Nurb end of life comm loss and final hours

Question 1

: acknowledging vulnerability, intuition, empathy, being in the moment, and serenity and silence.

Answer 1

Presence requires

Question 2

everyone grief is their own, never say that you know how they feel
-setting the right atmosphere: who you want in the room, take to private room, spoke slowly and calmly, say pt died then stop, gave them time does the family want to talk, attentive listening

Answer 2

Effective Communication:

Question 3

: the patients current medical status including the likely course if no treatment, interventions that might improve prognosis, professional opinion about alternatives available to the patient, recommendation from physician

Answer 3

disclosure

Question 4

: take reasonable precautions to ensure that such information is not inappropriately divulged

Answer 4

confidentiality

Question 5

: legal term, practical application of respect of the patients autonomy

Answer 5

informed consent

Question 6

: ability to understand or to make choices, ability to understand relevant information, appreciate the medical situation and its possible consequences, communicate a choice, goal in relation to the recommended treatment options

Answer 6

decisional capacity

Question 7

: frequently concerned that when crucial decision must be made about their medical care, no longer capable of participating in those decisions, solution to the problem, essential that patients discuss these concerns with their family and their health care provider, record in patients record

Answer 7

Advanced care planning

Question 8

from medical paternalism to patient self-determination, requires that all hospitals receiving federal funds must ask patients at the time of admission whether they have advance directives

Answer 8

Patient self-determination act:

Question 9

• person appointed by a judge to act on behalf of a minor when the court system has determined that the minor requires protective oversight of person and estate, not all state offer

Answer 9

Court appointed guardian

Question 10

-person or organization appointed by the court to care for an adult who cannot care for self or manage life eof decisions

Answer 10

court appointed conservator

Question 11

• person who is authorized to make a decision on behalf of another who is incapacitated, next of kin have been considered the natural, family members for the consent

Answer 11

surrogate

Question 12

1. Patient family expectations
   
   2. Palliative care planning
   3. Verbal and non-verbal communication
   4. Listening/ silence
   5. Presence
   6. Guidelines for encouraging free conversation

Answer 12

BARRIERS TO COMMUNICATION
2. Myths/Realities of communication
A. Communication process

Question 13

A. Family system
B. Financial/educational
C. Physical Limitations
D. Health care professional

Answer 13

Factors Influencing Communication

Question 14

1. Lack of continuity of care among caregivers

2. Lack of support (physical or emotional) among family members

Answer 14

Factors Influencing Communication

Family system

Question 15

: Financial insecurity/ Anxiety, stress, grief/ Inability to comprehend/communicate

Answer 15

Factors Influencing Communication

Financial/educational

Question 16

Sensory changes, Sleep deprivation, Inability to comprehend/communicate

Answer 16

Factors Influencing Communication

Physical Limitations:

Question 17

1. Behaviors and communication style be aware
   
   2. Communication barriers
   3. Family meetings/ breaking bad news
   4. Communication strategies to facilitate end-of-life decision

Answer 17

Factors Influencing Communication

Health care professional

Question 18

: review medical issue and history, coordinate health care team, discuss goals of meeting with team, identify a meeting leader among the health care team, discuss with family members, arrange private quiet and location, minimize distractions

Answer 18

Recommendations for conducting a family meeting

1. Prepare for meeting

Question 19

: intro all in attendance, review med situation, establish goal of meeting “everyone understands and answer all questions”

Answer 19

Recommendations for conducting a family meeting

Open the meeting

Question 20

: ask family question “what do you know about the patient’s conditions” Follow up question: is there anything that isn’t clear that we can help to explain”

Answer 20

Recommendations for conducting a family meeting

Elicit family understanding

Question 21

A. open ended questions= what are your hopes? What are important for the patient?
B. understand ethnic and cultural influences
C. maintains focus on the pts perspectives, can help to relieve guilt that family members may feel over making decisions
D. dealing with decisions that need to be made:
E. close the meeting
follow up on the meeting

Answer 21

Recommendations for conducting a family meeting

Elicit Patient and Family Values and Goals:

Question 22

offer brief summary, ask for any final questions, statement of appreciation and respect for the family, make a clear follow up plan family and how to contact health care team

Answer 22

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
E. close the meeting

Question 23

document the meeting in chart, follow up any information or reassessment agreed upon during the meeting

