Care of Patient and Family Flashcards
1
Q
US Hospice founded?
A
Connecticut Hospice Florence Wald (former Dean of Yale Nursing School) early 1970s
2
Q
US Hospice modeled after?
A
work of Dame Cicely Saunders at the St. Christopher’s hospice in London, England
3
Q
Hospice developed to
A
address specific needs of the dying and their families
4
Q
Hospice: medicare/medicaid benefit began?
A
1980s
5
Q
Palliative care model branched off?
A
from traditional hospice programs in late 1980s in academic teaching hospitals such as Cleveland Clinic and Medical College of Wisconsin
6
Q
Palliative focus: goal
A
address problems facing hospice philosophy in addressing long-term, progressive disease paths as well as in allowing patients a choice of hterapies
7
Q
Palliative focus: effort
A
made to improve the quality-or-life concerns for those patients whose death was not near yet, a distinct and complicated set of care issues
8
Q
Palliative: medicare/medicaid
A
not regulated or funded by Medicare
9
Q
Common fears of dying patient
A
pain fear of being a burden fear of loss of control and independence death bodily changes
10
Q
Fears of dying patient:pain
A
lingering and uncontrolled suffering relieving discomfort provides improved quality of life
11
Q
Fears of dying patient: being a burden
A
family face tasks of dealing with own fears as well as increased responsibility for the patient that can be taxing and unwelcome by either party
12
Q
Fears of dying patient: loss of control and independence
A
patients need to maintain a sense of control in decision-making in all areas of their life and care sense of control helps alleviate feelings of guilt, frustration and helplessness
13
Q
Fears of dying patient: dying alone
A
ill persons often feel they will be abandoned
14
Q
Fears of dying patient: death
A
facing the unknown. leaving loved one or “unfinished business”
15
Q
Fears of dying patient: bodily changes
A
loss of body parts and changes to physique can be unnerving and shift the patient’s sense of self
16
Q
National Consensus Project: 5 goals
A
Identify definitions, philosophies and principles create clinical ractice guidelines enable clinical practices to grow and improve provide key elements of palliative care promote quality recognition, initiatives, and stability
17
Q
National Consensus Project: promote
A
quality recognition initiatives for growth and certification stability for reimbursement and practice measures
18
Q
National Consensus Project: key elements of palliative care
A
that may be used in practices where there is an absence of formal care programs
19
Q
National Consensus Project: enable clinical practices to
A
grow and improve their resources and performances through structural organization and defined requirements
20
Q
National Consensus Project: create clinical practice guidelines for
A
high quality care for both the patient and family
21
Q
National Consensus Project: identify
A
definitions philosophies principles concerning palliative care that will be nationally recognized
22
Q
Palliative care: recognizes and respects
A
each individual’s uniqueness across the lifespan and in diverse settings
23
Q
Palliative care:center
A
patient centered and guided in order to improve the patient’s quality of life through supportive care
24
Q
Palliative care: is both
A
scientific humanistic
25
Palliative care: doesn't limit
patient's treatment options and includes any therapy medically indicated and desired by patient includes life-prolonging care even when death is imminent
26
Palliative care: World Health definition
an approach that improves quality of life of patients and their families facing the problem 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, psycho-social and spiritual
27
Palliative care: effective care
includes: multiple dimensions of care: holistic approach to pain and symptom control nursing interventions psycho-social and spiritual resources
28
Palliative care: goal
to provide an active, caring presence for patients and families
29
Hospice: care designed
to fit needs of terminally ill in the last 6 months of life
30
Hospice: philosophy
of improved quality of life for the terminally ill
31
Hospice: offers
symptom management physical care emotional care psycho-social care spiritual care bereavement care
32
Hospice: settings
inpatient various residential
33
Hospice: focus
to provide comfort and support to patients and families experiencing a life-limiting illness when cure-oriented treatments are no longer feasible
34
Hospice: caregivers offer
specialized knowledge of medical care and symptom management, with emphasis on pain and discomfort management
35
Hospice: not designed
to either prolong life or hasten the death
36
Hospice: goal
improve quality of patient's last days through comfort and dignity
