Course Module. Basic Certificate Course in

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BCCPN Module_Page-1

Course Module

Basic Certificate Course

in

Palliative Nursing (BCCPN)

Prepared by:

Centre for Palliative Care

Bangabandhu Sheikh Mujib Medical University

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Participants of Curriculum Development Committee

Sl. Name of participants Designation Remarks

1. Prof. Nezamuddin Ahmad Professor & Project Co-ordinator, CPC, BSMMU. Advisor

2. Md. Nurul Anwar Ph.D Nursing Instructor, Dhaka Nursing College,

Dhaka.

Resource person

3. Ms. Moniza Khatun Nursing Superintendent, RMCH, Rajshashi Resource person

4. Ms. Shahanara Khatun Instructor, College of Nursing, Mohakhali, Resource person

5. Ms. Probhaboti Roy Nursing Superintendent of Hospital, BSMMU Member

6. Ms. Mabel D Rozario Chairman, Dept. of Graduate Nursing, BSMMU Member

7. Ms. Halima Begum Deputy Nursing Superintendent (Education &

Training), BSMMU

Member

8. Ms. Shantana Rani Day Deputy Nursing Superintendent (Admin),

BSMMU.

Member

9. Ms. Habiba Zaman Nursing Officer, BSMMU Member

10. Ms. Mayabini Boiragi Nursing Officer & Nurse co-ordinator, ICU nurses

training progam, BSMMU.

Member

11. Ms. Magdalina Pandey Nurse Manager, Square Hospital, Dhaka Member

12. Ms. Fatema Akter In-Charge Nurse, Centre for Palliative Care,

BSMMU.

Member

13. Mst. ShilpiAktar SSN, Centre for Palliative Care, BSMMU. Member

14. Ms. RozinaAkter SSN, Centre for Palliative Care, BSMMU. Member

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Course at a Glance

Title of the Course : Basic Certificate Course in Palliative Nursing (BCCPN)

Entry Qualification : Registered Nurse of Bangladesh Nursing Council

Type of Course : Full time (08:30 AM to 2:30 PM)

Duration : 6 Weeks (42 days)

Number of Participants : 10 (Ten) each batch

Venue : Centre for Palliative Care, BSMMU, Shahbag, Dhaka.

TIME ALLOCATION

Theory sessions : 15 days (15 x6 hours = 90 hours)

Clinical Practice : 15 days (15x6hours = 90 hours)

Demonstration Class : 02 days (2 x 6hours = 12 hours)

Review : 02 days

Examination : 02 days

Week End : 06 days

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Master plan

For 6 weeks BCCPN course structure

Theory Clinical practice Demonstration

Review Examination Week end

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

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Rotation plan

For Clinical Practice (15 days)

IPD- 7 days OPD- 3 days Procedure Room- 2 days Counseling-1 day Homecare – 2 days

Group- A

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Group- B

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

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Introduction:

People with life-limiting diseases including cancer suffer a lot in their last days. Pain, other difficult symptoms and psychosocial and spiritual problems dramatically decrease the quality of life, place a burden on the family and on the health care system. This is the same for most of the elderly also towards the end of their life.

Palliative care improves the quality of life of people with life-threatening or debilitating illness by providing relief from pain and other physical symptoms and addressing psychosocial and spiritual needs. To ensure the most effective care for patients, palliative care begins at the point of diagnosis, continues throughout treatment, and extends to bereavement support to the family after the patient’s death. In situations where cure is possible, palliative care can provide essential supportive care to provide pain relief, control symptoms, and minimize suffering.

Palliative Care has not found a proper place in undergraduate or post graduate medical education in the country. There have been a few developments in delivery of services for the incurably ill, bedridden and dying patients in the country over the last 3-4 years. But these initiatives have been able to address only a minor fraction of patients in need of care. Universal nature of the problem and the potential for addressing most of it at the Primary Health Care level demands necessary skills for health care professionals in the community. One of the major areas which need urgent attention is capacity building among nurses who are the key professionals at the point of delivery of care. This needs to be done through a organized, structured regular training program in palliative care in the country so that quality and uniformity of training is maintained.

