Nursing Care of Older Adults: End-of-Life Care

End-of-Life Care for Older Adults

• Faye Chan, Fellow in Thanatology: Death, Dying & Bereavement, highlights the importance of spiritual self-awareness for nurses caring for older adults at the end of life.

Spiritual Self-Awareness for Nurses

• Recognizing and addressing personal fears and responses to caring for clients is essential for spiritual care.
• Strategies to increase spiritual awareness include: • Writing a self-epitaph • Exploring personal end-of-life issues • Creating a personal loss history • Listing significant values • Conducting a spiritual self-assessment

Manifestations of Grief

• Normal manifestations of grief include: • Verbalization of the loss • Crying • Sleep disturbance • Loss of appetite • Difficulty concentrating
• Complicated grieving may involve: • Extended time of denial • Depression • Severe physiologic symptoms • Suicidal thoughts

Factors Influencing the Loss and Grief Response

• Age
• Significance of the loss
• Culture
• Spiritual beliefs
• Gender
• Socioeconomic status
• Support systems
• Cause of loss or death

Facilitating Grief Work

• Explore and respect ethnic, cultural, religious, and personal values
• Teach what to expect in the grief process
• Encourage clients to express and share grief with support people
• Teach family members to encourage the client's expression of grief
• Encourage clients to resume activities on a schedule that promotes physical and psychological health

Impending Clinical Death

• Signs of impending clinical death include: • Loss of muscle tone • Slowing of the circulation • Changes in respirations • Sensory impairment

Assisting Families or Caregivers of Dying Clients

• Use therapeutic communication
• Provide an empathetic and caring presence
• Explain what is happening and what to expect
• Have a calm and patient demeanor
• Encourage participation in the physical care of the client as they are able
• Support those who feel unable to care for or be with the dying

Care of the Body After Death

• Follow policy of the hospital or agency
• Check the client's religion and rituals and make every attempt to comply
• If family or friends wish to view the body: • Make the environment as clean and as pleasant as possible • Make the body appear natural and comfortable • Remove all equipment, soiled linen, and supplies from the bedside • Follow agency policy when caring for tubes

Hospice/Palliative Care

• Principles of hospice/palliative care include: • Affirming life, regarding death as a normal process • Not intentionally hastening or postponing death • Providing relief from pain and other distressing symptoms • Integrating psychological, social, and spiritual aspects of care • Offering a support system to help patients live actively and constructively until death • Helping families cope during the patient's illness and in bereavement

Advance Care Planning

• Concerned with how a mentally competent adult can make an advance decision about life-sustaining treatment when they become mentally incapacitated in the future.
• The SPIKES protocol for breaking bad news has four objectives: • Gathering information from the patient • Transmitting the medical information • Providing support to the patient • Eliciting patient collaboration in developing a strategy or treatment for the future.