1/8/2018. Chapter 55. End-of-Life Care

Transcription

1 Chapter 55 End-of-Life Care Some deaths are sudden; others are expected. Health team members see death often. Death and dying mean helplessness and failure to cure. Your feelings about death affect the care you give. You will help meet the dying person s physical, psychological, social and spiritual needs. Therefore you must understand the dying process. Then you can approach the dying person with care, kindness, and respect. 1

2 Terminal Illness Is an illness or injury for which there is no reasonable expectation of recovery Many illnesses and diseases have no cure. Some injuries are so serious that the body cannot function. Recovery is not expected. Cont. Doctors cannot predict the exact time of death. The person may have days, weeks, months, or years to live People expected to live a short time have lived for years. Others expected to live longer have died sooner than expected. Cont. Modern medicine has found cures or have prolonged life in many cases. Research will bring new cures. Hope and the will to live strongly influence living and dying. Many people have died for no apparent reason when they have lost hope or the will to live. 2

3 Attitudes about Death Experiences, culture, religion, and age influence attitudes about death. Some fear death Others don t believe they will die Some look forward to and accept death Attitudes change as people get older & with changing circumstances. Cont. Dying people often need hospital, nursing center, hospice, or home care. The family is often involved in the person s care. They usually gather at the bedside to comfort the person and each other. When death occurs the funeral director is contacted Cont. For some adults and children they have never had contact with a dying person. Have not been present at the time of death, nor have they ever attended a funeral. Therefore, it is frightening, morbid and a mystery. 3

4 Culture & Religion See caring about culture In some cultures, dying people are cared for at home by the family. Some prepare the body for burial. Attitudes about death are closely related to religion Age Adults fear pain and suffering, dying alone and the invasion of privacy. Also fear loneliness and separation from loved ones. Worry about who will care for those left behind Resent death because it affects plan, hope, dreams, and ambitions The Stages of Dying Dr. Elisabeth Kubler-Ross five stages of dying Denial Anger Bargaining Depression Acceptance 4

5 Comfort Needs Comfort is a basic part of end-of-life care Caring about culture It involves physical, mental, and emotional, and spiritual needs Often need to talk during the night, when things are quite and distractions are few Listening the person may need to talk and share worries and concerns. You need to listen! Touch shows care and concern when words cannot. Silence along with touch is powerful! Psychological, Social, & Spiritual They may want family & friends present families may remain there as long as they desire. They want to talk about their fears, worries and anxieties be a good listener. Physical Needs Dependent on others for ADL s The person is allowed to die in peace and dignity. Pain management always report signs and symptoms of pain at once. Breathing problems positioning and oxygen. Some like a window open, or a fan. The nurse may need to suction the mucus that collects in the airway. 5

6 Vision, Hearing & Speech Vision blurs and gradually fails Some darkened rooms may frighten them Eye care is essential HEARING IS ONE OF THE LAST FUNCTIONS LOST Speak in a normal voice. Provide reassurance and explanations about care. Speech becomes difficult. It may be hard to understand. Ask yes or no questions Mouth, Nose and Skin Oral care lip balms and cleaning the mouth if mucus collects Nasal care crusting and irritation from the O2 cannuala, or NG tube (if present). Skin care bathing and preventing pressure ulcers, linen and gown changes PRN Elimination Incontinence may occur Give perineal care prn 6

7 Comfort & Positioning Skin care, personal hygiene, back massage, oral care, and good alignment promote comfort. The Family This is a hard time for the family Show your feelings by being available, courteous and considerate. Use touch to show your concern Family is allowed to stay as long as they want. You must respect right to privacy Cont. The person and family need time together. However, you cannot neglect care Sometimes family members want to stay or help with care You could suggest they take a break for a beverage or meal at this time. Families may be tired, sad, and tearful. 7

8 Hospice Care Focuses on the physical, emotional, social and spiritual needs of the dying persons and their families Pain relief and comfort are stressed The goal is to improve the quality of life remaining for the dying person. Legal Issues Much attention is given to the right to die, Many people do not want machines or other measures keeping them alive. Consent is needed for any treatment When able the person makes care decisions Some make end-of-life wishes known The Patient Self-Determination Act And OBRA give persons the right to accept or refuse medical treatment. See The Dying Person s Bill of Rights Focus on Long-term Care 8

9 Advanced Directives Is a document stating a person s wishes about health care when that person cannot make his or her own decisions. They usually forbid certain care if there is no hope of recovery Living wills and power of attorney are common advance directives. Protect the quality of care DNR When death is sudden and unexpected, efforts are made to save the person. Do Not Resuscitate or Allow Natural Death order or No Code orders for terminally ill (and some other) persons. No heroic measures are taken Even if you do not agree with it you must follow the doctor s orders Signs of Death There are signs that death is near. These signs may occur rapidly or slowly Discuss signs 9

10 Care of the body after death May involve repositioning the body. Soiled areas are cleansed Nurse usually gives you directions for what is to be done. See delegation guidelines Most facilities no longer shroud the bodies. You will follow the policies & procedures of the facility. 10