2.04 residents nearing_end_of_life
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Transcript of 2.04 residents nearing_end_of_life
Understanding the Understanding the dying dying processprocess and and needsneeds of the of the resident nearing the end resident nearing the end of life. of life.
Nursing Fundamentals 7243 12.04
Unit A Nurse Aide Workplace FundamentalsEssential Standard NA2.00 Apply communication and interpersonal skills and physical care that promote mental health and meet the social and special needs of residents in long-term care. Indicator 2.04 Understand the Dying Process and Needs of the Resident Nearing the End of Life.
Nursing Fundamentals 7243 2
2.04 Introduction2.04 Introduction
Death is defined as the final stage of Death is defined as the final stage of life. life. The nurse aide will need to The nurse aide will need to develop a realistic attitude toward develop a realistic attitude toward the topic of death to meet the the topic of death to meet the physical and psychological needs of physical and psychological needs of the resident and the family as they the resident and the family as they experience the dying process. experience the dying process. This This indicator also includes care of the indicator also includes care of the body following death.body following death.2.04
Nursing Fundamentals 7243 32.04
The s u n s e t t i n gThe s u n s e t t i n g i s n o l e s s b e a u t i f u l i s n o l e s s b e a u t i f u l th a n th e s u n r i s i n g . th a n th e s u n r i s i n g .
PSYCHOLOGICAL CHANGES OF PSYCHOLOGICAL CHANGES OF THE GRIEVING RESIDENTTHE GRIEVING RESIDENT
Nursing Fundamentals 7243 42.04
Five stages of grieving have been identified by
Elizabeth Kubler-Ross
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 52.04
Not all residents go through all the Not all residents go through all the stagesstages
Some residents may stay in one stage Some residents may stay in one stage until death occursuntil death occurs
Residents may move back and forth Residents may move back and forth between grieving stagesbetween grieving stages
Family and friends of the resident will Family and friends of the resident will experience the grief stagesexperience the grief stages
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 62.04
Understanding the Understanding the stages of griefstages of grief helps helps
the Nurse Aidethe Nurse Aide apply apply psychological psychological
support to resident, support to resident, family, and friendsfamily, and friends
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 72437
2.04
DENIALDENIAL
• Defense mechanismDefense mechanism• Buffer against realityBuffer against reality• Emotional escape Emotional escape
hatchhatch• Resident may request Resident may request
another opinion another opinion
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 82.04
DENIAL (continued)
• Resident may Resident may avoid discussion avoid discussion of deathof death
• Feeling of, “This Feeling of, “This can’t be can’t be happening to me.”happening to me.”
Care PointCare Point
Nursing Fundamentals 7243 92.04
Nurse Aides must be Nurse Aides must be ready to listen if the ready to listen if the
resident expresses their resident expresses their feelingsfeelings
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 102.04
ANGER• Bitterness and turmoilBitterness and turmoil
• Sense of unfairnessSense of unfairness
• Blame of others such Blame of others such as health care workersas health care workers
• Feeling of, “Why me?”Feeling of, “Why me?”
Care PointCare Point
Nursing Fundamentals 7243 112.04
Nurse Aide must not take the Nurse Aide must not take the accusations personallyaccusations personally
Do not follow the urge to leave the Do not follow the urge to leave the angry residentangry resident
Listen empathetically Listen empathetically
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 122.04
BARGAINING• Turn to religious Turn to religious
and spiritual and spiritual beliefsbeliefs
• Promises to God Promises to God and othersand others
• Comfort and Comfort and hope when all hope when all seems lostseems lost
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 132.04
BARGAINING (continued)
• Generally know Generally know this won’t workthis won’t work
• Frustration and Frustration and anger dissolve into anger dissolve into depressiondepression
• ““If only...I will”If only...I will”
Care PointCare Point
Nursing Fundamentals 7243 142.04
Listen and reflect what is said, Listen and reflect what is said, express understandingexpress understanding
Be aware of when silence is Be aware of when silence is helpful and words are nothelpful and words are not
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 152.04
DEPRESSION Belief that hope is lostBelief that hope is lost
Overwhelming despairOverwhelming despair
Introverted and withdrawnIntroverted and withdrawn
Reminiscing and reviewing Reminiscing and reviewing lifelife
SleeplessnessSleeplessness
““I always wanted to”I always wanted to”
Care PointCare Point
Nursing Fundamentals 7243 162.04
Your touch, Your touch, if acceptedif accepted, can be , can be very helpfulvery helpful
Understand the resident’s feeling Understand the resident’s feeling of lossof loss
Do not deny death is approachingDo not deny death is approaching
ELIZABETH KUBLER-ROSS FIVE STAGESELIZABETH KUBLER-ROSS FIVE STAGES
Nursing Fundamentals 7243 172.04
ACCEPTANCE• Calm and subdued interest Calm and subdued interest
in lifein life
• Strives to complete Strives to complete unfinished businessunfinished business
• Helps loved ones accept Helps loved ones accept deathdeath
• Needs others to validate Needs others to validate worth of lifeworth of life
• ““I’ve had a good life.”I’ve had a good life.”
