as a result of the illness. The clinical experience for the patient can occur within this context of referring and obtaining mental health services. The client’s progress could be measured in terms of resolving the symptoms of mental illness by receiving the treatment. A study could be conducted in which the client is assessed before and after the services and treatment are provided. The intended audience for the study could be other nursing professionals who would be provided with valuable information about the benefits of providing mental health resources to clients. The target population, in this case, would be the patient who is receiving the services however it could be expanded to all terminally ill patients who are having difficulty adjusting to the diagnosis. The testing of the patient’s progress could occur through completing a mental health assessment before and after the treatment is provided. The nurse could also use scaling techniques to measure the extent of the patient’s depression before and after treatment. The knowledge gained from this study would be beneficial for not just the patient but all terminally ill clients. 

An activity which could be conducted during the education phase of the competency, in which the nurse is taught how to apply the competency to her practice with the clients, may include role-playing with the family to discuss suicide and mental illness symptoms. The role play would also involve discussing referrals to these other agencies with the patient which can be difficult for the patient to hear. The patient may be resistant to seeking out mental health services as he may claim that he does not need services. This activity would prepare the nurse to have the discussion with the family and the patient. This activity would also calm any nerves that the nurse has regarding speaking to the family about the mental health services that would be provided to them. 

Another activity might involve studying the various mental health diagnoses that a patient may have. This is important in helping the nurse identify the various mental health symptoms that a patient might exhibit. In order to be able to accurately refer the clients to services, it is necessary to understand what the client is experiencing. The nurse could be taught the mental health symptoms through training. This could also be done through case examples provided to the nurses in which they must diagnose patients with certain symptoms. This would allow the nurse to be more competent when working with terminally ill patients as they may experience numerous mental health symptoms.

This model and procedure are beneficial in helping the client overcome the life-changing diagnosis of terminal illness. The nurse can play a vital role in mediating the process and trauma that the client may be experiencing. Addressing the mental health component is important as it can be often overlooked by doctors who just focus on the medical aspect of the care. As a nurse it is important to understand the competencies within which they must work. An effective nurse is trained in the services she is providing and the clients she is providing services towards their clients.

References

Board of Nurses. (nd). Pain Management Nursing Role. Core Competency A Guide for Nurses, np. Retrieved from http://www.mbon.org/practice/pain_management.pdf>.

Change, C. (nd). Strengthening Cancer Competencies. Cancer Core Competencies, np. Retrieved fromhttp://www.cancercorecompetency.org/index.php?page=strengthening-cancer-competencies>.

Park, M. (2004). Development of evidence based nursing practice guideline document model for electronic distribution. Journal of Korean Society of Medical Informatics, 10(2), 147-159.