37
Maladaptive behaviors
denial guilt depression avoidance decathexis aggression
38
Maladaptive behaviors: denial
way for person to reject reality of the situation refusal of physical, psychological and emotional triggers of knowledge they do not want to believe of deal with
39
Maladaptive behaviors: guilt
unreasonable feeling of responsibility for negative influences of which the person may or may not have control
40
Maladaptive behaviors: depression
a mental state of hopelessness and despair severe loss of happiness and motivation
41
Maladaptive behaviors: avoidance
withdrawal; turning away from actions of consequences associated with negative stimulus
42
Maladaptive behaviors: decathexis
detachment from mood and feelings lack of variation in emotional responses despite changing circumstances
43
Maladaptive behaviors: aggression
hostile behavior, physical or verbal, meant to be demeaning, destructive, and increase negative emotions in those around them
44
Hospice inter-dimensional care process
assessment identified problems and needs set goals and interventions provide therapeutic care evaluate
45
Hospice inter-dimensional care process: assessment
in depth holistic assessment in order to collect both subjective and objective data from patient and family
46
Hospice inter-dimensional care process: identify
root cause for needs, problems and opportunities to improve patient's quality of life backbone for all care provided
47
Hospice inter-dimensional care process: goals and interventions
collaborate with team members to set patient- and family-directed goals establish appropriate interventions understood and accepted by all team members
48
Hospice inter-dimensional care process: care
palliative therapeutic care, education, collaboratoin, and ongoing assessments that empower the patient and family and focus on their needs
49
Hospice inter-dimensional care process evaluate
all care and interventions for future planning, identifying productive areas for continuation and areas needing revision
50
Life completion and closure: landmarks
sense of completion satisfaction in life and work feelings of love and acceptance identify understanding of meaning of life willingness to move forward into unknown
51
Life completion and closure: sense of completion
in all affairs, including worldly, community, and interpersonal relationships with family and friends feel they have taken care of all unfinished business
52
Life completion and closure: satisfaction in life and work
after reflecting on their lives, patients can accept themselves and their accomplishments as fulfilling and worthwhile
53
Life completion and closure: feelings of love and acceptance
for self and others: pursuing worthiness, forgiveness, gratitude, closure and resolution of past hurts and wrongs to bring about peace and satisfaction
54
Life completion and closure: identify understanding of meaning of life
identify a general understanding of the meaning and finality of life
55
Life completion and closure: willingness to move forward into unknown
by accepting death and saying good-bye
56
Hospice: eligibility related to
patient's prognosis
57
Hospice: prognosis
patient will reach end of life through course of natural disease process within 6 months of qualifying
58
Hospice: certification
from physician confirming this status is required and can limit access for some who may have benefited
59
Hospice: timely referral
education needed to reinforce to physicians timely referral of patients
60
Palliative care: eligibility
exceeds 6 months
61
Palliative care: designed to
meet needs of a variety of individuals with chronic illnesses such as Alzheimer's disease
62
Palliative care: limits
not limited to comfort care of a specific time frame
63
Palliative care: treatement
any treatment to improve quality of life is respected by palliative care team
64
Palliative care: costs
aspects must also be considered no Medicare and Medicaid funding
65
Hospice: costs
is available for those who qualify for Medicare and Medicaid
66
Hospice core services: designed to
maintain general health and quality of life for paitent
67
Hospice core services required by law
physician and nursing services social work dietary services spiritual bereavemnt
68
Hospice core services: further services based on
may be added based on patient need and availability
69
Hospice core services: added benefits
physical therapy occupational therapy speech therapy massage infusion therapy home health aides medical supplies and equipment daycare homemaking services funeral services
70
Domains of Consensus Project
Structure and Practice of Care Physical Psychological and Psychiatric Social Spiritual, Religious and Existential Cultural Imminently Dying Patient Ethics and Law
