Chapter 30 Dying, Death, and Grieving Flashcards
advance directives
the right of a person to provide directions for the clinician to follow in the event of a serious illness. indicated preferences for the amount and types of medical care. The directive goes into effect if person is physically or mentally incapable of making medical decisions
anticipatory grief or
anticipatory mourning
what happens when a life-threatening diagnosis received or
curative efforts are stopped.
a future loss is being mourned in the present.
people acknowledge the importance of the dying person, adjust their lives to accommodate the intervening time, foresee the future.
Art of Presence
2 skills
listening and observing
artificial nutrition and hydration
through feeding tubes or intravenous fluids is legally considered a medical intervention and not a comfort measure. food and water for patients that are actively dying is not basic care.
fluids can increase edema, pulmonary congestion, ascites, nausea, and vomiting
unwillingness to eat or drink is caused by impending death
nursing care can encourage families to offer water orally as long as loved one desires it or is able to swallow.
remember patient dying from illness not lack of food or dehydration. -
bereavement
period of grieving after death.
dementia - how many in the world, how many dx annually
50 million
10 million
disenfranchised grief
Dual process model of coping and bereavement
restoration - coping with everyday life
loss oriented - grief work
durable power of attorney for healthcare
the designation of a person to act as the patient’s medical decision maker,
Patient must be competent when making this appointment and competent to revoke it
euthanasia/mercy killing
the act of putting someone to death.
someone other than the patient commits an action with the intent of ending the patient’s life.
Euthanasia
Three types
Voluntary -requested by the patient -usually when in great pain
Passive - omission of acts - withdrawing or withholding that which would keep the patient alive who is unable to make the decision
Involuntary - homicide- actively ending someone’s life without their consent, typically by injecting a lethal drug.
Full Code
Do Not Resuscitate (DNR)
Do Not Resuscitate - comfort care arrest (DNR-CCA)
Do Not Resuscitate - comfort care only (DNR-CCO)
Full code - all life sustaining measures
Do Not Resuscitate DNR - no CPR
DNR - CCA comfort care arrest - everything up to cpr and after arrest- no heartbeat or respirations- airway suctioning, o2, positioning and pain meds.
Do Not Resuscitate - comfort care only (DNR-CCO)- pain free and free of invasive procedures, intubation. Usually terminal illness or short time to live
grieving
normal and complex process in response to loss.
hospice
Begins after treatment of the disease of condition is stopped, when it is clear that survival is not possible.
Multidisciplinary team approach
focuses on patient care rather than cure.
6 months or less to live, can leave and return
goal is quality of life.
Hospice locations
- routine - in individual residences
- continuous home care 8-24 hours manage paine and acute medical symptoms
- inpatient respite = temp relief for caregiver can be in hospital
- general inpatient care - pain control and symptom management
Kubler-Ross
1973 Denial and Isolation Anger Bargaining Depression Acceptance
DA B DA
legally assisted death
patient is dying and is choosing one form of death over another.
Someone else makes the mean of death available but does not act as the direct agent.
death with dignity
assisted dying
assisted death
physician assisted death or dying
physician aid in dying
aid in dying
medical aid in dying
Nurses prohibited from administering med that aids in dying.
Nurse must be objective about patient’s decision and can object to being involved in the process.
living will
personal statement of who and where one wished to die.
provides guidance or instructions for making healthcare decision.
activated when patient terminally ill and incapacitated.
mourning
things people do to cope with grief including shared social expressions of grief.
quality of life concerns - most important concern
addressing pain
pain involves whole person- physical, spiritual, and emotional
palliative care
provides comfort, can begin at time of dx and continue through treatment.
may or may not be terminally ill. could be incurable chronic - diabetes, heart disease, dementia.
patient and family centered care that optimizes quality of life anticipating, prevently, and treating suffering.
addresses physical, intellectual, emotional, social, and spiritual needs.
persistent complex bereavement disorder
addresses prolonged grieving
grief beyond 12 months
POLOST
MOLOST
provider/Physician orders for life sustaining treatment (includes nurses)
medical orders for life sustaining treatment
PSDA. what is it?
Patient self-determination act of 1990
health care facilities need clear written info for every patient including legal rights to make healthcare decisions,
including right or refusal of treatment.
What is the fifth vital sign?
Pain
Worden (2018) Grief Theory
- Task 1 accepting the reality of loss
- Working through and experiencing the pain of grief
- Adjusting to an environment without the deceased. New roles and changing dynamics
- Withdrawing emotionally from or relocating the deceased and moving on. Relationship with the memories while engaging in activities that bring pleasure.
disenfranchised grief
intense loss that is not congruent with a socially recognized relationship -
patient, caregiver, abortion, pet
Grieving - potential for dysfunctional
social isolation extensive dependency on the deceased person unresolved interpersonal conflicts loss of a child violent and senseless death catastrophic loss
Nonmalefience
ethical concept - do no harm
patient: no difference in lethal injection or stopping treatment
nurse: promote, preserve and protect human life.
assisted death violates the oath to do no harm.
beneficence
means to do good
Patients: relief from pain by doctors who can legally assist
Doctor: what is there is a misdx, pressure from family, inadequate assessment of competence
preserve and support life
Good Death
Pain free but human experience
