Module 9 – Assisting the

Dying Person

General Directions:

A. There are a total of 40 questions.

B. Answer all questions directly on the question paper as indicated.
C. Your score will be the number of correct responses. There is no penalty for
incorrect answers.
D. This exam is out of 170 marks. You must receive 119 marks to receive 70%.
E. This exam will count for 40% of your final mark in Module 9.

Name

Date: _ _ __ _ _ _ _ __ _ _ _ _ ___

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 Understanding Dying and a Palliative Approach

1) One key message in the text is that the principles of palliative care can be integrated
into care early in the dying process. Is this a new concept for you? Write about this idea.
What are the benefits of the palliative approach? Do you already follow some of these
principles? (Marks 1)

This is a new concept for me. The benefits of the palliative approach are it will help you
understand the needs of person and their family. Providing palliative and end-of- line
care means supporting the dying person, their family and their community.

2) a) Identify two key changes in the way that people die differently now than they did 100 years
ago. (Marks 1)

1. The development of hygienic methods, medications, and rehabilitation

therapies has extended the human life span and the dying process.
2. People way of living is different from 100 years ago, now there is a lot of
chemical and substances that our body intake from our food and
medications compared to 100 years ago.

b) Considering the aging population and changes to the way people die, what are two challenges in
providing care for dying people now?

1. They have the right to refuse to the care regardless how much they need it.
2. Family members are involved in providing care for dying people.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 3) Using the text, define the following terms: (Marks 6)
a) Dementia: are life limiting illnesses that affect a person’s memory, thinking
behaviour, and ability to perform everyday activities.
b) End of life: The last days and weeks of life.
c) Holistic care: Care that considers all aspects of a person’s being. As well as
attending to physical needs, holistic care considers the psychological, emotional,
spiritual, cultural and social needs of a person and recognizes that the person is
part of the social, environmental and cultural setting of their family and
community.
d) Hospice: A residential or day service facility, a visiting program, an inpatient unit,
or a home care service providing holistic care by a team of people a various
disciplines to a person and their family when the person is expected to die within
six months. Care extends beyond the person’s death to bereaved.
e) Palliative care: Holistic, person-centered, supportive care available to person
with a life-limiting illness, and their family, to manage physical, emotional,
spiritual, and psychosocial symptoms associated with a life-limiting illness and
dying. Such care maybe provided at the same time as acute curative treatments
and is beneficial for people from early in the disease process through death and
bereavement.
f) Palliative approach to care: An approach that integrates principles, practices and
philosophy of palliative care into the care of a person with any life-limiting
illness, and their family, early in the disease process, across all settings. And is
provided by all members of the team.

4) List the principle of palliative care in your own words. (Marks 10)

1. Considers the dying individual and their family to be central to the unit’s care approach.
2. May positively influence the course of the illness but does not intend to expedite or prolong
death.
3. Acknowledges various cultural understandings of dying and death.
4. Supports individuals in living as fully as possible until death by helping to manage all symptoms
and sources of distress.
5. Facilitates communication among the individual, their family, and other members of the care
team.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

5) Circle the best definition: A "palliative approach" is: (Marks 2)

a. The integration of palliative care principles, practices, and philosophy into care for people with
cancer, started in the last six months before death

b. The integration of palliative care principles, practices, and philosophy into care for people with
all life-limiting illnesses, early in the disease process, across all care settings

c. The integration of palliative care principles, practices, and philosophy into care for people with
all life-limiting illnesses, for the last six months of life

6) In what ways can the PSW help to integrate a palliative approach into care? (Marks 4)

PSW play a crucial role in the delivery of palliative care at home. PSW are responsible for assisting with
personal care tasks, managing medications, preparing meals, and providing, emotional support. PSW in
palliative care also involves coordinating with the care team and advocating for the patient’s needs and
wishes.

7) What is self-awareness? Describe it in your own words. (Marks 1)

Self-awareness is the ability to reflect on oneself and evaluate how your actions, thoughts, or emotions
align or misalign with your internal standards.

8) Identify an early experience you had related to death, dying and/or grief. (Marks 3)

a) Describe the experience.

My experience related to death, dying, and grief came when my grandparents passed away. They died
at home, as there were no hospitals nearby. We had to accept their situation since they were at the end
of their lives, and the hospitals had informed us that there was nothing more they could do for them.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 b) What support did you receive? What support would you have liked to receive?

I receive support from my family, which helps me understand that this is a natural part of life. My
grandparents' time has come, and while I didn't expect any specific support, I appreciate it. I understand
that everyone eventually faces the end of their lives.

c)How did this experience affect you?

The experience affects me that it makes me sad knowing that you will not able to get the chance again
to see them and accepting the reality the sadness of losing someone you really love.

9) Answer the reflective questions, listed on page 32 in the text, under the heading “strategies for
addressing systemic bias and racism”. (Marks 2)

My beliefs about indigenous people, ethnic minorities and people in underserved population is that they
are still part of the community, and they still deserved a proper treatment and proper benefits from the
government and other services.

