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1. Evaluate two performance and prognostic methods that are predictive of poor survival.
2. Compare palliative care services to hospice care.
3. Differentiate unique palliative care interventions for the complexities of five end stage diseases.
4. Identify two ethical issues often seen in end stage disease.
5. Specify three challenges faced at the end of life.
6. Recognize two strategies to overcome fear of death and moral distress.

Disease Prognostication: An Inexact Art & Science

• Illness and Dying Trajectory
• Performance Scales
• Prognosis Tools
• Determining Palliative Care vs. Hospice
• National Consensus Project: Eight Domains for Quality Practice
• Crucial Conversations

Heart Failure

• Stages
• Treatment options
• Devices to Extend Life
• Symptom Burden/Management
• Prognostic Models
• Living better - or prolonging suffering?

Advanced Cancer/ Neoplastic conditions

• Staging Cancer
• Spiritual needs
• Complications and interventions
  • Spinal cord compression
  • Superior vena cava syndrome
  • Bowel obstruction
  • Hypercalcemia
  • Fungating wound care
  • Signs of impending death

Pulmonary Disease

• Staging the disease
• Spirometry: a required test
• The MMRC Breathlessness Scale
• Treating dyspnea: The pain of non-malignant disease
• The medical toolbox: oxygen, bronchodilators, opioids & steroids

Amyotrophic Lateral Sclerosis

• Diagnostic tests
• Post-polio syndrome: An ALS mimic
• Advance directives and life support decisions: nutrition & gastrostomy, non-invasive ventilation or invasive?
• Table of useful medications

Advanced Dementia

• Stages
• Ethical issues: feeding, medications
• Ensuring comfort
• Delirium & dementia
• Interventions for agitation and aggression

Renal Disease

• Appropriate use of dialysis
• Staging disease with Glomerular Filtration Rate (GFR)
• Hemodialysis mortality predictor
• Symptom burden
• Underutilization of hospice

Liver Disease

• Prognostic Determination
• Ethical issues
• Signs of ‘end stage’

Challenging Decisions

• What do People Want at the End of Life?
• Honoring Patients Wishes
• Delirium vs near death experience
• Dying Signs, symptoms and needs - is hydration needed?
• Mental health needs of the dying
• Managing pain as death nears
• Palliative sedation therapy: for intractable symptoms

Moral Distress

• Ethical dilemmas
• Medication errors
• Conflicted consciences
• Giving the last dose
• Attending the first death
• Strategies for diminishing death discomfort
• Personal versus professional grieving

Nancy Joyner, RN, MS, APRN-CNS, ACHPN® is a nationally recognized consultant, speaker, educator and author. As a Palliative Care Clinical Nurse Specialist, she works as the palliative care specialist disseminating awareness and education regarding palliative care statewide. Nancy has over 40 years of nursing proficiency that includes 17 years as an advanced practice nurse in palliative care. Nancy is an End-of-Life Nursing Education Consortium (ELNEC) trainer. She has had training through the Center to Advance Palliative Care (CAPC). Nancy created numerous CME sessions on palliative care for the University of North Dakota’s Project ECHO and is involved with the Dakota Geriatric Workforce Enhancement Program. She has presented and published at local, state, and national levels. She has researched and published articles on POLST and advance care planning. Nancy is an ambassador for the Serious Illness Community of Practice, Ariadne Labs. She is currently president of Honoring Choices® North Dakota, North Dakota’s POLST Program Coordinator and co-creator of the HCND ACP Facilitator Certification Course.

Speaker Disclosures:
Financial: Nancy Joyner maintains a private practice and has employment relationships with CSU Shiley Haynes Institute for Palliative Care, UND Center for Rural Health, UND Dakota Geriatrics, WilliamsTown Communications, and the University of North Dakota. She receives royalties as a published author. Nancy Joyner receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Nancy Joyner is the President of Honoring Choices® North Dakota and is a member of the North Dakota Hospice Association, the North Dakota Cancer Coalition, and others. For a complete list, please contact info@pesi.com.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). 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 are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**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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Certification in Thanatology: This self-study educational offering is recognized by the Association for Death Education and Counseling to meet the thanatology-related educational contact hour requirements to be Certified in Thanatology: Death, Dying and Bereavement. This course will award 6.25 contact hours to participants.

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Counselors
This intermediate self-study activity consists of 6.25 clock hours of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from the activity and contact your state board or organization to determine specific filing requirements.

California Counselors: 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.

Florida Social Mental Health Counselors: 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.

Montana Counselors: 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.

Nevada Counselors: PESI, Inc. is an approved CEU provider with the State of Nevada Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. This self-study activity qualifies for 6.25 contact hours. Approved Provider # NVCEP2006.

New York Counselors: PESI, Inc. is recognized by the New York State Education Department's (NYSED) State Board for Mental Health Practitioners as an approved provider of continuing education for Licensed Mental Health Counselors. #MHC-0033. 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 Counselors: 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.

South Carolina Counselors: This self-study program has been approved for 6.0 continuing education hours by the South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists. Provider #4540.

Texas Counselors: This self-study activity consists of 6.0 clock hours of continuing education instruction. Texas State Board of Examiners of Professional Counselors no longer approves programs or providers. PESI activities meet the continuing education requirements as listed in Title 22 Texas Administrative Code, Chapter 681, Subchapter J, Section 681.142 Acceptable Continuing Education. Please retain the certificate of completion that you receive and use as proof of completion when required.

Ohio Counselors: 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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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 10/7/2019
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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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.

Case Managers, Chaplains/Clergy, Counselors, Nurses, Social Workers