Perspectives on End-of-Life Care Flashcards
Exam 4 (Final)
Introduction: End-of-Life Issues
What do people usually want- having to do with death?
People want a “good death.”
Introduction: End-of-Life Issues
Nurses have an essential role in providing end-of-life (E O L) care by:
Nurses have an essential role in providing end-of-life (E O L) care by:
improving symptom management;
communication;
and education about choices, referrals, and psychosocial treatments.
Introduction: End-of-Life Issues
What do nurses need to do?
Nurses need to explain options and provide referrals and resources to older adults and their families.
Introduction: End-of-Life Issues
What do we need to be aware of?
our own attitudes, values, and beliefs regarding death
Introduction: End-of-Life Issues
What is the nursing care goal?
The nursing care goal is to explore how to assist older adults to die well through the excellent care and support we provide them as they approach the end of their lives.
Dying, Death, and Palliative Care
Dealing with dying reflects what?
Dealing with dying reflects one’s own culture and how a person responded to earlier losses
Dying, Death, and Palliative Care
Nurses need to be prepared to be how?
Nurses need to be prepared to be a positive influence for appropriate E O L issues.
Dying, Death, and Palliative Care
Nurses need to be prepared to be a positive influence for appropriate E O L issues.
What do they need to be educated in? Skilled in? What do they need to provide?
Be educated in E O L issues.
Provide older adults with high quality of life and a good death.
Be skilled at teamwork with other caring professionals, families, and the dying person.
Dying, Death, and Palliative Care
Nurses need to be prepared to be a positive influence for appropriate E O L issues.
What do nurses need to communicate?
communicate issues, listen and work closely with family members when trying to fulfill patient wishes, work as a team with other caring professionals, maintain a positive and open work environment and apply the guiding principles of gerotranscendence for yourself and your patients
Perspectives on End-of-Life Care
How is dying perceived in cultures? How is it in western culture?
Culturally diverse perspective on death and dying (Western culture tends to deny or ignore death)
Perspectives on End-of-Life Care
What exerts a strong influence on end of life?
Cultural perspective exerts strong influence
Perspectives on End-of-Life Care
What are perceptions of good death?
Perceptions of good death - Good death viewed as aging well
Perspectives on End-of-Life Care
How do older adults typically view death?
Older adults are more aware and accepting of inevitability of death
Perspectives on End-of-Life Care
Older adults are more aware and accepting of inevitability of death:
What is there an acceptance of?
Acceptance of hospice and palliative care
Perspectives on End-of-Life Care
Older adults are more aware and accepting of inevitability of death:
What are there lines of communication about?
Lines of communication about pending death and end-of-life decisions
Perspectives on End-of-Life Care
Older adults are more aware and accepting of inevitability of death:
What are there expectations about?
Expectations about medical interventions
Perspectives on End-of-Life Care
Older adults are more aware and accepting of inevitability of death:
What else are they concerned about?
Place where death occurs
Practices and rituals
Decisions about autopsy or organ donation
Trend in Providing End-of-Life Care
What matters to older adults?
cost of care and quality of care
Trend in Providing End-of-Life Care
Gaps In care: What is there a call to action for?
Gaps In care – call for action to develop competence in addressing complex decisions and clinical aspects related to end of life care.
Trend in Providing End-of-Life Care
Holistic nursing:
Bringing back the goodness, compassion, peace, dignity, and release related to end of life.
Trend in Providing End-of-Life Care
Nursing :Measures that indicate quality care:
- Increase in the number of staff trained in palliative care
- Increase in the use of hospice services
Hospice and palliative care
What is it?
interdisciplinary approach to care that holistically addresses the needs of persons with life-limiting conditions along with their families and others who care for and about them.
Hospice and palliative care
What is the objective of both?
Objective of both hospice and palliative care is pain and symptom relief. T
Hospice and palliative care
How do they differ?
The prognosis and goals of care tend to be different between the two.
Hospice and palliative care
What is hospice specifically?
Hospice is comfort care without curative intent.
Hospice and palliative care
What is palliative care specifically?
Palliative care is comfort care with or without curative intent.
Hospice and palliative care
Payment: more than 90 percent of hospice care is paid for through what?
Because more than 90 percent of hospice care is paid for through the Medicare hospice benefit,
Hospice and palliative care
Because more than 90 percent of hospice care is paid for through the Medicare hospice benefit- What does this mean?
Because more than 90 percent of hospice care is paid for through the Medicare hospice benefit, hospice patients must meet Medicare’s eligibility requirements;
palliative care patients do not have to meet the same requirements ( private insurance/private pay)
Hospice Care Definition
Hospice Care Definition Compassionate comfort care (as opposed to curative care) for people facing a terminal illness with a prognosis of six months or less, based on their physician’s estimate if the disease runs its course as expected.
Hospice Care: philosophy of care that does what?
philosophy of care that seeks to support dignified dying for the person and their families and caregivers
Hospice treats what? What is it?
