Leo G Rafail BSW Director of Client Care
Leo G. Rafail, BSW Director of Client Care Services President Thomas Cellini Huntington’s Foundation Board Trustee Rock Steady Boxing Former Care Services Program Manager The ALS Association Indiana Chapter Thomas Cellini Huntington’s Foundation
Caring for Patients at the End of Life
The Nurse’s Role Caring for a dying patient is a complex role for a nurse. Some nurses are better prepared for this role, others are not. In order to effectively care for this type of patient, nurses need to shift from saving life to preparing for death.
Advocacy • Pain and symptom management • Culturally sensitive practices • Assisting patients and their families through the death and dying process • Ethical decision making
Palliative Care A patient is seeking comfort measures They are not seeking curative treatments Palliative Care Includes: Radiation Blood Transfusions IV Fluids Antibiotics Some Chemo Some Surgeries
When Do We Start? Preparing for death and grief counseling starts on admission!
Patient’s Right to Information • How much should we tell them? • Are they competent to understand?
Recognize the Symptoms • • Increased Pulse Decreased Blood Pressure Increased Respirations-Irregular Respirations Temperature Decrease output Cooling of extremities-Mottling “Death Rattle”
EOL Interventions • • Roxanol Ativan Atropine Tylenol
Types of Loss • Loss of a loved one • Loss of a pet • Loss of a job • Loss of a limb • Loss of independence • Loss of material possessions **LOSS OF MEMORY**
Types of Grief • Normal • Delayed • Anticipatory • Chronic
Grief Theories • Kubler-Ross 5 stages: Denial, Anger, Bargaining, Depression, Acceptance • Multi-Dimensional: Emotional, Social, Physical, Lifestyle, Practical, Spiritual, Identity • Rando’s 6 R Model: Recognize, React, Recollect, Relinquish, Readjust, Reinvent
Develop Care Plan Need to Know: What type of loss What type of grief History of Loss
Signs / Symptoms of Grief Physical • • • Crying Headaches Loss of appetite Difficulty sleeping Weakness Fatigue Emotional • • • Sadness Worry Anxiety Frustration Anger Guilt
Signs / Symptoms Continued Social Spiritual • Feeling of detachment • Isolation • Behaving in ways society considers “abnormal” • Questioning the reason for loss • Questioning one’s purpose • Questioning the meaning of life / death • Wishing ill on others
5 Things to Say • • • Forgive Me I Forgive you Thank you I Love you Goodbye
Hospice Criteria • End of Life Diagnosis • Death will result in 6 months if disease run it’s normal course, must be certified by 2 physicians • Seeking palliative care, not curative
What do we want to do? • Keep the patient comfortable • Keep the family calm-providing support and information • Treat patient, family and other caregivers with kindness, compassion and respect • DOCUMENT, DOCUMENT!!!!
What Happens After Death What is in, will come out Clean the body Cover, leaving arms and hands out Don’t worry about closing mouth, chances are, you can’t • Give family time alone with loved one • Stay with the body until the funeral home arrives • •
If there is any question to the cause or manner of death, simply cover the body and wait for the coroner. Do not clean the body, do not remove catheters, do not remove IV’s or PICC’s.
A Nurse’s Loss Personal grief experience Feeling of loss Feeling incompetent Scared Guilty Care for Self Talk to team Ask for help Have other team members present for support Attend Memorial Service Do things “In Memory Of”
Ethical Issues • Who’s in charge • What’s best for the patient • Who steps in when a decision can’t be reached • To sustain life or allow natural death
QUESTIONS? Thanks to Amy Adams RN, Ph. D for her assistance with this presentation
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