Delivering Bad News

Question 1

Advanced directives

Answer 1

. DNR
. Advanced healthcare directive, living will
. Durable power of attorney for healthcare decisions
. Vary in state

Question 2

Palliative care team

Answer 2

. For terminal and non-terminal patients
. Managing symptoms and side effects of lime limiting and chronic illnesses
. Team: physician, NP, social worker

Question 3

Hospice care

Answer 3

. Last 6 months of life
. No hope for cure
. Palliative care until death
. Larger team w/ home health, volunteers on top of normal medical team

Question 4

Stages of grieve/death and dying

Answer 4

. Denial 
. Anger
. Bargaining 
. Depression
. Acceptance 
. Family goes through same emotions as patient

Question 5

End of life care

Answer 5

. Info
. Support
. Change in medical care: no longer curative
. Affirmation of life
. Minimize anguish
. Palliative care
. Keep patient wishes at center of decisions

Question 6

Spiritual assessment

Answer 6

FICA, HOPE
. Gives patient chance to contemplate and celebrate life
. Faith/belief/Meaning in life
. Importance/influence of faith/beliefs in decisions and stress management
. Community: part fo spiritual community, support
. Address/action of care: getting clergy involved in patient care if they want it

Question 7

Pronouncement

Answer 7

. When pronouncing due to pacemaker or ventilator, don’t be rushed
. If you sense annoyance that is took awhile to get there apologize
. Be very clear that they have passes away
. Be respectful, show empathy
. Prepare: know circumstances, diagnosis, interventions
. Code blue: bring nurse, sit down, look everyone in eye, explain what you found and what was done to patient