Full Course Description

Pharmacology of Pain Management at the End-of-Life: Association Between Pain, Anxiety, Delirium and Sleep Disorders in Terminally ill Patients

Assessment and management of pain at the end of life is a manifold issue with a deep impact on the patient's quality of life. With a better understanding of pain management's key principles at the end of life, caregivers can contribute to providing comfort and solace to their dying patients.

Studies of dying patients reveal that up to 57 percent describe moderate or severe pain in the last month of life and 23 percent experience uncontrolled pain in the last week of life. Untreated pain can be devastating to the patient and family or other loved ones not only because of the suffering it produces, but also because it interferes with the ability to complete important tasks at the end of life. Pain management at the end of life is a right of the patient and the duty of the clinician. 

A key element to achieving satisfactory pain relief for the patient at the end of life is knowledge of pain reduction medications. Failure to treat pain effectively can result from a lack of clinician training regarding end-of-life care or from the fear of violating ethical, moral, and legal tenets in the administration of pain medication to the dying patient. Clinicians may have an exaggerated misperception of the risk of hastening death when treating patients with opioids. Furthermore, some clinicians may be unclear about the clear associations between sedation for intractable pain, anxiety, delirium and sleep disturbances at the end of life as they relate to pain management.

This presentation will highlight the latest pharmacologic modalities to treat pain at the end of life. In addition to discussing the pharmacology of opioids, we will also state the importance of NSAIDS, benzodiazepines, antidepressants, hypnotics and anticonvulsants in pain management. The importance of drug-drug interactions and organ failure with regards to end-of-life pharmacology will be highlighted. 14

Program Information

Objectives

Describe the stepwise progression in pain management at the end of life.
State at least two indications for initiating opioids at the end of life.
Discriminate the medications for breakthrough pain when opioids are not effective for pain control.
Identify at least two medications which are used for intractable pain.
List at least two medications which can be used to aid sleep for the patient at the end of life.

Outline

Pharmacokinetics of analgesics

Non-opioid medications

NSAIDS
Acetaminophen
Anti-depressants
Anti-convulsant

Opioid medications

Naturally occurring
Semisynthetic compounds
Synthetically manufactured

Breakthrough pain management

Benzodiazepines

Intractable pain
Anxiety relief

Delirium recognition and pharmacologic treatment

Pharmacologic agents used in sleep management

Complications with pharmacologic pain management at the end of life

Drug-drug interactions
Drug-food interactions
Organ Failure

Case studies

Target Audience

Nurse Practitioners
Advanced Practice Nurses
Physician Assistants
Physicians
Pharmacists
Nurses

Copyright : 09/06/2023

Pharmacology Update: End of Life Symptom Management

Alleviation of non-pain symptoms at end of life can often be challenging for patients, families, and practitioners. Managing these symptoms includes a thorough history and physical, understanding complex pathophysiology related to the symptoms, and prescribing appropriate medications that lead to an optimal quality of life. This session will review common symptoms, pharmacologic management, and relevant family education, while utilizing an interdisciplinary approach.

Program Information

Objectives

Discuss the components of treating dyspnea at end of life, to include history and physical, pathophysiology, pharmacologic management, family education, and inclusion of the interdisciplinary team.
Review pharmacologic and non-pharmacologic management of GI symptoms at end of life to include nausea, vomiting, constipation, diarrhea, and anorexia.
Identify specific strategies to treat anxiety and existential distress at end of life utilizing medications and the interdisciplinary team.
Evaluate the causes and treatment of fatigue when it presents with terminal illness.
Assess depression at end of life and pharmacologic management.

Outline

Alleviating Suffering at End of Life: Managing Non-Pain Symptoms

Dyspnea
GI symptoms - nausea, vomiting, constipation, diarrhea, anorexia
Anxiety/existential distress
Fatigue
Depression

Discover the latest best practices for each symptom:

History and physical
Pathophysiology
Pharmacologic management
Family education
Interdisciplinary approach
Case study
Sample assessment tools

Copyright : 10/19/2023

End Stage Diseases: Care When There is No Cure

Each particular end-stage disease has unique complexities for the patient, the family, and the healthcare professional. This presentation will cover specific strategies to care for various end stage patients. This will include end-stage liver, kidney, lung disease, heart disease, cancer, and pharmacological interventions to provide palliative care measures.

