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Palliative Care for Caregivers
The last days of life Palliative Care for Caregivers
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Learning Outcomes At the end of the session you will be able to:
Recognise deterioration Understand symptom management in the last days of life Describe the holistic nature of loss and grief Know the importance of self care Te Ara Whakapiri should be your reference for this session.
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May happen gradually over a few days
Recognising deterioration Weaker Difficulty swallowing medication Eat and drink less Loss of interest Drowsiness Sleep more Restlessness Disorientation Confusion Poor circulation Incontinence Loss of skin integrity Breathing changes Maybe put heading up and ask the question before showing the answers. Are there any other changes they have seen? May happen gradually over a few days
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How care changes as a person is dying Emphasis on comfort cares
Stop unnecessary medication and procedures Continue necessary drugs Think about how medication will be given when person can no longer swallow Avoid unnecessary interventions Inform, update and support family and whānau Involve family in care Address spiritual issues Respect cultural differences Keep talking to patient even when no obvious response
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Common symptoms and their management
Drowsiness Eating and drinking less Confusion Restlessness and agitation Changes in communication Incontinence Pressure area care Noisy secretions Irregular breathing Divide into groups and give them a couple of symptoms each to discuss why they might occur and how they may help. You might like to cut up the symptoms, have them in a bag and each group pull out a couple – give them an A3 piece of paper and markers to display their answers/thoughts – these can then be displayed on the wall. Impress upon them the importance of noticing and communicating. Remember your responsibility is to notice and communicate any of these symptoms
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When death has occurred
No breathing No heartbeat Loss of bladder/bowel control Eyelids may be slightly open Pupils fixed and dilated Jaw relaxed and mouth slightly open No rush and no rules Check in with participants to see who has witnessed death before – what was that experience like. What worries them about death? Maybe someone has witnessed an unpleasant death and may need time to discuss afterwards.
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What happens in your workplack after death?
How does family and whānau find out? How do others find out? How do your colleagues find out? How do you honour the death in your workplace? Discuss the questions above. Question 2: think about residents, neighbours, other patients dependent on workplaces represented in participants. Question 3: remember to include all members of multidisciplinary team e.g. pharmacist, chaplain, GP, volunteers, gardener, cleaner, cook etc.
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Grief Grief is the process of adjusting to a loss and learning to live with the changes it has brought to your life
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How does grief feel? Sadness Numbness Anger Guilt and regret
Helplessness Overwhelming Confusing Unbelievable Loneliness Fear and anxiety Relief Tiredness Hollow/lost Exhausting Irritability Yearning
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How can you help people who are grieving?
Your role How can you help people who are grieving? Allow time for discussion and asking what they are allowed to do in their workplace.
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When supporting recently bereaved
Do: Acknowledge the loss Listen Use appropriate language Talk about the person who has died Give information Reassure Normalise Allow mourning – let them cry, let them be angry Do not: Use clichés Do all the talking Give too much advice Promote your own values and beliefs Discourage emotion or expressions of grief Predict someone else's grief reaction
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Loss and grief Everyone responds to loss and shows their grief in different ways There is no right or wrong way to grieve Grieving takes time – it isn’t something you move through step by step Grief may never completely resolve
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Caring for ourselves Caring for dying people can be very stressful:
What do you do to care for yourself? What self care is encouraged in your workplace?
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What enables you to do this work?
Remember your own sources of strength Using your colleagues for support Have a laugh when appropriate Feel proud of your commitment to this valuable work Continuing educational opportunities Take the opportunity to say goodbye to people and families Leaving work behind at the end of the day Good outside support network Make deposits into your emotional bank account Interactive exercise: Have an emotional bank on the wall and deposit slips for participants to fill out with ideas of how they will ‘fill up their emotional reserve’. Or Te Whare Tapa Whā poster they can fill up with ways they can focus on their own wellness. Or self care plan template they can take away and complete.
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How can your team take care of itself
Rituals Talking with team Meal breaks Debriefing Ask for help Support each other
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Reflection Final thoughts and comments, concerns and evaluations.
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