- END OF LIFE CARE AND DEATH -

Question 1

Differentiate between end of life care and palliative care

Answer 1

End of life
– patients are ‘approaching the EOL’ when they are likely to die within the next
6-12 months.

Palliative care
– An approach that improves the quality of life of patients and families facing
the problems associated with life-threatening illness.
– Prevention and relief of suffering by means of early identification and comprehensive assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Question 2

Discuss the nursing considerations in regards to end of life care

Answer 2

– pain and symptom management;
– clear decision-making;
– preparation for death;
– completion; and
– affirmation of the whole person.
– making contributions such as gifts, time and money (meaning/role/usefulness);
– not being a burden, planning ahead, arranging affairs, and saying good bye.
- identifying goals and prioritising this
- honest and open discussion with patient and families

Question 3

Identify what you can do for the family of the dying pt in ED

Answer 3

 Support for family member witnessing the resuscitation can be
interdisciplinary-must have time + knowledge of what to expect and how to
support the family.
 Support for the deceased family may also be interdisciplinary.
 Ongoing debriefing, explaining what happened and why.
 Bereavement support needs to be ongoing-Possible referral to social
worker, pastoral care worker (dependent on cultural background & family
preferences). Bereaved family members need TIME.
 Prepare family for viewing the deceased.
 Where next…where will the body go? Autopsy? Police/Coroner
involvement?
 Most health services have protocols or CPGs and brochures for family
members.
 Traumatic death experiences are more likely to result in pathological grief
and PTSD, so bereavement support is important.

Question 4

Discuss the issues surrounding family presence in resuscitation

Answer 4

 Research shows family witnessed resuscitation facilitates grieving.
 Demonstrates that everything was done to save their loved one. Helps families
understand the severity of the situation.
 Facilitates a sense of closure. Allows family to see and touch their loved one,
making the death seem real.
 Erases the mystery- seeing what really happens is better than imagining what it
was like.
 Families who had and had not witnessed resuscitation were interviewed, and
nearly all, in both groups, wanted to be present.
 Patients wanted the family present…but:
– The most appropriate family member should be present
– Family members should be prepared beforehand for what they might see
– Family members should have a clinical support person with them
– It should be the family member’s decision
– Patients reported being not concerned about confidentiality

Question 5

Discuss the potential organ or tissue donation criteria

Answer 5

Specific inclusion criteria for each organ, however generalised criteria include:

• Age: ~<65-70yrs but with disgretion
• lack of exclusion criteria (comorbidities, lifestyle, ability to comply)

Question 6

Define the exclusion criteria for tissue or organ donation

Answer 6

• Lifestyle: any lifestyle factors that can result in poorer outcome can be exclusion criteria
• Inability to comply with complex medical therapy
• Comorbidities: condition that results in unacceptably high mortality and morbidity risk

Question 7

List the organs and tissues that can be donated

Answer 7

• heart
• kidney
• liver
• lung
• pancreas

Question 8

Discuss the nursing responsibilities in supporting the family of a donor

Answer 8

• ensuring that the family have the resources and support that they need
• providing information and connection to Donate life and the Australian Government Organ and Tissue Orthority

Question 9

Discuss the process of procurement surgery

Answer 9

Organ procurement is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation.
Pt must meet criteria for procurement surgery.

Question 10

Discuss the indications for reporting a death to the coroner

Answer 10

• death in victoria
• death unexpected
• death resulted directly/indirectly from injury
• death occurs during or following a medical procedure
• death certificate cannot be signed as cause of death is undecided
• the identity of the person is unknown

Question 11

Discuss the preparation of the pt for the coroner

Answer 11

• ideally body is left as it was at the time of death and not cleaned
• the removal of any tubes, cannulae and even bags attached is not recommended and any removal should be carefully considered as forensic pathologists will use these
• if family have requested the removal of tubes it may occur