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End-of-Life Care Chapter 39

End-of-Life Care Chapter 39. Patty Maloney MSN Ed,RN. Death. Definition: The final termination of life, the cessation of all vital functions, the act or fact of dying. Brain death-death of brain cells, determined by a flat electroencephalogram (EEG).

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End-of-Life Care Chapter 39

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  1. End-of-Life CareChapter 39 Patty Maloney MSN Ed,RN

  2. Death • Definition: The final termination of life, the cessation of all vital functions, the act or fact of dying. • Brain death-death of brain cells, determined by a flat electroencephalogram (EEG). • Somatic death-determined by the absence of cardiac and pulmonary functions.

  3. Death • Molecular death-determined by the cessation of cellular function . • Controversy lies in deciding at which level of death a person is considered dead.

  4. Death • Death is inevitable, unequivocal, and a universal experience. • Difficult for many individuals to face. • Reluctance to accept mortality. • Gerontological nurses often face death.

  5. Family Experience With The Dying Process • Past: -death in the home was a natural process -higher mortality rates • Present: -reduced experience with death -most deaths occur in an institutional setting

  6. Results of Changes in the Experience of Death in Society • Most people have minimal direct involvement with dying persons • Death is an uncomfortable and stressful experience • Avoidance of discussions about death • Nurses need to analyze their own feelings about death and dying to be an effective caregiver

  7. Factors Affecting the Death Experience • Previous experience with death • Religious and spiritual beliefs • Philosophy of life • Age • Health status

  8. Supporting the Dying Individual • Nurses were used to dealing with the care of a dead body; present day nurses need to be more involved in the dying process • Nursing now offers a more humanistic approach to caring for the dying patient. • Emphasis is on meeting the total needs of the dying patient.

  9. Supporting the Dying Individual • The process of dying is a unique journey for each individual • Common reactions have been observed that provide a basis for understanding the process • Elisabeth Kubler-Ross developed a conceptual framework outlining the coping mechanisms of the dying in terms of five stages that have now become classic (Kubler-Ross 1969)

  10. Supporting the Dying Individual • Not all people progress through the stages in an orderly sequence or experience all of the stages

  11. Stages of Dying: Denial • Initial awareness of impending death • Deny the reality of the situation • Denial may occur at various times throughout an illness

  12. Stages of Dying: Anger • Feeling that nothing is right • Difficult for individuals around the dying person • Family may feel guilt, embarrassment, grief, or anger in response to the dying person’s own anger

  13. Stages of Dying: Bargaining • Postponement of the inevitable • Promises in return for life • Most bargains made with God are usually kept a secret

  14. Stages of Dying: Depression • Reality of the dying process is emphasized • Many losses can lead to depression • Interest in prayer and desire for clergy

  15. Stages of Dying: Acceptance • Struggling ends and relief ensues • Possibility of this being a final rest to gain strength for the journey • Sense of peace with the prospect of death

  16. Physical Care Needs: Pain • Fear of pain is common • Patients perceive and express pain differently based on many factors • Need to assess pain on a regular basis • Goal of pain management is to prevent pain from occurring • Pain management interventions

  17. Physical Care Needs: Respiratory Distress • Common problem in dying patient • Physical discomfort of dyspnea • Psychological distress • Interventions to decrease the symptoms of respiratory distress

  18. Physical Care Needs: Constipation and/or Poor Nutrirional Intake • Potential cause of constipation • A source of additional discomfort to someone who is dying • Anorexia, nausea, and vomiting often prevent adequate nutritional intake • Fatigue and weakness also play a role

  19. Physical Care Needs: Respiratory Distress • Common problem in dying patients • Physical discomfort of dyspnea • Psychological distress • Intervention to decrease the symptoms of respiratory distress

  20. Signs of Imminent Death • Bodily functions slow down • Close observation of the dying patient • Nurses need to be aware of these signs and keep the family informed • Assess if clergy is desired by the patient and family • Care of the patient and the family

  21. Advance Directives • Legal document that allows patients to express their desires regarding terminal care and life-sustaining measures • Nurses need to determine if patients have advance directives, review the patient’s wishes, and place the document in the medical record

  22. Helping Family and Friends After a Death • Be available to provide support • Viewing the body may be desired • Encouragement to express grief openly • Guidance with funeral and burial arrangements during the time of grief • Need for bereavement follow-up

  23. Supporting Nursing Staff • Staff working with dying patients also need support • Nurses need to explore their own reactions to death experiences • Acknowledgment of feelings • Resources available to assist nurses

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