1. Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 21 - Caring for People Who Are Terminally Ill

2. Slide 2 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Introduction To Caring for People Who Are Terminally Ill

3. Slide 3 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A terminal illness is an illness or condition for which there is no cure Examples of terminal illnesses: Acquired immunodeficiency syndrome (AIDS) Certain cancers Some chronic respiratory disorders Some heart conditions Some chronic kidney disorders Introduction To Caring for People Who Are Terminally Ill

4. Slide 4 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Stages of Grief

5. Slide 5 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Stages of grief are: Denial Anger Bargaining Depression Acceptance Hope Stages of Grief

6. Slide 6 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Denial occurs when a person is told that he or she has a terminal illness The person may: Refuse to accept the diagnosis Feel that a mistake has been made Ask for a second opinion Act as if nothing is wrong Avoid returning to the doctor for a period of time Denial helps to protect a person emotionally from overwhelming grief This stage of grief can last only a few minutes, or it may last until the person actually dies Stages of Grief: Denial

7. Slide 7 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities of a nursing assistant: Avoid convincing the person that his or her illness exists Avoid arguing with the person about treatment or care issues Recognize that denial is a normal part of the grieving process Respond to the person in an honest yet neutral way Communicate your observations to the nurse if the person refuses medication or other medical treatment Stages of Grief: Denial

8. Slide 8 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Anger occurs when the person realizes that he is actually going to die The person may: Be angry with himself for  Not seeking help sooner  Making a lifestyle choice that contributed to the illness Become moody and withdrawn Become uncooperative and hostile Yell, or throw objects Lose faith in religion Take his or her anger out on  Family members  Health care professionals Stages of Grief: Anger

9. Slide 9 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities of a nursing assistant: Avoid taking the anger personally because  It can hurt your emotional well being  It can affect your ability to care for the person Stages of Grief: Anger

10. Slide 10 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Bargaining is typically done on a very private basis by the terminally ill person The person may Wants to “make a deal” with someone he or she feels has control over his or her fate, such as:  God  A health care provider  Family members Want to live long enough to accomplish a goal, or to witness a specific event, such as:  The birth of a child  A wedding  An anniversary celebration The will to live can be a very powerful force, and may, in fact, extend the person’s life by a few months Stages of Grief: Bargaining

11. Slide 11 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities a nursing assistant: Explore ways to help the person maintain the will to live Allow the terminally ill person to experience the feeling of hope that accompanies this stage of grieving Stages of Grief: Bargaining

12. Slide 12 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Depression occurs when a person fully realizes that death will be the end result of the illness The person may: Feel sad Have regrets about things he or she was not able to accomplish during his or her lifetime Feel withdrawn Talk very little Openly mourn for his or her loss Stages of Grief: Depression

13. Slide 13 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities of a nursing assistant: Recognize that depression is a normal part of the grieving process Be supportive of your resident or patient Let the person know that it is all right for him to be feeling the way he is feeling Stages of Grief: Depression

14. Slide 14 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities of a nursing assistant: Tell the nurse if a grieving person’s depression causes the person to:  Cry constantly  Refuse food  Fail to sleep Some people will require medical intervention to treat their depression Stages of Grief: Depression

15. Slide 15 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Acceptance occurs when: A person comes to terms with the reality of his or her own impending death He or she is finally at peace with this knowledge The person may: Demonstrate acceptance by completing unfinished business and saying goodbye Plan her funeral service Write a poem or letter to be read after she is gone Want to talk about her death, in an effort to help family members accept it Stages of Grief: Acceptance

16. Slide 16 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Throughout the grieving process, the one thing that usually persists is hope Even the most realistic and accepting patients hold onto the hope that a cure will be found Hope is what helps a terminally ill person face another day or another painful treatment Hope is what drives the person to keep up with normal activities, such as eating and praying Stages of Grief: Hope

17. Slide 17 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Responsibilities of a nursing assistant: Be responsive to, and nurture, a person’s hope, without being unrealistic Stages of Grief: Hope