Bangabandhu Sheikh Mujib Medical University (BSMMU), the only medical university in the country has introduced and incorporated Palliative Care in its services in 2007. The university has decided to address the knowledge and skill gap in palliative care in the country through a series of training programs and courses starting with Six Weeks ‘Basic Certificate Course in Palliative Medicine’ and ‘Basic Certificate Course in Palliative Nursing’.

Most of the patients at the end of their lives are looked after by health care professionals working in hospitals and in the community. Basic Certificate Course in Palliative Nursing is aimed at helping nursess to consolidate and develop their confidence and expertise in palliative care. Interactive theory session and clinical exposure in the background of availability of rich background material makes the course productive and useful for all clinicians. Successful candidates will be awarded Basic Certificate in Palliative Nursing at the end of the six weeks course.

The course is jointly organized, run and evaluated by the palliative care service of BSMMU and the WHO Collaborating Centre at the Institute of Palliative Medicine of Calicut, Kerala, India. Curriculum for the course was finalized in 2012 following three pilot courses and a feedback, evaluation and consensus workshop supported by Bangladesh University Grants Commission.

Course Outline:

The Basic Certificate Course in Palliative Nursing has 6 weeks of direct interactive tutorials, bed side clinical sessions, written assignments and skill development in nursing procedures related to palliative care.

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BCCPN Module_Page-7 As part of the course, the candidate must submit 10 case histories, 6 written assignments and 1 project proposal for evaluation.

The course material provided will contain modules, which will cover essential information on principles and practice of palliative nursing.

There will be an evaluation at the end of the course. Successful candidates will be awarded the Basic Certificate in Palliative Nursing

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Aim of the course:

The course aims to:

Provide the candidate with an opportunity to demonstrate the ability to develop clinical practice by integrating this with up-to-date and relevant theoretical palliative care knowledge. Particular attention will be paid to the holistic, patient and family centered nature of palliative care, including grief and bereavement.

Provide opportunities to develop personal and professional reflection about the management of a patient with palliative care needs.

Develop the ability to evidence-based clinical practice in the light of increased knowledge, newer skills and personal reflection.

Learning Objectives:

At the end of the course, the participants will be able to:

 Patient Care:

o Demonstrate knowledge and proficiency in evaluation of (a) patients with incurable and life

limiting illnesses and (b) patients with specific symptom palliation needs

o Perform a careful and complete history and physical examination, with emphasis on

communication with the patient and/or his/her family about end-of-life issues such as advance directives and prognosis

o Develop a basic treatment plan for patients with common symptoms associated with

life-limiting illnesses

o Identify indications for transferring patients to the inpatient Palliative Care service

 Medical Knowledge:

o Acquire basic knowledge of the following topics:

 Symptom evaluation and management: The trainee should demonstrate advanced and

sophisticated knowledge of evaluation and management, of patients with advanced diseases

 Pain:

 Dyspnoea

 Constipation and diarrhea

 Nausea and vomiting

 Anorexia and weight loss, abdominal distension, lymphedema

 Urinary incontinence, frequency, retention

 Spinal cord compression, management of unconscious patients

 Delirium and agitation, including terminal delirium

 Anxiety and depression

End of life issues: ethics and communication

 Breaking bad news

 Advance directives

 Resuscitation status

 Artificial nutrition and hydration

 The family meeting

Prognosis

 Chronic medical conditions

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Total Timing of the theory sessions in the course will be 90 hrs organised as six modules

Module 1: Introduction to Palliative Care: 5hrs

Introduction to palliative care 2 hr

Organizing Palliative care services 1hr

Introduction to home care 1 hr

Nurses home care protocol 1 hr

Module 2: Communication Skills: 14hrs

Introduction to communication skills 1 hr

Basic principles of communication 1 hr

Effective communication & barriers of communications 2 hr

Breaking bad news 2 hr

Collusion, denial & handling difficult reactions 1 hr

Communicating with other professionals 1 hr

Communication with oneself 6hr

Module 3: Symptom Assessment and Management: 19 hrs

Pain management- definition, general principles, causes & assessment 2 hr

Pathophysiology & classification of pain 1 hr

Management of pain 2 hr

WHO analgesic ladder & non pharmacological measures 2 hr

Gastrointestinal symptoms:

o Symptoms-nausea, vomiting & intestinal obstructions 1 hr

o Dysphagia, constipation, diarrhea, hiccoughs & anorexia 1 hr

Respiratory symptoms- Dyspnea, cough & haemoptysis 1 hr

Old age problems 2 hr

Geriatric care- management 3 hr

Dementia – Prevalence, Etiology , Pathophysiology and social issues 1 hr

Dementia - clinical manifestations, diagnosis & management 3 hr

Module 4: Palliative Nursing: 29 hrs

Terminal care 1 hr

Ethical issues 1 hr

Nutrition in advanced diseases 1 hr

Pressure sore-definition, causes, stages and sites 1 hr

Prevention and management of pressure sore 1 hr

Wound management- 3hr

Oral problems in palliative care 3hr

o ( Oral candidiasis and dry mouth (xerostomia)..