71
Domains of Consensus Project: Structure and Practice of Care
Care is based on the interdisciplinary team's commitment to comprehensive assessment and care of the patient and family, education and quality improvement, and support of each other as a team
72
Domains of Consensus Project: Physical
Best practices are employed to address the patient's pain and other symptoms, and educate the patient and family and include them in the plan of care
73
Domains of Consensus Project: Psychological and Psychiatric
Psychological, psychiatric, grief, and bereavement issues are addressed and managed with high standards using pharmacological, nonpharmacological, support, and counseling treatments as needed
74
Domains of Consensus Project: Social
Comprehensive care plans will take into account family and social dynamics, interpersonal needs, finances, caregiver availability, and access to health care to promote well-being and ease patient and caregiver burdens
75
Domains of Consensus Project: Spiritual, Religious, and Existential
Assessing, recognizing, respecting, and supporting spiritual concerns and religious beliefs
76
Domains of Consensus Project: Cultural
Careful consideration is given to assessing, respecting, and accommodating for culture-specific needs Resources available reflect cultural diversity and the needs of community
77
Domains of Consensus Project: Imminently Dying Patient
Recognition of imminent death, making appropriate referrals, and educating the patient and family in an appropriate and sensitive manner
78
Domains of Consensus Project: Ethics and Law
Demonstrating knowledge of federal and state laws, statutes, and regulations while respecting and implementing patient and family goals and choices in plan of care
79
Diverse cultures: ways to show respect
assess own background obtain further knowledge show acceptance acknowledge differences be sensitive and open do not make assumptions
80
Diverse cultures: own assessment
background values beliefs to avoid biases
81
Diverse cultures: obtain further knowledge
in order to understand the background being addressed
82
Diverse cultures: show acceptance
of differences even when they may diverge from the nurse's own comfort zone and culture
83
Diverse cultures: acknowledge differences
concerning end-of-life care
84
Diverse cultures: be open and sensitive
to individual patient's beliefs rather than trying to predict behavior
85
Diverse cultures: do not make assumptions
regarding care, needs, or beliefs should not made based on race or ethnicity
86
Language differences: federally funded agencies
required to provide free interpretive services for clients speaking commonly encountered foreign languages
87
Language differences: patient must be informed
that an interpreter will be made available to them
88
Language differences: interpreter
trained in medical terminology fluent in both languages being used familiar with the ethics and HIPPA regulations
89
Language differences: family members
can't be required to serve as interpreters unless client specifically requests a family member to act in this capacity
90
Language differences: emergency situations
use whatever means are readily available to assist in communicating with patient
91
Grief: definition
emotional response to a loss that begins at the time a loss is anticipated and continues on an individual timetable.
92
Grief: process
not an orderly and predictable
93
Grief: involves overcoming
anger disbelief guilt myriad of related emotions
94
Grief: individual
may move back and forth between stages or experience several emotions at any given time
95
Grief: response
unique to own coing patterns, stress levels, age, gender, belief system and previous experiences with loss
96
Spiritual care: assessment
patient's basic beliefs assessed to provide holistic care at end of life
97
Spiritual care: provided according to
patient's religion of choice caregiver must be unbiased regardless of his or her own beliefs
98
Spiritual care: if patient does not wish
should not be forced upon them
99
Spiritual care: advice and comfort
can be provided by anyone known to patient
100
Spiritual care: advice and comfort: intention
to relieve spiritual suffering and answer questions patient and family may have
101
Spiritual care: no formal religion
may have questions and search for meaning and comfort at end of life
102
Dying: task-based model
physical tasks psychological tasks social tasks spiritual tasks
103
Dying: task-based model: physical
bodily needs must be met and physical distress minimized in ways that are consistent with patient's values and beliefs
104
Dying: task-based model: psychological
patient must feel a sense of dignity seek reassurance and satisfaction in lives, securtiy, and autonomy
