1. Caring for the ICU patient at the End of Life The Art of Nursing

2. Review of Legal Concepts Advance Directives Health Care Proxy DNR/DNI Palliative Care Comfort Care Post Mortem care

3. Death May Occur Anyway Cardiopulmonary Resuscitation Family Presence During CPR Helping the Family Decide Working with the Bereaved Family Brain Death

4. HOW DO WE CONVEY BAD NEWS? Communication with Family and Loved Ones

5. Communication Fining out what they already know Finding out how much information the patient and/or family want to know Sharing information, starting from their viewpoint and step by step bringing them closer to medical facts Responding to their reactions, using an empathetic approach Explaining the treatment plan and prognosis, summarizing and making a contact Not forcing decisions, that is, allowing the patient and family time to absorb information and discuss their concerns

6. Family Needs Families need to be with dying patient Families may want to be helpful Families need to be sure of the patients comfort Families need to be informed about the patients condition Families need to be comforted and allowed time to express their emotions Meeting the spiritual needs of the family Donation request

7. WHO CARES FOR THE HEALTHCARE PROVIDER? What about us when it is all over.

8. SUPPORTING EACHOTHER Allow your time to grieve In a private setting discuss with the health care team how that patient experience made you feel. What went well and what could the team improve on? Acknowledge your own feeling and work through them. Don’t suppress them. Make sure you are emotional able to deal with the patient assignment. Remember you are there for the patient and family, they are not there for you.