End of Life Care
Let’s talk about it! Death and Dying in America What has changed over the past century?
End of Life Decisions What would you do? What have you done? What should you do? Healthcare Surrogate decisions?
Advanced Directives Written instructions that guide health care decision making in accordance with a patient’s wishes, should they lose the ability to speak for self.
Advance Directives Common Forms –L–Living Will –H–Health Care Surrogate Designation –D–Do-Not-Resuscitate Order
Do not need lawyer to prepare Forms available –H–Health care facility –P–Physicians –I–Internet –H–Hospice
WHY? What if you don’t have Advance Directives? –Role of the nurse What care is covered?
Death and Dying Caring for a dying pt is: Opportunity Privilege Natural part of life
End of Life Care Therapeutic Presence Cheerful - don’t overdo Gentle and kind Promote comfort Pt is team leader
End of Life Care Supportive Empathetic Allow maintenance of self-esteem, dignity
EOL: Symptom Management Pain –WHO Analgesic Ladder Resp. Sx. –Dyspnea, Cough
EOL: Symptom Management G.I. Sx. –Anorexia, Cachexia –Constipation –Diarrhea –Nausea / Vomiting
EOL: Symptom Management General Sx. –Fatigue / Weakness Psych. Sx. –Depression –Anxiety –Delerium / Agitation / Confusion
Care of the family OK to cry in front of Allow expression Allow to stay and help Keep on even keel Offer chaplain / clergy
Care of the family Involve social services if necessary Is healthiest: - be honest - allow to know
Kubler-Ross Stages of Dying 1.Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance 6. Detachment
Hospice Philosophy of Care Physical and Emotional comfort Quality of life Terminally ill cared for with dignity
Hospice Symptom Control Palliative Care Not curative measures Most care given in home
Hospice characteristics Autonomous Goal of care is symptom control Pt / Family is primary unit Interdisciplinary
Hospice characteristics Specially trained On-call services Support for staff Bereavement care Based on need, not $$
Goal of Hospice Death with dignity Relief of pain and other distressing sx.
Hospice Admission Criteria Confirmed, terminal dx Agree to goal Life expectancy < 6 m Primary Caregiver - 24 hrs/day Agree to DNR
Signs of Approaching Death Failing Circulation –Cold and Mottled Extremities Decreased U/O V/S Changes
Signs of Approaching Death Resp. Congestion Breathing Pattern Changes Failing Senses –Hearing last to go!
Clinical death When resp and heart beat stop Note time of cessation
Biologic Death Maintain vital signs with mechanical means Brain dead
Death Pronouncement Check policies Document –Pt. name –Date and time of death –Details of physical exam –Others notified
Helping the Family Prepare the body Allow to stay as long as needed Asst. with phone calls Other notifications
Organ Donation Family MUST be asked Even if have signed driver’s license request Family has custody of body at death
Death Can death be a good experience?? Fear of death shaped by culture and religion