Courses

Overview & Objectives

This orientation to hospice is an excellent overview for new hospice aides and home health/LTC aides caring for hospice patients, as well as a general review for experienced hospice aides. It covers a brief history of hospice in the United States, patient eligibility and admissions, levels of care, hospice services, Medicare guidelines for hospices, and a brief overview of symptom management. The role of interdisciplinary team members is reviewed with emphasis on hospice aides and the duties they perform. The learning objectives for this inservice include:

• Describe the growth of hospice in the United States
• Discuss eligibility, admissions, and hospice diagnoses
• Review services and funding for hospice
• Identify the roles of the interdisciplinary team
• Discuss general symptom management
• Review the hospice aide’s role and duties

Contents

• Learning Module
• Discussion Topics
• Group Exercise:  Interdisciplinary Team Roles
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Pain management in hospice is based on a holistic model of physical, psychosocial, and spiritual care, and this inservice is an overview of the interdisciplinary approach to pain management. It covers a brief history of pain management going back to ancient times, the elements necessary for effective pain management, tools used by clinicians for assessing pain, types of pain, treatment protocols, and barriers to effective pain management. It also includes non-verbal signs of pain and non-pharmaceutical comfort measures. The role of the hospice aide in pain management is addressed throughout. This module contains the following learning objectives:

• Describe the history of pain management
• Review the components of a pain assessment
• List pain assessment tools
• Describe types of pain and non-verbal pain assessment
• Discuss barriers to effective pain management
• List non-pharmaceutical methods of comfort
• Describe the hospice aide’s role in pain management

Contents

• Learning Module
• Discussion Topics/Case Study
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

An overview of the most common symptoms in hospice patients is covered in this module, as well as general causes, and hospice aide interventions. It is written to assist hospice aides with symptom management within their scope of practice and in the context of bodily systems. Symptoms are divided into sections under neurological, respiratory, gastrointestinal/urinary, circulatory, integumentary, and general symptoms.  NOTE:  It is recommended that this module be combined with the Pain Management in-service which focuses on pain management only.  This module contains the following learning objectives:

• Review common patient symptoms in hospice
• Analyze causes of common symptoms
• Discuss hospice aide interventions
• Identify guidelines for reporting symptoms
• Summarize symptom management for hospice aides

Contents

• Learning Module
• Group Exercise: Discussion Topics/Case Study
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

This module serves as a reference for hospice aides to become familiar with the hospice regulations set forth by the Centers for Medicare & Medicaid (CMS) in the Conditions of Participation (CoP). It focuses on section §418.76 which outlines the CMS requirements for hospice aides, as well as additional sections of the CoPs pertaining to hospice aides as members of the interdisciplinary team. It includes an introduction to Medicare guidelines for hospice aides, training and education, assignments and duties, and the supervision of a registered nurse. The learning objectives for this module include:

• Review section §418.76 of the Conditions of Participation
• Define hospice training and education for aides
• Describe the responsibilities of the hospice aide
• Review responsibilities of the registered nurse and hospice aides
• Review additional CoP sections that apply to hospice aides as an interdisciplinary team member

Contents

• Learning Module
• Group Exercise:  Which CoP Applies?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

All healthcare personnel must maintain patient privacy and confidentiality at all times based on the Health Insurance Portability and Accountability Act (HIPAA). The purpose of this module is to help hospice aides identify potential violations of HIPAA privacy rules, and be proactive in preventing patient information disclosures. It includes key terms, examples of personal health information (PHI), HIPAA in the hospice setting, preventing HIPAA violations, and legal consequences of violating HIPAA privacy rules. It also includes examples of HIPAA violations in the news. This module contains the following learning objectives:

• Define HIPAA and protected health information (PHI)
• Identify HIPAA challenges in the workplace
• Apply preventive measures to the role of hospice aide
• Examine the legal consequences of HIPAA violations
• Summarize the responsibilities of the hospice aide and patient confidentiality

Contents

• Learning Module
• Brain Booster:  HIPAA Violation or Not?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Boundaries are especially important in hospice where patients and families are more vulnerable and need increasing support as the patient moves toward death. The purpose of this module is to help hospice aides define boundaries and understand the potential for crossing them. It includes examples of boundary issues across the continuum from minor to serious, consequences and prevention, as well as identifying the factors that can increase the risk of boundary violations. This module contains the following learning objectives:

• Describe relationship dynamics and boundary issues
• List examples of less serious to very serious boundary violations
• Review the consequences of serious boundary violations
• Identify individuals who are at risk for violating boundaries
• Discuss prevention of boundary violations