My current beliefs help will not hinder my ability to provide compassionate, respectful, non-judgmental
care to everyone I encounter in my work if I respect and understand their beliefs and listen to what are
coming from and what they believe in.

10) As discussed in the “Maintaining Therapeutic Boundaries” section on pages 41 to 45 in the text,
therapeutic boundaries are necessary when providing care. Maintaining therapeutic boundaries is not
always easy. (Marks 3)

a) How might you know if you are not maintaining boundaries?

i. Ask for opinions on treatment issues or to sign documents

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 ii. Ask questions that should be addressed to the physician or nurse.

iii. Confide in you rather than in other members of family or a team.

b) What steps can you take to establish therapeutic boundaries?

i. Acknowledge the importance of boundaries.

ii. Be clear about your scope of practice, job description, and any legal and ethical
guidelines relating to the work to do.

iii. Ask your employer to clarify your job description, responsibilities and task as well as
related policies and guidelines and to provide information to staff and to people for
whom you provide care.

11) Review page 38 in the text and provide examples of 􀁢our common roadblocks to communication.
(Marks 4)

a) Minimizing the problems

b) Offering false reassurance

c) Offering excessive praise

d) Offering platitudes

12) Describe when a trauma-informed approach to care is important. What are the steps to integrating
trauma-informed approach into your practice? (Marks 6)

Strategies are:
1. Develop your trauma awareness
2. Provide safety and build trust with the person.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 3. Provide opportunities for choice, collaboration and connection.
4. Identify their strengths and help build their skills

13) As a PSW you are a member of the interdisciplinary team. You observe, gather information from
the person and the family, and, when needed and as appropriate, you discuss with the team issues that
affect the person's quality of life. You collaborate to develop or update the care plan. Reflect on how
you feel about collaborating with the team. Write about two strategies you believe will help you to feel
more confident in collaborating with the team. (Marks 2)

I feel good because team collaboration involves creative problem-solving, communication, knowledge
sharing, and innovation.

The two strategies I believe will help me feel more confident in collaborating with the team are:
1.Team members should feel respected and free to contribute ideas by leading through example.

2.Creating a collaborative work environment where team members and considered that their ideas,
opinions and suggestions are important.

14) Caregivers in many countries and in many settings use the Palliative Performance Scale (PPS) to
identify the person's current level of functioning and needs, changes, and the need to adapt the care
plan. What five things are measured on the scale? (Marks 5)

a. Ambulation

b. Activity and evidence of disease

c. Self-care

d. Intake

e. Consciousness level or mentation

15) Using words from the PPS, describe a person whose PPS is 20% (Marks 5)

A person who is 20% PPS is totally bed-bound.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

Unable to do any activity and have an extensive disease.
Needs a total care.
Minimal to sips.
He might have full or drowsy confusion.

16) Using words from the PPS, describe a person whose PPS is 10%. (Marks 5)

Unable to do any activity and have an extensive disease.

Needs total care and mouth care only.
He is in a coma status and no sign of conscience.

17) The psychosocial Assessment Tool helps to identify psychosocial, spiritual, and cultural values and
practices of a person. On of the roles of the PSW is to be open and sensitive to values and practices that
are different from their own. Reflect on best practice interactions, and which interactions might help
you to provide support and space for rituals and practices different from yours. (Marks 10)

1. Openness to and awareness of traditional healing and medicines can

determine whether a person of family feels comfortable using them.
2. Avoid judging instead be curious about the person and their culture.
3. Learn about their traditional practices and with the person’s permission
share information about these practices with the team to consider including
as a component of providing care.
4. The traditional healing and medicines of indigenous people vary, depending
on the dying person’s community.
5. When a person is interested in receiving traditional healing and medicines,
record and report this within the person’s community.

18) Consider a time when you were ill or experiencing pain. Reflect on what might have helped you to
feel more comfortable. What would you like someone to have in their comfort basket if that person

©NACCPSWDE2022 Module 9. Assisting the Dying Person

were caring for you? (Marks 2)

I grew up in a home where my family members occasionally used medications to manage pain, while at
other times they relied on home remedies. Not all medications are compatible with one another, and
their effectiveness can vary depending on an individual's body response. Additionally, beliefs play a
significant role in how people receive care and medications.

19) Circle the principles that guide the team in making decisions about administration of medications for
symptom management. (Marks 2)

a) The term determines the goal for pain relief.

b) Medications should be given only after pain occurs, not on regular schedules.

c) Breakthrough doses are used when a symptom recurs between regularly scheduled doses.

d) A combination of medications may be necessary to control a symptom and side effects.

e) Side effects and fears or concerns about medications should be recorded and reported.

f) Comfort measures may help improve comfort.

