End-of-Life and Palliative Care Flashcards
Who created the Bereavement Theory?
The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.
What are the stages of the Bereavement Theory?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Introduction Background Context
Care of individuals who are dying is an integral part of health care. In Canada, chronic disease is the predominant cause of death, with deaths from cancer now exceeding deaths from cardiovascular diseases.
These two diseases now account for almost 60% of all deaths in Canada. The prevalence of chronic disease in older adults, combined with an aging population, means that providing high-quality care specific to the needs of individuals at the end of life and their families is imperative.
What is palliative care?
Palliative care is a philosophy and an approach to care. Palliative care aims to improve the quality of life of persons facing life-limiting illness and their families through the prevention and relief of suffering by means of early identification, assessment and treatment of symptoms. It is also referred to as hospice palliative care.
What is hospice care?
Hospice care, on the other hand, usually refers to the last months of life and brings with it an association with the place of care as a specialized facility.
What is end-of-life care?
Care for persons who are expected to die in the foreseeable future and for their families. It includes helping persons and their families prepare for death, ensuring their comfort and supporting decision making that is consistent with the person’s prognosis and goals of care (RNAO, 2020).
What role does the nurse play in end-of-life care?
- Care for and comfort the patient and family
- Alleviate fear of the unknown
- Preserve the patient’s dignity and support the family
- Respect the role of culture and religion
What is the aim of palliative care?
Relieve suffering and improve the quality of living and dying.
Address the physical, psychological, social, spiritual (existential) and practical issues of persons and their families, and their associated expectations, needs, hopes and fears.
Prepare persons and their families for self-determined life closure and the dying process and help them manage it.
Help families cope with loss and grief during the illness and bereavement experience.
Treat all active issues, prevent new issues from occurring and promote opportunities for meaningful experiences, personal and spiritual growth, and self-actualization.
Palliative care extends across the trajectory of life-limiting illness, including care at the point of diagnosis, during treatment and at the end of life, as well as grief and bereavement support.
What is the delivery of palliative care and end-of-life care?
The delivery of palliative care and end-of-life care is based on comprehensive and ongoing assessment of the needs of persons and families, along with their wishes and preferences. Depending on where the person is along the illness trajectory, considerable variability exists with respect to the type and level of care and the services that are required from health providers.
What does the Canadian Hospice Palliative Care Association (CHPCA) define as hospice care?
Relieve suffering and improve the quality of living and dying. Such care approach strives to help patients and families:
1) Address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears;
2) Prepare for and manage self-determined life closure and the dying process; and
3) Cope with loss and grief during the illness and bereavement
Advanced Directives (Living Wills)
Advanced directives come into effect should a person become incompetent or incapacitated.
Advanced directives provide instructions regarding decisions about care and they identify a substitute decision maker.
Since it is difficult to envision all possible scenarios, a recent trend is towards life, advance directives can outline values in advance.
Advanced directives are not yet legal in all provinces and territories.
Advance Care Planning
What is the RNAO’s BPG for advance care?
A process that involves understanding, reflection, communication, and discussion for the purposes of prospectively identifying a surrogate, clarifying preferences and developing an individualized plan of care as the end of life nears.
Ethical Issues Related to Resuscitation
Do not resuscitate (DNR) is a broader term than “no CPR”.
Decision making places a significant burden on the family to either “do nothing” or “play God”.
It is better to focus the discussion on allowing for a natural death.
Decisions must be made in context, and nurses play a vital role.
Vulnerable Neonates: Low Birth Weight
Health care professionals and families must weigh the risks and benefits of intervention, particularly when early death or severe morbidity is likely.
Families must understand the impact of medical interventions that will prolong dying.
Families need to know when the prognosis is uncertain.
Survival may be associated with a diminished quality of life.
Significant disability may be possible.
The infant may suffer pain with medical interventions.
The Child Approaching Death and Dying
There are many moral and ethical issues related to decision making on behalf of a child, such as:
Whether life-sustaining therapies can be continued when outcomes are unclear?
Whether continuing care because of family wishes is in the child’s best interests?
At what age the can child participate in decision making?
