Palliative & End-of-Life Care

Start here. This module sets the three boundaries that make everything after it safe to use.

What this module covers. Who the programme is for and how a fully self-directed online course is completed; how the assessment and certificate work; the scope-of-practice rule; and the two boundaries that matter most in this subject - medicines and the law.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 5-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Completing a course is not authority to act. Knowledge, assessed competence and authority from your employer are all required, every time - and where your organisation's policy is more restrictive than this course, your organisation's policy applies.

Palliative care is triggered by need, not by prognosis - and waiting for treatment to fail is the commonest reason people receive it too late to benefit.

What this module covers. What palliative care is and is not; the difference between a palliative approach, specialist palliative care, end-of-life care and terminal care; the three trajectories of decline; the triggers that should start a palliative approach; who provides it; and the misconceptions that delay it.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 5-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Most people needing palliative care in Australia do not have cancer. Frailty and dementia carry the trajectory that is missed most often.

The most valuable output of advance care planning is not the document. It is that the family has heard the person say it in their own words.

What this module covers. What advance care planning is and what it produces; capacity and how it is assessed; advance care directives and how far they vary between states and territories; substitute decision-makers; goals-of-care and resuscitation plans; and what to do when the plan and the moment do not match.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 7-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. A substitute decision-maker is asked what the person would have decided - not what they themselves want. Saying that out loud relieves families of a burden they should not be carrying.

Communication is a clinical procedure with a technique, and it is the one most often delegated upwards and then never done.

What this module covers. The structure of a serious-news conversation; responding to emotion; answering the hardest questions; prognosis and hope; requests to withhold information; running a family meeting; working with interpreters; talking with children; and documenting what was actually said.

In this section. A narrated slide deck (0.75 CPD hours), the student learner guide, and a 6-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Emotion before information. Nothing said immediately after a person begins to cry is retained - and 'there's nothing more we can do' is never true and is the sentence most often quoted back in a complaint.

There is no objective test for pain. The person's report is the measurement - and where they cannot report, a validated behavioural tool is.

What this module covers. Pain as a subjective and total experience; structured assessment including people who cannot self-report; the types of pain and what each responds to; the principles of analgesia; opioid myths and genuine adverse effects; non-drug measures; incident and procedural pain; and when to escalate.

In this section. A narrated slide deck (0.75 CPD hours), the student learner guide, and a 7-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. New behavioural change in a person with dementia is pain until proved otherwise. This module names no medicine doses - the prescription, Therapeutic Guidelines and local policy are the authority on those.

Pain gets the attention. These are the symptoms that more often decide whether the last weeks are bearable.

What this module covers. Breathlessness, nausea and vomiting, constipation, delirium, fatigue and loss of appetite, anxiety, and mouth problems: assessment, what helps without medicines, the principles of treatment, and what to escalate.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 7-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. A handheld fan directed at the face is among the best-evidenced interventions for breathlessness, and mouth care matters more than almost anything else you can offer. Neither needs a prescription.

Recognition is the bottleneck. Without it nothing changes - and everything that makes a death comfortable follows from it.

What this module covers. Recognising that a person is entering the dying phase; what must change once it is recognised; comfort care in the last days; respiratory secretions, terminal restlessness and changed breathing; what families need to be told and when; the moment of death; and what to do when the recognition was wrong.

In this section. A narrated slide deck (0.75 CPD hours), the student learner guide, and a 9-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Recognising dying is everybody's business - care workers and families frequently notice first. If you think someone is dying and nobody has said so, say it.

Swallowing fails before the need for medicines does. This module is about what happens then.

What this module covers. Why the route changes in the last days; the subcutaneous route and cannula care; as-required doses and continuous subcutaneous infusions; what a syringe driver is and the myth attached to it; anticipatory prescribing and the medicines box at home; supported carer administration; storage, checking and documentation.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 6-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. A prescription that has not been dispensed is not a plan. The commonest reason a planned home death ends in an ambulance is that the anticipatory medicines were not physically in the house, or nobody there was authorised to give them.

Cultural safety is judged by the person receiving care, not by the person providing it. You cannot declare your own care culturally safe.

What this module covers. Culturally safe palliative care with Aboriginal and Torres Strait Islander people; working across cultures and languages; religious and cultural practices at the time of death; and spiritual care, spiritual distress and when to refer.

