Core Curriculum Module 8 Final Hours

Section I: Preparing for a Good Death The important role of the nurse Hydration? Resuscitation? Hasten death request?

Preparing for Death Everyone dies Advance care planning Recognizing the transition to active dying Care for the dying Post death care

The Nurse, Dying and Death Nurses provide support to staff, patients/families Interpersonal competence Being present “Bearing witness” Interdisciplinary care

Describe a Recent Death You Have Observed What went well? Were the patient and family’s wishes honored? Describe any cultural traditions that were honored. Was pain controlled, as well as other symptoms? Was interdisciplinary care evident? What could have been improved? What issue(s) could have been prevented? Are there policies/procedures that need to be developed to provide better direction?

Open, Honest Communication Convey caring, sensitivity, compassion Provide information in simple terms Patient awareness of dying Maintain presence

Dying is an Individualized, Personal Experience There is no typical death Patient preferences Nurses advocate for choices Setting of death Support Psychological and emotional considerations

What About Artificial Nutrition & Hydration at End of Life? Perceptions of “starving to death” Hydration does not decrease “dry mouth” Patients who fasted to end their lives experienced peaceful death Gabriel & Tschanz, 2015; HPNA, 2011a; Prince-Paul & Daly, 2010

Resuscitation No advance planning Unrealistic beliefs regarding survival Family presence during resuscitation Outcomes are usually poor

Discontinuation of Dialysis When should dialysis be discontinued? When burdens outweigh benefits and/or, When dialysis is no longer prolonging life or only prolonging death

Organ/Tissue Donation Regulations Talking to the family about organ/tissue transplantation What can be donated?

Organ/Tissue Donation (cont.) Death declared on the basis of cardio-pulmonary criteria versus neurological criteria in “brain death” Can cause ethical and moral angst for healthcare providers witnessing this

Hastened Death Request Statement made by patient Progressive incurable illness Judgment not impaired Intervention to cause death more immediately than if illness took its natural course Assisted suicide/dying Clinician-assisted Stopping eating and drinking Other means

Psychosocial Changes We only die once Fear of dying Feelings of loss At end of life, patient may be more introspective

Spiritual Considerations When Death is Imminent

Cultural Considerations When Death is Imminent Death rites Rituals Mazanec & Panke, 2015

The Dying Older Adult

Case Study: Gail 62-year-old woman diagnosed with stage IV ovarian cancer 16 months ago Admitted to the hospital with a bowel obstruction, cachexia, and dehydration 1 week ago 3 adult sons Divorced “Spiritual,” but not affiliated with any religion Served in the Army for 20 years Home hospice