Contents

• Learning Module
• Group Exercise:  What Would You Do?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

It is believed that tuberculosis existed long before humans inhabited the planet. The first evidence of tuberculosis in humans dates back to the Neolithic era 9,000 years ago. Over centuries and eons it has gone through cycles of low incidence and risk, to epidemic proportions and massive mortality rates. This inservice reviews the history of TB, causes, how it is spread, symptoms, the incidence and risk factors, testing for tuberculosis, treatments, and the global implications of tuberculosis. It also includes a section describing the role of hospice aides and measures used to prevent tuberculosis in hospice settings. The following learning objectives for this module include:

• Discuss the origin and causes of tuberculosis
• List the symptoms of tuberculosis
• Review the incidence and risk factors for patients and healthcare workers
• Review diagnosis and testing for tuberculosis
• Discuss treatment for latent and active tuberculosis
• Discuss the hospice aide’s role in tuberculosis prevention

Contents

• Learning Module
• Group Exercise:  Matching
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Methicillin-resistant Staphylococcus aureus, or MRSA, is responsible for many infections in humans that are difficult to treat with common antibiotics. This module covers a brief history of MRSA, how bacteria become antibiotic resistant, types of infections where MRSA is found, high risk populations, and how it is transmitted. It also includes the signs and symptoms, diagnosis and treatment, and measures to prevent the spread of MRSA for hospice aides. A brief review of the incidence of MRSA and ongoing research is also included. The following learning objectives for this module include:

• Discuss the history of MRSA and how it developed
• List the signs, symptoms, and at-risk populations for MRSA
• Review how MRSA is diagnosed and treated
• Identify measures to prevent the spread of MRSA
• Review the prevalence of MRSA in the United States
• Discuss the hospice aide’s role in preventing the spread of MRSA

Contents

• Learning Module
• Group Exercise:  Matching
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Before the germ theory of disease was discovered by Louis Pasteur in 1861, some physicians were offended if it was suggested that they wash their hands after handling cadavers (all together now…“ewww”). Thankfully, times have changed. This inservice explores the origins of infection control, as well as the fundamental principles of infection control and standard precautions for hospice aides. It covers routes of transmission, bloodborne pathogens, infection prevention, and personal protective equipment (PPE) based on the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) standards. It is specific to hospice aides within their scope of practice and includes tips for optimizing their own immune health. The learning objectives for this module include the following:

• Review the history of standard precautions
• List routes of transmission and portals of entry for infections
• Describe bloodborne pathogens and modes of transmission
• Explain the fundamentals of standard precautions for infection control
• Utilize self-care measures to enhance immune health

Contents

• Learning Module
• Brain Booster: Pathogen Particulars
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Biohazardous waste is regulated by local, state, and federal agencies because it can pose a threat to humans. This inservice covers the fundamentals of managing biohazardous waste including definitions, fluids that can harbor infectious pathogens, handling and disposal of potentially infectious materials, proper containment and storage, household waste, and clean-up of biohazardous spills. It also covers policies, procedures, and regulations for occupational exposure to biohazardous materials as well as strategies for prevention. The learning objectives for this module include the following:

• List potentially infectious body fluids
• Define biohazardous materials
• Explain proper handling, containment, storage, and disposal of biohazardous waste
• Name strategies for preventing occupational exposure
• Describe procedures required if an occupational exposure occurs

Contents

• Learning Module
• Module Extra: Sample Flow Chart for Biohazardous Waste
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Hospice aides may be asked to assist with post mortem care if they are present at the time of a patient’s death. This inservice covers the preparation and duties of hospice aides when providing post mortem care. It contains a brief review of the signs and symptoms of imminent death, and team procedures for attending a patient’s death. Specific steps for performing post mortem care within the scope of practice are covered, as well as providing support to the family at the time of death. A section describing unusual circumstances or traumatic deaths involving the medical examiner is also included in addition to a brief discussion of organ and tissue donation in hospice. This module contains the following learning objectives:

• Describe symptoms of impending death and team procedures for attending a death
• List the steps involved in post mortem care within the hospice aide scope of practice
• Define the role of the medical examiner in hospice deaths
• Review responsibilities before and after a traumatic, suspicious, or unexpected death
• Discuss the issues surrounding organ/tissue donation and hospice
• Summarize the responsibilities of the hospice aide in post mortem care

