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End-of-Life Decision Making for Older Adults: Competent and Compassionate Care

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Getting Started 

This teaching strategy focuses on assessing expectations, coordinating and managing care, and making situational decisions with older adults. The strategy enhances students’ human flourishing and nursing judgment. 

1.  The following tools can be used in a variety of teaching and learning settings to enhance student learning and understanding of end-of-life care: videos, case studies, concept mapping. 

  • Videos can be useful to help students understand the human aspect of providing care for older adults and their families at the end of life. Using end-of-life (palliative care and/or hospice) videos helps demonstrate to students the difficulties older adults face when making decisions regarding end-of-life care. This may be particularly useful when introducing end-of-life concepts during large didactic lectures, as it provides students with real-life situations and a view of the complexity and challenges older adults face at the end of life.
  • Case studies are useful to help students better understand the challenges individuals and families face during end-of-life transitions. Case studies foster students’ critical thinking by illustrating and contextualizing the complexities associated with end-of-life care. This approach may be best suited for small group discussions, or post-clinical debriefings and discussions.
  • Concept mapping facilitates students’ critical thinking related to the needs of older adults and their families during end-of-life decision making. Concept mapping based on a clinical situations or case studies stimulates student thinking and broadens students’ conceptualization of important end-of-life care needs, as well as allowing them to individualize those needs to specific contexts, individuals, and family situations. 

2.  Each of the above approaches should emphasize the essential and important role of the interdisciplinary team regarding end-of-life care. Students should be introduced to various professional roles on the interdisciplinary end-of-life care team (nurse, physician, pharmacist, chaplain, social worker, bereavement counselor, and other relevant roles as appropriate), and the impact and specific role of nurses on the care of the older adults at the end of life. 

3.  Students should be encouraged to explore websites such as the How to Try This and the Hospice and Palliative Care Nurse Association websites for additional assessment tools and information. 

4.  If time and circumstance allow, assessments regarding end-of-life care on clients residing in assisted living facilities, long-term care facilities, acute- care facilities, and at home can be completed and compared for differences and similarities.

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