Oral ulcer, Halitosis and painful mouth, Coated tongue

Bladder care- ( Common problems and urinary retention, 2hr

Urinary incontinence and catheter care)

Bowel care- (Constipation,Diarrhea, over flow diarrhea,enema. 12hr

Artificial Feeding- ( Definition-Indication for tube feeding. 1hr

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Ostomy care- (Definition, colostomy care and colostomy Irrigation 3hr Tracheostomy and ileostomy care).

Lymphoedema- (Definition, causes, Lymphoedema, skin care & bandaging 6hr

Massage and exercise)

Home care kit 1 hr

Interventions at home care 1 hr

Documenting case notes 1 hr

Assessments of patients 1 hr

Module 5: Pharmacology : 12 hrs

Introduction- (drugs & medication, classification Drugs forms, source of information about medication, Medication order & abbreviations, Hours of administration, weights and

measures) 2 hr

Principles of drugs action and effect of drugs on the body 1 hr

Dosage, absorption and excretion of drugs 1 hr

Rules and time of administrations 1 hr

Storing of medicines 1 hr

Common drugs used in Palliative Care 3hr

Stocking and dispensing of opioids 1 hr

Drug compliance 1 hr

Rules of administration of medication and safety measures 1 hr

Module 6: Other topics: 11hrs

HIV/ AIDS- ( introduction & symptoms, Management and stigma) 2 hr

Psycho Social issues in advanced disease 4 hrs

Social mobilizations in health care & Rehabilitation 2hrs

Community participation in palliative care 1 hr

Strategies for mobilizing local community 2 hr

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Module Contents:

Module 1: PALLIATIVE CARE

1. INTRODUCTION TO PALLIATIVE CARE

 Learning objectives

By the end of the section, the students will be able to:

Discuss the history, philosophy, definitions of palliative care, its role in present health care delivery system and its social relevance

Demonstrate that this knowledge understanding informs clinical practice decision making management and teaching

Incorporate concept of total care in clinical practice  Content

 History of palliative care

 Philosophy & goals of palliative care  Definition of palliative care, total care

 Components of palliative care programme

 Scope of Palliative care

Physical Social Psychological Spiritual  Principles of Palliative care

- Who, When & where needed

2. HOME CARE

Discuss the types of home care & how to organize a home care

Understand the importance of nurses home care protocol & home care kit

Understand how to assess the symptoms and chart in the case sheet

 Content

 Introduction to home care

 Types of home care

 Selection of patients in home care

 Nurses home care protocol

 Home care kit

 Interventions done at home care

 Symptom assessment

 Assessment of patient in home care

 Case sheet charting

Module 2: COMMUNICATION SKILLS  Learning objectives

 Explain the principles of communication

 Understand the importance of effective communication & banners of

communication

 Understand the steps of breaking bad news & handing difficult situation

 Be aware of one’s strengths and weaknesses in intervening in issues related to

palliative care  Content

 Definition of communication

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 Needs of communication

 Basic principles of communication

 Effective communication

 Burners of communication

 Breaking and news

 Handing collections & denial

 Handing difficult questions & reactions

 Reflection on self

Module 3: Symptom Assessment and Management

Pain

 At the end of the section, the students will be able to:

Define pain & develop skills in assessment of pain

Understand the general principles pathophysiology of pain Describe the classification of pain & management of pain Explain WHO analgesic ladder

 Content

 Definition

 General principles of pain & causes of pain

 Patho physiology

 Classification of pain

 Assessment of pain

 Management of pain

 WHO analgesic ladder

 Non – pharmacological measures to relieve pain

Other Symptoms:

 Learning Objectives

 By the end of the section the student will be able to:

Discuss various methods of assessment of symptoms Describe method of management of symptoms  Content

 Gastro intestinal symptoms

Nausea & vomiting - Causes & management

Intestinal obstruction - Causes & management

Dysphasia - Causes & management

Constipation & diamboea - Causes & management

Hiccoups - Causes & management

Anorexia - Causes & management

 Respiratory Symptoms

Dyspnoea - Causes & management

Cough - Causes & management

Haemoptysis - Causes & management

Module 4: Palliative Nursing  Learning objectives:

By the end of the session, the candidate should have knowledge and skills for professional nuring care of the incurably ill and dying patients

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 Terminal care

 Ethical issues

 Nutrition in advanced diseases

 Pressure sore-definition, causes, stages and sites

 Prevention and management of pressure sore

 Wound management-

 Oral problems in palliative care

o ( Oral candidiasis and dry mouth (xerostomia)..

 Oral ulcer, Halitosis and painful mouth, Coated tongue

 Bladder care- ( Common problems and urinary retention,

 Urinary incontinence and catheter care)

 Bowel care- (Constipation,Diarrhea, over flow diarrhea,enema.

 Artificial Feeding- ( Definition-Indication for tube feeding.  General instruction & Nurses responsibility in tube feeding)

 Ostomy care- (Definition, colostomy care and colostomy Irrigation

Tracheostomy and ileostomy care).

 Lymphoedema- (Definition, causes, Lymphoedema, skin care & bandaging

Massage and exercise)

Geriatric care

- Old age problems

- Managements

Dementia - causes, pathophysiology, clinical manifestations, Management

 Characteristic changes in Alzheimer’s disease,

- Clinical manifestation & Diagnosis

- Management

 Home care kit

 Interventions at home care

 Documenting case notes

 Assessments of patients

Module 5: Pharmacology  Learning objectives

By the end of the section, the candidate should be able to

Understand the routes of administration, mode of action and side effects of drugs commonly used in palliative care

Know the requirements, procedure and documentation of storage and dispensing of opioids  Content:

 Introduction- (drugs & medication, classification Drugs forms, source of information about

medication, Medication order & abbreviations, Hours of administration, weights and measures)

 Principles of drugs action and effect of drugs on the body

 Dosage, absorption and excretion of drugs

 Rules and time of administrations

 Storing of medicines

 Common drugs used in Palliative Care

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 Drug compliance

 Rules of administration of medication and safety measures

Module 6: Other Topics

HIV/AIDS

By the end of the section, the student will be able to:

 Discuss the clinical features and management of HIV/AIDS

 Discuss the psycho-social issues of Retro-positive patients.

 Content

 Introduction

 What is HIV/AIDS?

 Clinical features, causes, investigators

 Medical and Nursing management

 Psycho-social issues.

Psycho Social issues

At the end of the section, the student will be able to understand The psycho-social issues related to chronic diseases. Distress related advanced disease

Adjustment disorders  Content

Psyho social issues in adavanced and chronic disease Tools to assess psychological morbidity

Distress Thermometer Adjustment disorders Major Psychiatric disorders

Social mobilization in health care and Rehabilitation.

 Learning Objectives :

At the end of the section, the candidate should be able to understand Strategies for ensuring community participation in health care projects

Basic principles of social rehabilitation of the chronically ill and bedridden people  Content:

 Community participation – models

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Evaluation

Evaluation will be based on theory examination, evaluation of case histories, and written assignments. By the completion of the six weeks, each candidate has to submit 10 case histories, 6

written assignments and 1 project proposal.

Pass mark is 60%. The candidate has to score 60% for theory examination, case histories, written assignments and project proposal separately.

The total marks of the examination will be 300.

Types of exam Total Marks

Category Marks Distribution Written (Descriptive) 50 Short answered questions –

(10 out of 12) (10 x 5 ) MCQ 50 50 questions (50 x 1) OSCE 50 4 spotting (4 x 5) 6 station (6 x 5) Viva 50 Project 30 Assignment 30 6 Assignments (6 x 5)

Log Book 30 10 case sheet (10 x 3)

Attendance 10 Per class = 0.278 Grading Criteria

Grade E – Excellent (Score of 80% and above) Grade G – Good (Score between 70% and 79%) Grade P – Pass (Score between 60% and 69%) Grade F – Fail (Score below 60%)