Contents

• Learning Module
• Discussion Topics: Post Mortem Care
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

The history of dementia in written texts dates back to the 7th century B.C., and by all accounts it was believed to be a normal part of aging for centuries. (Keep in mind that many people did not live long enough to develop dementia). It was not until the 1800’s, when anatomists discovered changes in the brain associated with dementia, that it was no longer considered a normal part of aging. Since then several types of dementia have been identified aside from Alzheimer’s, and this module contains a description of other common types seen in hospice. It contrasts the signs, symptoms, and lifespans of other dementias and differences among them [For an in-depth review of Alzheimer’s see next module]. The following learning objectives for this module include:

• Discuss the history of dementias
• List types of dementias other than Alzheimer’s
• Review lifespan and treatment of other dementias
• Identify differences between other dementias and Alzheimer’s
• Brief hospice aide review of immobility and feeding in dementia patients (Alzheimer’s module covers the hospice aide’s role in more depth)

Contents

• Learning Module
• Group Exercise:  Matching
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Alzheimer’s is the most common type of dementia [see Dementias for a review of other types] that affects over five million people in the United States and an estimated 44.4 million worldwide as of 2013. The costs associated with Alzheimer’s care now and in the future are staggering. This inservice covers the history of Alzheimer’s, statistics, the stages of decline, hospice eligibility, and guidelines for care such as bathing, dressing, feeding, elimination, and sleep patterns. A section for family and caregiver support is also included. This module contains the following learning objectives:

• Review the discovery and history of Alzheimer’s
• Discuss Alzheimer’s statistics in the United States
• Identify the stages of Alzheimer’s (mild, moderate, severe)
• Discuss hospice eligibility and the FAST scale
• Define the role of the hospice aide

Contents

• Learning Module
• Group Exercise:  Share Your Experience
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Palliative sedation has often been a controversial and poorly understood subject among the widespread population. This module is an overview of palliative sedation in hospice.  It covers the definition of palliative sedation and distinguishes it from euthanasia and physician-assisted suicide.  The bioethical principles involved in palliative sedation are discussed as well as a general review of protocol, documentation, patient assessment, and responsibilities of the care team and hospice aides.  The following learning objectives for this module include:

• Define palliative sedation vs. euthanasia and physician-assisted suicide
• Discuss bioethical principles and medical/legal issues in palliative sedation
• Review palliative sedation policies, procedures, and protocol
• Define clinical practices in palliative sedation
• Discuss hospice aide self-reflection regarding palliative sedation

Contents

• Learning Module
• Group Exercise:  Case Study
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Good Grief is an overview of the most common aspects of healthy grieving and various perspectives on grief in the context of hospice patients and families. It contains a brief historical view of grief from a societal standpoint and reviews the five stages of grief by Elisabeth Kubler-Ross. It also contains the four tasks of grieving by William Worden. With inspirational quotes throughout, a review of the factors that influence grief, how to cope with grief, and self-care during grief are discussed, as well as a summary on the hospice aide and grief. This module contains the following learning objectives:

• Discuss societal views of grief
• List and discuss the five stages of grief
• Define Worden’s four tasks of grief/mourning
• Identify factors influencing grief
• Describe strategies for coping with grief
• Review self-care measures during grief
• Discuss self-reflections about grief as hospice aides

Contents

• Learning Module
• Group Exercise:  Five Stages of Grief
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Certificate of Attendance

Overview & Objectives

The United States is a virtual melting pot of different cultures, customs, and belief systems. This inservice is a general overview of mourning traditions across a variety of cultures commonly served in hospice. It covers American populations of Asians, Hispanics, Africans, Haitians, Europeans, Native Americans, and traditional American customs. It also includes the most common religious beliefs within these cultures. It serves as a reference for hospice aides, but also acknowledges variations as a result of blended communities. All cultural expectations should be verified with the patient or family. This module contains the following learning objectives:

• Review the nature of mourning
• Discuss cultural differences among different populations served in hospice
• Identify religious influences in cultural mourning
• Review the hospice aide’s role in supporting cultural differences

Contents

• Learning Module
• Group Exercise:  What is Your Heritage?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Parents often have questions about how much exposure children should have to a patient who is terminally ill or dying. This module contains a brief history of children and death from the past until the present. It reviews how much children understand about death at different ages and describes activities that may be helpful to children at different stages. Hospice aide tips are included if questions arise about how children can best be supported during this time. A section on how to prepare children as a patient gets closer to death is also included. This module contains the following learning objectives:

• Review the history of children and death
• Discuss issues regarding the exclusion of children in the dying process
• Identify age groups and their understanding of death
• Review preparing children for a loved one who is ill and dying
• Discuss how hospice aides can help families with questions about children and death

Contents

• Learning Module
• Group Exercise:  Share Your Experience
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

There is no separation between the mind and body, which means that every thought we have has a physiological response in the body. This module is a primer on the mind-body connection, how it works, the stress response, and mind-body techniques that can be used to reduce stress. Practice tips are highlighted throughout. Mind-body techniques include deep breathing, imagery, progressive relaxation, meditation, and biofeedback. Hospice aides who understand and manage their own stress are in a better position to support patients and families under stress. Completion of this inservice is recommended before the Everyday Relaxation Techniques module. The learning objectives for this module include:

• Review the prevalence of stress in our daily lives
• Examine the physiology of stress
• Define the stress response/relaxation response
• Identify mind-body techniques for managing stress
• Discuss stress management in self-care

Contents

• Learning Module
• Activity Exercise: The Relaxation Response
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

This inservice is a follow-up to the The Mind-Body Connection. It contains a brief review of the mind-body connection and highlights activities in everyday life that can be used to manage stress: Music, exercise, social connectedness, volunteering, humor, hobbies, nature, forgiveness, gratitude, random acts of kindness, and mindfulness. Completion of The Mind-Body Connection inservice is recommended as a prerequisite to this module. The emphasis for hospice aides is learning how to manage their own stress to be in a better position to help patients and families with their stress. This module contains the following learning objectives:

• Read a brief review of the stress response
• Identify everyday activities for stress management
• Discuss the rationale for daily stress management
• Review mindfulness in everyday life
• Develop a regular practice of self-care

Contents

• Learning Module
• Discussion Topics
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

With advances in cardiopulmonary resuscitation in the 1970’s an unexpected phenomenon began to occur worldwide:  reports of near death experiences happening with more frequency.  This inservice is a review of the research on the controversial subject of the near death experience (NDE).  It contains the growing global awareness of NDEs as well as the following:  Classic features, clinical circumstances, aftereffects, and the controversies surrounding them.  It also includes NDEs in children, blind people, and distressing NDEs, with easy to understand explanations about how they occur from scientists who are either believers or skeptics.  This module is a prerequisite to Nearing Death Awareness (NDA) on the website course list which is directly applicable to hospice aides, patients, and families.  The learning objectives for this module include:

• Describe the incidence of NDEs since the 1970’s
• List the clinical circumstances involving NDEs
• List the classic features of NDEs
• Discuss the aftereffects of NDEs
• Analyze the controversies surrounding NDEs

Contents

• Learning Module
• Group Exercise:  Discussion Topics
• Module Extra:  NDE Quotes
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

In 1992 a book called Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying was published by hospice nurses Maggie Callahan and Patricia Kelley. In it they described common characteristics of nearing death awareness (NDA) in hospice patients, but is it delirium or a divine mystical experience? This module is a review of nearing death awareness by these authors and others. It describes the language patients might use to convey the experience and how hospice aides should respond, both to patients and families. It also addresses the needs of dying patients who display these behaviors and ways to facilitate a more peaceful death. The following learning objectives for this module include:

• Describe the difference between near death experiences and nearing death awareness
• Discuss descriptions and definitions of nearing death awareness
• Identify examples of symbolic language that might be used by patients
• Review how to respond to nearing death awareness in patients
• Discuss examples of NDA communication with patients

Contents

• Learning Module
• Module Extra: Guidelines for Communication
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Spiritual care has always played a role in caring for the terminally ill and dying. This module is an overview of the fundamentals of spiritual care in hospice including the definition of spiritual care, guidelines and standards for chaplains and spiritual counselors, the spiritual assessment, and spiritual distress. It also includes a discussion of spiritual support related to the interdisciplinary team and hospice aides. The learning objectives for this module include:

• Define the difference between spirituality and religion
• Describe Medicare guidelines and professional standards for spiritual care
• Discuss the fundamentals of spiritual care
• Review the components of a spiritual assessment
• Describe the signs and symptoms of spiritual distress and interventions
• Apply principles of spiritual support by hospice aides

Contents

• Learning Module
• Module Extra: Summary of Major Religions
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Compassion Fatigue