Care PointCare Point
Nursing Fundamentals 724318
2.04
Your presence lets them know Your presence lets them know you will not desert themyou will not desert them
Listen if they wish to discuss Listen if they wish to discuss their deaththeir death
BRAIN STORMThinkThink
Recall the conversation of a friend Recall the conversation of a friend who had a family member to die. who had a family member to die. Did you hear any of Kubler-Ross Did you hear any of Kubler-Ross stages of death (grieving)? stages of death (grieving)?
ActActRaise your hand and share your Raise your hand and share your thoughts.thoughts.
Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B
Nursing Fundamentals 7243 192.04
Kubler-Ross – Five stages of griefKubler-Ross – Five stages of grief
Have we got it?Have we got it?Let’s check and seeLet’s check and see
20
Stick diagnostics
Student Name A
Student Name B
Nursing Fundamentals 72432.04
FACTORS INFLUENCING RESIDENTS/FAMILY FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATHATTITUDES TOWARD DEATH
Nursing Fundamentals 7243 212.04
Personal experiencesPersonal experiences Culture; some fear Culture; some fear
death others look death others look forward to and accept forward to and accept death death
FACTORS INFLUENCING RESIDENTS/FAMILY FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATHATTITUDES TOWARD DEATH
Nursing Fundamentals 7243 222.04
Religion Belief in life after death Belief in life after death Reunion with loved ones Reunion with loved ones ReincarnationReincarnation Punishment for sins Punishment for sins No afterlife No afterlife
FACTORS INFLUENCING RESIDENTS/FAMILY FACTORS INFLUENCING RESIDENTS/FAMILY ATTITUDES TOWARD DEATHATTITUDES TOWARD DEATH
Nursing Fundamentals 7243 232.04
Age: ChildrenChildren view death at view death at temporarytemporaryAdultsAdults may develop fears of may develop fears of pain and suffering, dying alone, pain and suffering, dying alone, separation from loved onesseparation from loved onesElderlyElderly generally have fewer generally have fewer fearsfears
Individual resident’s reaction to death
Nursing Fundamentals 7243 242.04
Accept or be resigned to deathAccept or be resigned to death
Open and receptiveOpen and receptive
Communicate about uncertaintiesCommunicate about uncertainties
Fearful or angryFearful or angry
Despairing or anxiousDespairing or anxious
HostileHostile
Thoughtful and meditativeThoughtful and meditative
COMMONCOMMON PHYSICAL SIGNSPHYSICAL SIGNS OFOF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 252.04
Changes in SENSORY FUNCTIONSENSORY FUNCTION and the ability to speak
VISION Blurred and failing vision
Increased secretions in corner of eye
No eye movement / staring / unfocused eye
Nursing Fundamentals 7243 262.04
Reduce glareReduce glare and keep keep room lightening lowroom lightening low
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 272.04
Changes in SENSORY FUNCTIONSENSORY FUNCTION and the ability to speak
SPEECHSPEECH becomes difficultbecomes difficult hard to understandhard to understand may be unable to speakmay be unable to speak
Nursing Fundamentals 7243 282.04
Do not expect an answerDo not expect an answer
Observe body language of Observe body language of the residentthe resident
Anticipate needsAnticipate needs
Changes in SENSORY FUNCTIONSENSORY FUNCTION and the ability to speak
HEARINGHEARING
last sensory last sensory function to be lost…function to be lost…
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 292.04
Changes in SENSORY FUNCTIONSENSORY FUNCTION and the ability to speak
TOUCHTOUCH
SENSE OF TOUCH IS SENSE OF TOUCH IS
DEMINISHEDDEMINISHED
