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Nursing Interventions for Palliative Care Patients

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Katherine Zych

on 20 November 2012

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Transcript of Nursing Interventions for Palliative Care Patients

The end Palliative Care Teaching the Patient Personal Care After Death Nursing Interventions before death occurs End Of Life Nursing What is palliative care?
-Care designed to prevent and relieve suffering at any stage of illness
(Lewis 180)
-The goals of palliative care are:
* provide comfort and supportive care during the dying process
* improve the quality of the remaining life, and help ensure a dignified death
*managing pain and symptoms
*provide support for family members and caregivers
(Lewis 181)

What does it mean to us as a nurse?
-"it is a science and an art"
-As nurses we need to do more then just providing care, it has to do with being there for the patient
-It is shaped by an individual’s search for a sense of meaning and their desire for honesty and control over their life, and a need to maintain personal dignity as they see it, for the life they have left
(Becker, 2009) Hospice vs. Palliative Care
-In Canada both of these terms are used interchangeably thought each term differs a little. Palliative refers to a more health institutional area, while a hospice refers to community based at home or homelike facility.
(Lewis 186)
-The patient and the family have then choice to choose were they would like to be placed.
-The hospice setting can be more denationalization to make the atmosphere more relaxing and calm.
-A couple of problems come with the idea of palliative care:
*Patients may see this as the death sentence where no treatment will be actively given, which is not true.
(Lewis 187) What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal
-Albert Pike Nursing Interventions for
Palliative Care (Livebeforedeathmovie, 2011) 1. Speak directly to the patient and talk as if the patient can always hear you.
2. Speak calmly and gently reorient the patient to time, place and person.
3. Do not restrain a patient at the end of life.
4. Let the patient choose if and when they want to eat and drink – perform good oral care.
5. Keep the patient clean and dry – provide a disposable pad on the bed.
6. Keep the patient warm – use blankets.
7. The patient will probably rest easier on their side with pillows placed behind their back for
support.
8. Provide pain medication as ordered and notify the physician for break- through pain.
9. Employ non-pharmacologic measures for pain control:
Positioning
Massage
Therapeutic touch
Application of heat or cold
Music therapy
Spiritual counseling
-Swallowing may be difficult at the end of life so it may be necessary to establish alternate
routes of medication administration
(State of Nebraska Transition Grant 2011) “When the death of a person is expected it is good practice to have identified with the patient, in advance of the death, any wishes for care (spiritual, cultural or practical) they have around the time of death or afterwards.” (Henry 2012) -Some considerations a nurse must keep in mind are:
*what they would like done with their body ex. organ or tissue donation
*where they would like to die
*who they would like to be present by their bedside
* if they have any spiritual/cultural/individual needs they would like to be addressed
-If possible offer the patient and their family a single room for more of a private and intimate atmosphere
(Henry 2012) Care after death There has been a new emphasis placed on the nurses responsibility of taking care after the death of the patient has occurred. These responsibilities include:
*Supporting any family and carers present who want to take part in the caring process
*Honouring the religious or cultural wishes/requirements of the deceased and their family while ensuring legal obligations are met
*Preparing the deceased for transfer to the mortuary or the funeral director’s premises
*Ensuring the deceased’s privacy and dignity is maintained
*Ensuring the health and safety of everyone who comes into contact with the deceased is protected
*Returning the deceased’s personal possessions to the next of kin.
(Henry 2012) The newest emphasis being placed on after death is the rituals/preparations and care of the body. -Family members may wish to be involved in personal care after death. Prepare them sensitively for changes to the body and guide them to minimise risk from manual handling and infection-control issues
Be aware of manual handling guidelines. It is best practice for two people to be involved, one of whom must be a registered nurse or suitably trained person
Lay the deceased person on their back, straightening the limbs if possible, and place a pillow under the head
Close the eyes by applying light pressure for 30 seconds. Use saline-moistened gauze if corneal or eye donation is to take place
