End of Life Care Notes - HCAP 1210 PDF

HCAP 1210 Counselling Services https://www.kpu.ca/counselling Call KPU at 604-599-2828 and speak with one of the counselling assistants – they will provide you with information about the drop-in and where you can attend. Room 1075: The office is open from 8:00 AM to 4:00 PM, Monday t...

HCAP 1210 Counselling Services https://www.kpu.ca/counselling Call KPU at 604-599-2828 and speak with one of the counselling assistants – they will provide you with information about the drop-in and where you can attend. Room 1075: The office is open from 8:00 AM to 4:00 PM, Monday to Friday (the office is closed from 12:00 PM to 1:00 PM daily). Fill out an intake form while you are waiting to see the Intake Counsellor Crisis Centre of BC (24/7) Phone: 604-872-3311 or 1-800-784-2433 Online Chat: crisiscentrechat.ca  Explain Explain how culture, religion, and age influence attitudes toward death. Describe Describe the impact that grief can have on people. Describe the stages, phases, or tasks clients, families, and caregivers may Describe encounter when dealing with grief. Learning Explain Explain how to help meet a dying client’s needs. Objectives Describe Describe the needs of the family of a dying client. Describe Describe palliative care. Identify Identify the signs of approaching death and the signs of death. Describe Describe how to assist in giving postmortem care. Questions to Ponder… 2. What are your 3. How have your 1. What has been feelings and experiences and your experience beliefs about culture shaped with death? death and dying? your beliefs? Death & Dying  Death may be sudden or expected.  Your feelings about death affect the care you give.  You must understand the dying process.  Then you can care for the dying client with compassionate care—DIPPS.  An illness or injury for which there is no reasonable expectation of recovery Life-  Health care providers cannot predict the exact time of death. Threatening  Hope and the will to live strongly influence living and dying. Illnesses Attitudes About Death  Experiences, culture, religion, personal beliefs, and age influence attitudes about death.  Attitudes about death often change as a person grows older and with changing circumstances. Attitudes About Death Cont.  Attitudes about death are closely related to culture and religion.  Some believe in an afterlife; others do not.  Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life.  Many people strengthen their religious beliefs when dying.  Religion provides comfort for the dying person and the family.  Practices and attitudes about death differ among cultures and religions. Age & Experience Pain and suffering Dying alone Adults fear: Loss of dignity Loneliness and separation from loved ones Adults worry about the care and support of those left behind. Adults often resent death because it affects plans, hopes, dreams, and ambitions. Grief Grief is the emotional response to a loss or a death. Grief is the process of moving from deep sorrow caused by loss toward healing and recovery. Both the client who is dying and his or her loved ones experience a range of emotions when faced with loss. Critical Thinking!  What physical symptoms are associated with grief?  What emotional symptoms are associated with grief?  What is different about older adults who are grieving?  Why does an older adult who is grieving need help?  What can be done to help an older person who is grieving?  Review the follow statements and determine whether each represents a fact or myth with regard to grief. State your rationale.  The pain will go away faster if you ignore it.  It’s important to “be strong” in the face of loss  If you don’t cry, it means you aren’t sorry about the loss  Grief should last about a year  Moving on with your life means forgetting about your loss  Compare and contrast the following terms: Grief, mourning and bereavement.  List 5 ways to advise loved ones to care for themselves (physical and emotional needs) as they grieve.   Dr. Elisabeth Kübler-Ross described five stages of grieving.  Stage 1: Denial  “No, not me” is a common response.  Stage 2: Anger  The person thinks, “Why me?”  Stage 3: Bargaining Stages of  The person now says, “Yes, me, but...” Stage 4: Depression Grieving:   The person thinks, “Yes, me” and is very sad. Kübler-Ross  Stage 5: Acceptance  The person is calm and at peace.  Dying persons do not always pass through all five stages. Some move back and forth between stages.   The WHO defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through Palliative Care 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”.  