Unit 4 Chapter 22: Caring for People who are terminally ill Nursing Assistant Unit 4 Chapter 22: Caring for People who are terminally ill

Caring for the Terminally Ill People die from many different causes at many different ages Terminal Illness Illness or condition for which there is no cure AIDS Cancers Certain heart conditions Chronic respiratory disorders Kidney disorders Liver disorders

Caring for the Terminally Ill In the past, most people with a terminal illness received care at home All caregivers could do was make patient comfortable We must allow person to live and die with dignity When taking care of a dying person you should be aware of the power of listening and touch

Stages of Grief Grief Mental anguish, specifically associated with loss Dr. Elisabeth Kubler-Ross (1926-2004) Psychiatrist Wrote famous book, On Death and Dying Worked specifically with terminally ill people Identified distinct stages of grief

Stages of Grief Stage I: Denial Occurs when the person is told they have a terminal illness Person refuses to accept the diagnosis or feels a mistake has been made Denial helps protect a person emotionally from overwhelming grief This stage may last only a few minutes or until the person actually dies Not your place to convince the patient that the illness exists Be honest but neutral

Stages of Grief Stage II: Anger Occurs when the person realizes that they are actually going to die People may feel angry for different reasons Each person handles anger differently Some people are angry with themselves, and some make take it out on others Do not take anger personally

Stages of Grief Stage III: Bargaining Typically done on a very private basis by the patient Person wants to “make a deal” with someone who has control over their fate Person may want to live long enough to accomplish a goal or witness a specific event The will to live can be a very powerful life force and may extend the persons life for many months Allow the person to experience the feeling of hope that comes with this stage

Stages of Grief Stage IV: Depression When the person fully realizes that death will be the end result Person will be sad and may have regrets about things they were not able to do Some are quite withdrawn and quiet Normal part of process Be supportive Some people require medical intervention

Stages of Grief Stage V: Acceptance When a person comes to terms with the reality of their own death Is at peace with this knowledge Complete unfinished business Says goodbyes Plan funeral service Usually want to talk about their death Some people gain acceptance months or years before it happens

Wills A will is a legal statement that expresses a person’s wishes for the management of their affairs after death Person must be deemed competent when will is made to be valid Many health care facilities offer assistance You may witness wills By signing you are just saying you watched the person sign

Dying with Dignity Advance Directives Allows a person to make wishes know about health care decisions Many pertain to “end of life issues” May elect to avoid “life sustaining treatments” Respiratory ventilation CPR Feeding Tubes

Dying with Dignity Advance Directives May elect to have supportive care only Will not prolong life but will make person more comfortable Oxygen Pain medication ROM Grooming Hygiene

Dying with Dignity Advance Directives DNR (do not resuscitate) Also called a no-code Only means CPR will not be performed to save a persons life

Dying with Dignity Hospice Care Hospice organizations have the mission of offering the terminally ill person the best quality of life possible Care is provided by a multidisciplinary care team Doctors Nurses CNA’s Clergy Social Workers Mental Health Professionals

Dying with Dignity Hospice Care Team not only takes care of the patient, but takes care of family as well After patient’s death, hospice provides grief counseling and other types of assistance to the family Available to patient’s and families 24 hours a day 7 days a week Care provided in patient’s home, long term care center, hospital, and hospice houses

Dying with Dignity Hospice Care Care given is palliative care Focused on relieving uncomfortable symptoms Pain medications Chemotherapy Radiation Oxygen Surgery In no way is a terminally ill person is told to give up hope for recovery

Dying with Dignity Hospice Care Can also assist with equipment Hospital bed Bedside commode Mechanical lifts Focus of hospice team is to honor the wishes of the patient and family

Effects of Caring for the Terminally Ill on the Caregiver Caring for a terminally ill person will affect you We actually go through the grief process May feel inadequate when we watch others grieve Make sure to take time for yourself Use clergy and counseling services available Openly talk about your feelings on death with friends and family