Planning for the End of Life Chapter 15 Planning for the End of Life Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Key Terms Advance Health Care Directives (AHCD) assisted suicide culturally competent durable power of attorney for health care euthanasia hospice care informed consent palliative care therapeutic communication therapeutic presence Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Death As Part Of The Life Cycle Normal part of the life cycle Not unique to the elderly Acute care hospital versus home or hospice environment Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Signs And Symptoms Of Death Prepare family for the symptoms that accompany death Finality of the actual death will come as a shock to most family members See Box 15-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. The Process Of Dying Psychological death begins when a person is told that he or she has a terminal illness Physiological death starts when the body processes decline in function Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Psychological Responses of the Dying Patient Death is accompanied by tasks and responses Grief process May loose self esteem with disability and increasing dependence on others Therapeutic communication See Table 15-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Family Behaviors Related to the Dying Process Preparation and education are key Helplessness and guilt should be quickly recognized Pain-relieving techniques Therapeutic communication See Table 15-2 and Table 15-3. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Options For End-Of-Life Care Options include Acute Care and Hospice Care. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Acute Care of the Dying Patient Continuation of full life support Full cardiopulmonary resuscitation Removing all life support or life-sustaining equipment Stopping all drugs except sedation and relief of pain See Box 15-2. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Hospice Care Supports the patient and family through the dying process Helps the survivors through the period of bereavement Palliative care Settings include home, nursing facilities, or long-term care facilities Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Ethical And Legal Issues Ethical issues concerning death are influenced by values, culture, and religion Legal issues are rooted in the law Informed consent Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Advance Directives Durable Power of Attorney for Health Care Living Will Do Not Resuscitate Order Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Assisted Suicide and Euthanasia The action of a person other than the patient to facilitate suicide An intentional act which causes death Involve legal, moral, and ethical issues that have been tested in the courts through the years and remain controversial Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Role Of The Health-Care Worker In End-Of-Life Care Ensure education of the patient and family concerning the diagnosis Ensure that informed consent is provided with a clear offer of all available options of care Ensure that the patient's and family's cultural and personal wishes are respected Communicate with the multidisciplinary health-care team when death is imminent or has occurred Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Death Of A Child Discussion of life and death should be a normal part of the growth and development Typically progress through specific stages as they prepare for death Truthfulness, explained in age-appropriate terms is the optimal approach Emotional impact on the family is often devastating Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Developmental Concepts of Death and Dying Toddler Preschooler School-Age Child Adolescent See Table 15-4. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Physical Care After Death Performed according to the culture of the patient and the protocols of the institution Communicate with the family concerning policies and routines related to care and transport of the body Family may want private time with the deceased Provide referrals for funeral home and support groups Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.