Answer 23

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
follow up on the meeting

Question 24

common understanding of issues, “have you decided what you want and don’t want?”, open ended assessments then specific interventions, offer clear recommendations, coming to an understanding, check understanding of decision s made

Answer 24

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
dealing with decisions that need to be made:

Question 25

2. : factual content, style of pt statements, emotional content

Answer 25

6 step protocol for breaking bad news | finding out how much the pt know

Question 26

1. physical context right 2. finding out how much the pt know: 3. find out how much the pt wants to know 4. sharing medical communication: 5. responding to the pts feelings 6. planning and summarizing:

Answer 26

6 step protocol for breaking bad news

Question 27

align, educate, give info in small amounts, use lamen terms, check reception frequently, reinforce the info, blend concerns and anxieties

Answer 27

6 step protocol for breaking bad news | 4. sharing medical communication:

Question 28

identify coping of pt and reinforce, other sources of support for the pt

Answer 28

6 step protocol for breaking bad news | 6. planning and summarizing:

Question 29

presence during cpr

Answer 29

``` in or out introduction now outcome relationship option understanding time ```

Question 30

Family Presence yourself as a nurse, clearly short sentences, use pt name

Answer 30

during CPR: in or out | Introduction:

Question 31

explain pt current status, lamen terms when explaining

Answer 31

during CPR: in or out | now

Question 32

explain the possible results, realistic don’t give false hope, say work die

Answer 32

during CPR: in or out | outcome

Question 33

learn who makes the decisions, next of kin

Answer 33

during CPR: in or out | relationship

Question 34

: assess comprehension, prepare the family for what see and hear, reassure they can leave if they wish

Answer 34

during CPR: in or out | understanding

Question 35

take action, when is it time to go in, alert healthcare team that family is entering the room, if family behavior is disruptive let the family know behavior is making it hard for the healthcare team to do their best work

Answer 35

during CPR: in or out | time

Question 36

Interdisciplinary team, Resolving conflict

Answer 36

Team Communication:

Question 37

: loss for words at least say I am sorry for your loss, it is okay to say I don’t know

Answer 37

. Summary | eof

Question 38

- be prepared, be brief, tell the truth, listen carefully, be reassuring, be yourself : gear info toward dev age younger concrete and older abstract, begin with child experiences : begin with basic info : look for clues to talk, accept w.e emotion is presented : ask to summarize what they heard, clarify misunderstandings : books movies, name people who have had it

Answer 38

``` Talk to children about death: Begin on the child’s level: Let the child’s questions guide Provide opportunities for the child to express feelings Encourage feedback Use of other resources ```

Question 39

): death is temporary and reversible, death is mixed up with trips and sleep, may wonder what the deceased is doing

Answer 39

Children’s understanding of death: | 3-5 (preschool

Question 40

think about finality and biologic process of death, death is related to mutilation, spirit gets you when you die, who cares for them if parent die, their actions and words caused the death

Answer 40

6-9 death understanding

Question 41

understanding and finality of death, show their feelings they are weak, need to be in control of their feelings, actions and words caused the death

Answer 41

12 and older (teenagers): | death understanding

Question 42

experience the world through sensory information: aware of tension and separation, comfort by familiar people

Answer 42

Children’s concepts of death: | Infancy 0-2:

Question 43

death as reversible death is not personalized, magical thinking, don’t believe it could happen to them, think they caused death bc wished go away

Answer 43

Children’s concepts of death: | Early childhood 2-6:

Question 44

: personalize death, aware death is final, death is caused by and event then later age cause by illness

Answer 44

Children’s concepts of death: | Mid childhood 7-12

Question 45

: appreciate universality of death my feel distant, engage in risky behavior

Answer 45

Children’s concepts of death: | Adolescence

Question 46

The Grief Process:

Answer 46

Loss, grief, mourning, and bereavement

Question 47

physical emotional cognitive and behavioral actions to death

Answer 47

Grief:

Question 48

: reaction of the survivor to the death of a family member or close friends

Answer 48

Bereavement

Question 49

: grief before loss

Answer 49

Anticipatory grief

Question 50

: regular feelings, behaviors, and reactions to loss

Answer 50

Normal grief

Question 51

normal grief reactions that do not subside and continue over very long periods of time

