Chapter Eleven End-of-Life Issues

End-of-Life Issues People want a “good death.” Nurses have an essential role in providing end-of-life (EOL) care. Need to explain options and provide referrals and resources to older adults and their families.

Mystery of Death Nurses need to be prepared to be a positive influence for appropriate EOL issues. Educated in EOL issues Provide older adults with high quality of life and a good death. Need to be skilled at teamwork with other caring professionals, families, and the dying person.

Stages of Grief Grief is the normal reaction to a catastrophic loss. Kübler-Ross defined stages of grief. Stages of grief describe normal human reactions to death. Stages include denial, anger, bargaining, depression, and acceptance. Person can move from one stage to another and then up or down the stages.

Stages of Grief (cont’d) Denial Person is unable to accept loss. May show signs of shock, praying that it is not true; may seem “dazed” Survivor may not realize what happens in the next few days Anger Demonstrates awareness of loss and its consequences Person needs be able to vent anger in a safe environment.

Stages of Grief (cont’d) Bargaining Making bargains with God or a supernatural power The thinking is that if one trades something of value, then the person will get better. Family needs to be supportive during this stage.

Stages of Grief (cont’d) Depression The individual does not accept the loss but accepts the fact that nothing can change it. May not have desire or energy to do anything including ADLs Assess for suicidal thinking. Acceptance Person accepts death and feels a sense of relief. Able to go on with life’s activities Happens at different times for all

Anger Denial Depression Acceptance Bargaining Which of the stages of grief is observed by the patient saying that he or she will begin going to church more if he or she is okay? Anger Denial Depression Acceptance Bargaining

Answer E. Bargaining

In which of the stages of grief is the patient able to move on with daily activities? Anger Denial Depression Acceptance Bargaining

Answer D. Acceptance

Qualities for a Nurse Providing EOL Care Tolerance and empathy With tolerance person(s) will show compassion and endurance Empathy is ability to identify with the client by being sympathetic and understanding Gain an understanding of people and their differences. Provide an environment that meets the physical, emotional, social, and spiritual needs of each dying person.

Qualities for a Nurse Providing EOL Care (cont’d) Be flexible with dying client Sense of humor Assists in relieving, reducing, and soothing the symptoms of a disease Know the personality and mood of the older adult in your care before using humor. Communication Strong communication allows for open discussions about death.

Qualities for a Nurse Providing EOL Care (cont’d) Good listening skills Must be fully present and attentive to the other person. Taking time to listen Asking appropriate questions Not interrupting Speak in a voice that the older person can hear.

Which quality of the nurse should be used to help increase open discussions? Tolerance and empathy Good listening skills Sense of humor Communication

Answer D. Communication

Which of these skills should be used when the mood is right? Tolerance and empathy Good listening skills Sense of humor Communication

Answer C. Sense of humor

Cultural Accountability Be familiar with the cultural diversities of the older adults in your care. Cultural needs should be addressed immediately on admission.

End-of-Life Decisions Be aware of the decisions a person has made about his or her current and future medical care. Help protect the patient’s right to make his or her own health-care choices. Palliative care-measures that are taken to help client with terminal illness; not to treat client Hospice care serves not only the dying patient but also the patient’s family, finding out their needs and responding to them in a culturally sensitive way. Usually client has about 6 months to live when referred. Often underused. A quality hospice program will have an interdisciplinary team that is sensitive to cultural differences, and responds to patient and family needs. Will provide guidance and support.

End-of-Life Decisions (cont’d) Advance directives Written documents that outline patient’s wishes about life-sustaining treatments Durable Power of Attorney Used in cases in which an individual is incompetent Forms need to come from a qualified attorney to ensure their legality in the state where the older adult resides.

End-of-Life Decisions (cont’d) Living will Allows individuals to share their opinions and wishes regarding their death

Which of the following is the written plan for end-of-life care? Living will Accountability Advance directives Durable Power of Attorney

Answer C. Advance directives

What allows another person to make decisions if the patient is not able? Durable Power of Attorney Advance directives Accountability Living will

Answer A. Durable Power of Attorney

Imminent Signs of Death Bodily functions slow Signs and symptoms Rapid, weak pulse Decline in blood pressure Dyspnea and periods of apnea Slower or no pupil response to light Profuse perspiration even though cool to touch

Imminent Signs of Death (cont’d) Signs and symptoms (cont’d) Cold extremities-cover with blanket if needed Bladder and bowel incontinence Pallor and mottling of skin Loss of hearing is the last thing to go