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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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Some are quite withdrawn and quiet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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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