In this section. A narrated slide deck (0.50 CPD hours), the student learner guide, and a 5-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Assumption is uniquely dangerous at the end of life, because a body handled by the wrong person or a rite missed cannot be undone afterwards. Ask early, and never use a family member as the interpreter for a conversation about prognosis.

What you do in the hour after a death, and in the weeks after that, is what the family will remember for years.

What this module covers. The moment of death and what families need; verification and certification of death; the deaths that must be reported to the coroner; care of the body including cultural and religious requirements; the practical steps and paperwork; and bereavement - normal grief, the risk factors, and referral.

In this section. A narrated slide deck (0.75 CPD hours), the student learner guide, and a 6-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. Say the plain words: 'I'm so sorry. She has died.' And note that a death following a fall or any injury is potentially reportable to the coroner even when the death was otherwise expected - expected does not mean non-reportable.

The rules that govern what you may do, the questions the law leaves to your own state or territory, and what this work costs the people who do it.

What this module covers. Scope of practice and delegation applied to a person who is dying; voluntary assisted dying as a jurisdictional question and the nurse's position within it; the ethical distinctions that matter - double effect, withholding and withdrawing, non-beneficial treatment, palliative sedation; documentation; and moral distress, cumulative grief and genuine self-care.

In this section. A narrated slide deck (0.75 CPD hours), the student learner guide, and a 5-item knowledge check with a rationale for every option. The knowledge check is formative - not graded, no attempt limit.

The one thing to take from it. A delegation that was appropriate on Monday may be unsafe by Thursday, because the dying phase is by definition changing. And on voluntary assisted dying: you may decline to participate, but you may not obstruct - concealing, delaying or discouraging a request is not conscientious objection.

The assessment of record for this programme, and the documents that explain it.

In this section. The assessment brief, which explains the components, the blueprint and what happens if you do not pass; the case study assessment, five unfolding clinical cases with feedback on every option; the summative assessment paper copy for offline and accessibility use; and the summative assessment itself - 60 single-best-answer items across all eleven modules, 80 per cent to pass, two attempts.

How it is weighted. The module knowledge checks and the case studies are formative and are not graded. Only the summative assessment is graded, and a pass on it issues your certificate automatically.

Nine items are mandatory-correct. They test knowledge where an error causes immediate, serious and avoidable harm. Answer one of them wrongly and you will be directed back to the relevant module regardless of your overall score.

The single most important document in this programme, and the shortest.

In this section. The student scope of practice card - one page, designed to be printed and kept where you work.

What it holds. The rule that governs everything here: knowledge, assessed competence and authority, all three, every time. Plus the escalation list - what to call about and when - and the ten things never to do.

Completing this course does not authorise you to perform anything described in it, and where your organisation's policy is more restrictive than this course, your organisation's policy applies.

Three tools for practising the judgement the modules describe. Optional, and deliberately not counted in the 9.5 claimable CPD hours - if you complete them you may claim that time separately as self-directed CPD.

Symptom response simulator. Five scenarios, four decisions each - what you assess, what you do, how you escalate, and what you say. Wrong answers show you what actually happens, because the consequence is the lesson.

Recognising dying - trigger checklist. Twenty-two weighted indicators. Tick what is true for one real person you have in mind. It is a prompt, never a prognosis: its purpose is to make it easier to say out loud what you have already noticed.

Scope of practice self-check. Choose your role, then sort every activity in the programme. The feedback names the condition, not just the verdict.

The documents you keep, use in practice, or hand to a family.

Further reading and organisations. Eighteen Australian organisations with live links, reading by module, the consumer and carer services worth handing over, and the standards documents to keep current.

Student reflective workbook (fillable). Type into it, save it, keep it. The NMBA expects registered and enrolled nurses to hold their own CPD evidence - this workbook together with your certificate is that evidence.

Symptom and comfort record (fillable). A three-day record for a person being cared for at home or in a facility. It captures the pattern, which is what a clinician actually needs. It names no medicine and no dose, and it is designed to be printed and used at a bedside.

Advance care planning conversation guide (fillable). A working tool for the conversation that should happen before a directive is written. It is not an advance care directive - the directive itself, and who may be appointed, is set by the law of your state or territory.