Clean the mouth and clean and replace dentures as soon as possible after death. If dentures cannot be replaced send them with the body in a clearly identified receptacle
Tidy the hair and arrange into the preferred style, if known
Shaving too soon after death can cause bruising, so this is done by the funeral director. Explain this to the family if they request shaving. Remember some faith groups prohibit shaving
Support the jaw with a pillow or rolled up towel underneath, removing before the family view the body
If the death is not being referred to the coroner remove mechanical aids and document disposal of medication
Contain leakages from the oral cavity or tracheostomy sites by suctioning and positioning, then cover exuding wounds and unhealed surgical incisions with a clean absorbent dressing and secure with an occlusive dressing
Pad and pants can be used to absorb any leakage of fluid from the urethra, vagina or rectum
Intravenous cannulas, drains, indwelling catheters and so on should be capped and left in situ. This helps prevent leakage of body fluids. Mortuary staff will ensure funeral directors can safely remove the lines before the funeral or will remove the lines if a relative is collecting the deceased
Leave endotracheal tubes in situ without cutting
Clean and dress the deceased person appropriately. A shroud is used in many acute hospitals
Remove jewellery (apart from the wedding ring) in the presence of another staff member (unless the family have asked you not to do so) and document this. Provide a signature if any jewellery is removed as procedures are needed to account for this information to onward caregivers
Ensure the deceased person is clearly identified with a name band on the wrist or ankle. The person responsible for identification is the person who verified the death
Provided no leakage is expected and there is no infection risk, the body can be wrapped in a sheet and taped lightly.
If the body continues to leak, place the deceased on absorbent pads in a body bag and advise the mortuary or funeral director
(Henry 2012) It is the nurses responsibility to explain what will be happening with the deceased body.
-For example with the lines, and tubes that the patient is attached too. Religious/ Cultural and Traditional aspects to consider Communication and culture -Face challenges with traditional values for the family and community to be taking care of each other until death
-Hospital pose barriers for those that are grieving and traditional practices.
-Elders make the decisions
-Native people believe that not talking or telling the person that is dying why they are dying will decrease their fear and everyone's fear around them.
-Interpreters are sometimes a better resource then families due to not having attachment and being able to explain better to the patient and family what is happening
-A ritual for the natives is that they sing when/while someone dies.
-The Elders place the body in specific positions which nurses need to respect.
-All children must be present at the deceased side before he/she is removed from the hospital
-Some elders may request to be transferred home before death occurs to die in the presents of children and grandchildren
(Kelly 2009) Stress on the unit The stresses experienced by nurses are:
Burnout
Conflicts between healthcare providers
Anger
Sadness
Moral distress (helplessness)
Patient/family disatisfaction
critical care nurses reported that moral distress affected their job satisfaction, physical and psychological well- being, self-image, spirituality, and decisions about their own health.
(Hansen 2009)
References Becker, R. (2009) Palliative care 1: principles of palliative care nursing and end-of-life care. Nursing Times; 105: 13 Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/end-of-life-and-palliative-care/palliative-care-1-principles-of-palliative-care-nursing-and-end-of-life-care/2007480.article
Hanssen L. (2009). Nurses’ Perceptions of End-of-Life Care After Multiple Interventions for Improvement. American Journal of Critical Care. Retrieved from: http://ajcc.aacnjournals.org/content/18/3/263.full
Henry C, Wilson J (2012). Personal care at the end of life and after death. Nursing Times; 108. Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/end-of-life-and-palliative-care/personal-care-at-the-end-of-life-and-after-death/5044559.article
Kelly L. (2009). Palliative care of First Nations people: A qualitative study of bereaved family members. Canadian Family Physicians. Retrieved from: http://www.cfp.ca/content/55/4/394.full
Lewis, Sharon L. (2007). Medical-Surgical Nursing in Canada (with Media), (2nd ed.). Toronto, ON: Elsevier Canada.
State of Nebraska Transition Grant. (2011). End-Of-Life Care for the Newly Licenced Practical Nurses. Education Module. Retrieved from:http://www.center4nursing.com/documents/edmoduleendoflife_LPN_REV1.pdf
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