end of life care let’s talk about it! death and dying in america what has changed over the past...

End of Life Care

Let’s talk about it!

•Death and Dying in America

•What has changed over the past century?

End of Life Decisions

•What would you do?•What have you done?•What should you do?•Healthcare Surrogate decisions?

Advanced Directives•Written instructions that guide health care decision making in accordance with a patient’s wishes, should they lose the ability to speak for self.

Advance Directives•Common Forms

–Living Will–Health Care Surrogate Designation

–Do-Not-Resuscitate Order

Advance Directives•Do not need lawyer to prepare

•Forms available–Health care facility–Physicians–Internet–Hospice

Advance Directives

•WHY?•What if you don’t have Advance Directives?–Role of the nurse

•What care is covered?

Death and Dying•Caring for a dying pt is: Opportunity Privilege•Natural part of life

End of Life Care

Therapeutic PresenceCheerful - don’t overdoGentle and kindPromote comfortPt is team leader

End of Life CareSupportiveEmpatheticAllow maintenance of self-esteem, dignity

EOL: Symptom Management

Pain–WHO Analgesic Ladder

Resp. Sx.–Dyspnea, Cough

EOL: Symptom Management

G.I. Sx.–Anorexia, Cachexia–Constipation–Diarrhea–Nausea / Vomiting

EOL: Symptom Management

General Sx.–Fatigue / Weakness

Psych. Sx.–Depression–Anxiety–Delerium / Agitation / Confusion

Care of the familyOK to cry in front ofAllow expressionAllow to stay and helpKeep on even keelOffer chaplain / clergy

Care of the familyInvolve social services if necessary

Is healthiest: - be honest - allow to know

Kubler-Ross Stages of Dying

1. Denial 2. Anger3. Bargaining4. Depression5. Acceptance6. Detachment

HospicePhilosophy of CarePhysical and Emotional comfort

Quality of lifeTerminally ill cared for with dignity

HospiceSymptom ControlPalliative CareNot curative measuresMost care given in home

Hospice characteristics

AutonomousGoal of care is symptom control

Pt / Family is primary unitInterdisciplinary

Hospice characteristics

Specially trainedOn-call servicesSupport for staffBereavement careBased on need, not $$

Goal of HospiceDeath with dignityRelief of pain and other distressing sx.

Hospice Admission Criteria

Confirmed, terminal dxAgree to goalLife expectancy < 6 mPrimary Caregiver - 24 hrs/day

Agree to DNR

Signs of Approaching Death

Failing Circulation–Cold and Mottled Extremities

Decreased U/OV/S Changes

Signs of Approaching Death

Resp. CongestionBreathing Pattern Changes

Failing Senses–Hearing last to go!

Clinical deathWhen resp and heart beat stop

Note time of cessation

Biologic DeathMaintain vital signs with mechanical means

Brain dead

Death PronouncementCheck policiesDocument

–Pt. name–Date and time of death–Details of physical exam–Others notified

Helping the Family

Prepare the bodyAllow to stay as long as needed

Asst. with phone callsOther notifications

Organ DonationFamily MUST be askedEven if have signed driver’s license request

Family has custody of body at death

DeathCan death be a good experience??

Fear of death shaped by culture and religion