Program Information

Objectives

Evaluate functional assessment scales that are predictive of poor survival.
Explain the benefits of using palliative care principles for five end-stage diseases.
Discuss pharmacological measures for acceptable interventions.

Outline

Prognostication

Palliative Performance Scale (PPS)
Mortality Risk Indicator (MRI)
Charlson
Mitchell Mortality Index
E-Prognosis

Palliative Care for Serious Illness

Definitions of PC

National Consensus Project (4th Ed)

Management of End-Stage Heart Failure

Assessment and Prognosis
Symptoms and Symptom Management
Pharmacologic
Non-pharmacologic

Management of End-Stage COPD

Assessment and Prognosis (GOLD) tools
Symptoms and Symptom Management
Pharmacologic
Non-pharmacologic

Management of End Stage Renal Disease

Assessment and Prognosis (GFR)
Symptoms and Symptom Management
Pharmacologic
Non-pharmacologic

Management of End Stage Liver Disease

Assessment and Prognosis (MELD)
Symptoms and Symptom Management
Pharmacologic
Non-pharmacologic

Management of End Stage Dementia

Assessment and Prognosis (FAST, GDS, MRI, MMRI)
Symptoms and Symptom Management-Delirium/Agitation
Pharmacologic
Non-pharmacologic

Copyright : 10/20/2023

Palliative Wound Care

Palliative wound care utilizes mutual goal setting to maximize quality of life in patients where wound healing may not be the primary goal. Knowledge of pain management, decreased dressing change frequency, and infection prevention methods can facilitate successful outcomes in this specialized cohort of wound patients. Learn about the special considerations of palliative wound care including an increased emphasis on infection prevention, comfort, and pain management. In addition, hear which management strategies are contraindicated in certain palliative wound types to avoid complications.

Program Information

Objectives

Define palliative wound care and what constitutes a palliative wound.
List common palliative care wound types.
Describe core management concepts of palliative wounds.
Determine interventions to treat common complications seen in palliative wounds.

Outline

Palliative wound care and what constitutes a palliative wound

When to choose palliative care
Wound healing v symptom palliation
How to prioritize symptom relief

Common palliative care wound types and review management considerations

Wound in patients with cancer
Fungating tumors
Cancerous wounds
Arterial ulcers
Non-adherence to medical plans of can in medically complex patients
Overwhelming comorbidities

Core management concepts of palliative wounds

Infection prevention
Pain reduction
Odor and drainage management

Target Audience

Occupational Therapist
Occupational Therapy Assistant
Physical Therapist
Physical Therapist Assistant
Registered Nurse
Licensed Practical Nurse/Licensed Vocational Nurse
Certified Nurse Assistant
Medical Assistant
Nursing Home Administrator
Nurse Practitioner
Podiatrist
Physician Assistant/Associate
Physician

Copyright : 06/19/2023

Nourishing the Older Adult: Challenges and Controversies

In this session, Liz will provide a general overview of the nutritional needs of older adults and components of nutrition assessment that are unique to this population. She will outline key nutrients needed by older adults, the roles they play, and food sources of those nutrients. She will discuss the use of dietary supplements and other ways to meet an older adult’s unique nutritional needs. She will also address topics that are perceived to be controversial including the obesity paradox, the use of therapeutic diets for disease management of older adults, and the relationship of diet to cognitive decline.

Program Information

Objectives

Identify at least 4 factors related to aging that can affect nutritional status in older adults.
Demonstrate an understanding of macronutrients needed for the health of older adults.
Demonstrate an understanding of micronutrients needed for the health of older adults.
Select appropriate nutrition interventions to help promote health and longevity in older adults.

