Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition PDF

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett  Chapter 27 Comfort, Palliative Care, Death, and Loss  Learning Objectives (1 of 2) Up...

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, Kathleen Jett  Chapter 27 Comfort, Palliative Care, Death, and Loss  Learning Objectives (1 of 2) Upon completion of this chapter, the reader will be able to: Differentiate between loss and grief. Explain the different types of grief and the dynamics of the grieving process. Explain the nursing competencies required to effectively intervene in the older adult’s grief and bereavement. Describe the principles of hospice palliative care. 1-3  Learning Objectives (2 of 2) Upon completion of this chapter, the reader will be able to: Identify and discuss the needs of people who are in the process of dying, as well as appropriate interventions. Explain the role and responsibility of the nurse in advance directives. Explain the role of the nurse in medical assistance in dying (MAID). 1-4  The Grieving Process (1 of 2) Physical and psychological manifestations of acute grief (when it is first felt) Middle period in which the manifestations of grief (e.g., despair, depression) affect the person’s day-to-day functioning Ending phase where the person learns to adjust to life in a new way without that which has been lost 27-5  The Grieving Process (2 of 2) Worden’s Model of Bereavement Four tasks 1. Accept reality of the loss. 2. Work through the physical and emotional pain. 3. Adjust to life without the lost person. 4. Find an enduring connection with the deceased and move on with life. Loss Response Model Incorporates a systems approach that provides a framework for the design of nursing interventions Refer to Fig. 27.1 27-6  Types of Grief Anticipatory Acute Persistent or Complicated Disenfranchised 27-7  Stages of Grief The Seven Stages of Grief: 1. Shock 2. Denial 3. Anger 4. Bargaining 5. Depression 6. Testing 7. Acceptance 27-8  Death of a Child or Grandchild Loss of children later in life can result in a conflicting state of emotions: trying to remain strong for the family members who have lost a child, parent, or a sibling mourning the loss of one’s own child or grandchild Older adults may not be ready to endure the grief that comes with losing a younger family member. 27-9  Implications for Gerontological Nursing and Healthy Aging Assessment Goal is to differentiate those likely to cope effectively from those at risk for ineffective coping so that appropriate interventions can be planned Includes questions about recent significant life events, life or religious values, and relationship to that which has been lost and that which has been gained Interventions Gently establish rapport. Be ready to listen. Offer support and direction. Encourage griever to talk and tell story of relationship as it had been. 27-10  Countercoping Clarification and control Collaboration Directed relief Cooling off 27-11 Dying, Death, and Palliative Care Conceptual Models Living-Dying Interval Dying begins at a moment called the “crisis knowledge of death” (when someone receives information that they will not live as long as anticipated) and ends at the moment of physiological death. Most of the dying time is spent in the chronic phase. Refer to Fig. 27.2 27-12  Implications for Gerontological Nursing Nurses who are aware of these trajectories can anticipate the needs of those who are dying and help them and their families to cope and plan. Three distinct illness trajectories: 1. Short period of decline over weeks, months, and occasionally years 2. Long-term functional limitations and gradual deterioration in health and functioning, with intermittent exacerbations 3. Prolonged dwindling over years 27-13  The Six Cs Approach Care Control Composure Communication Continuity Closure 27-14  Care and Life Partners, Family, and Loved Ones Nursing actions that newly bereaved people have found helpful: Kept them informed Asked how they were doing and offered support Put an arm around them when they cried Brought them food Knew their name Cried with them Brought a bed and encouraged them to stay in the room with the dying person Told them to hold their dying loved one’s hands Held their hands Got the spiritual or religious leader for them Let them take care of their loved one Stayed with them after the nurse’s shift was over 27-15  Hospice Palliative Care Palliative care is “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” Whole-person health care that aims to relieve suffering and improve the quality of living and dying. Hospice palliative care depends on interprofessional care teams made up of both formal and informal caregivers, the dying person, the family, and the loved ones. The Framework on Palliative Care in Canada Act was passed by Parliament in late 2017 ; see Box 27-3 27-16  Dying and the Nurse Caring for older adults requires knowledge of the grieving and dying processes as well as skills in providing relief of symptoms or palliative care. Working with the grieving or dying, day in and day out, is an art. Calls for inner strength and coping skills As grieving people themselves, nurses may need to tell the story of the dying or of the person’s story to the health care providers around them, either in formal or in informal support groups. The most important coping skills for nurses may be the ability to find meaning and being able to balance seeing the person who is dying as a human being and staying professional throughout the care trajectory. 27-17 Decision Making at the End of Life (1 of 2) A legal, ethical, medical, and personal concern Nurses have an obligation to know legal requirements in their jurisdictions and then to work with the older adult and family in determining how these will fit with their cultural patterns and needs related to end-of-life decisions. In June 2016, the Government of Canada passed Bill C-14, legalizing medically assisted dying. The nurse’s role in medical assistance in dying is to provide nursing care. Nurses are not legally permitted to administer medication in medical assistance in dying; only the patient, and NP, or a physician may do this. 27-18 Decision Making at the End of Life (2 of 2) Advance Care Planning The process of planning for a time when a person may not have the mental capacity to make decisions about his or her health care It involves the person: 1. Choosing a substitute decision maker, and 2. Communicating their wishes about future health care, personal care, and living arrangements to the substitute decision maker 27-19