1. Core Curriculum
Module 8 Final Hours

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

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

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

5. 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?

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

7. 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

8. 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

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

10. 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

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

12. 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

13. 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

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

15. Spiritual Considerations When Death is Imminent

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

17. The Dying Older Adult

18. 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