Outline

Introduction

Demographics and health status of older adults
- Life expectancy
- Health status/Health concerns of older adults
- Where do older adults reside (community dwelling vs. post-acute care)
- Rates of obesity and frailty

Nutrition assessment of older adults

Factors unique to older adults
Identifying over nutrition and under nutrition
- Body mass index
- Serum albumin
- Academy/ASPEN criteria for identification of malnutrition
Potential barriers to providing effective nutrition interventions

Nutrients needed for good health

Food sources
Roles of nutrients in the body
Use of dietary supplements to meet nutritional needs
Meeting nutritional needs when food intake is inadequate

Controversies

The obesity paradox
Using therapeutic diets to treat disease
Can diet prevent cognitive decline?

Target Audience

Nurses
Nurse Practitioners
Occupational Therapists
Occupational Therapy Assistants
Physical Therapists
Physical Therapist Assistants
Physician Assistants
Speech Language Pathologists
Other Healthcare Professionals

Copyright : 09/29/2022

End of Life: Palliative and Hospice Care Benefits

Caring for patients facing the end of their lives requires extreme sensitivity, deep compassion, and extraordinary knowledge. To deliver informed and compassionate care, healthcare professionals need to understand the differences between hospice and palliative care.

You will leave this session with concrete strategies to identify patients for whom aggressive therapy is not appropriate, skills to work through palliative referral and financial considerations, and the latest when it comes to hospice eligibility criteria.

Each end-of-life patient trusted to your care deserves to be optimally supported, on the final journey of their life.

Program Information

Objectives

Determine referral considerations for palliative care.
Analyze the myths surrounding hospice care.
Differentiate between hospice and palliative care services.
Evaluate the eight domains of the National Consensus Project.

Outline

Pillars of Palliative Care

National Consensus Report
Referral considerations
Financial considerations
Barriers and Benefits to PC

Hospice

Services
IDG/IDT
Medicare benefit (levels of care)
Eligibility criteria
Financial considerations
Barriers and Benefits to Hospice

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants
Social Workers
Case Managers
Physical Therapists
Occupational Therapists
Speech Language Pathologists

Copyright : 08/29/2022

End-of-life Compassionate Care: Ethical and Legal Issues

The goal of end-of-life care is to prevent or minimize suffering while respecting the dying person’s wishes. End-of-life decisions are made in all age groups and the number of individuals aged sixty-five (65) years and older is projected to double by 2060. Health care providers are facing enormous challenges in assisting patients and their families to transition to the final stage of existence. Self-care and education are paramount in developing appropriate coping mechanisms necessary to provide compassionate end-of-life care. This course will provide strategies for implementing safe and effective end-of-life care. Case studies illustrating ethical dilemmas and plausible resolutions are incorporated.

Program Information

Objectives

Describe the appropriate uses and requirements for Physician Orders for Life- Sustaining Treatment (POLST).
Discuss ethical and legal issues related to the decision to withdraw treatment or lifesaving measures.
Identify how to navigate the health care professional’s responsibilities and obligations while respecting the dying patient’s values and wishes.
Expand the health care professional’s knowledge of how to cope with the ethical dilemmas thar occur with end-of-life.

Outline

END-OF-LIFE CARE

Affects all age groups
65-year-old population is projected to double by 2060.
Patients, families, health care providers, and community members all in need of support and education

SUGGESTED CHECKLIST

DNR forms
Physician Orders for Life (Physician Orders for Life-Sustaining Treatment (POLST}
Durable medical power of attorney
Living will
Last will and testament
Revocable living trust
Beneficiary designation for non-probate assets
Durable financial power of attorney
Pet trust
End-of life housing arrangements
Instructions for digital assets
Life insurance
Funeral or celebration of life instructions. Burial, cremation, organ, and body donation

DEATH WITH DIGNITY/WITHDRAWAL OR WITHHOLDING OF TREATMENT OR LIFE SAVING MEASURES

Hospice
Palliative care
Euthanasia
Assisted suicide/Aid in dying
Abuse/neglect

PATIENT VALUES/CULTURAL (psychological, sociological, and physiological)

Family conflict/decisions not cohesive
Communication
Preparation
Education

HEALTH CARE PROVIDERS’ COPING MECHANISMS

Peer groups (intervention, support, therapy, and review)
Ethics panels, boards, or committees
Licensure/Credentialing Boards
Institutional regulations, policies, procedures, and protocols
Professional negligence or malpractice

Target Audience

Nurse Practitioners
Advanced Practice Nurses
Physician Assistants
Physicians
Pharmacists
Nurses

Copyright : 08/03/2023

Culture into Practice: Improving the End of Life Experience

Death is a natural part of the life. The process of dying is as important as the birthing process and all other stages of life. With unique backgrounds, values, and beliefs, individuals bring different needs and expectations to the dying process. It is imperative that healthcare professionals understand, value, and deliver end of life care that is unique to each patient and their family.

