Nurb Final end of life

Question 0

, research on dying in America, doing in America improving quality at and near end of life=pt value, goal, preferences

Answer 0

IOM- Institute of Medicine

Question 1

educating nurses in all 50 states and teach as many nursing program s as possible, 3 days training

Answer 1

ELNEQ-

Question 2

The study to understand prognosis (outcome, how long) preferences for outcome (quality of life=say they want to die and how and where they actually die) risk of treatment (ethnic issues)

Answer 2

A. Three major studies in the last decade paint a grim picture of the experience of dying for patients and families

Question 3

means to a better end

-more than ¼ die in 7 days when entered into hospice, need to access earlier on

Answer 3

last acts

Question 4

1-2 days, maybe a week to a few weeks, body is shutting down

Answer 4

Actively dying:

Question 5

• 2 main fears of dying and death= don’t want be a burden or financial burden/ fear that they will be in pain
• Nothing more can be done= need to refer to hospice, fear that health care providers will abandon them
• Adjusting to changes in roles
• Drain life savings and go bankrupt
• Older adults are cared for by older parent (70 and 90 yr old)

Answer 5

Toll of death and dying on pt and family

Question 6

providing symptom management and discussing emotional aspects of disease (focus on quality not quantity)
Post: physician order for scope of tx- are they a DNR=outpt, power of attorney

Answer 6

Good quality care at end of life:

Question 7

• on average 78 years, more older adults living with chronic illness, technology prolonging inevitable , health care cost, lack of control over risking drug and device cost, failure to treat pain and other symptoms

Answer 7

Death and dying in America:

Question 8

: frequent emergency room visits, increase of inpt admission, promote suffering, increase risk of depression and anxiety, promote complicated bereavement, prevent delay in hospice care

Answer 8

Advanced illness ad care involved

Question 9

a.comfort, not a whole lot they could do for pt, cause of death was infectious disease= no vaccines, age died 50, site of death at home with family and relatively short disease trajectory

Answer 9

Early 1900’s:

Question 10

b. cure goal, cause of death more chronic illness bc living longer, age 77.8 , die in an intuition being cared for by stranger and prolonged disease trajectory
- less than 10 percent are sudden=mi, trauma

Answer 10

Early and middle 1900’s:

Question 11

= pancreatic cancer

trajectory

Answer 11

steady decline short terminal phase

Question 12

• gradually going downhill short time in hospital Ex: COPD, kidney failure, congestive heart failure, and organ system failure

Answer 12

Slow decline and periodic crises

Question 13

frail elderly, will die eventually from disease but not actively dying Ex: fall and broke hip never bounce back, Parkinson, degenerative diseases, cerebral palsy

Answer 13

Lingering or expected death-

Question 14

1. The realities of life limiting-disease
2. Lack of adequate training of professionals
3. Delayed access to hospice and palliative care services

Answer 14

Barriers to quality care at the end of life

Question 15

i. Services well not well understood: counseling for family; Chaplin nurse social workers, interdisciplinary care / lack of understanding by public= Medicare does pay for some
ii. Rules and Regulations
iii. Denial of death

Answer 15

Delayed access to hospice and palliative care services

Question 16

• concept of care delivery, physician has to say 6 months/ must have volunteer to help out it is key
  a. History- use to designate waste system on the journey of pilgrimage

Answer 16

A. Hospice

Question 17

b. - prognosis expected to die in 6 months, congress decided on the amount of time= early 1980s Florida decided Medicare would offer payment for end of life services for 18 months can’t afford to pay for so long so 6 months
- still alive at end of 6 months and revaluate= better can do alive discharge can come back in
- still met criteria renew for 6 months again

Answer 17

hospice

Eligibility

Question 18

• Medicare Medicaid, most private health insurers/ only pay for things directly for care other things will stay being paid for by the other providers, enroll in Medicare approved program

Answer 18

Payment:

hospice

Question 19

1. Interdisciplinary care
2. Medical appliances and supplies
3. Drug for symptoms and pain relief
4. Short term inpatient and respite care
5. Homemaker/ home health aide
6. Counseling
7. Spiritual care
8. Volunteer services
9. Bereavement

