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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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
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9. 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.

10. 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.

11. 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.

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

13. 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.

14. Critical Thinking Question 2
Why is it often more difficult to respect the dying person’s bill of rights in an acute care setting?
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15. 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
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16. Ethical And Legal Issues
Ethical issues concerning death are influenced by values, culture, and religion
Legal issues are rooted in the law
Informed consent
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17. 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
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18. Critical Thinking Question 3
What options are available to families and health care workers if the patient cannot execute an advance directive?
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19. 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.

20. 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.

21. 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.

22. 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?
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23. 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.

24. 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.

25. Developmental Concepts of Death and Dying
Toddler
Preschooler
School-Age Child
Adolescent
See Table 15-4.
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26. 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?
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27. 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.