Module 12 - Navigating End of Life Care

Question 1

What is loss?

Answer 1

• Active and evolving process that includes behaviors through which the experience of loss is incorporated into one’s life
• Influenced by social and cultural norms

Question 2

What is grief?

Answer 2

A response to the loss of a loved one

Question 3

What are the stages (5) of grief according to Ross?

Hint - DABDA

Answer 3

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Question 4

What are the different types of grief (4)? Hint - AACD

Answer 4

1) Anticipatory- perceived loss before it occurs
2) Acute - crisis
3) Chronic/Complicated – memories persist and experienced as acute grief
4) Disenfranchised - cannot be openly acknowledged or publicly mourned

Question 5

Dynamics of the grieving process

Answer 5

• Physical, emotional and psychological changes
• Affecting daily life
• Depression/despair
• Adjusting to a new way of life

Question 6

Factors that affect the grieving process

Answer 6

• Personal responses/views
• Relationships
• Social support
• Timing of loss
• Cultural and spiritual beliefs

Question 7

What is the palliative care approach?

Answer 7

• Improves quality of life
• Care at any stage of an illness
• Addresses issues of physical, social, spiritual and psychological health
• Care for the symptoms not the illness itself

Question 8

What are the rights of the Dying Patient’s Bill of Rights (8)?

Answer 8

1) Right to be in control
2) Right to be treated as a living human being until I die
3) Right to have a sense of purpose
4) Right to be cared for by those who can maintain a sense of hopefulness
5) Right to express my feelings and emotions about my approaching death
6) Right to have a respected spirituality
7) Right to participate in decisions about my care
8) Right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals

Question 9

What are holistic needs and approach in end of life care?

Answer 9

• Tolerance
• Empathy
• Communication
• Listening skills
• Holistic medications - natural remedies
• Humor
• Knowledge of end of life care

Question 10

Person-centered focused for end of life care

Answer 10

• Support and preparation
• Legal advise and requirements
• Cultural customs
• Rights are followed and respected
• Death with dignity
• Provide symptom relief
• Reduce mental and physical stress
• Reminiscing
• Building relationships

Question 11

Family needs for end of life care

Answer 11

• Keep informed
• Offer support
• Kindness
• Empathy
• Legal Advice
• Personal time with the family member

Question 12

Cultural beliefs of Indigenous people related to death and spirituality

Answer 12

• Involve Creation stories - legacy of relationships with
  ancestors
• When dying, a traditional person will call for the
  ceremonies, medicine and prayers that will guide his/her spirit back to the spirit world
• Spiritual leader or medicine person close to the dying person will conduct the ceremonies
• Family and tribe members will present

Question 13

Components of advance care planning

Answer 13

• Palliative/ hospice care
• Relieve suffering to improve quality of life
• Physical, social, spiritual and psychological symptom relief
• Prepare and support patient and family
• Promote death with dignity

Question 14

What is the role of the nurse in medical assistance in dying (MAiD)?

Answer 14

• Provide care
• Nurses are not legally permitted to administer medication in medical assistance in dying; only the patient, NP and MD
• Important to self reflect on beliefs and values about MAID and an approach for practice