Answer 19

hospice services

Question 20

communicating with multiple health care providers, patient and family on the team=what they want, Pharmacist OT PT dietary Chaplin

Answer 20

interdisciplinary care hospice

Question 21

• family gets a break from taking care of pt, can go to home and mow lawn or go grocery shopping, free services

Answer 21

Volunteer services- Respid care

hospice

Question 22

• counseling after patient die, help out with grieving in the aftermath, 13 months goes through all important events that happen and anniversary date of death, can continue

Answer 22

Bereavement services

hospice

Question 23

• emphasis on quality over quantity, strictly comfort, can still receive curative services= chemo, dialysis
• don’t have to be dying to receive must have serious life threatening illness and don’t have to be in terminal phase, time factor not a piece
  a. Eligibility- anyone can get it if they have life threatening disease
  b. Confusion of blending

Answer 23

Palliative Care

Question 24

a. The patient and family as the unit of care
b. Attention to physical, psychosocial, social and spiritual needs
c. The interdisciplinary team (IDT)
d. Education and support of patient and family
e. Bereavement support

Answer 24

General principle of palliative care

Question 25

curative for a long time, palliative a little, then barely any hospice
Palliative care: disease modifying treatment most time overlap with palliative care and hospice, will do bereavement support after death

Answer 25

Continuum of care:

Question 26

physical well being
psychological well-being
social well- being
spiritual well-being

Answer 26

quality of life model

A. Addressing multiple dimensions of care to achieve quality palliative care

Question 27

a. most focused on-functional ability, strength/fatigue, sleep and rest, nausea

Answer 27

Physical well-being:

quality of life model

Question 28

: anxiety, depression, enjoyment/leisure, pain distress

Answer 28

quality of life model

b. Psychological well-being

Question 29

c.: financial burden, caregiver burden

Answer 29

quality of life model

Social well-being

Question 30

d. big piece when thinking about quality of life hope, meaning, suffering

Answer 30

quality of life model

Spiritual well-being

Question 31

– where are they right now and where they would like to be, look at suffering

Answer 31

Meaning of “quality of life”

Question 32

• what does it mean, ask what they hope for right now Ex: make it to daughter’s wedding

Answer 32

Maintaining hope

Question 33

prevent and manage symptoms, encourage to transcend their current situation, encourage aesthetic experiences, lighteheartedness and humor appropriateness, Suggest books films and art that is uplifting and highlight the joy, encourage reminiscing, assist to focus on present and past joy, share positive hope inspiring stories, support in positive self-talk

Answer 33

Experimental processes:

maintaining hope

Question 34

: facilitate participation in religious rituals and spiritual practices, necessary referrals to clergy and spiritual support people, assist in finding meaning in current situation and keep a journal, suggest book fill and art to explore suffering

Answer 34

Spiritual/transcendent processes

maintaining hope

Question 35

• minimize isolation, keep open relationship, sense of self-worth, hopefulness between pt and support system, pt identify significant others and then reflect on personal characteristics and experiences that endear, communicate sense for hopefulness

Answer 35

Relational processes

maintaining hope

Question 36

: goals without own agenda, identify available and needed resources to meet goals, assist in breaking larger goals into smaller steps, give accurate information, facilitate reality surveillance as appropriate, help identify past success, increase sense of control when possible

Answer 36

Rational thought processes

maintaining hope

Question 37

Tools for palliative care

Answer 37

assessment tools and prognositcation tools

Question 38

prognositication tools

Answer 38

2 parts forseeing and foretelling

Question 39

A. Nurses can establish and impact the quality of care
B. Use of presence: therapeutic
C. Maintaining a realistic perspective: cannot be fixed
D. Nurses are the constant across all settings
E. Expand concept of healing: not for a cure what is it they hope for to provide quality across life, goes across lifespan
F. Education

Answer 39

Role of the nurse

palliative care

Question 40

A.Quality care
B. Professional knowledge and skill: I need to know to help all
C. “doing for” and “being with”
D. nurses play a vital role in improving care

Answer 40

palliative care conclusion