1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 48 End-of-Life Care

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  End-of-life care describes the support and care given during the time surrounding death.  End-of-life care may involve days, weeks, or months.  Sometimes death is sudden, but often it is expected.  Your feelings about death affect the care you give.  You must understand the dying process. Then you can approach the dying person with caring, kindness, and respect. Then you can approach the dying person with caring, kindness, and respect. Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Terminal Illness  An illness or injury for which there is no reasonable expectation of recovery is a terminal illness.  Hope and the will to live strongly influence living and dying.  Types of care  Palliative care involves relieving or reducing the intensity of uncomfortable symptoms without producing a cure.  Hospice care focuses on the physical, emotional, social, and spiritual needs of dying persons and their families.  The goal is to improve the dying person’s quality of life. Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Attitudes About Death  Experiences, culture, religion, and age influence attitudes about death.  Attitudes about death often change as a person grows older and with changing circumstances.  Practices and attitudes about death differ among cultures. Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Culture and spiritual needs  Practices and attitudes about death differ among cultures.  Attitudes about death are closely related to religion.  Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life.  Many religions practice rites and rituals during the dying process and at the time of death.  Age affects a person’s attitudes and feelings about death. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. The Stages of Dying  Dr. Elisabeth Kübler-Ross described five stages of dying.  Denial is the first stage.  Anger is the second stage.  Bargaining is the third stage.  Depression is the fourth stage.  Acceptance of death is the last stage.  Dying persons do not always pass through all five stages.  A person may never get beyond a certain stage.  Some move back and forth between stages. Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Comfort Needs  End-of-life care involves addressing physical, mental and emotional, and spiritual needs.  Comfort goals are to:  Prevent or relieve suffering to the extent possible  Respect and follow end-of-life wishes  Dying persons may want to see a spiritual leader.  Provide privacy during prayer and spiritual moments.  Be courteous to the spiritual leader.  Handle the person’s religious objects with care and respect. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Needs  Dying may take a few minutes, hours, days, or weeks.  To the extent possible, independence is allowed.  Every effort is made to promote physical and psychological comfort. The person is allowed to die in peace and dignity. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Pain  Skin care, personal hygiene, back massages, oral hygiene, and good alignment promote comfort.  Frequent position changes and supportive devices promote comfort.  Breathing problems  Vision, hearing, and speech  Vision blurs and gradually fails.  Hearing is one of the last functions lost.  Speech becomes difficult. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Mouth, nose, and skin  Oral hygiene promotes comfort.  Crusting and irritation of the nostrils can occur.  Circulation fails and body temperature rises as death nears.  Nutrition  Elimination  Urinary and fecal incontinence may occur.  Constipation and urinary retention are common. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The person’s room  The person’s room should be comfortable, pleasant, well lit, and well ventilated.  Unnecessary equipment is removed.  Equipment upsetting to look at is kept out of the person’s sight if possible.  The person and family arrange the room as they wish. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Mental and Emotional Needs  Mental and emotional needs are very personal.  Some persons have specific fears and concerns, such as:  Severe pain  When and how death will occur  What will happen to loved ones  Dying alone  The doctor may order drugs for anxiety or depression.  Simple measures may soothe the person. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. The Family  This is a hard time for the family.  The family usually is allowed to stay as long as they wish.  You must respect the right to privacy.  You cannot neglect care because the family is present.  The family goes through stages like the dying person.  They need support, understanding, courtesy, and respect.  A spiritual leader may provide comfort. Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Legal Issues  The Patient Self-Determination Act and OBRA:  Give persons the right to accept or refuse medical treatment.  Give the right to make advance directives.  Nursing centers must inform all persons of the right to advance directives on admission.  Living wills  Durable power of attorney for health care  “Do Not Resuscitate” (DNR) orders  Even if you do not agree with care and resuscitation decisions, you must follow the person’s or family’s wishes and the doctor’s orders. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Signs of Death  Signs that death is near may occur rapidly or slowly.  Movement, muscle tone, and sensation are lost.  Peristalsis and other gastrointestinal functions slow down.  Body temperature rises.  Circulation fails.  The respiratory system fails.  Pain decreases as the person loses consciousness.  The signs of death include no pulse, no respirations, and no blood pressure.  A doctor pronounces the person dead. Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Care of the Body After Death  Care of the body after death is called post- mortem care.  It begins when the doctor pronounces the person dead.  It is done to maintain a good appearance of the body.  The right to privacy and the right to be treated with dignity and respect apply after death.  Within 2 to 4 hours after death, rigor mortis develops.  An autopsy is the examination of the body after death to determine the cause of death. Slide 16

17. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  Quality of life is important to dying persons and their families.  A person has the right to die in peace, with dignity.  The dying person has these rights under OBRA:  To privacy before and after death  To visit others in private  To confidentiality before and after death  To be free from abuse, mistreatment, and neglect  To freedom from restraint  To have personal possessions  To a safe and home-like setting  To personal choice Slide 17