105
Dying: task-based model: spiritual
identify, develop and reaffirm sources of spiritual energy and comfort in order to define the purpose to their existence and create hope
106
Cultural competence: behavior
goes beyond knowing general facts dynamic process of being aware and showing respect for cultural differences of all types
107
Cultural competence: begins with
being aware of one's own beliefs not letting them interfere with care provided
108
Cultural competence: care plan
each patient and family have unique contributions to care plan
109
Cultural competence: provides
competent care that corresponds with patient and family's own cultural background
110
Cultural competence: assessment
complete, unbiased, sensitive of background and beliefs obtains further knowledge as necessary coordinates and eecutes plan of care
111
Cultural competence: plan of care
meaningful to patient and family, regardless of care provider's own beliefs
112
Normal grief: preoccupied with
self-limiting to loss itself
113
Normal grief: emotional responses
will vary and may include open expressions of anger
114
Normal grief:may experience difficulty
sleeping or vivid dreams lack of energy weight loss
115
Normal grief: crying
evident provides some relief of extreme emotion
116
Normal grief: individual remains
social responsive seeks reassurance from others
117
Depression: marked by
extensive periods of sadness preoccupation extending beyond 2 months
118
Depression: not limited to
a single event
119
Depression: absence of
pleasure or anger
120
Depression: isolation
from previous social support systems
121
Depression: individual experiences
extreme lethargy weight loss insomnia hypersomnia no recollection of dreaming
122
Depression: crying
is absent or persistent provides no relief of emotions
123
Depression: intervention
professional intervention is required to relieve
124
Body after death: prepared
to give clean, peaceful impression for family members who desire an opportunity to say goodbye before funeral home removal
125
Body after death: caring for body
show family care and concern and continued value of the deceased, as well as models grief-facilitating behaviors for others present
126
Body after death: religious rituals
should be encouraged invite family to participate in preparation of body
127
Body after death: explain
process and what to expect as care is given
128
Body after death: remove
tubes, drains and other medical devices
129
Body after death: bandages
should be applied as fluids may still be expressed
130
Body after death: waterproof pad or incontinence brief
helpful for containing fluids
131
Body after death: vagina and rectum
packing of vagina or rectum is unnecessary
132
Body after death: care
wash body and comb hair
133
Body after death: dressing
consider dressing the body in something normalizing
134
Body after death: "sigh"
body may "sigh" as it is rolled and lungs compressed
135
Body after death: room temperature
cool decomposition process will be slowed, allowing family time to grieve
136
Bereavement complications: assess for
multiple life crises that take energy away from grieving process other recent unresolved, or difficult losses that may need to be addressed
137
Bereavement complications: important factor
grieving individual's history with past grieving experiences
138
Bereavement complications: need to be addressed before
can move toward reolution of current loss
139
Bereavement complications: additional stressors
age mental health substance abuse extreme anger anxiety dependence on individual dying
140
Bereavement complications: additional risk factors
income strains community support outside and personal responsibilities absence of cultural and religious beliefs difficultly of disease process age of loved one
141
Rigor Mortis: adenosine phosphate (ATP)
within 4 hours of death ATP is no longer synthesized because of depletion of glycogen stores
142
Rigor Mortis: ATP affects
muscle fiber relaxation
143
Rigor Mortis: lack of ATP
causes exaggerated contraction of muscle fibers immobilizes joints
144
Rigor Mortis: begins in
involuntary muscles found in heart, GI tract, bladder and arteries
145
Rigor Mortis: progresses through
muscles of head, neck, trunk and lower limbs
146
Rigor Mortis: after 96 hours
muscle activity totally ceases rigor passes
147
Rigor Mortis: large muscle mass
may be prone to more pronounced rigor mortis
148
Rigor Mortis: frail individuals
less prone to rigor mortis
149
Rigor Mortis: post-death postioning
minimize effects limbs and hands are in proper body alignment eyelids and jaw should be closed dentures should be placed in mouth
150
Suffering: multiple aspects
emotional spiritual physical affects whole person
151
Suffering: must be addressed from a
