Family Nursing in End of Life Care

Question 1

Characteristics of a good death?

Answer 1

Free from avoidable distress/suffering for pt/families. It’s in accord with pt/fam wishes and isn’t the same for everyone. Considers various needs and is consistent with cultural/clinical/ethical standards.

Question 2

Death in Canada?

Answer 2

More people are dying every year because we have an aging population. 60% of Canadians die in hospital despite their wishes.

Question 3

What is palliative care?

Answer 3

Seeks to improve persons quality of life once a chronic/life limiting condition is diagnosed. Continues till death/family bereavement/care of the body. Provides relief from pain and regards dying as normal process. Neither hastens nor postpones death. Offers support system to help fam cope and uses team approach. Recommended to start as early as possible.

Question 4

What is end of life care?

Answer 4

Starts in final stage of dying and continues until death/into family bereavement. Seeks to relieve suffering/improve quality of life until death

Question 5

Role of nurse in palliative approach?

Answer 5

They deliver person centered care. They honour values/healthcare wishes by promoting autonomy, dignity, control, and shared decision making. The focus is not on prognosis but on the person’s needs/wishes.

Question 6

What is community integrated PC?

Answer 6

Integrate PC providers early and provide high quality PC/end of life care in all settings.

Question 7

True or false: our system is still based on cure model with PC as secondary considerations

Answer 7

True

Question 8

What is MAID stand for and when was it created?

Answer 8

Medical assistance in dying. June 2016

Question 9

Criteria for MAID?

Answer 9

1. 18+ and have capacity to make decisions about their health
2. Be eligible for health services funded by government
3. Move voluntary request for MAID
4. Give informed consent to receive MAID after having received all info/access to PC
5. Be in advanced state of irresistible decline in capacity
6. Have serious/incurable illness/disease/disability excluding mental illness as underlying condition
7. Death is reasonably foreseeable, can request Advance Consent Arrangement if at risk for losing capacity
8. Has enduring/intolerable physical or psychological suffering that can’t be alleviated

Question 10

How to make informed consistent independent decision?

Answer 10

Information is provided about issue, pt has capacity to make the decision, pt is making decision independently (free of influence), and pt is consistent is decision over time

Question 11

What is capacity and the 3 components?

Answer 11

C- ability to perceive and remember info and communicate a choice
1. Understanding- clear perception of meaning/comprehends choices to be made
2. Appreciation- appropriate critical judgement to see values of what’s understood
3. Processing- ability to process/plan/organize/execute actions rationally and consistently

Question 12

RNs involvement in MAID?

Answer 12

Must be licensed by CRNS to be involved in MAID. They are involved in nursing care but can’t accept delegation from medical/nurse practitioner to administrate the medication used to provide MAID

Question 13

How do nurses talk about MAID?

Answer 13

They should be open/non-judgy. If they have a conscientious objection than make sure to connect the pt asking for MAID to someone who doesn’t object it.

Question 14

Nursing responsibility with MAID?

Answer 14

1. Acquire knowledge/skills to provide end of life care
2. Understand legal framework for MAID
3. Be familiar with MAID best practices
4. Inform your employer if you have a conscientious objection

Question 15

Most common illness for MAID?

Answer 15

Cancer

Question 16

Is PC related to MAID?

Answer 16

NO because PC is quality end of life care and MAID isn’t PC.

Question 17

What do pt/families want at end of life?

Answer 17

1. Listen to their wishes
2. Be truthful
3. Support them emotionally
4. Consider cultural and religious background
5. Support the family
6. Help with practical matters

Question 18

How to provide information?

Answer 18

Give it straight, make it clear, show your care, give time, pace information (spread it out), and stay the course.

Question 19

What does living parallel realities mean?

Answer 19

Acknowledge terminal nature of the disease but still have hope for a cure.

Question 20

What is not expected for end of life?

Answer 20

Pain/breathing troubles that can’t be controlled, feeling like you’re losing your mind, and no dramatic crisis of pain/breathing/agitation/confusion should occur.

Question 21

What to expect with end of life?

Answer 21

Having less energy, spend more time resting, sleeping most of day, and gradually your body systems will shut down/your heart will stop while you’re sleeping.

Question 22

How to prepare students for end of life care?

Answer 22

Open conversations, good relationship with preceptors, confidence in clinal skills, teach strategies to manage emotions, train nurse educators, and provide ongoing support.

Question 23

3 clinical practice guidelines for fam meetings?

Answer 23

1. Prepare for family meeting
2. Conduct family meeting
3. Document and follow up

Question 24

Principles to guide fam meetings?

Answer 24

Share information, learn goals of care, be a resource, avoid conflict/crisis, offer family meetings routinely on admission/prn, and have meetings based on need.

Question 25

CNA position statement about PC?

Answer 25

PC is support for fam during/following death. Determines a proxy/substantive decision maker should individual become incapable (like having an advanced care directive).

Question 26

3 Ts of what dying people want?

Answer 26

1. Truth- from fam, friends, and HCPs but not at expense of hope and reassurance
2. Touch- physical and emotional closeness
3. Time- to have with loved ones/manage unresolved issues

Question 27

What is grief and loss?

Answer 27

Process of adjustment and healing. Loss is the wound and grief is healing. It’s a normal part of the life cycle.

Question 28

5 stages of grief?

Answer 28

Denial, anger, bargaining, depression, and acceptance. A 6th stage could be finding meaning in loss.

Question 29

Suffering meaning?

Answer 29

Loss of control, a result of loss and is very personal. People search for meaning and it can cause loneliness, spiritual distress.

Question 30

Manifestations of grief?

Answer 30

Cognitive (affects our thinking), affective, somatic (cry, loose appetite), social (affects our relationships) and spiritual (loss belief)

Question 31

Factor associated with survivor of grief?

Answer 31

Hx of concurrent mental illness, survivors perceived lack of social support, family conflicts, loss of traditions/beliefs, concurrent stressors, and angry/dependant relationship with deceased.

Question 32

Nurses role with grief?

Answer 32

Be a companion (listen, witness), actively listen, avoid imposing models about right way to grieve, encourage sharing memories, normalize responses/provide accurate info about grief process, and assist individual in making meaning of loss.