Palliative care and Palliative refers to the hospice care are terms care given and hospice often used refers to the place the interchangeably care is given Palliative Care Cont. Focuses on providing Three main goals of hospice or palliative care: compassionate care to Assist in controlling the pain and symptoms of illness dying persons and their Ensure that death is a natural families process Provide compassionate care Characteristics of Palliative Care 1. Provides relief from pain and other distressing symptoms 2. Affirms life and regards dying as a normal process 3. Intends neither to hasten nor postpone death 4. Brings together the psychological, spiritual aspects of patient care with the physical aspects 5. Offers a support system to help patients live as actively as possible until death 6. Offers a support system to help the family cope during the patient’s illness and on into their own bereavement 7. Use a team approach to address the needs of patients and their families, including bereavement counseling 8. Will enhance quality of life, and may also positively influence the course of illness.  Palliative Care Core Values Hospice palliative care is entirely focused Appropriate for this person, at this time, on facilitating an “appropriate death” under these circumstances and can include: Making sure the person is a comfortable as he/she wants to be Taking the time to get to know the person and what dying means to them Giving accurate information with compassion Supporting families and patients to make decisions without judgment  Dignity Independence How to Provide Preferences Compassionate Care for the Privacy Dying Client Safety ….What's that spell… DIPPS Bill of Rights of the Dying Person BE TREATED AS A BE CARED FOR PEOPLE PARTICIPATE TO THE EXPRESS MY FEELINGS BE FREE OF PAIN LIVING BEING UNTIL I WHO MAINTAIN A BEST OF MY ABILITIES ABOUT MY DIE SENSE OF HOPE; WHO IN DECISIONS APPROACHING DEATH ARE BOTH CONCERNING MY CARE IN MY OWN UNIQUE COMPASSIONATE AND WAY COMPETENT HAVE MY QUESTIONS DIE IN PEACE AND EXPECT THAT THE ANSWERED HONESTLY DIGNITY SANCTITY OF THE HUMAN BODY WILL BE RESPECTED AFTER DEAT  People who are dying have emotional, intellectual, social, and spiritual needs.  You need to listen, use touch, and be respectful. Dying Client   Touch shows caring and concern when words cannot. Some people may want to see a spiritual leader. Emotional,  Some want to take part in religious practices. Social &   Provide privacy during prayer and spiritual moments. Be courteous to the spiritual leader. Spiritual Needs  Handle religious objects with care and respect  Dying may take a few minutes, hours, days, or weeks. Dying To the extent possible, As the client weakens, Client’s independence is allowed. basic needs are met. Physical Every effort is made to promote physical and psychological comfort. Needs The client is allowed to die in peace and with dignity.  Vision blurs and gradually fails. Always assume that the client can hear. Hearing is the last function to go. Dying Speech becomes harder. Client’s Mouth and nostril care is important. Physical Circulation fails and body temperature rises as death nears. Needs The skin feels cool, pale, and mottled (blotchy) — provide good skin care. Urinary and fecal incontinence may occur. Constipation and urinary retention are common.  The following may be areas to aid with: Comfort and positioning Dying Pain relief drugs Vision and eye care Client’s Hearing, speech Mouth, nostril, and skin care Physical Elimination and nutrition Provide a comfortable and pleasant Needs room. Remove unnecessary equipment. The client and family arrange the room as they wish. Advance Directive or Living Will  A living will is a document about measures that support or maintain life when death is likely.  A living will may instruct doctors:  Not to start measures that prolong dying  To remove measures that prolong dying  Power of attorney for personal care gives the power to make health care decisions to another person.  In most provinces and territories, residents name a proxy to make decisions about personal care as well as medical care and treatment. “Do Not Resuscitate” Orders  After consulting with the person and family, doctors often write “Do Not Resuscitate” (DNR) or “No Code” orders for people who are terminally ill.  This means that the person will not be resuscitated. What is Medical Assistance in Dying? MAiD  Medical Assistance in Dying (MAiD) is the process whereby a doctor or nurse practitioner helps and supports a patient who wants to voluntarily and intentionally end their life.  