Suffering and Total Pain

Partageons nos savoirs: Formation pour les professeurs afin soutenir les étudiant(e)s en soins infirmiers dans leurs

interventions de fin de vie

Sharing expertise: Enhancing end-of-life care education for nursing students

Susan Brajtman RN, PhD

School of NursingUniversity of Ottawa

May 7, 2008

Objectives

• Identify and discuss the different dimensions of total pain/suffering

• Discuss a holistic model of care and explore the implications of using the model in addressing suffering/total pain.

• Explore and discuss teaching strategies that allow students to explore and understand the concepts of total pain/suffering

• Explore and discuss teaching strategies that enhance students’ ability to understand, assess and manage their patient’s total pain.

Fear and depression are a part of life. In illness there are no ‘negative emotions,’ only experiences that have to be lived through. What is needed in these moments is not denial but recognition. The ill person’s suffering should be affirmed, whether or not it can be treated. What I wanted when I was most ill was the response, “Yes, we see your pain; we accept your fear.”

Arthur W. Frank, At the will of the body. Houghton-Mifflin, 2001.

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/Cultural

Physical Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

-Finances-Relationships-Personal routines-Recreation-Vocation-Rituals-Legal issues-Family caregiver support-Practical

Social/Cultural, e.g.

-Disease management-Pain & other symptoms-Function-Nutrition habits-Physical activity

Physical, e.g.-Personality-Psychological symptoms-Emotions-Control & dignity-Coping responses-Self image/ self esteem-Loss & Grief

Psychological, e.g.

-Meaning & values-Existential issues-Beliefs-Spirituality -Rites & rituals-Symbols & icons-Loss & Grief-Life transitions-Religions

Spiritual, e.g.

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/Cultural

Physical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/CulturalPhysical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/CulturalPhysical

Psychological

Spiritual

Aspects/Domains of Holistic Care

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Social/Cultural

Physical

Psychological

Spiritual

Physical Psychological

SpiritualSocial/Cultural

Holistic Care and Environmental Influences

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

FamilyFriends

Physical Psychological

SpiritualSocial/Cultural

Formal Care Givers (includes Volunteers)

FriendsFamily

Holistic Care, Environmental Influences and Interprofessional Relationships

Adapted from: “Domains of Issues Associated with Illness and Bereavement” in A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. CHPCA, March 2002, page 15.

Holistic Care, Environmental Influences, InterprofessionalRelationships, Culture & Society

FamilyFriends

Physical Psychological

SpiritualSocial/Cultural

Formal Care Givers (includes Volunteers)

Learning in Action

What am I learning about myself when I listen to someone who is suffering?

How can I be truly

present to someonew

ho is suffering?

Dimensions of Total Pain/ Suffering

• Physical Pain: Comprehensive pain assessment, WHO ladder

• Psychological Pain: fear, anxiety, anguish: Complementary therapies, pharmacological therapy, support , Dignity-Conserving Care (Chocinov, 2002)

• Social Pain: affect on family and friends, feelings of burden: family dynamics, involvement

• Spiritual Pain: spiritual needs assessment (Puchalski & Romer, 2000)

• Meaning and purpose of life events, meaningful relationships, need to give and receive love, hope

Collaborative patient Centred Care (Herbert, 2005)

• Collaborative interprofessional team approach: no one health care professional can meet all of these patients’ multiple, complex needs

Teaching Strategies

• Case studies created and/or of patients students are

caring for

• Narrative Pie - dimensions of holistic care

• Interprofessional team map

• The Humanities: books, movies, art, poetry

Your ideas!

References

• A model to guide hospice palliative care: Based on national principles and norms of practice. (2002). CHPCA From: http://www.chpca.net/marketplace/national_norms/II.pdf

• Chochinov, H.(2002). Dignity-conserving care- a new model for palliative care. JAMA,287(17), 2253-2260.

• Greenstreet, W. (2001). The concept of total pain: a focused patient care study. British Journal of Nursing, 10(19), 1248-1255

• Herbert, C. (2005). Changing the culture: Interprofessional education for collaborative patient-centred practice in canada. Journal of Interprofessional Care. 1, 1-4.

• Puchalski, C., & Romer, A. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137.

• Self learning Module: You the Learner, The Person in Your Care in Palliative Care Unit (PCU) & The Interprofessional Care Team AtSCO Health Service. ( 2007). Interprofessional Education for Collaborative patient Centered Practice in the Humanities.

• Teamwork in healthcare: promoting effective teamwork in healthcare in Canada. (June, 2006). Report to Canadian Health Services Research Foundation, Canada.