2. End of Life Care

3. Let’s talk about it! Death and Dying in America What has changed over the past century?

4. End of Life Decisions What would you do? What have you done? What should you do? Healthcare Surrogate decisions?

5. Advanced Directives Written instructions that guide health care decision making in accordance with a patient’s wishes, should they lose the ability to speak for self.

6. Advance Directives Common Forms –L–Living Will –H–Health Care Surrogate Designation –D–Do-Not-Resuscitate Order

7. Do not need lawyer to prepare Forms available –H–Health care facility –P–Physicians –I–Internet –H–Hospice

8. WHY? What if you don’t have Advance Directives? –Role of the nurse What care is covered?

9. Death and Dying Caring for a dying pt is: Opportunity Privilege Natural part of life

10. End of Life Care Therapeutic Presence Cheerful - don’t overdo Gentle and kind Promote comfort Pt is team leader

11. End of Life Care Supportive Empathetic Allow maintenance of self-esteem, dignity

12. EOL: Symptom Management Pain –WHO Analgesic Ladder Resp. Sx. –Dyspnea, Cough

13. EOL: Symptom Management G.I. Sx. –Anorexia, Cachexia –Constipation –Diarrhea –Nausea / Vomiting

14. EOL: Symptom Management General Sx. –Fatigue / Weakness Psych. Sx. –Depression –Anxiety –Delerium / Agitation / Confusion

15. Care of the family OK to cry in front of Allow expression Allow to stay and help Keep on even keel Offer chaplain / clergy

16. Care of the family Involve social services if necessary Is healthiest: - be honest - allow to know

17. Kubler-Ross Stages of Dying 1.Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance 6. Detachment

18. Hospice Philosophy of Care Physical and Emotional comfort Quality of life Terminally ill cared for with dignity

19. Hospice Symptom Control Palliative Care Not curative measures Most care given in home

20. Hospice characteristics Autonomous Goal of care is symptom control Pt / Family is primary unit Interdisciplinary

21. Hospice characteristics Specially trained On-call services Support for staff Bereavement care Based on need, not $$

22. Goal of Hospice Death with dignity Relief of pain and other distressing sx.

23. Hospice Admission Criteria Confirmed, terminal dx Agree to goal Life expectancy < 6 m Primary Caregiver - 24 hrs/day Agree to DNR

24. Signs of Approaching Death Failing Circulation –Cold and Mottled Extremities Decreased U/O V/S Changes

25. Signs of Approaching Death Resp. Congestion Breathing Pattern Changes Failing Senses –Hearing last to go!

26. Clinical death When resp and heart beat stop Note time of cessation

27. Biologic Death Maintain vital signs with mechanical means Brain dead

28. Death Pronouncement Check policies Document –Pt. name –Date and time of death –Details of physical exam –Others notified

29. Helping the Family Prepare the body Allow to stay as long as needed Asst. with phone calls Other notifications

30. Organ Donation Family MUST be asked Even if have signed driver’s license request Family has custody of body at death

31. Death Can death be a good experience?? Fear of death shaped by culture and religion