Culture plays a significant role in how individuals view themselves and their role in the family and the world around them. Therefore, patients’ approach to illness and death is directly impacted by cultural factors. End of life care should be personalized with the patient’s cultural factors in mind. This webinar will provide important factors and practices to consider when delivering culturally responsive end of life care.

Program Information

Objectives

Evaluate culture and culture humility for individual patient considerations.
Analyze major categories of cultural influence on end-of-life beliefs and decisions.
Explore how culture impacts the end-of-life experience.
Discuss practice considerations to improve patients' end-of-life experiences while honoring cultural preferences.
Determine the impact of social determinants of health on the quality of comfort care and end-of-life.

Outline

Improving the End-of-Life experience

Cultural care considerations
- Culture
- Culture humility
- Provider’s self-assessment
Categories of cultural influence (understanding values, belief, preferences of EOL care)
- Race/ethnicity
- Religion
- Geographical region
- Socio-economic status
Social drivers of health
- Education access and quality
- Access to quality healthcare
- Economic stability
- Social and community context
- Neighborhoods and built environments

Exploring the patient’s end of life preferences

Preparing for your death experience.
Meaning and purpose (Viktor Frankel)
Dying gracefully
Family dynamics
Leaving a legacy

Copyright : 10/19/2023

Death, Dying & Bereavement: New Strategies for Clients & Their Families to Find Meaning at the End of Life

Death is inevitable. Looking into the face of death is one of the scariest and most emotional battles that your clients will ever have to go through. Are you ready and able to guide your clients through their death, or the death of a loved one?

Join Ligia M. Houben, MA, FT, FAAGC, CPC, CHT, and she’ll walk you through how to best help your client and your client’s family cope with dying and bereavement. You’ll learn new techniques for processing and normalizing grief, as well as strategies to help your clients create meaningful rituals and get the most out of their hospice care.

You’ll finish this recording having gained new insights into the needs of the dying, including the emotional need to have difficult conversations with family members who may not yet be ready to accept that their loved one is dying. You’ll obtain new tools to address death anxiety and learn how culture and spirituality shape your client’s end-of-life experiences.

Purchase today to transform the way you treat clients struggling with death, dying and bereavement.

Program Information

Objectives

Analyze and explain how different perspectives on the afterlife affect individual responses to death and bereavement.
Develop strategies to assist clients and their caregivers with end-of-life preparation.
Utilize tools and strategies to normalize grief and to aid clients and their caregivers in processing grief.

Outline

CONTEMPORARY ATTITUDES TOWARD DEATH & DYING

Death anxiety (Thanatophobia) or death acceptance?
The new death awareness movement
Clinicians’ attitudes toward death & dying

THE DYING PATIENT & THEIR FAMILY SYSTEM

Terminal illness is a family matter
The dying trajectory
Forgiveness, love & emotional healing at the end of life
How belief in the afterlife effects death
Anticipatory grief & preparatory grief

PREPARING FOR THE END OF LIFE

Validate & help to process emotions
Assist in addressing spiritual needs
Pain management & comfort
Legal documents & advanced care planning

CONTEMPORARY ASSESSMENTS & INTERVENTIONS

Assess death anxiety
Tools for processing & normalizing grief
Meaningful rituals for patients & families
Considerations for cancer patients

Target Audience

Counselors
Social Workers
Psychologists
Psychiatrists
Nurses
Nursing Home Administrators
Case Managers
Marriage & Family Therapists
Chaplains/Clergy
Palliative Care Services
Thanatologists
Funeral Directors
Addiction Counselors
Other Mental Health Professionals