Overview & Objectives

Healthcare providers, volunteers, and other helpers who work in areas associated with more intense pain, suffering and trauma are at risk for compassion fatigue. Hospice is one area in which hospice aides and other members of the interdisciplinary team are at higher risk for developing compassion fatigue. This inservice differentiates compassion fatigue from burnout, and includes symptoms, assessment, and interventions with recommendations for hospice aides, other caregivers, and managers/supervisors. It includes a section on self-care relevant to work and home life for preventing or managing compassion fatigue. The learning objectives for this module include:

• Define the differences between compassion fatigue and burnout
• Describe symptoms of compassion fatigue
• Review the components of a compassion fatigue assessment
• Discuss interventions for preventing or managing compassion fatigue
• Apply self-care principles for prevention and management of compassion fatigue

Contents

• Learning Module
• Group Exercise:  Burnout or Compassion Fatigue?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Documentation is mandatory for the coordination of care and delivery of hospice services. The hospice aide’s role in documentation is important for monitoring patient status, eligibility, functional ability, and decline. This inservice includes a general overview of the legal aspects of documentation, regulatory requirements, documentation content in care and data gathering, the do’s and don’ts of documentation, continuous (crisis) care documentation, and terminology to avoid. The importance of timeframes is also discussed. The learning objectives for this module include:

• Discuss the importance of hospice aide documentation
• List the do’s and don’ts of documentation
• Explain the rationale for continuous (crisis) care documentation
• Identify terminology to avoid in documentation
• Explain the importance of timeframes in documentation

Contents

• Learning Module
• Group Exercise:  Weak vs. Strong Documentation
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Up until the 1970’s, physicians made decisions about a patient’s care with little or no input from the patient or family. In two separate studies done in 1953 and 1961, the Journal of the American Medical Association (JAMA) reported that 69% and 90% (respectively) of doctors did not tell their patients they had cancer. Human experimentation studies were done on prisoners and poor and orphaned children. By today’s standards, those stories and others would bring lawsuits. In 1973 the American Hospital Association (AHA) published the first standards for patient rights. This inservice covers the evolution of patient rights, the role of medical ethics, the Patient Self-Determination Act, and the rights of hospice patients. The learning objectives for this module include:

• Discuss the history of patient’s rights
• Review the scope of medical ethics
• Define the Patient Self-Determination Act
• List the rights of hospice patients
• Discuss autonomy in hospice care

Contents

Learning Module
• Group Exercise: YOUR Patient Rights
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

Advance directives are recommended for everyone over the age of 18, but they are required by law to be addressed with hospice patients upon admission. This module covers the benefits and explains the basics of advance directives. It includes a general overview of advance directives: living wills, healthcare surrogates, CPR, DNR, DNI, and artificial nutrition and hydration. It also includes a section on the “Five Wishes” which is a national advance directive. The learning objectives for this module include:

• Discuss the purpose of advance directives
• List specific advance directives
• Review advance directives in hospice
• Define the “Five Wishes”
• Discuss the importance and benefits of advance directives

Contents

• Learning Module
• Group Exercise: Advance Directives Recall
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

All hospice care is palliative, but not all palliative care is hospice. Confusing? You are not alone. Patients, families, and even healthcare providers do not always understand the differences between hospice and palliative care. The purpose of this module is to clarify the differences and similarities between the two. It covers the evolution and definition palliative care as a subspecialty of end-of-life care. It also includes the criteria for palliative care, barriers to providing it, the services and team members, and the differences/similarities between hospice and palliative care aides. The learning objectives for this module include:

• Define palliative care
• Differentiate between hospice and palliative care
• Discuss the similarities between hospice and palliative care
• Explain the barriers to palliative care
• List the differences and similarities between palliative care aides and hospice aides

Contents

• Learning Module
• Module Extra: Overview of Palliative Care & Hospice Care
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

For pediatric hospice and palliative care aides there are many similarities in the basic care of patients, but also many differences from adult hospice patients. From the age group, to the diseases and illnesses children die from, this module covers common life-limiting/life-threatening conditions, hospice and palliative care for children and families, eligibility, funding, and bereavement. It also discusses the role of hospice and palliative care aides in the pediatric population, and the emotional challenges involved in taking care of terminally ill children. The learning objectives for this module include:

• Review the history and causes of death in children
• Differentiate between pediatric and adult hospice and palliative care
• Discuss the interdisciplinary team model and additional support services for children
• Review the role of bereavement in pediatric hospice and palliative care
• Describe the role of nurse’s aides in pediatric hospice/palliative care

Contents

• Learning Module
• Group Exercise: Pediatric Age Groups
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Overview & Objectives