18. Slide 18 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Terminally ill people may not pass through all the stages of grief, and they may not pass through them in order Many people work through the first five stages of grief, only to “relapse” and experience some of the earlier stages again Stages of Grief

19. Slide 19 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The family of a terminally ill person will also go through the stages of grief as they prepare for their loss Sometimes the family members may be upset and they may direct their anger at you Report your observations of family turmoil to the nurse Arrange for the assistance of clergy or other professionals experienced in grief counseling Stages of Grief

20. Slide 20 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Wills

21. Slide 21 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A will is a legal statement that expresses a person’s wishes for the management of his or her affairs after death For a will to be valid, at the time it is made the person must be deemed: Competent, and Of sound mind Wills

22. Slide 22 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. If you are asked to sign a will as a witness, your signature means: You saw the person sign the document To the best of your knowledge the document acurately expresses that person’s wishes You should never sign a will as a witness if you have been named as a benefactor of the will Wills

23. Slide 23 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Dying with Dignity

24. Slide 24 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. An advance directive is: A document where a person makes his wishes regarding health care known Made in case the time comes when he is no longer able to make those wishes known himself Advance directives include: Living wills Durable powers of attorney for health care Advance Directives

25. Slide 25 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A living will requests that death not be artificially postponed A durable power of attorney for health care transfers the responsibility for handling a person’s affairs and making medical decisions to a family member, friend, or other trusted person in the event that the person is no longer able to make these decisions on his own behalf Advance Directives

26. Slide 26 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. This act ensures that the wishes of patients and patients’ family members are followed The wishes are regarding measures to be taken on their own behalf (or on the behalf of their loved one) This act requires health care facilities and providers to: Educate patients and residents about advance directives Offer them the opportunity to establish either a living will, a durable power of attorney, or both Patient Self-Determination Act of 1990

27. Slide 27 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Supportive care offers treatments that will not prolong life, but will make a person more comfortable Examples of supportive care are: Oxygen therapy Nutritional supplementation Pain medication Range-of-motion exercises Grooming and hygiene Positioning assistance Supportive Care

28. Slide 28 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Life-sustaining treatments tend to be more aggressive Examples are: Respiratory ventilation Cardiopulmonary resuscitation (CPR) The placement of a feeding tube or intravenous (IV) line for the provision of nutrition Life-Sustaining Treatments

29. Slide 29 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Written on the chart of a person who wants to receive only supportive care at the end of his life Means that the usual efforts to save the person’s life will not be made Helps to ensure that the person will pass on with the compassion and dignity he has requested Entire health care team should be aware of this order No-code or do not resuscitate (DNR) order

30. Slide 30 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Hospice Care

31. Slide 31 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Hospice agencies are organizations founded to: Offer the terminally ill person the best quality of life possible Ensure his or her comfort and dignity as death approaches Hospice Care

32. Slide 32 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Hospice care is provided by a multidisciplinary team, consisting of: Nurses Nursing assistants Social workers Doctors Mental health providers Hospice Care

33. Slide 33 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. After the person’s death, hospice provides grief counseling and assistance for the family People are eligible for hospice care when their doctors say they have approximately 6 months left to live Hospice Care

34. Slide 34 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Palliative care focuses on relieving uncomfortable symptoms, not curing the problem that is causing the symptoms Palliative care includes: Administration of medications to control pain Use of chemotherapy or radiation to shrink a tumor Use of oxygen therapy to help keep a person with breathing problems comfortable Surgical procedures to remove a tumor that is interfering with the functioning of an organ system Palliative Care

35. Slide 35 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Effects of Caring for the Terminally Ill on the Caregiver

36. Slide 36 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Caregivers go through grief similar to that of the patient and the family Caregivers may feel inadequate when there is little they can do to relieve a person’s suffering Caregivers may even question their professional calling Effects on the Nursing Assistant

37. Slide 37 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Take time for yourself Talk to your supervisor, a clergy member, or another person you trust about your feelings Effects on the Nursing Assistant

38. Slide 38 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation