Planning for the End of Life Chapter 15 Planning for the End of Life Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Objectives Describe the grieving process for the patient who is facing death. List the stages of the dying process. Discuss behaviors related to the dying process. Describe the philosophy of hospice and palliative care. Define quality of life from a child's point of view. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Objectives (cont.) Summarize the statements in the Dying Person's Bill of Rights. Discuss the response and needs of the family of the dying patient. Review ethical and legal issues involved in end-of-life care. State the role of the nurse or healthcare worker in end-of-life care. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Objectives (cont.) State three cultural practices related to end-of-life care. Describe the development of the concept of death and dying in young children. Discuss similarities and differences in end-of-life care for adults and children. List signs of impending death. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Key Terms Advance Health Care Directives (AHCD) assisted suicide culturally competent durable power of attorney for health care euthanasia hospice care informed consent palliative care therapeutic communication therapeutic presence Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Death As Part Of The Life Cycle Normal part of the life cycle Not unique to the elderly Acute care hospital versus home or hospice environment Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Signs And Symptoms Of Death Prepare family for the symptoms that accompany death Finality of the actual death will come as a shock to most family members See Box 15-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. The Process Of Dying Psychological death begins when a person is told that he or she has a terminal illness Physiological death starts when the body processes decline in function Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Psychological Responses of the Dying Patient Death is accompanied by tasks and responses Grief process May loose self esteem with disability and increasing dependence on others Therapeutic communication See Table 15-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Family Behaviors Related to the Dying Process Preparation and education are key Helplessness and guilt should be quickly recognized Pain-relieving techniques Therapeutic communication See Table 15-2 and Table 15-3. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 1 Why is it important for nurses and other health care workers to be familiar with the various cultures in the community? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Options For End-Of-Life Care Options include Acute Care and Hospice Care. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Acute Care of the Dying Patient Continuation of full life support Full cardiopulmonary resuscitation Removing all life support or life-sustaining equipment Stopping all drugs except sedation and relief of pain See Box 15-2. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 2 Why is it often more difficult to respect the dying person’s bill of rights in an acute care setting? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Hospice Care Supports the patient and family through the dying process Helps the survivors through the period of bereavement Palliative care Settings include home, nursing facilities, or long-term care facilities Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Ethical And Legal Issues Ethical issues concerning death are influenced by values, culture, and religion Legal issues are rooted in the law Informed consent Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Advance Directives Durable Power of Attorney for Health Care Living Will Do Not Resuscitate Order Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 3 What options are available to families and health care workers if the patient cannot execute an advance directive? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 4 If the patient has no living will or durable power of attorney for health care, how is the decision made for a do not resuscitate order? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Assisted Suicide and Euthanasia The action of a person other than the patient to facilitate suicide An intentional act which causes death Involve legal, moral, and ethical issues that have been tested in the courts through the years and remain controversial Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Role Of The Health-Care Worker In End-Of-Life Care Ensure education of the patient and family concerning the diagnosis Ensure that informed consent is provided with a clear offer of all available options of care Ensure that the patient's and family's cultural and personal wishes are respected Communicate with the multidisciplinary health-care team when death is imminent or has occurred Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 5 What resources regarding end-of-life standards of care should be available to the general medical or surgical nurse who seldom cares for dying patients? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Death Of A Child Discussion of life and death should be a normal part of the growth and development Typically progress through specific stages as they prepare for death Truthfulness, explained in age-appropriate terms is the optimal approach Emotional impact on the family is often devastating Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 6 Support or refute the following statement: School nurses should provide age-appropriate classes on death and dying to students. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Developmental Concepts of Death and Dying Toddler Preschooler School-Age Child Adolescent See Table 15-4. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Critical Thinking Question 7 How could the nurse respond to parents who are asking if a 7-year-old should attend the funeral of her grandfather? Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Physical Care After Death Performed according to the culture of the patient and the protocols of the institution Communicate with the family concerning policies and routines related to care and transport of the body Family may want private time with the deceased Provide referrals for funeral home and support groups Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.