It is estimated that over 65% of elder abuse is committed by family members, and only one out of every five cases of elder abuse is identified and reported. These statistics will worsen as the “boomer generation” grows older unless healthcare providers and communities are proactive in preventing and reporting elder abuse. This module contains elder abuse statistics in the United States and lists the most common types and signs of elder abuse (physical, emotional, sexual, neglect, financial, abandonment, self-neglect), as well as the characteristics of abusers. It includes prevention, reporting, and national resources for obtaining information in each state. The learning objectives for this module include:

• Discuss the statistics of elder abuse in the U.S.
• Review the purpose of the Elder Justice Act
• List the types of elder abuse
• Describe the signs of various types of elder abuse
• Discuss the characteristics of abusers
• Review methods for preventing and reporting elder abuse

Contents

• Learning Module
• Module Extra: Power & Control Wheel
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Communication Skills

Overview & Objectives

Communication skills are essential in hospice and healthcare in general for quality care, safety, and building relationships.  Hospice aides can foster positive relationships with patients, families, co-workers, and other staff by using effective communication skills.  This module covers the following components of effective communication:  Verbal, non-verbal, listening, barriers to communication, and conflict resolution.  The learning objectives for this module include:

• Discuss the importance of effective communication
• Review the primary components of communication
• Describe the barriers to effective communication
• Discuss the importance of body language
• Analyze the role of the hospice aide in conflict resolution

Contents

• Learning Module
• Module Extra:  Zones of Personal Space in the U.S.
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Humor in Hospice

Overview & Objectives

There is no room for humor in a serious place like hospice, right?  Wrong.  Humor used appropriately benefits patients, families, healthcare, and hospice workers.  This module is a lighthearted and informative look at humor in hospice which includes the physiological, mental health, social, and workplace benefits.  It reviews humor with patients and families, inappropriate humor, and developing a sense of humor.  If morale is low and hospice aides are stressed out, this is the module for you.  The learning objectives for this module include:

• Discuss humor in healthcare
• Describe the physiological benefits of humor
• Review humor in mental health, social networks, and the workplace
• Highlight the benefits of humor with patients and families
• Discuss inappropriate humor
• Develop a plan for incorporating humor

Contents

• Learning Module
• Group Exercise:  Laughter Exercises (Seriously!)
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form Certificate of Attendance

The Science of Happiness

Overview & Objectives

What does happiness have to do with working as a hospice aide?  The warm fuzzies of happiness make us better at our jobs, improve working relationships, increase performance and accuracy, and boost health and well-being.  Studies have shown that happiness promotes more positive working environments which affect how hospice aides interact with co-workers, patients, and families.  Happiness in employees leads to greater overall job satisfaction, a reduction in turnover rates, and the increased success of a hospice (or any) organization.  This module explores the science of positive psychology (or the science of happiness) which focuses on the positive side of human potential as individuals and in community.  It also debunks the cultural belief that status and possessions lead to greater happiness.  The learning objectives for this module include:

• Discuss the effect of happiness on work
• Analyze current cultural beliefs about happiness
• Discuss the foundation of positive psychology
• List steps to increase happiness at work and in life
• Describe how life balance increases happiness

Contents

•  Learning Module
• Group Exercise:  The Happiness Tool
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Caring for Cancer Patients

Overview & Objectives

Patients with a primary diagnosis of cancer are one of the most common types of terminal illnesses in hospice.  They have typically reached the point where life-prolonging interventions are no longer effective and their prognosis is weeks to months.  In this module the criteria for admission to hospice is covered as well as the most common types of cancer and sites for metastasis.  Hospice aide care in cancer patients is determined by the type of cancer and parts of the body and systems affected which is reviewed within the hospice aide scope of practice.  Also included is a section on general comfort measures that can be provided by hospice aides.  The learning objectives for this module include:

• List the criteria for a terminal cancer patient to be admitted to hospice
• List the most common cancers and sites of metastasis
• Describe how cancer metastasizes in the body
• Review the hospice aide’s duties in caring for cancer patients
• Describe general comfort measures for patients with cancer

Contents

• Learning Module
• Group Exercise:  Comfort Measures for Cancer Patients
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Caring for ALS Patients