20) These are the four most common side effects of opioids (Highlight your answer):
( Marks 1)

a) Nausea/ Vomiting, drowsiness, addiction, confusion

b) Nausea/ Vomiting, drowsiness, confusion, insomnia

c) Constipation, addiction, Nausea/ Vomiting, confusion

d) Nausea/ Vomiting, Constipation, drowsiness, confusion

21) Describe each of the four common fears and misunderstandings about using opioids for symptom
management. (Marks 4)

©NACCPSWDE2022 Module 9. Assisting the Dying Person

a) Fear of the Symbolism- if he is taking morphine, if means he is dying.

b) Fear of Developing Tolerance- if he becomes used to this dose of medication, then it will not work
for him when his pain increases.

c) Fear of Becoming Dependent- he will become dependent on this medication.

d) Fear of Developing a substance use disorder- I don’t want to become addicted.

22) Why is it important to provide medications for symptom management regularly, around the clock?
(Marks 2)

It is important to provide medications for symptoms regularly around the clock because if you ignore
each symptom it may lead to worse situation of each client or even to death.

The consequence of not providing medications regularly for a person experiencing pain they change
their behavior even before they talk about pain.

23) A dying person often loses weight and loses interest in eating. Refer to the story about Yetta’s
experience on page 4 in the text. (Marks 6)

a) What did Yetta do address her lack of appetite?

Yetta’s experience on page 4 in the text.

b) Identify five things that you as a PSW could have done to help Yetta and her family adjust to her

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 decrease in appetite.

ii)

iii)

iv)

v)

vi)

24) Dehydration

Read pages 104 to 106 in the text to complete the table below. (Marks 12)

What you might observe What you might ask a Comfort measures that Ways to support Family
if a person is dehydrated dying person to better might be helpful
understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 25) Depression

Complete the table below using information from pages 115 and 116 of the text. (Marks 12)

What you might observe What you might ask a Comfort measures that Ways to support Family
if a person had dying person to better might be helpful
depression understand their needs
1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

26) Fatigue
If the person you are caring for has PPS of 40% and is very fatigued, what comfort strategies can
You suggest that might help them have the energy to accomplish their priority activities?
Complete the table below using pages 121 to 123 of the text. (Marks 9)

What you might prevent Fatigue What you might ask a dying person to Comfort measures that might
better understand their needs be helpful
1. 1. 1.

2. 2. 2.

3. 3. 3.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

27) Identify four keys about dying with dementia. (Marks 4)

a)

b)

c)

d)

28) Identify eight ways that PSWs can support advance care planning. (Marks 8)

a)

b)

c)

d)

e)

f)

g)

h)

29) As a PSW you can sign legal documents including wills, legal forms, and contracts. (Marks 1)

True False (Highlight the correct answers)

30) Write five things you learned about grief that you did not know before reading the text. (Marks 5)

a)

b)

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 c)

d)

e)

31) Describe ways to support children whose loved one is dying. (Marks 5)

a)

b)

c)

d)
32) Refer to page 186 to 193 in the text and complete the following chart. (Marks 2)

Physical changes in the last days Comfort measures for the dying Comfort measures for the
and hours person family

Decreased physical strength and

increase drowsiness

Reduced intake and difficulty

swallowing

©NACCPSWDE2022 Module 9. Assisting the Dying Person

Delirium or confusion

Agitation or restlessness

Unresponsiveness

Irregular breathing

Congested breathing

Changes in skin colour and

temperature

©NACCPSWDE2022 Module 9. Assisting the Dying Person

 Dry eyes

Decreased urinary output

Bowel or bladder incontinence

33) The family ask you “What changes can I expect in the last days and hours?” What are four
appropriate ways for you as a PSW to respond? (Marks 4)

a)

b)

c)

d)

34) What physical changes in a person suggest that death is very close? (Marks 4)

©NACCPSWDE2022 Module 9. Assisting the Dying Person

35) It is always important to know what a person’s DNR status is before entering their home.
(Marks 1)

True False (Highlight the correct answers)

36) List three ways you can show respect and support for people whose cultural traditions or spiritual
practices are different from yours. (Marks 3)

a)

b)

c)

37) Describe two reasons why it is important to explore the family’s understanding when they are asking
how long the person might live. (Marks 2)

a)

b)

38) Just as the team needs to individualize care to meet the needs of dying people they care for; each
member needs to personalize self-care strategies. (Mark 2)

List the activities that help you to refuel and re-energize.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

39) Reflect on the term “self-care”. Write freely for five minutes about the topic of self-care. What did
you learn? Where did your reflections take you? (Marks 6)

40) Review the information about compassion fatigue in chapter 7 of the text. (Marks 6)

a) Write freely for five minutes about compassion fatigue.

b) Review the chart n pages 206 and 207 in the text. What zone are you in?

Red Green Yellow (Highlight the correct answers)

c) Respond to the reflective questions in the table on Compassion Fatigue that related to the zone
you are in.

©NACCPSWDE2022 Module 9. Assisting the Dying Person

©NACCPSWDE2022 Module 9. Assisting the Dying Person