comprehensive, holistic perspective
152
Suffering: recognize
it is not always possible to find source or resolve suffering
153
Suffering: indentifictaion
careful observation different disciplinary perspectives
154
Suffering: issues
must be addressed or suffering is more likely to compound rather than diminish over time
155
Suffering: answers
when patient address these questionsit is not necessarily expected for caregiver to give, or have, the answers to questions
156
Suffering: caregiver should
reassure patient of his presence and support while patient finds answers hiimself
157
Suffering: useful exploration
religious or spiritual
158
Spiritual assessment: must assess
prior and present religious affiliations and beliefs about God and the afterlife
159
Spiritual assessment: information
devotional practices rituals routine
160
Spiritual assessment: identify
involvement and support from patient's chosen religious community
161
Spiritual assessment: opens door for
effective spiritual care-giving allows patients to access spiritual coping strategies and support mechanisms
162
Spiritual assessment: holistic assessment
addresses ability to resolve meaningful spiritual questions identifying meaning retaining hope, strength, and peace
163
Spiritual assessment: questions can include
patient's interpretation of meaning and purpose of life personal strengths connections to various spiritual communities, including nature
164
Spiritual assessment: provisions
should be made to explore spiritual relationships and provide support for loss and crisis as desired by the patient and family
165
Algor Mortis: temperature
when circulation and hypothalamus stop functioning, the body's core temperature begins to drop by about 1.8 degrees every hour until it reaches a stasis at room temperature
166
Algor Mortis: skin
begins to lose its natural elasticity as the body cools
167
Algor Mortis: high fever
if it was present at time of death, person may lose excess fluid through the skin, causing the skin to feel moist or giving the appearance of sweating even after death
168
Algor Mortis: loss of moisture and elasticity
casuse skin to become more fragile and easily damaged
169
Algor Mortis: body
should be handled gently, avoiding excess pressure or traction on skin
170
Algor Mortis: dresing
should be applied with a wrap or paper tape
171
Algor Mortis: definition
cooling of body that follows death
172
Loss: term
blanket term used to denote absence of valued object, position, ability, attribute, or individual
173
Loss: experience
individualized and subjective depends on perceived attachment between individual and missing aspect
174
Loss: value range
little or no value to significant
175
Loss: represented by
withdrawal of a valued relationship one had or would have had in the future
176
Loss: reactions
depending on the unique and indivdual responses to perception of loss and its significance, reactions to loss withe vary accordingly
177
Loss: three main attributes (Robinson and McKenna)
something had been removed item removed had value to person response is individualized
178
Disenfranchised grief: occurs
when loss being experienced cannot be openly acknowledged, publicly mourned, or socially supported
179
Disenfranchised grief: responsible for grief
society and culture are partly responsible for an individual's response to a loss
180
Disenfranchised grief: social context
if a person incurring the loss will be putting himself or herself at risk if grief is expressed, disenfranchised grief occurs
181
Disenfranchised grief: risk for
greatest among those whose relationship with individual they lost was not known or regarded as significant
182
Disenfranchised grief: found among
bereaved persons who are not recognized by society as capable of grief young children ex-spouse secret lover
183
Postmortem decomposition: bruising and softening of body
largely related to breakdown of red blood cells
184
Postmortem decomposition: hemoglobin
as cells breakdown, hemoglobin is released, resulting in a staining effect on the vessel walls and surrounding tissues
185
Postmortem decomposition: mottling or bruising
frequently appears on dependent parts of the body as well as any area that experienced recent trauma, such as puncture wounds from invasive procedures
186
Postmortem decomposition: discoloration
can become extensive in a very short period of time
187
Postmortem decomposition: remainder of body
take on a gray hue
188
Postmortem decomposition: face
often appears purple in color when death is a result of cardiac complications
189
Postmortem decomposition: assure family
this bruising process is a normal after-death occurence
190
Bereavement: definition
emotional and mental state associated with having suffered a personal loss
191