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 312.04
Nursing Fundamentals 7243 322.04
Resident can no longer Resident can no longer turn themselves, turn themselves,
SKIN CARE IS SKIN CARE IS PARAMOUNTPARAMOUNT
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 332.04
Changes in CIRCULATION AND MUSCLE TONECIRCULATION AND MUSCLE TONE and the ability to speak
LOSS OF MOVEMENT, LOSS OF MOVEMENT, MUSCLE TONE, AND FEELINGMUSCLE TONE, AND FEELING
Body is limpBody is limp Jaw may dropJaw may drop Mouth may stay partly Mouth may stay partly
openopen
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 342.04
Changes in CIRCULATION AND MUSCLE TONECIRCULATION AND MUSCLE TONE and the ability to speak
CIRCULATION FAILSCIRCULATION FAILS Heat is lost from the body’Heat is lost from the body’ Mottling (bruised Mottling (bruised
appearance), spotting, or appearance), spotting, or blotching of skin caused by blotching of skin caused by poor circulationpoor circulation
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 352.04
Changes in CIRCULATION AND MUSCLE TONECIRCULATION AND MUSCLE TONE and the ability to speak
CIRCULATION FAILSCIRCULATION FAILS Hands and feet cold to Hands and feet cold to
touchtouch Face becomes pale or gray Face becomes pale or gray
and mottledand mottled Perspiration may increase Perspiration may increase
(DIAPHORESIS)(DIAPHORESIS)
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 362.04
Changes in VITAL SIGNSVITAL SIGNS
BLOOD PRESSURE BLOOD PRESSURE DECREASESDECREASES
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 372.04
Changes in VITAL SIGNSVITAL SIGNS
PULSE:PULSE:Abnormally slow, Abnormally slow, rapid, or irregularrapid, or irregular
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 382.04
Changes in VITAL SIGNSVITAL SIGNS
TEMPERATURE:TEMPERATURE:Rising or below-Rising or below-normalnormal
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 392.04
Changes in VITAL SIGNSVITAL SIGNS
RESPIRATIONS:RESPIRATIONS:Slow, irregular Slow, irregular alternating with alternating with
rapid, shallowrapid, shallowakaaka Cheyne-StokesCheyne-Stokes
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 402.04
Changes in VITAL SIGNSVITAL SIGNS
RESPIRATIONS:RESPIRATIONS:““fish out of water fish out of water
breathing” breathing” akaaka
Agonal BreathingAgonal Breathing
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 412.04
Changes in VITAL SIGNSVITAL SIGNS
RESPIRATIONS:RESPIRATIONS:Rattling or gurgling Rattling or gurgling sound referred to as sound referred to as
Death RattleDeath Rattle
Nursing Fundamentals 7243 422.04
Elevate HOB Elevate HOB to facilitate to facilitate breathingbreathing
BRAIN STORMThinkThink
Why do you think the vital Why do you think the vital signs change as they do when signs change as they do when a resident is dying?a resident is dying?
ActActRaise your hand and share Raise your hand and share your thoughts.your thoughts.
Unit A / Essential Standard NA2.00 / Indicator 2.01 / Letter B
Nursing Fundamentals 7243 432.04
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 442.04
Changes in BOWEL AND BLADDER ELIMINATIONBOWEL AND BLADDER ELIMINATION
URINARYURINARY ANDAND ANALANAL
INCONTINENCEINCONTINENCE
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 452.04
Changes in BOWEL AND BLADDER ELIMINATIONBOWEL AND BLADDER ELIMINATION
DECREASED DECREASED PERISTALSISPERISTALSISABDOMINAL ABDOMINAL DISTENTIONDISTENTIONRELEASE OF RELEASE OF FLATUSFLATUS
BRAIN STORMThinkThink
Why do you think the changes Why do you think the changes in bowel and bladder in bowel and bladder elimination occur?elimination occur?
