1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 06: End-of-Life Issues in Critical Care

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Recommendations to Improve End-of-Life Care See Box 6-1.

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Palliative Care The goal of palliative care is to provide treatment that relieves suffering.

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Palliative Care Advanced care planning Symptom management Family-centered care Holistic care Facilitate communication with family, client, and health professionals Provide support to client and family on ethical issues Provide care for the caregiver

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Incorporating Palliative Care Throughout the Patient’s Illness

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Symptoms Experienced at the End of Life Pain Dyspnea Anxiety and insomnia Confusion/agitation Depression Nausea and vomiting

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse’s Role Before and After the Family Conference See Box 6-2.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins How to Facilitate a Family Conference See Box 6-3.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question While discussing end-of-life care with a dying patient, which of the following should the nurse consider first when establishing a visiting schedule? A. Consider the patient’s wishes first. B. Consider the family’s wishes first. C. Consider family dynamics first. D. Consider making a schedule for visiting hours first.

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Consider the patient’s wishes first. Rationale: The nurse needs to establish flexible visiting hours for a patient at the end of life by considering the patient’s wishes first because the patient will be more open to discuss who may visit and who may not visit when the nurse consults the patient first. The nurse will need to assess family dynamics and determine a visiting schedule that meets the patient’s needs and the family’s needs.

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about end-of-life sedation is correct? A. Hospice uses end-of-life sedation as soon as a patient enrolls in the program. B. End-of-life sedation is used instead of pain medications. C. End-of-life sedation is only used if all other measures have failed to provide symptom control. D. End-of-life sedation is used to decrease the amount of pain medication used.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. End-of-life sedation is only used if all other measures have failed to provide symptom control. Rationale: End-of-life sedation is used by hospice or other health care professionals when a specialist in palliative care or pain management believes that all measures to provide comfort have been tried and are ineffective to provide comfort to the patient. The least amount of sedation possible is used along with pain medications to provide comfort. The sedation does not decrease the need for pain medication.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements about family presence at the time of resuscitation is correct? A. Family members experience increased anxiety and depression. B. Family members are more likely to sue the hospital. C. Hospitals should have a policy on how to deal with family presence at the time of resuscitation. D. Family members do not have a right to be present during resuscitation.

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Hospitals should have a policy on how to deal with family presence at the time of resuscitation. Rationale: The AACN recommends that hospitals should establish a policy on how to deal with family presence at time of resuscitation. Research shows that family presence is a right, and that it helps the family during the grief process. Family members who are present during resuscitation have not experienced more anxiety or depression than members who were not present. There is no evidence that family presence during resuscitation will result in increased number of lawsuits.