Bereavement: reactions of
reactions of grief and sadness initiated by the loss of a loved one
192
Bereavement: normal process
of feeling deprived of something of value
193
Bereavement: "reave"
plunder, spoil, rob
194
Bereavement: recognizes lost individual
had value and a defining role in surviving individual's life
195
Bereavement: encompassess
all acts and emotions surrounding the feeling of loss for the individual
196
Bereavement: grieving period
increased risk for mortality
197
Bereavement: positive bereavement
means being able to recognize the significance of loss while still recognizing the resilience and value of life
198
Anticipatory grief: definition
mental, social, and somatic reactions of an individual as they prepare themselves for a perceived future loss
199
Anticipatory grief: individual experiences
a process of intellectual, emotional, and behavioral responses in order to modify their self-concept, based on their perception of what the potential loss will mean in their life
200
Anticipatory grief: process timeframe
takes place ahead o the actual loss, from the time the loss is first perceived until it is resolved as a reality for the individual
201
Anticipatory grief: process can blend with
with past loss experiences
202
Anticipatory grief: associated with
individual's perception of how life will be affected by the particular diagnosis as well as the impending death
203
Anticipatory grief: acknowledging allows
family members to begin looking toward a changed future
204
Anticipatory grief: suppressing may inhibit
relationships with the ill individual and contribute to a more dificult grieving process at a later time
205
Anticipatory grief: does not take place of
grief during the actual time of death
206
Therapeutic relationships: principles
empathy unconditional positive regard genuiness
207
Therapeutic relationships: to build qualities
express empathy(try to understand other's viewpoint) nonjudgmental acceptance of other genuine concern and respect attention to detail
208
Therapeutic relationships: ability to convey
trustworthiness honesty openness in professional manner
209
Therapeutic relationships: attention to detail
allows nurse to think critically and analyze situation without drawing hasty conclusions of assumptions
210
Therapeutic relationships: attentive to
own part in relationships watching for actions, words, or attitudes that may be destructive to the realtionship if they are misinterpreted by other party
211
Unrealistic hope: determine
if hope is broad or too severe
212
Unrealistic hope: to severe
complete denial of disease process belief cure when there is none available
213
Unrealistic hope: if unlikely to be realized
how determined is individual to their course
214
Unrealistic hope: able to admit
limitations and acknowledge the possibility of a negative outcome
215
Unrealistic hope: does individual state
sure knowledge of what will happen rather than expressing realistic hopes and fears
216
Unrealistic hope: individuals more likely to
engage in reckless behaviors and ignore or avoid acknowledging worsening symptoms or warning signs
217
Unrealistic hope: may alienate
individual from family and friends
218
Unrealistic hope: alienation creates
isolation from family and friends
219
Unrealistic hope: person experiencing?
increasing distress and anxiety
220
Unrealistic hope: impeding
ability to place personal affairs in order or acknowledge their own loss
221
Nurse: vital role
to facilitate communication and establish a trusting relationship with patient and family
222
Communication: levels
takes place on many different levels message received may not always be in control of the sender
223
Communication: 80%
nonverbal
224
Communication: information
overwhelming for patient and family
225
Communication: most individuals express
honesty and truthfulness
226
Communication: should establish
trust and openness include patient and family in all options and care decisions assure individual they will be listened to respect they they will not be ignored or abandoned avoid and resolve conflict allow patients to vocalize their needs and expect them to be addressed
227
Communication: extend communication
healthcare team to facilitate understanding and continuity of care
228
Family-centered palliative care: recognizes
terminally ill patient's place within a family environment
229
Family-centered palliative care: illness effects
entire family necessitating involvement of whole family in plan of care
230
Family-centered palliative care: nurse coordinate based on
not only individual need of patient, but needs of patient as a family member and needs of additional family members
231
Family-centered palliative care: family unit
