1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 38 End-of-Life Care

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Acceptance occurs while clients deal with their losses and are completing unfinished business.

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Acceptance occurs after clients have dealt with their losses and completed unfinished business.

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care Terminal illness: recovery from the condition is beyond reasonable expectations Stages of dying –Denial: psychological defense mechanism; refusal to believe certain information; helps to cope with reality of death

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Stages of dying (cont’d) –Anger: emotional response to feeling victimized; occurs because there is no way to retaliate against fate –Bargaining: psychological mechanism to delay the inevitable –Depression: sad mood; realization that death will come sooner rather than later

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Stages of dying (cont’d) –Acceptance: attitude of complacency that occurs after clients have dealt with their losses Promoting acceptance: nurses can help client to pass from one stage to another by providing emotional support and supporting client’s choice regarding terminal care

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Dying

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Promoting acceptance (cont’d) –Emotional support: part of missing nursing care; more necessary for dying clients –Arrangements for care: respecting the rights of dying clients

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Helping Dying Clients Cope

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Arrangements for care (cont’d) –Home care oRespite care: relief for the caregiver by a surrogate –Hospice care oEligibility for hospice care: 6 months or less to live

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Dying Person’s Bill of Rights

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? In home care, the focus of support may shift back and forth from the client to the caregiver.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. In home care, the focus of support may shift back and forth from the client to the caregiver.

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Arrangements for care (cont’d) –Hospice care (cont’d) oHospice services: clients receive care in their own homes; multidisciplinary team of hospice professionals and volunteer support are provided

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medicare Home Hospice Benefits

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Arrangements for care (cont’d) –Terminating hospice care oResidential care: form of intermediate care oAcute care: sophisticated technology and labor-intensive treatment

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Providing terminal care –Hydration: maintenance of adequate fluid volume –Nourishment: tube feeding and parenteral nutrition –Elimination: catheterization; enemas or suppositories; skin care

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Providing terminal care (cont’d) –Hygiene: clean, well groomed, and free of unpleasant odors –Positioning: promote comfort and circulation –Comfort: keep clients free from pain

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Family involvement: maintain family bonds to help coping with future grief Approaching death: decrease and ultimate cessation of function –Multiple organ failure: two or more organs cease to function –Family notification: family should be aware of approaching death

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Multiple Organ Failure

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Summoning the Family of a Dying Client

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Hospice services can be terminated if the client does not meet the Medicare criteria.

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Hospice services can be terminated if the client does not meet the Medicare criteria.

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Family notification (cont’d) –Meeting relatives to promote smooth transition –Discussing organ donation Confirming death: determined on the basis that breathing and circulation have ceased

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Age Criteria for Organ Donation

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Confirming death (cont’d) –Brain death: irreversible loss of function of the brain –Death certificate –Permission for autopsy: examination of organs and tissues of human body after death

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Organ Procurement Form

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) Performing postmortem care: –Cleaning and preparing the body to enhance its appearance during viewing at the funeral home –Proper identification –Releasing the body to mortuary personnel

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Grieving Process of feeling acute sorrow over a loss Pathologic grief: dysfunctional grief; refusing to accept the client’s death Resolution of grief: time taken for mourning; ability to talk about the dead person; controlling emotions

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Many nursing diagnoses: –Acute pain, fear, spiritual distress, social isolation, ineffective coping, decisional conflict, hopelessness, powerlessness, dysfunctional grieving, anticipatory grieving, caregiver role strain, death anxiety, and chronic sorrow

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Understand that the dying older client is a living person who may want to maintain the same interpersonal relationships as someone who is not dying Encouraging older clients, who have experienced the death of a close friend or family member, to express feelings associated with grieving is important

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Reading obituaries can be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death