Medical Assistance in Dying is administered with drugs that can be taken by mouth or given intravenously.  Medical Assistance in Dying has been legal in Canada since June 2016 and is governed under federal law. This law sets out the eligibility requirements and processes under which Medical Assistance in Dying can be delivered to a patient. Eligibility for MAiD  To receive Medical Assistance in Dying, you must meet all of the following criteria:  Be at least 18 years old  Be eligible for publicly-funded health services in Canada  Be able to give informed consent throughout the process, including at the final moment when Medical Assistance in Dying is to be provided  Have a grievous and irremediable medical condition (illness, disease or disability), and:  be suffering intolerably from this condition  be in an advanced state of decline that cannot be reversed  be at the point with your condition where natural death is reasonably foreseeable  Make a request for MAiD of your own free will, without pressure or influence from anyone else The Medical Assistance in Dying Process in BC  Talk to your doctor or nurse practitioner about the end-of-life care options available to you. If you are considering MAiD, they can help you navigate the process or refer you to someone who can help. This process also ensures you are aware of all the care options available to you and that you have the information required to make an informed decision. These care options may include comfort care, pain control, hospice care, palliative care, or other options. You do not have to accept any of these services, but it is important you know about them before you pursue Medical Assistance in Dying.  Should you choose to go ahead with Medical Assistance in Dying, you can always change your mind and stop the process any time. If you pursue MAiD, palliative care support is still available to you.  Supports for Patients & Families  https://www.islandhealth.ca/sites/default/files/2019-05/maid-bereavement- guide-patients-families.pdf The Process Step by Step 1. Complete the Patient 2. Undergo assessments Request Record form By signing this form, you are formally asking Two assessments are required. These for Medical Assistance in Dying and stating assessments ensure that you are aware of that you believe you meet all the eligibility other options, that you meet the criteria criteria. for Medical Assistance in Dying and that you have the mental capacity to make this important decision. Two different doctors or nurse practitioners each do a separate assessment. The Process Step by Step Cont. 3. Complete a 10-day ‘period of 4. Decide where you want Medical reflection’ Assistance in Dying to take place If the assessment shows you are eligible for During the period of reflection, you can decide Medical Assistance in Dying, federal law where you want Medical Assistance in Dying to requires a 10-day ‘period of reflection’ before take place. This can be in your own home, in Medical Assistance in Dying can take place. a long term care setting, in hospital or another The waiting period can be shortened in certain location. You can also decide if you’d like circumstances. anyone with you when Medical Assistance in Dying is administered.  Signs that death is near may occur rapidly or slowly:  Movement, muscle tone, and sensation are lost  Peristalsis and other digestive functions slow down  Circulation fails  The respiratory system fails  Increased sleep and extreme fatigue Changes in eating Signs of Death   Social withdrawal  Coolness in the tips of the fingers and toes; bluish tint to client’s skin, and cyanosis of the nail beds  The signs of death include no pulse, no respirations, and no blood pressure  The pupils are fixed and dilated  A doctor determines that death has occurred  In some provinces, nurses are allowed to pronounce death when death is expected   Care of the body after death is called postmortem care.  A nurse gives postmortem care. Care of the  You may be asked to assist. Body After  Postmortem care begins when the client is pronounced dead. Death  Postmortem care is done to maintain a good appearance of the body.  Always follow Standard Practices.   The right to privacy and the right to be treated with dignity and respect apply after death.  Within 2 to 3 hours after death, rigor mortis (the stiffness or rigidity of skeletal muscles that occurs after Postmortem death) develops. Care  The body is positioned in normal alignment before rigor mortis sets in.  Movement of the body can cause sounds to come from the body as air is expelled—do not be frightened by these sounds as they are normal and expected.