ActActRaise your hand and share Raise your hand and share your thoughts.your thoughts.
Nursing Fundamentals 7243 462.04
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 472.04
DECREASED PAIN
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 482.04
DECREASED DECREASED INTAKE INTAKE OF FOOD OF FOOD AND FLUID AND FLUID
Nursing Fundamentals 7243 492.04
• Modify diet.Modify diet.• Do not force feed.Do not force feed.• Fluids most Fluids most
important.important.
COMMON COMMON PHYSICAL SIGNSPHYSICAL SIGNS OF OF IMPENDING DEATHIMPENDING DEATH
Nursing Fundamentals 7243 502.04
Disorientation and
Disorientation and
confusion, loss of
confusion, loss of
consciousness
consciousness
Physical Signs of impending DeathPhysical Signs of impending Death
Have we got it?Have we got it?Let’s check and seeLet’s check and see
51
Stick diagnosticsStick diagnostics
Student Name A
Student Name B
Nursing Fundamentals 72432.04
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243 522.04
Observe Observe ““Care Care PointsPoints”” in previous in previous slides related to slides related to sensory function sensory function
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243 532.04
Care of Care of NoseNose and and MouthMouth::
Give mouth care often; if resident Give mouth care often; if resident unconscious, every two hoursunconscious, every two hours
Apply lubricant such as a lip balm, to lips Apply lubricant such as a lip balm, to lips and noseand nose
Olive oil is a good lubricant for lipsOlive oil is a good lubricant for lips
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243 542.04
Care of SKIN:Give bed baths and incontinence care as needed
Bathe perspiring patients often
Keep skin clean and dry
Change sheets and clothes for comfort
Keep sheet wrinkle free
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243 552.04
Care of Care of SKINSKIN::Reposition resident often, Reposition resident often, use supportive devices as use supportive devices as neededneeded
At least every 2 hours or At least every 2 hours or prnprn
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243 562.04
Promote Promote COMFORTCOMFORT::Observe for signs of pain and report Observe for signs of pain and report them!them!
Frequent changes of position, back Frequent changes of position, back massage, and body alignmentmassage, and body alignment
Elevate head of bed (HOB) to facilitate Elevate head of bed (HOB) to facilitate breathingbreathing
NURSE AIDE CARE NURSE AIDE CARE FOR THE DYING RESIDENTFOR THE DYING RESIDENT
Nursing Fundamentals 7243572.04
Control Control ENVIRONMENTENVIRONMENT::Place resident’s favorite objects and Place resident’s favorite objects and photographs where resident can see themphotographs where resident can see them
Provide appropriately lit and well-ventilated Provide appropriately lit and well-ventilated room without odorroom without odor
Place call bell in reach, even if resident Place call bell in reach, even if resident unresponsiveunresponsive
Nursing Fundamentals 7243 58
Control Environment
Features of resident’s room:Features of resident’s room:–Contains personal items which Contains personal items which
provide comfort and provide comfort and reassurancereassurance• PicturesPictures• MementosMementos• CardsCards• FlowersFlowers• Religious objectsReligious objects
2.04
Nursing Fundamentals 7243 59
Nurse Aide Role - RespectNurse Aide Role - Respect
• Treat religious objects Treat religious objects with care and respect:with care and respect:–medalsmedals–picturespictures–statuesstatues–BiblesBibles
• Encourage family and Encourage family and friends to be includedfriends to be included
2.04
Nursing Fundamentals 7243 60
Nurse Aide’s Role - SupportNurse Aide’s Role - Support
• Source of strength and Source of strength and comfortcomfort
• Open and receptiveOpen and receptive• Know own feelings Know own feelings
about death and do not about death and do not project those feelings project those feelings onto resident.onto resident.
