End Of Life Care PDF

End of Life Care Abbey Ward, MSN, RN, CCRN October 2, 2024 1 TOPIC: END OF LIFE CARE CLASS OBJECTIVES: At the completion of class, the student is able to: 1. Adapt communication strategies to meet the end of life needs of clients with terminal illness and the...

End of Life Care Abbey Ward, MSN, RN, CCRN October 2, 2024 1 TOPIC: END OF LIFE CARE CLASS OBJECTIVES: At the completion of class, the student is able to: 1. Adapt communication strategies to meet the end of life needs of clients with terminal illness and their caregivers. (Communication) 2. Summarize the historical, legal, and sociocultural perspectives of palliative and end-of-life care in the United States (Patient-Centered Care) 3. Discriminate between palliative care and hospice care. (Patient-Centered Care) 4. Analyze the components of the grief and mourning process and plan care to support the terminally ill patient and caregivers (Patient-Centered Care) 5. Evaluate one’s own attitude and perception towards care of a terminally ill patient. (Professionalism) 6. Manage care using the principles of prioritization. (Nursing Judgment) 7. Manage care using appropriate delegation. (Teamwork and Collaboration) 2 REQUIRED READING ASSIGNMENTS: Hoffman, J. J., & Sullivan, N. J. (2024). Davis Advantage for Medical-Surgical Nursing (3rd ed.). F. A. Davis Company. Chapter 5 Morgan, K. I. (2022). Davis Advantage for Townsend's Essentials of Psychiatric Mental-Health Nursing (9th ed.). F. A. Davis Company pp 766- 769 End of Life Resources Additional Resources: https://youtu.be/TZCI25C8tEQ American Cancer Society www.cancer.org The National Hospice and Palliative Care Organization. www.nhpco.org 3 Background: Previous focus of healthcare was on comfort, especially at the time of death People usually died at home following sudden acute illness Advances in medicine, public health, and infectious disease prevention extended life expectancy Life expectancy increased from 47 years to 78 years 4 Background: Increased life expectancy=increased disability Management of chronic illnesses Poor understanding of exacerbation cycle Many treatment efforts have marginal benefits, do not improve function, & increase suffering 70% of deaths now occur in hospitals and institutional settings What is quality of life? What is a “good” death? 5 Palliative Care PC focuses on relief of pain, symptoms, and stress Maximizes quality of life For patients with serious, life-limiting illness AND their families Interdisciplinary No time limit 6 Palliative Care Anyone with a serious, life-threatening illness can be eligible Dialysis-dependent CKD Alzheimer’s Disease Cancer Curative treatments can still be given along with palliative care Chemotherapy/radiation Ventilator 7 Palliative Care vs. Hospice Palliative Care Hospice Can begin at diagnosis Begins after completion of Can be ongoing while treatment receiving treatment No heroic measures Goal: improve quality of Prognosis is less than six life months 24-hour on-call 8 9 10 Palliative/Hospice Care Domain 1: Structure and Process Incorporates patient’s goals, preferences, and values Travel across healthcare settings Hospice/goals of care reintroduced as patient declines Domain 2: Physical Aspects of Care Assess, treat and document symptoms using standardized scale Evaluate outcomes and effectively treat symptoms 11 Palliative/Hospice Care Domain 3: Psychological and Psychiatric Aspects Anxiety, depression, and delirium Standard Scale Memorial Symptom Assessment Scale Edmonton Symptom Assessment Scale 12 Palliative/Hospice Care Domain 4: Social Aspects of Care, Including Advanced Care Planning Regularly scheduled meetings Goals of care, prognosis, and advanced care planning Assess patient and family social networks, concerns, coping skills, and access to care 13 Palliative/Hospice Care Domain 4: Social Aspects of Care, Including Advanced Care Planning, ctd. Advanced Care Planning: Three main aspects: Full comprehension of disease Expectations about treatment Therapeutic goals, preferences, and wishes Advanced Directives Living will, power of attorney, health-care proxy (p. 769) 14 Palliative/Hospice Care Domain 5: Spiritual, Religious, and Existential Aspects of Care Domain 6: Cultural Aspects of Care Cultural humility Sensitive and emotional 15 Palliative/Hospice Care Domain 7: Care of the Imminently Dying Recognize, document, and inform Signs and symptoms of dying Early, middle, and late stage (p. 55) Honest communication and education 16 Palliative/Hospice Care Domain 8: Ethical and Legal Aspects of Care Decisional capacity and surrogate decision maker Ability to understand nature and consequences of treatment Ability to evaluate burdens, benefits, and risks of treatment Ability to communicate a decision Nurse as Patient Advocate Interventions that are appropriate and provide comfort 17 Ethical Considerations Medications given for symptom management Opioids Benzodiazepines Anticholinergics Principle of Double Effect Intended good effect is ethically permissible even if it produces an unintended secondary effect of hastening death Remember: Symptom management is not causing death. The chronic, uncurable disease process is causing death. 18 Bad Death VS. Good Death Bad Death Good Death Death without dignity Death with dignity Painful Free from avoidable Wishes are not followed stress, suffering, and prolongation May feel isolation, Clear communication abandonment, and agonizing about losses Patient, family, and associated with death caregivers are consistent Box 5.6, p. 64 19 Communication Family (Boxes 5.2 & 5.3, p. 63) Recruit the family’s help Sense of purpose in participation Communicate Educate on signs of pain or distress and the pathophysiology of the dying process Honesty is key Reflective Listening to help the family process the dying experience Encourage sharing and talking to the client 20 Communication Client (Box 5.4, p. 63) Goal: Express thoughts and feelings before dying Client should be centered in goals and discussions until not capable 21 The Grieving Process 22 The Grieving Process Anticipatory Grief Experiencing grief before loss actually occurs Intensifies as expected loss becomes imminent Grief doesn’t shrink-we grow around it. Coping depends on the ability to see purpose in living without the lost loved one. Length of grieving is individual Acute phase: 6-8 weeks (longer in older adults) Resolution may take much longer 23 Maladaptive Responses to Loss Delayed/Inhibited Grief May be cultural or denial Grief response may be triggered many years later Distorted (Exaggerated) Grief Response Fixed in anger stage Anger may turn internal Chronic or Prolonged Grieving Enduring thoughts, emotions, and behaviors prevent performance of ADLs Loss of self-esteem 24 Maladaptive Responses to Loss, Ctd. 25 Nursing Considerations Management of Symptoms Communication Care of Patient and Family Postmortem Care Self Care Professionalism 26 Nursing Considerations-Moral Distress Causes: The inability to do the morally correct thing because of situational factors Differences in values, attitudes, culture, or religion High-technology care situations How to cope: Shared decision making Talking with other nurses and members of the care team Ethics rounds Self Care 27  Signs of approaching death https://www.youtube.com/watch?v=D4SyDCJCNwE How to recognize a dying patient https://www.youtube.com/watch?v=vgQ_VOeQa-I Cheyne stokes breathing https://www.youtube.com/watch?v=Ymkqd4MiR0k Death Stare and Reach https://www.youtube.com/watch?v=5G158-a_0Yg A Beautiful Death https://www.youtube.com/watch?v=HT60zruKYIM Actively Dying https://www.youtube.com/watch?v=NgqQCAJPk_s What do we say to someone who's dying? https://www.youtube.com/watch?v=2_5nCWiAz1s The Messy Part of Dying https://www.youtube.com/watch?v=qcyPgikzXpw 28