Overview & Objectives

Patients with a primary diagnosis of amyotrophic lateral sclerosis (ALS) have needs that are specific to this neuromuscular disorder.  ALS, or Lou Gehrig’s Disease, involves degeneration of both the upper and lower motor neurons, which leads to the eventual wasting and atrophy of all voluntary muscles including the muscles that are used for respiration.  This module covers the statistics, basic physiology, symptoms, and treatments for patients with ALS.  The most common problems associated with ALS in hospice patients are reviewed along with comfort measures hospice aides can carry out within their scope of practice.  The learning objectives for this module include:

• Discuss the prevalence of ALS in the United States
• Explain the basic physiology of ALS
• Review common symptoms in ALS patients
• List hospice aide comfort measures for ALS patients
• Describe the overall goals of care in ALS patients

Contents

• Learning Module
• Group Exercise:  Comfort Measures for ALS Patients
• Test Questions
•  Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Caring for ESRD Patients

Overview & Objectives

It is estimated that over 20 million Americans are affected by various stages of kidney disease.  In End Stage Renal Disease (ESRD) normal kidney function is lost due to chronic or acute kidney damage.  This module covers the incidence of kidney disease, causes, treatments, and comfort measures within the hospice aide’s scope of practice.  It focuses on the most common symptoms in ESRD including pain, dyspnea, pruritus, restlessness, seizures, and fatigue/coma.  Hospice aide documentation in ESRD patients is also reviewed.  The learning objectives for this module include:

• Review the incidence of kidney disease in the United States
• Discuss the causes of chronic and acute kidney disease
• Review common symptoms in ESRD patients
• List hospice aide comfort measures for ALS patients
• Discuss the importance of hospice aide documentation

Contents

• Learning Module
• Group Exercise:  Comfort Measures for ESRD Patients
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form Certificate of Attendance

Caring for HIV/AIDS Patients

Overview & Objectives

The first identified case of HIV in a human was in 1959 and since then the number of cases and treatment for HIV/AIDS has gone through dramatic changes worldwide.  This module covers the early history of HIV/AIDS, how it is transmitted from person to person (including how it is NOT transmitted), and the basic physiology of how it progresses. Hospice eligibility for patients with HIV/AIDS is included as well as common symptoms in the final stages and comfort measures within the hospice aide’s scope of practice related to nutrition/digestion, weakness/fatigue, functional, and mental status changes. Hospice aide documentation and symptoms that should be reported to the nurse are also reviewed.  The learning objectives for this module include:

• Review history and progression of HIV/AIDS
• Describe the criteria necessary for hospice eligibility
• Discuss transmission of HIV/AIDS
• Describe common symptoms and comfort measures in the final stages
• List important documentation and symptoms to report to the nurse

Contents

• Learning Module
• Group Exercise:  Comfort Measures for HIV/AIDS Patients
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Hospice and Veterans

More than 2.5 million men and women serve our country in the Armed Forces, through active duty and reserve forces, or as civilians.  In 2001, the Department of Veterans Affairs (VA) established an initiative to address the end-of-life needs of veterans through collaboration with the National Hospice and Palliative Care Organization (NHPCO) and other hospice organizations and advocates.  Today, the NHPCO’s “We Honor Veterans” program is dedicated to working in partnership with the VA to provide the highest quality of hospice care and services for veterans and their families.  This module reviews the collaboration between hospice and the VA, the special needs of veterans, and the role of hospice aides and staff in caring for veterans and their families. This module contains the following learning objectives:

• Describe the rationale for collaboration between hospices and the Dept. of Veterans Affairs (VA)
• Explain the benefits of hospices working with veterans and the VA
• List the special needs of veterans on hospice
• Describe four types of PTSD symptoms
• Discuss the needs of families of veterans
• Review the ways hospice aides and staff can enhance the veteran’s hospice experience

Contents

•  Learning Module
• Group Exercise:  Special Needs of Veterans
• Test Questions
• Instructor Answer Key
• Attendance Sheet
•  Evaluation Form
• Certificate of Attendance

Death With Dignity Act

Helping patients die with dignity is a primary function of hospice aides and other hospice workers, but what if the patient wants to die before they reach the stage where they lose bodily functions, autonomy, or mental competence?  In 1997, Oregon was the first state to pass the Death with Dignity Act (DWDA), otherwise known as physician-assisted suicide.  Since then, five other states have passed it and several additional states are trying to make it legal.  This module examines the Death with Dignity Act based on data collected by the state of Oregon between 1998 and 2017.  It includes patients’ reasons for wanting physician-assisted suicide, their eligibility, the process of requesting it, the medications used, and the opposition to it in language that is understandable and informative.  This module contains the following learning objectives:

• Define “death with dignity”
• List reasons for wanting physician-assisted suicide
• Describe the process to request it in states where it is legal
• Discuss the patient requirements for physician-assisted suicide in states where it is legal
• Discuss the methods used in physician-assisted suicide
• Reflect on opposition to physician-assisted suicide

Contents

• Learning Module
• Group Exercise:  What Would You Do?
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Hospice Aide Bag Technique

Overview & Objectives

Using proper bag technique is an important part of infection control.  Hospice aides are responsible for preventing the spread of infection by using proper bag technique during home visits.  Not only do hospice patients have weakened immune systems, but hospices aides routinely go from patient to patient throughout the day.  This module covers several aspects of bag technique such as rationale, types of bags used, arrangement of contents, preventing the spread of infections through bag technique, and cleaning and disinfecting equipment and supplies.  It also includes recommended protective barriers, when NOT to bring the nursing bag into a residence, and other considerations.  This module contains the following learning objectives:

• Discuss bag technique in infection control
• Describe the characteristics of recommended nursing bags
• List the steps used in bag technique
• Review recommended protective barriers
• List other considerations when following bag technique policies and procedures

Contents

• Learning Module
• Group Exercise:  Chronological Order of Bag Technique Steps
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Food Safety in Hospice

Although it is well known that the food and fluid intake of patients on hospice declines through the dying process, food safety remains an important part of comprehensive care.  Hospice aides are often involved in handling food and feeding patients.  Food safety includes storage, preparation, and knowledge of cross-contamination that can cause foodborne illnesses (also called “food poisoning”).  This module covers how microorganisms cause foodborne illnesses, the importance of time and temperature, proper cooking, thawing, prep, and cleaning, and how personal hygiene that can contribute to foodborne illnesses.  Symptoms of foodborne illnesses and the hospice aide’s responsibilities are also included.  This module contains the following learning objectives:

• Discuss the causes of foodborne illnesses
• Define the importance of time and temperature
• Review thawing, preparing, and cooking foods
• Discuss cross-contamination in food preparation and storage
• List symptoms of foodborne illnesses and the hospice aide’s responsibilities
• Discuss personal hygiene as a contributor to foodborne illnesses

Contents

• Self-study Section
• Appendix A:  Microorganisms that Cause Foodborne Illnesses
• Appendix B:  Minimum Safe Internal Temperatures & Times
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Preventing Pressure Ulcers

Overview & Objectives

The key for hospice aides regarding pressure ulcers is to do as much as possible to prevent them from forming and allowing existing pressure ulcers to get worse.  This module discusses the role of hospice aides within their scope of practice.  It includes sections on the skin (integumentary system), the most common causes, and stages of pressure ulcers that hospice aides should be observing for when providing personal care to the hospice patient.  It covers the elements that should be reported to the nurse and education for caregivers, as well as the reasons why hospice patients are at higher risk for pressure ulcers.  This module contains the following learning objectives:

• Review characteristics and functions of skin (integumentary system)
• List the most common causes of pressure ulcers in hospice patients
• List pressure points where pressure ulcers are most likely to occur
• Discuss the signs and symptoms of early stage pressure ulcers
• Describe the actions hospice aides can take to prevent pressure ulcers
• Review examples of devices/products used to prevent and treat pressure ulcers

Contents

• Self-study Section
• Module Extra:  Pressure Ulcer Devices/Products
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance

Hospice Aides & QAPI

Overview & Objectives

As with all members of the interdisciplinary team, Medicare requires hospice aides to have a role in QAPI processes and projects.   If hospice aides are unfamiliar with Performance Improvement Projects (PIPs), this module provides a basic overview of the components of a PIP.  It covers members of the QAPI committee, key members of the PIP team, how PIPs are chosen, and the common P-D-S-A model used to guide a PIP.  It also describes the roles of PIP team members, sources for PIPs, and the essential elements of a PIP.  Examples of PIPs are included, as well as methods for keeping the organization informed of the progress of a PIP.  This module contains the following learning objectives:

• Discuss the importance of QAPI programs and projects in hospice
• List the key members of a QAPI committee and PIP team
• Describe sources for PIPs and examples of a PIP
• Describe the P-D-S-A cycling format for a PIP
• Review the essential elements of a PIP

Contents

• Self-study Section
• Appendix A:  Sample PIP Assignment Sheet
• Appendix B:  Essential Elements of a PIP
• Test Questions
• Instructor Answer Key
• Attendance Sheet
• Evaluation Form
• Certificate of Attendance