2.04
Nursing Fundamentals 7243 61
Nurse Aide’s Role - SupportNurse Aide’s Role - Support
• EmpatheticEmpathetic• Calm and efficient Calm and efficient • Normal tone of voiceNormal tone of voice• Good listening skillsGood listening skills• Non-judgmentalNon-judgmental
2.04
Nursing Fundamentals 7243 62
Nurse Aide Role Support to Family & Friends
• Offer comfort measures such as Offer comfort measures such as drinks, food, chairs, blankets etc. drinks, food, chairs, blankets etc. within facility policy.within facility policy.
• Use good communication skillsUse good communication skills
• Listen and provide understanding Listen and provide understanding throughout the grief/loss stagesthroughout the grief/loss stages
• Answer questions or refer to Answer questions or refer to supervisorsupervisor
2.04
Nursing Fundamentals 7243 63
Nurse Aide Role Support to Family & Friends
• Available for supportAvailable for support
• Use touch as appropriateUse touch as appropriate
• Courteous and Courteous and considerateconsiderate
• Respect right to privacyRespect right to privacy
• Let family assist with care, Let family assist with care, if they desire, where if they desire, where appropriateappropriate
2.04
Nursing Fundamentals 7243 64
Nurse Aide Role – Spiritual Support
• Priest, rabbi, minister or Priest, rabbi, minister or other clergy may be other clergy may be contacted at request of contacted at request of resident or familyresident or family
• Privacy to be provided Privacy to be provided when clergy with when clergy with residentresident
2.04
Nursing Fundamentals 7243 65
Nurse Aide Role – Spiritual Support
• Support resident’s Support resident’s religious/spiritual practices even if religious/spiritual practices even if different from that of nurse aidedifferent from that of nurse aide
• Listen respectfully to Listen respectfully to religious/spiritual beliefs religious/spiritual beliefs
• Participate in religious practices if Participate in religious practices if asked and acceptableasked and acceptable
2.04
Nursing Fundamentals 7243 67
Hospice CareHospice Care
• Hospice Care offered:Hospice Care offered:– in hospitals and extended care in hospitals and extended care
facilitiesfacilities–by special facilitiesby special facilities–usually in the individual’s homeusually in the individual’s home
• Continuing care provided by team Continuing care provided by team of health professionalsof health professionals
• Designed for residents with Designed for residents with terminal illnessterminal illness
2.04
Nursing Fundamentals 7243 68
Hospice CareHospice Care
• Acceptance of death as imminent (6 months or Acceptance of death as imminent (6 months or less)less)
• Assures that individual dies with dignity and Assures that individual dies with dignity and comfortcomfort
• Not concerned with cure or life-saving Not concerned with cure or life-saving proceduresprocedures
• Emphasis on pain reliefEmphasis on pain relief
• Trained volunteers and professionals make Trained volunteers and professionals make regular visits.regular visits.
2.04
Nursing Fundamentals 7243 69
Hospice CareHospice Care
• Provides counseling for individual and Provides counseling for individual and family:family:– EmotionalEmotional– PsychologicalPsychological– SpiritualSpiritual– FinancialFinancial– Bereavement Bereavement
• Family included in all aspects of care as Family included in all aspects of care as desireddesired
2.04
Nursing Fundamentals 7243 71
Reasons for Postmortem Care Reasons for Postmortem Care
• Prevent discoloration and skin Prevent discoloration and skin damagedamage
• Maintain good appearance of bodyMaintain good appearance of body
• Identify body and prepare for Identify body and prepare for transportationtransportation
• Position body in normal alignmentPosition body in normal alignment
• Arrange time family to view the bodyArrange time family to view the body
2.04
Nursing Fundamentals 7243 72
Postmortem Care – Genenral GuidelinesPostmortem Care – Genenral Guidelines
• Begin care when instructed by Begin care when instructed by supervisorsupervisor
• Treat body to privacy, respect Treat body to privacy, respect and gentlenessand gentleness
• Give care before rigor mortis Give care before rigor mortis sets insets in
2.04
2.04 Nursing Fundamentals 7243 73
SKILLSKILL 2.042.04Postmortem CarePostmortem Care
Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Engage in the Skill EXPLORATIONEXPLORATION Process for: Process for: