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Core Curriculum Module 8 Final Hours
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Section I: Preparing for a Good Death
The important role of the nurse Hydration? Resuscitation? Hasten death request?
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Preparing for Death Everyone dies Advance care planning
Recognizing the transition to active dying Care for the dying Post death care
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The Nurse, Dying and Death
Nurses provide support to staff, patients/families Interpersonal competence Being present “Bearing witness” Interdisciplinary care
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Describe a Recent Death You Have Observed
What went well? Were the patient and family’s wishes honored? Describe any cultural traditions that were honored. Was pain controlled, as well as other symptoms? Was interdisciplinary care evident? What could have been improved? What issue(s) could have been prevented? Are there policies/procedures that need to be developed to provide better direction?
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Open, Honest Communication
Convey caring, sensitivity, compassion Provide information in simple terms Patient awareness of dying Maintain presence
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Dying is an Individualized, Personal Experience
There is no typical death Patient preferences Nurses advocate for choices Setting of death Support Psychological and emotional considerations
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What About Artificial Nutrition & Hydration at End of Life?
Perceptions of “starving to death” Hydration does not decrease “dry mouth” Patients who fasted to end their lives experienced peaceful death Gabriel & Tschanz, 2015; HPNA, 2011a; Prince-Paul & Daly, 2010
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Resuscitation No advance planning
Unrealistic beliefs regarding survival Family presence during resuscitation Outcomes are usually poor
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Discontinuation of Dialysis
When should dialysis be discontinued? When burdens outweigh benefits and/or, When dialysis is no longer prolonging life or only prolonging death
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Organ/Tissue Donation
Regulations Talking to the family about organ/tissue transplantation What can be donated?
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Organ/Tissue Donation (cont.)
Death declared on the basis of cardio-pulmonary criteria versus neurological criteria in “brain death” Can cause ethical and moral angst for healthcare providers witnessing this
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Hastened Death Request
Statement made by patient Progressive incurable illness Judgment not impaired Intervention to cause death more immediately than if illness took its natural course Assisted suicide/dying Clinician-assisted Stopping eating and drinking Other means
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Psychosocial Changes We only die once Fear of dying Feelings of loss
At end of life, patient may be more introspective
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Spiritual Considerations When Death is Imminent
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Cultural Considerations When Death is Imminent
Death rites Rituals Mazanec & Panke, 2015
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The Dying Older Adult
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Case Study: Gail 62-year-old woman diagnosed with stage IV ovarian cancer 16 months ago Admitted to the hospital with a bowel obstruction, cachexia, and dehydration 1 week ago 3 adult sons Divorced “Spiritual,” but not affiliated with any religion Served in the Army for 20 years Home hospice
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