CHANGES IN HEALTH CARE RELATED TO DYING AND DEATH:

A shift in where and how people die, from home-based care to institutional settings, influenced by health care system changes from the 1950s onward including advances in technology, DRGs & home healthcare.

Dying generally occurred at home with family support, not in hospitals.

Dying increasingly happened in hospitals with high tech equipment focused on prolonging life.

Medical payment system from the early 1980s that influenced the type of patients admitted and discharged from hospitals.

Terminally ill patients frequently are discharged to home, convalescent centers, or nursing homes, in contrast to being routinely hospitalized.

Terminally ill patients are increasingly cared for at home with various support systems by nurses; receiving technical/mechanical assistances such as intravenous infusions.

Four tasks that facilitate the transition from grief to closure: accepting the loss, experiencing the pain, adjusting to the loss, and reinvesting energy.

Studies such as Kübler-Ross' work have advanced understanding of the dynamics of loss. Grief therapy and hospice care became more developed.

Involuntary return of emotions and behaviors associated with grief, triggered by various stimuli.

Nurses' heightened empathy for patients, potentially complicated by their own grief, especially when caring for dying patients.

A health care delivery system focused on providing palliative care, support, and end-of-life patient care, recognized in the 1970s.

When a nurse experiences multiple losses at work without adequate processing of prior losses, adding to the workload and stress.

Programs assisting people in coping with the pain of loss, often including mental health treatments that develop over time.

Stages or phases individuals may experience when facing a life-threatening situation or loss. (Note: These may not apply to everyone.)

Delayed or exaggerated response to loss; characterized by difficulty moving past grief and related issues.

Evaluation of a patient's physical health, including sleep, body image, daily activities, mobility, and pain.

Evaluation of a patient's and their family's emotional state, including anxiety, guilt, anger, and acceptance; considering their fears of the dying process.

Oregon law allowing terminally ill patients to end their lives with physician-assisted suicide.

A medical practice where a physician provides a terminally ill patient with medication to end their life.

A clearly identifiable loss, like the death of a loved one or a physical injury.

A loss that's not easily seen, like loss of confidence or a disappointment.

Loss resulting from normal life transitions, like growing up and leaving home.

Sudden loss due to external events, like a car accident or job loss.

Subjective reaction to loss, involving thoughts, feelings, and behaviors.

A process, not an episode, of dealing with loss that can continue for a long time and have many ups and downs.

A project establishing domains for quality palliative care.

Any major loss requiring adaptation through the grieving process.

A state law allowing terminally ill patients to obtain medication to end their lives.

Care focusing on relieving suffering and improving quality of life for those with serious illnesses.

Evaluation of patient and family's educational level, knowledge, abilities, and expectations regarding death.

Alterations in cognitive abilities during the dying process due to physiology, medication, emotions, and the disease itself.

Evaluation of patient and family's support systems, including family's desire to assist with care.

Family members need support during the dying process, both individually and as a unit.

Ensuring families taking patients home are prepared for caregiving responsibilities before discharge, including access to hospice or ongoing support.

Identifying and supporting the major social support figure in the patient's life, e.g., friend, religious figure.

Incorporating the patient's philosophy, spirituality, and religion into the care plan, while acknowledging one's own feelings.

Supporting patient and family beliefs and values through clergy, family, friends, healthcare providers, emphasizing hope and meaning.

Shock and denial are frequent responses to loss.

Grief expression varies greatly due to cultural and ethnic background, which impacts decisions about life-sustaining measures.

Nurses provide support and guidance to grieving patients and families. They assist with managing feelings of shock and denial and answer questions.

Licensed Practical/Vocational Nurses (LPN/LVN) participate in planning care, reviewing plans, following priorities, and using care paths.

Identify patient problems through careful data collection and analysis of behaviors to formulate individual care plans.

A single or few characteristics aren't enough to accurately identify a patient's problem. Multiple symptoms and related factors are needed.

To select the correct interventions, the why behind the patient's problem must be understood.

Terminally ill patients may have multiple problems. Nurses must prioritize and re-evaluate priorities constantly based on changing needs.

When a patient is grieving, address the grief first, then tackle other health problems related to loss (like reduced appetite from anxiety).

Patients should actively participate in addressing their grief.

Help patients find purpose and future goals during loss or grief.

Nurses should include outside resources like legal aid or therapists to support patients experiencing complex problems.

Recognize that every patient and family experiences loss and grief differently; their needs, fears, and expectations change over time.

Family members can be invaluable resources in caring for a dying patient.

Focus on helping terminally ill patients achieve the best possible physical, emotional functioning, rather than expecting a return to their previous state.

Use established goals and outcomes to measure patient progress related to their grief.

Provide personalized care that prioritizes comfort, dignity, and cooperation with the patient to maintain the best quality of life possible.

Important questions to ascertain patient satisfaction and areas of concern.