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GDA > Compassionate Care > Flashcards

Compassionate Care Flashcards

1
Q

What percentage of patients will die within facilities?

A

50%

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2
Q

How many patients want to die in their own homes?

A

80-90%

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3
Q

What percentage of dying patients die in the ICU?

A

25%

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4
Q

What aids in the increase of patients dying in facilities?

A

Technology

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5
Q

What are some reasons as to why dying patients are unable to die in their homes?

A
  1. devices have to be monitored
  2. caregivers are working and stressed(canot provided the support needed)
  3. Caregivers comfort level in providing pain medication
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6
Q

What percentage of people in America have an advanced directive?

A

26%

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7
Q

What event normally follows the death of a loved one?

A

PTSD

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8
Q

Name the risks to caregivers when caring for a dying patient?

A
  1. Compassion Fatigue
  2. Burnout
  3. Depression
  4. Return of your own grief responses
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9
Q

What is compassion fatigue?

A

A PTSD experience that occurs after you have lost a patient that has left an impression on you.

Over time, your compassion gradually lessens.

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10
Q

Which type of caregivers experience burnout?

A

Residents and medical students

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11
Q

What are some danger signs of the risks to caregivers?

A

When the caregiver shows a lack of emotion or too much emotion to any situation

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12
Q

Who is the best person that the doctor can confide their feelings of loss and grief of a patient with?

A

Another doctor

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13
Q

What the forms of grief?

A 
Fear
Anger
Silence
Avoidance
Depression
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14
Q

What are the four fears of the dying patient?

A
  1. “I will be a burden to my family”
  2. “No one will visit me”.
  3. “Will I be suffering pain at death?”
  4. “What will happen to me after death?”
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15
Q

Who are the five members of the hospice team?

A 
Social worker
Doctor
Nurse
Chaplain
Volunteer
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16
Q

Why is the volunteer such an integral part of the hospice team?

A

The volunteer represent the community.

The community needs to support the dying patient

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17
Q

What does the dying patient want?

A
  1. To be heard!!!!
  2. To know what to expect
  3. Prompt help when they call
  4. To know that they are not alone
18
Q

What are three roles of an excellent physician?

A

Teacher
Healer
Friend

19
Q

What is the doctor’s role as a healer?

A

To alleviate all symptoms in every way and as quickly as possible.

Doctors diagnose, treat, and anticipate the prognosis!

20
Q

In hospice/palliative care, what should be considered if a patient asks for death?

A

That there is an ongoing symptom that is not controlled

21
Q

What is the doctor’s role as a teacher?

A
  1. To make explanations simple and clear

2. To pay attention to body language

22
Q

What is the doctor’s role as a friend?

A
  1. To listen

2. To give compassionate attention

23
Q

Name some types of compassionate conversations.

A
  1. Family meetings
  2. Delivering Bad News
  3. Discussion of advance directives as routine parts of medical care
  4. Advanced directives
  5. Code status discussion and questions
24
Q

Advance directives need to be readdressed time and time again.

True/False

A

True; as patients evolve in their lives and diseases, the advance directives are prompt to change

25
Q

What is a code status question ?

A

Code status question: ask the patient what they want done in case they stop breathing in a primary care setting.

26
Q

When should a code status discussion take place?

A

Code status discussion: <30% of pts who are older than 75, have multiple co-morbidities, stage 4 cancer are going to survive to discharge.

With these patients, a discussion is necessary instead of questions.

27
Q

How should the physician prepare for the conversation?

A
  1. Get your mind focused on the patient and family
  2. Make the room quiet and peaceful
  3. Consider who should be present
  4. Consider cultural factors
  5. Make sure the pt has adequate support present of the conversation
  6. Make sure you have the facts correct and have discussed it will all involved clinicians
28
Q

What is the criteria for delivering bad news?

A
  1. Be sitting an in a quiet room
  2. Give a warning shot( “I have bad news)
  3. Have staff present for you and family
  4. Be quick and clear
  5. Prepare for & allow ALL emotional responses
29
Q

Name the SPIKES

A 
Setting
Perception
Invitation
Knowledge
Emotion
Summary, next steps
30
Q

What should be considered during a setting in SPIKES?

A

Make sure that it is a quiet atmosphere.

31
Q

What should be considered during the perception in SPIKES?

A
  • Make sure you know what they know and understand about the topic at hand
  • You want to undercover denial and defense mechanisms
32
Q

What should be considered during the Invitation in SPIKES?

A

It is tricky what patients and family members in the room…Does everyone wants to know?

33
Q

What is necessary to inform the patient during the invitation portion of SPIKES?

A

You still have to inform he patient sometimes about their life expectancy, plan, and prognosis

34
Q

What should be considered during the Knowledge portion in SPIKES?

A

Be simple, clear, and straight-forward

35
Q

What should be considered during the emotion portion of SPIKES?

A

Name the emotion and dealing/empathize with the emotion otherwise you will come across very cold to your patient

36
Q

What should be considered in the summary portion of SPIKES?

A

This is a very crucial step; the next steps provide a game-plan for the patient

37
Q

Under which circumstances will SPIKES be excluded from the conversation?

A

When a patient has died; avoid using SPIKES with the family and friends

38
Q

How should you approach having the conversation about a bad news to the patient and the families?

A
  1. Find out what the patient and family already know, and what they want to know
  2. Give a warning shot when delivering bad news
  3. Redirection must be gentle- use the “I hope, but I fear approach..”
  4. Answer honestly and clearly in terms your patient and the family can understand
  5. Use the right words, Do not use euphemisms or platitudes- Keep it simple
  6. Allow for silence as well as emotions…
39
Q

What is meant by the world prognosticate?

A
  1. Be disease specific information
    - If COPD, discuss PFTs, meds, etc.
  2. Functional status
    - Ability to be independent(eat, dress self, etc.)
  3. Rate of Change
    - How quickly you are changing in functional status
  4. Caregiver support
    - Needs to know what is available for the patient and what is not(= nursing home care)
40
Q

What is the significance of the rate of change while prognosticating?

A

If you are changing very rapidly, the prognosis may be shorter(days to weeks)
If things are changing on a longer rate, the prognosis may be longer

41
Q

While prognosticating, specific dates should be used.

True/False

A

False!!

Use ranges(that is less than you think it’s going to be)

DONT PROMISE ANYTHING!!

GDA (5 decks)

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