Answer 51

Complicated grief | 1. chronic grief:

Question 52

chronic grief delay grief exaggerated grief masked grief

Answer 52

Complicated grief

Question 53

normal grief reactions that are suppressed or postponed,survivor consciously or unconsciously avoids the pain of the loss

Answer 53

delay grief:

Question 54

survivor resorts to self-destructive behavior such as suicide, drugs, alcohol

Answer 54

exaggerated grief:

Question 55

: survivor is not aware that behaviors that interfere wit normal function are a result of loss

Answer 55

Masked grief

Question 56

. Risk factors: sudden losses: heart attack, stroke, tragic death, Violent death: suicide, homicide/ multiple losses/ child loss

Answer 56

complicated grief

Question 57

loss cannot be openly acknowledged or socially sanctioned, not recognized by employers, biological family,

Answer 57

Disenfranchised grief:

Question 58

At risk: aids partners, ex-spouses, step parent child, terminated pregnancy

Answer 58

Disenfranchised grief:

Question 59

mourn, grieve based on their development level, in spirts, act out=behavioral changes - Based on age and developmental level

Answer 59

Children’s grief:

Question 60

nervousness, uncontrollable rages, frequent sickness, accident proneness, antisocial behavior, rebellious,hyperactivity, nightmares, depression, memories fading in and out, excessive dependency on remaining parent

Answer 60

Symptoms of grief in younger children:

Question 61

difficulty concentrating, forgetfulness, poor school work, insomnia, social withdraw, over dependence or regression, talk of attempted suicide, nightmares, frequent illness, depression, alcohol or drugs, sexual promiscuity, compulsive behavior

Answer 61

Symptoms of grief in older children:

Question 62

1. Notification/shock 2. Experience the loss 3. Reintegration

Answer 62

Stages and tasks of grief

Question 63

A. Who it includes B. When it occurs C. Nursing assessment of grief

Answer 63

. Grief Assessment

Question 64

1. Type of grief 2. Grief reactions 3. Stages and tasks of grief 4. Factors that affects the grief process 5. Caregiver assessment

Answer 64

C. Nursing assessment of grief

Question 65

-Plan of care, Attitude, Cultural practices, What to say, Children and parents

Answer 65

Bereavement Interventions

Question 66

1. Decrease in sense of loss 2. Is advance directive in place? 3. Emotional support 4. Encourage verbalization 5. Assist with role changes, education and/or resources 6. Encourage life review 7. Educate the patient/family about dying process 8. Encourage patient/family to complete unfinished business 9. Provide presence, active listening, touch and reassurance

Answer 66

Anticipatory grief

Question 67

1. Presence, active listening, touch, silence 2. Identify support systems 3. Use bereavement specialists, bereavement resources 4. Normalize grief process and individual differences 5. Individualize the grief process 6. Actualize the loss and facilitating living without the deceased 7. Identify and express feelings 8. Disenfranchised grief- acknowledgement 9. Public funerals, memorial services, rites, rituals and traditions: private rituals 10. Spiritual Care 11. Recognizing developmental stage of children 12. Identify need for additional assistance and making referrals

Answer 67

Grief interventions

Question 68

``` A. Witness to futile treatments B. Moral Distress C. Personal death awareness D. Cumulative loss E. stages of adaptation for the nurse F. Factors influencing the nurse’s adaptation process ```

Answer 68

The nurse: death anxiety, cumulative loss, grief

Question 69

1. Professional education 2. Personal death history 3. Life changes 4. Support system

Answer 69

The nurse: death anxiety, cumulative loss, grief

Question 70

1. Balance | 2. Assessing support systems: formal, informal, instructor

Answer 70

Systems of support for healthcare provider

Question 71

medical futility- prolonged suffering, denial of palliative care services, nurse experience moral distress

Answer 71

Compassion fatigue nurses witness:

Question 72

- can take a toll, burn out from setting, death on frequent basis

Answer 72

Cumulative loss | nurses

Question 73

: finding meaning in your work, balance, assessing support systems, spiritual support, education in eof care, self-care strategies

Answer 73

Systems of support | nurses

Question 74

- nursing does not end with the death of patent A. Bereavement care continues after death B. Assessment with ongoing intervention C. Recognize own grief D. Bereavement care is interdisciplinary

Answer 74

Conclusion loss grieving and berevament

Question 75

provide support to staff and patients/families, interpersonal competence, being present, bearing witness, interdisciplinary care B. Dying is an individualized, personal experience C. The nurse as advocate- no typical death

Answer 75

Final Hours | A. The nurse, dying and death:

Question 76

= with present and listening, education, and support in any practice setting A. Open, honest communication as death approaches B. The dying older adult

Answer 76

Patient and family preparation through advocacy, communication

Question 77

signs, symptoms, and nursing interventions/ - sleepy lethargic obtunded semicomatose comatose dead - rest confused tremulous hallucinations, myoclonic jerks seizures - pain control, palliative sedation for difficult road

Answer 77

Two roads to death: easy hard

Question 78