Serious Illness Messaging and Crucial Conversations

One of the biggest challenges healthcare professionals face is the serious illness messaging and critical conversations that are vital for patient care. Advance care planning is often overlooked. Many patients we see simply do not have one. However, the important aspect of guiding patients through their medical treatment and care involves very specific discussions for them. In this session, you will learn about advance care planning and your role in it. You will also learn about serious illness messaging, conversation steps and guidelines, the power of four words, and how to address consent and decision-making challenges. We will end with a discussion on addressing the most difficult questions “how long do I have?”

Program Information

Objectives

Determine three measures to bring awareness of Advance Care Planning (ACP) to your facility.
Analyze two action steps to implementing ACP conversations.
Evaluate serious illness messaging and how to incorporate it into your practice/agency.
Recognize tools, tests and instruments used in assessing and discussing prognosis.
Plan your own conversations regarding choices, values, and wishes.

Outline

What is Advance Care Planning (ACP)

Why is ACP important and needed?
Benefits and barriers
Continuum of ACP
Impact of unwanted, nonbeneficial treatment
Why ACP discussions are not started

What is Serious illness

Serious illness/Dying trajectories

Serious Illness Messaging

Serious illness conversation guide
COVID-19 response tool
Vital talks
2023 serious illness conversation guide

Communication and Critical Conversations

Communication needs of the patient
Communication needs of the family
Patient and family expectations
Communication and shared decision making
Who initiates the discussion
Tools to assist ACP conversations
Explain the default policy
Non-beneficial treatment
Questions for the doctor
Questions at the time of diagnosis
How much can we share

The Power of Four Words

“What Matters to You”
What to discuss
Culturally appropriate discussions
Goals of care/ Treatment options discussion
Centering treatment on what matters
Lack of continuity

Treatments to Prolong life

Video, “Ain’t No Way to Die”
CPR discussion
Responding to emotion
COVID 19 and critical conversations
Maintaining hope and truth

Addressing Consent and Decision-Making Challenges

Medical/professional obligations

Advance Care Planning Documents

What is an advance directive (vs a will)?
When to review an advance directive
Misconceptions about advance directives
When to do an advance directive
What is a healthcare agent
Things to consider when choosing a healthcare agent
Examples of a healthcare agent
What is POLST
Where does POLST fit in?
Comparing advance directive to POLST
Our role with POLST
What happens in an emergency situation?

“How long do I have?”

What is medical prognosis
Determining prognosis
What about the probable outcome
Scales and tools to assist with prognostication
Our role is prognosis communication
Using the Serious Illness Conversation Guide
Cultural considerations about disclosure of diagnosis and prognosis

Older Adults with Pain: Most Effective Pharmacologic and Non-Pharmacologic Therapies

Pain can very seriously impact activities of daily living and quality of life for our elderly patients. Multiple comorbidities, polypharmacy, and potential for harm make it a challenge to determine the appropriate drug, dosages, and maintenance of therapy. Steven Atkinson, PA-C, MS, will deliver evidence-supported updates for pharmacological and nonpharmacological therapies to manage pain in the elderly.

Program Information

Objectives

Analyze the pathogenesis of pain in the elderly.
Evaluate screening tools available for the treatment of pain among older adults.
Differentiate between the most effective pharmacologic and non-pharmacologic therapies for older adults with pain.

Outline

Pathogenesis of Pain

Acute vs. persistent pain
Nociceptive vs. neuropathic pain
Physiological changes in the elderly

Assessing the Geriatric Adult for Pain

A comprehensive geriatric exam
Exam for those with dementia
Evaluate screening tool options

Multimodal Approaches to Pain Management

Non-pharmacological approaches
Pharmacological approaches
- Adjuvant therapies
- Opioids - Guidelines specific to geriatrics
- Cannabinoids

Target Audience

Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants
Physicians
Physical Therapists
Physical Therapist Assistants
Occupational Therapists
Occupational Therapy Assistants
Speech Language Pathologists
Social Workers
Nursing Home Administrators