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1. Analyze the current state of end of life care including symptom management in this country.
2. Evaluate criteria for services and anticipated benefits of palliative care vs. hospice care.
3. Apply appropriate communication techniques for families struggling with decisions at end of life.
4. Explain equianalgesia, tolerance, and titration and how they impact the ability to effectively treat pain.
5. Differentiate between medication options used to treat various types of pain.
6. Examine specific interventions that enable the nurse to provide quality end of life care through symptom management.
7. Create optimal patient outcomes through effective symptom management.

1. The Patient at End of Life
1. Palliative care vs. hospice care
2. Barriers to providing quality care at the end of life
3. Research that addresses death and dying
2. Family Communication at End of Life
1. Specific challenges addressed
2. Assessing goals of care
3. Communication strategies
4. Interdisciplinary approach
5. POLST/Advance directive documents
6. Examples of crucial conversations
3. Providing Holistic Care at End of Life
1. Cultural considerations
2. Grief and loss
3. Extent of symptoms
4. Impact on family
5. Type of disease and prior treatment success or failure
6. Legal/Ethical Issues
4. Symptom Management at End of Life
1. Pain
2. Dyspnea
3. Anorexia
4. Fatigue
5. Constipation
6. Nausea/Vomiting
7. Depression
8. Anxiety
5. Patient Outcomes
1. HCAHPS
2. Press Ganey
3. Nursing interventions that impact satisfaction scores
4. Performance improvement strategies
5. The Joint Commission Standards
6. Using MDS in long term care to capture pain management

Fran Hoh, PhD, APN, CS, ACHPN®, is an advanced practice nurse who is passionate about end of life care. As such, her doctorate in health administration allowed her to focus her dissertation work on pain management. She currently practices in a hospital as the manager of the inpatient pain service, where she instituted the pain resource nurse program. In this role, Dr. Hoh has been responsible for educating hundreds of nurses to successfully advocate for improved patient pain management. Additionally, she has her own practice, Always Think Comfort, in which she provides palliative care services to patients in long term care facilities, with the goal of preventing unplanned and unnecessary hospitalizations.

As one of the first trained ELNEC (End of Life Nursing Education Consortium) Trainers, Fran has trained nurses around the country in holistic end of life care. She presented the full day ELNEC course as a preconference at the national ASPMN (American Society of Pain Management Nurses) annual meeting for several years.

She currently holds three national certifications, including: pain management, advanced practice nurse in hospice and palliative care, and as a clinical nurse specialist in adult nursing. Fran has received recognition for her numerous contributions: she received the Clinical Nurse of the Year award from the American Society of Pain Management Nurses and the Nurse Excellence Award from Overlook Hospital. As a published author and respected national presenter, she has a wealth of knowledge to share from her vast clinical experiences caring for end of life patients. Speaker Disclosures:
Financial: Francine Hoh has an employment relationship with Signify Health and is a consultant with Always Think Comfort. She receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Francine Hoh has no relevant non-financial relationships.

For U.S. and Canadian customers, CE is available for $20.00 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion will be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Ethics
This self-study course includes 1.0 hours of general ethics instruction. Not all boards allow ethics credit for self-study products. If ethics is not specified within your licensing board’s approval statement below, please contact your board to determine the applicability and amount of ethics allowed.

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Chaplains/Clergy
This self-study program is designed to qualify for 6.25 continuing education hours.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 5/13/2020
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Pharmacology Nurse Practitioners
This self-study program offers 150 instructional minutes of pharmacology content which is designed to qualify for 2.5 contact hours toward your pharmacology requirement.

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Social Workers
PESI, Inc., #1062, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. PESI, Inc. maintains responsibility for this course. ACE provider approval period: January 27, 2020 - January 27, 2023. Social Workers completing this course receive 5.25 Clinical and 1.0 Ethics continuing education credits. No more than 6.25 total CE hours may be awarded for this activity.

Course Level: Intermediate. Format: Asynchronous distance learning. Full attendance is required; no partial credits will be offered for partial attendance.

Canadian Social Workers: Canadian provinces may accept activities approved by the ASWB for ongoing professional development.

California Social Workers: The California Board of Behavioral Sciences accepts CE programs that are approved by other approval agencies, including several that approve PESI and its programs. A full list of approval agencies accepted by the BBS can be found at www.bbs.ca.gov/licensees/cont_ed.html under “Where to find CE Courses.” This Intermediate level self-study activity consists of 6.0 clock hours of continuing education instruction.

Colorado Social Workers: PESI, Inc. is an approved provider with the Colorado Chapter of the National Association of Social Workers. Provider #1413. This course has been approved for 6.3 continuing education hours.

Florida Social Workers: PESI, Inc. is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. Provider Number 50-399. This self-study course qualifies for 6.25 continuing education credits.

Illinois Social Workers: PESI, Inc. is an approved provider with the State of Illinois, Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 159-000154. Successful completion of this self-study activity qualifies for 6.0 contact hours.

Kansas Social Workers: PESI, Inc. is an approved provider with the Kansas Behavioral Sciences Regulatory Board. Provider #14-006. This self-study course has been approved for 6.0 continuing education hours.

Minnesota Social Workers: PESI, Inc. is an approved provider with the State of Minnesota, Board of Social Work. Provider #: CEP-140. This self-study course has been approved for 6.0 continuing education hours. A certificate will be issued upon successful completion of a post-test.

Montana Social Workers: The Montana Board of Behavioral Health no longer pre-approves any courses or sponsors. Each licensee is responsible for taking courses which contribute to their competence and directly relate to their scope of practice as defined in board statute (MAR 24-219-32). Licensees must keep CE documentation for three years in case of an audit. This intermediate level self-study activity consists of 6.25 clock hours of instruction.

New York Social Workers: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0008. This self-study activity will qualify for 7.5 contact hours. Full attendance is required; no partial credits will be offered for partial attendance.

Pennsylvania Social Workers: The Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors accepts many national association CE approvals, several of which PESI offers. For a full list, please see your State Board regulations at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/. This intermediate self-study activity consists of 6.25 clock hours of continuing education instruction.

Ohio Social Workers: PESI, Inc. is an approved provider with the State of Ohio Counselor, Social Worker and Marriage & Family Therapist Board. Provider approval #:RCST071001. Full attendance at this course meets the qualifications for 6.25 clock hours of continuing education credit. TBD

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Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Nurses, Clinical Nurse Specialists, Nurse Practitioners, Nurse Educators, Case Managers, Social Workers, Chaplains