``` A. Determining prognosis B. Psychological and spiritual symptoms C. Artificial nutrition and hydration at the end of life D. Frequency of common symptoms E. Physical signs and symptoms vary ```

Answer 78

two roads of death

Question 79

1. Fear of the dying process, abandonment, unknown 2. Nearing death awareness 3. Withdrawal from family, friend and/or caregivers 4. Increased focus on spiritual issues

Answer 79

two roads of death | psychological and spiritual symptoms

Question 80

1. Confusion, disorientation, delirium: 2. Unconsciousness: 3. Weakness/fatigue: 4. Surge of energy 5. Drowsiness/sleeping: edu family 6. Restlessness/agitation: 7. Fever 8. Bowel changes 9. Decreased oral intake: 10. Incontinence 11. Pain:

Answer 80

Physical signs and symptoms vary

Question 81

implement safety measures, speak clearly, home care respite care for caregiver, assess cause and treat

Answer 81

Confusion, disorientation, delirium: | intervention and symptom

Question 82

: continue to speak to patient while doing care, educate family, peaceful settings, family say what they need to say, spiritual needs

Answer 82

Unconsciousness intervention and symptom

Question 83

increase assistance with adls, equipment, rom, respite care for family, social work for anticipatory grief, increase support, answer questions honestly

Answer 83

Weakness/fatigue: intervention and symptom

Question 84

common in final hours, multiple causes

Answer 84

Restlessness/agitation: intervention and symptom

Question 85

increased because progression, assess frequently, adjust meds, listen to concerns

Answer 85

pain intervention and symptoms

Question 86

A. Assessment and management of pain is critical B. Opioids C. Accumulation of metabolites D. Myoclonus-up dose of opioids

Answer 86

Pain during the final hours of life

Question 87

-Sedation, Treatment, Comfort measures/emotional support

Answer 87

Intractable pain and other symptoms at the end of life

Question 88

A. Universal symptoms of imminent death B. Management of symptoms related to imminent death C. The death vigil

Answer 88

6. Imminent Death

Question 89

1. Decreased urine output 2. Cold and mottled extremities 3. Vital sign changes 4. Respiratory congestion including respiratory bubbling 5. Death rattle 6. Delirium and confusion 7. Restlessness

Answer 89

imminent death universal symptom

Question 90

1. Family desires/preferences: pain control, comfort care, do they want to be present 2. Common fears 3. Nursing interventions- never jump in to assess for death wait till family is ready 4. Honor culture

Answer 90

The death vigil

Question 91

``` A. Communicating the death B. Signs and symptoms of death 1. Absence of heart beat/ respiration 2. Pupils fixed 3. Color and Body temperature drops 4. Muscles, sphincters relax ```

Answer 91

8. Death

Question 92

A. Preparing the family B. Nursing responsibilities for care after death C. Death of a parent: Care for the child

Answer 92

Care immediately following death

Question 93

1. Removal of tubes, medical supplies and equipment 2. Bathe, dress and position the body 3. Plans for burial/embalming 4. Removal of the body 5. Assistance with phone call and notification of other healthcare providers 6. Destroy medications (when death occurs at home) 7. Assist with funeral arrangements, as needed and requested 8. Initiate bereavement support 9. Organ/tissue transplantation

Answer 93

Nursing responsibilities for care after death

Question 94

A. Allow to verbalize feelings; refer at risk staff B. Organize memorial services and rituals C. Serve as role model

Answer 94

Supportive staff eof

Question 94

Process it takes to deal with. The void, adapting to changes

Answer 94

Mourning