Hospice treats the person not the disease; cost-effective alternative
Hospice Care:
Nursing Treatment during Hospice Care: What is NOT done?
Nursing Treatment during Hospice Care –no extending life treatment is provided ( no TPN, no chemo, no special assessments, PT /OT for hoyer transfer only.
Hospice Care:
Nursing Treatment during Hospice Care: What is PT/OT for?
PT /OT for hoyer transfer only.
Hospice Care:
Nursing Treatment during Hospice Care: What is the only intervention provided?
The only intervention is providing an opioid analgesic.
Main goal of hospice care?
- improving quality of care at end of life and cutting costs
Hospice Care: What is the eligibility criteria?
Eligibility Criteria: requires that two physicians certify that the patient has less than six months to live if the disease follows its usual course
Hospice care is available to who?
Hospice careis available for patients considering stopping curative treatments because they aren’t working or the side effects outweigh the benefits.
Palliative Care definition
compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness.
Palliative Care: When can it be pursued?
Palliative care can be pursued at diagnosis, during curative treatment and follow-up, and at the end of life.
Palliative care: What does it optimize?
Palliative care: patient and family-centered care optimizing quality of life by anticipating, preventing, and treating suffering;
Palliative Care: Is a method that does what?
method that improves quality of life of older adults and their families facing the issue associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment, treatment of pain, and other physical, psychosocial, and spiritual difficulties
Palliative care is considered a stepping stone for what?
“Stepping-stone” to hospice
The desired outcome of palliative care is what?
The desired outcome of palliative care is always comfort
Palliative Care:
Scope of palliative care: how it? What does it address? What does it facilitate?
broad;
addresses physical, intellectual, emotional, social, and spiritual needs;
and facilitates older adult’s choice, autonomy, and access to information.
Eligibility Criteria: Palliative care
Eligibility Criteria: Palliative careis begun at the discretion of the physician and patient at any time, at any stage of illness, terminal or not.
Palliative Care: people are eligible if what?
People are eligible forpalliative careif they are living with a serious illness – at any stage — and need solutions for pain, symptoms, and stress due to the serious illness, or the treatments to cure or manage it.
Palliative Care: WHO can it be provided for?
Palliative care can be provided to someone who may be cured of their disease,
a person who will live with their condition for a long time,
a person who has a progressive illness ,
or to a family needing explanations and support in order to make difficult care decisions during routine hospitalizations or times of crisis in the Emergency Department or Intensive Care Unit.
Slide 9
Is the following statement true or false?
Hospice care can be provided in the home, freestanding inpatient care centers, nursing homes, or the hospital
True
Hospice services are provided by public and private agencies in home or facility-based settings or in freestanding, short-term residential facilities
Promoting Wellness at the End of Life
Wellness at the end of life connected to what?
Wellness at the end of life connected to a “good death”
Promoting Wellness at the End of Life
Dignified death=
Dignified death = dignified care
Promoting Wellness at the End of Life
Nursing role:
Nursing: Empower the client and family to maintain as much control as possible.
Promoting Wellness at the End of Life
Nursing role: Empower the client and family to maintain as much control as possible.
What does this mean?
Treated as individual and with respect
Maintain personal independence by assisting with meeting basic needs
Involved in decision making regarding treatment or the choice to stop treatment
Safe and private environment
Good communication
Absence of anxiety
Core theme about what constitutes a good death includes:
preferences for specific dying process,
pain free status,
religiosity and spirituality
emotional well being,
quality of life,
life completion,
treatment preferences,
dignity,
presence of family,
and relationship with health care providers
Nursing Skills and Interventions for End of Life #1
Nursing skills for quality end of life:
Symptom management? communication? Discussion about? Support?
Aggressive and comprehensive symptom management
Open and honest communication about prognosis, treatment, and dying process
Ongoing discussion of patient’s goals of care
Psychological and spiritual support for patients and families- is essential
Nursing Skills and Interventions for End of Life #1
What tool is used? What services are provided?
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool (on classes)
Bereavement services
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
What does FICA stand for?
F FAITH AND BELIEF
I IMPORTANCE
C COMMUNITY
A ADDRESS IN CARE
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
F FAITH AND BELIEF: What is asked?
- Do you consider yourself spiritual or religious?
- Do you have spiritual beliefs that help you cope with stress?
If the patient answers “No,” the health care provider might ask,
* What gives your life meaning?
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
F FAITH AND BELIEF: How do patients usually respond?
Sometimes patients respond with answers such as family, career, or nature.
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
I IMPORTANCE: Questions to ask?
- What importance does your faith or belief have in your life?
- Have your beliefs influenced how you take care of yourself in this illness?
- What role do your beliefs play in regaining your health?
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
C COMMUNITY: What are the questions?
- Are you part of a spiritual or religious community?
- Is this of support to you and how?
- Is there a group of people you really love or who are important to you?
Nursing Skills and Interventions for End of Life #1
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
A ADDRESS IN CARE: Questions to ask?
- How would you like me, your healthcare provider, to address these issues in your healthcare?