how patient functions within the family unit is a vital portion of the patient's needs in a transitioning life structure
232
Family-centered palliative care: transition experienced by
entire family and each member will play a role in the loss experience
233
Factors affecting individual outlook during terminal illness
ability to experience one or more meaningful relationships maintaining feelings of lightheartedness, delight, joy or playfulness become more accepting of self spiritual beliefs short-term goals hope
234
Outlook: sense of being needed
patient needs to feel a sense of being needed, a part of something
235
Outlook: identify positive personal attributes
maintaining feelings of lightheartedness, delight, joy, or playfulness helps individual identify postivie personal attributes
236
Outlook: accepting
patients are more accepting of themselves and others as they continue to be able to identify courage, determination, serenity, and positive self-worth
237
Outlook: spiritual beliefs
participation in spiritual rituals provide a sense of meaning to livesi
238
Outlook: short-term goals
patient can focus energy on achieving short-term, positive goals that provide direction to lives and allow them to continue to share themselves with others
239
Outlook: final stage
patients who maintained feeling of hope are able to look toward their eventual death n peace and serenity
240
Mourning: definition
is a public grief response for the death of a loved one
241
Mourning: determined by
personal and cultural belief systems
242
Mourning: Kagawa-Singer definition
"the social customs and cultural practices that follow a death"
243
Mourning: Durkehim definition
mourning is not a natural movement of private feelings wounded by a cruel loss; it is a duty imposed by the group"
244
Mourning: involves participation in
religious and culturally appropriate customs and rituals designed to publicly acknowledge the loss
245
Mourning: rituals signify
individuals are adjusting to the change in relationships created by loss, as well as mark the beginning of the reorganization and forward movement of their lives
246
Spirtiual assessmetn tool: HOPE
H = hope O = organized P = Personal E = effects
247
HOPE: Hope
What sources of hope (who or what) do you turn to?
248
HOPE: Organized
Are you a part of an organized religion or faith group? What do you gain from membership in this group?
249
HOPE: Personal
What personal spiritual practices such as prayer or meditation are most helpful to you?
250
HOPE: Efffects
What effects do your beliefs play on any medical care or end-of-life issues and decisions? Do you have any beliefs that may affect he type of care the health care team can provide you with?
251
Spiritual assessment tools
HOPE FICA SPIRIT
252
Spiritual assessment tools: FICA
F = faith I = importance C = community A = address
253
FICA: Faith
Do you have a faith or belief system that gives your life meaning?
254
FICA: Importance
What significance does your faith have in your daily life?
255
FICA: Community
Do you participate and gain support from a faith community?
256
FICA: Address
What faith issues would you like me to address in your care?
257
Newborn/infant rights
to be listened to as individual right to cry entitled to hope allowed to interact with family needs can be met at home or hospital
258
Newborn/infant rights: right to be listened to
as individual person with rights not property of his parents, caregivers, medical personnel, or society
259
Newborn/infant rights: right to cry
natural course of emotion cries should be acknowledged and comfort given as needed
260
Newborn/infant rights: entitled to hope
he or she can create fantasies
261
Newborn/infant rights: interaction with family
should not be restricted from interacting with is or her siblings and parents
262
Newborn/infant rights: home or hospital
needs can be met at home or hospital, wherever parents are comfortable having care delivered family members may help provide that care
263
Spiritual assessment tools: SPIRIT
S = spiritual P = personal I = integration R = ritual I = implication T = terminal events
264
SPIRIT: Spiritual
Do you have a formal religious affiliation?
265
SPIRIT: Personal
Which practices and beliefs do you personally accept and practice? Does spirituality play a part in your daily life?
266
SPIRIT: Integration
Do you participate in a spiritual community and receive support from that community
267
SPIRIT: Ritual
Are there specific practices and restrictions in your religious convictions that would affect your health care choices?
268
SPIRIT: Implication
Are there aspects of your spirituality you would like me to keep in mind during your care?
269
SPIRIT: Terminal Events
As you prepare for the end-of-life, how does your faith affect the decisions you make or how you feel about death?
270
Death documentation
identify patient assessment
271
Death documentation: assessment
general appearance lack of reflex or response to stimulufs absence of breathing and lung sound absence of apical and carotid pulse
272
Death documentation: should include
patient's name time of contact and death pronunciation who was present at time of death time of assessment details of physical exam time physician notified identification of all parties notified special plans
273
Death documentation: special plans
burial or cremation organ donation autopsy cultural or religious procedures
274
Death documentation: who was present at time of death
health care personnel family members freinds
275
Medication use in elderly patients: risk factors
multiple health care professionals multiple prescriptions age-related factors self-medicating lack of social support finances fears of addiction or side effects language barriers
276
Medication use in elderly patients: multiple healthcare professionals
can lead to multiple medication prescriptions leads to complex dosing schedules, route or parameters for delivery
277
Medication use in elderly patients: age related
physiological pharmacokinetic and pharmacodynamic changes visual and hearing difficulties cognitive changes (delirium, dementia, depression and anxiety)
278
Medication use in elderly patients: self-medicating
over-the-counter medications alcohol herbal remedies
279
Quality end of life care: initiated
when supportive care and quality of life beomce primary patient and family concerns
280
Quality end of life care: experience continuity
with standardized protocols and measurable outcome
281
Quality end of life care: best medical treatment
should be provided to improve patient function
282
Quality end of life care: patient should be free from
overwhelming pain other distressing symptoms
283
Quality end of life care: always ensure
comfort
284
Quality end of life care: health care should be
continuous comprehensive coordinated
285
Quality end of life care: patient and family feel prepared for
future events understand what is likely to happen over course of illness
286
Quality end of life care: patient and family should feel
respected and valued have wishes sought, appreciated and followed as much as possible
287
Quality end of life care: allows patient to have
dignity self-respect ability to make best of every day, while having sense of control
288
Quality end of life care: goal
patient's burden relieved and relationships are strengthened
289
Learning: mild anxiety
can facilitate learning by enhancing awareness and promoting information-seeking behaviors
290
Learning: mild anxiety individual able to
absorb, process and test new information within personal parameters
291
Learning:moderate anxiety
begins to narrow perceptual field
292
Learning:moderate anxiety indivdual able to
observe and learn from new information
293
Learning: severe anxiety
reduces individual's ability to absorb new information because focus is on providing immediate relief
294
Learning: severe anxiety: behaviors
automatic, distancing, or self-soothing attempt to re-establish equilibrium
295
Learning: uncontrolled, severe anxiety
feelings of panic, awe, dread
296
Learning: uncontrolled, severe anxiety: behaviors
information is scattered and misinterpreted inability to focus attention outside of themselves or immediate needs
297
Learning: uncontrolled, severe anxiety: establish
control before learning can take place
298
Delivering bad news: 8 steps (Girgis and Sanson-Fisher)
provide privacy and adequate time assess understanding provide information simply and honestly avoid euphemisms encourage expression of feelings be empathetic give a broad realistic time frame for disease arrange for a review or follow up
299
Delivering bad news: provide privacy and adequate time
create a setting that is quiet and comfortable where participants will feel unrushed and uninterrupted establish who should be present
300
Delivering bad news: assess understanding
be informed about the condition determine what the family and patient already know
301
Delivering bad news: provide information simply and honestly
give a warning and allow participants to prepare themselves for discussion express goals of meeting establish a foundation of basic information that can be built upon use common language and easy to understand explanations provide an interpreter if necessay
302
Delivering bad news: avoid euphemisms
discuss matters in a clear and direct manner
303
Delivering bad news: encourage expression of feelings
confirm and accept all emotional responses
304
Delivering bad news: be empathetic
sit quietly and allow time for information to be absorbed listen carefully and refrain from judgement
305
Delivering bad news: broad realist time frame for disease progression
allow for questions and comments discuss need for a legal decision maker watch for indication of self-harm intention
306
DNR: steps
establish an appropriate setting establish what family and patient know find our patient's future expectations discuss DNR order discuss parameters in which resuscitation would be considered respond to emotion and assist in developing a plan
307
DNR: establish understanding of patient's condition
build on current knowledge
308
DNR: discuss so patient can understand
given present condition and expectorations for future use language patient can understand identify specific examples and options
309
DNR: respond to emotion and develop plan
encourage and respect any responses document patient's wishes in care plan