Nursing Skills and Interventions for End of Life #2
What is critical for al involved in EOL?
Communication: critical for all involved
Nursing Skills and Interventions for End of Life #2
Why is communication magnified in EOL?
Importance magnified due to complexity and uncertainty of situation
Nursing Skills and Interventions for End of Life #2
How should you listen?
Listen reflectively to both the patient and family with compassionate presence
Nursing Skills and Interventions for End of Life #2
By listening to the patient, what should you demonstrate? What should you offer?
Demonstrate empathy and ability to journey in suffering
Offer sensitivity
Nursing Skills and Interventions for End of Life #2
What are you addressing?
Addressing needs of the family
Decision-Making at The End of Life
What should you be aware of?
Be aware of the decisions a person has made about his or her current and future medical care.
Decision-Making at The End of Life
What should you protect?
Help protect the patient’s right to make his or her own health-care choices.
Decision-Making at The End of Life
What are Advance directives?
Written documents that outline patient’s wishes about life-sustaining treatments
Decision-Making at The End of Life
What are nurses obligated to know?
Nurses have an obligation to know the legal requirements in their jurisdictions and then work with the older adult and the family to determine how the local laws can fit with their cultural patterns and needs related to end-of-life decisions.
Cultural Barriers to the Use of Advance Directives and Hospice
What could there be a distrust of?
- Distrust of the health care system (especially in groups who have experienced violence or discrimination in the United States or their country of origin)
Cultural Barriers to the Use of Advance Directives and Hospice
Collectivism
Family rather than individual is “decision-maker”
Cultural Barriers to the Use of Advance Directives and Hospice
What might there be a preference for?
- Preference for physician, as expert, to make the decision
Cultural Barriers to the Use of Advance Directives and Hospice
What could there be a taboo for?
- Taboo to talk about death or dying
Cultural Barriers to the Use of Advance Directives and Hospice
What could there be an influence of?
- Influence of faith and spirituality: Illness as a test of faith
Cultural Barriers to the Use of Advance Directives and Hospice
What could there be a belief about life? Death?
- Belief that life is a gift from God that must be protected
- Death as a part of the cycle of life and must not be disturbed
Cultural Barriers to the Use of Advance Directives and Hospice
Dying away from home can lead to?
- Dying away from home may lead to a disturbance of the spirits
Cultural Barriers to the Use of Advance Directives and Hospice
Dying at home can lead to?
- Cannot die at home because the spirit will linger
A new nurse is talking to the family of a client who recently died. What is the priority nursing action to address the family’s emotional needs?
A. Giving the family as much time with the client as they need.
B. Educating the family that they are likely to feel angry in the short term.
C. Encouraging the family to go home and get some rest.
D. Collecting the client’s belongings and returning them to a family member.
Correct answer is A.
The priority action is to give the family as much time with the client as they need. Holistic care should be provided for the client and the family.
It would be presumptuous of the nurse to assume that anger would be the family’s most immediate emotion.
Rest is important but quality time with the ill family member is a priority.
Collecting belongings does not address the family’s emotional needs.
Common physical signs and Symptoms of EOL?
Fatigue
Constipation
Dyspnea
Nausea/Vomiting
Dehydration
Anorexia/cachexia
Signs of imminent death
Breathing changes (dyspnea with apneic periods)
Audible congestion (death rattle)
Decreased level of consciousness/terminal delirium
Extremity cooling, pallor, mottling
Decreased food and fluid intake
Urinary and fecal incontinence
Signs of imminent death
How is breathing?
Breathing changes (dyspnea with apneic periods)
Audible congestion (death rattle)
Signs of imminent death
How is LOC?
Decreased level of consciousness/terminal delirium
Signs of imminent death
How are extremities? Food and fluid intake?
Extremity cooling, pallor, mottling
Decreased food and fluid intake
Nursing Skills Needed for End-of-Life Care
Have ability to talk to patients and families about dying.
* Be knowledgeable about pain and symptom control.
* Have ability to provide comfort-oriented nursing interventions.
* Recognize physical changes that precede imminent death.
* Deal with own feelings.
* Deal with angry patients and families.
* Be knowledgeable and deal with the ethical issues in administering end-of-life palliative therapies.
* Be knowledgeable and inform patients about advance directives.
* Be knowledgeable of the legal issues in administering end-of-life palliative care
Is the following statement true or false?
Including family members in their loved ones’ dying process ultimately has a positive impact on the experience
True
Beneficial aspects of end-of-life care are nursing interventions that include families as well as the patient, as nurses assist patients and families with end-of-life tasks and teach families about the signs of imminent death and management of the dying process
The Medical Pause
How is The Pause executed?
Anyone can ask to do this following a code/death..
“Could we take a moment just to Pause and honor this person in the bed. This was someone who was alive and now has passed away. They were someone who loved and was loved. They were someone’s friend and family member. In our own way and in silence let us stand and take a moment to honor both this person in the bed and all the valiant efforts that were made on their behalf.”
45 seconds to a minute of silence.
“Thank you everyone.”
