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Care for the Dying and for Those Who Grieve

NURS 4531 Teaching Project
by

Peggy Hines

on 8 April 2013

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Transcript of Care for the Dying and for Those Who Grieve

When hospices were started in the 70’s the St. Christopher model was used. The hospice team consisted of the following:
Physician
Chaplain
Nurse
Social Worker
Aide Care for the Dying and for
Those Who Grieve Five Wishes Thank You for Listening How Hospice came to the US How Hospice was started Symptom Management Patients were neglected, isolated and left to die in pain. (1969) Dr. Elisabeth Kubler-Ross, identified phases in patients who were dealing with terminal illnesses Patient and their families presented with the following issues:
Anger
Denial
Bargaining
Depression
Acceptance The Start of Hospice How the NHPCO describes Hospice and Palliative Care: The first hospice opened in 1967 in London, known as the St. Christopher’s Hospice. The center was opened by Dame Cicely Saunders. In the 1960’s the dying were often neglected
Given PRN pain medications
Told, “Sorry we can’t help you” “Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice or palliative care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity." Communication 1. Start the Conversation
2. Listen to the patient, remember that you can not fix the problem, allow them to express there feelings.
3. Always remember that this is the patients story, don’t speak of your own beliefs this is a time to listen.
4. Ask the patient/family if they would like to meet with a counselor or spiritual leader.
5. Listen to the unspoken questions.
Ex: “Can you help me calm my fears”. Symptom Management
is the hallmark of palliative nursing. Misconceptions: Misconceptions: Most common end of life symptoms are:
Pain
Constipation
Dyspnea
Fatigue
Depression
Delirium
Fear
Sadness Providing normalization, counseling, and therapies help with these symptoms Patients who state or show signs of Depression:
Do not assume it is the normal grieving process. Patient who become lethargic or confused:
Don’t think it is related to the dying process, you need to still consider:
Medication effects, dehydration, delirium, urinary tract infection and constipation. Self-Care Guidelines when caring for the Dying Theory Grieving Mourning Grief all of an individual’s reactions to loss
Grief reactionsDepressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, poor concentration
Psychological states shock, denial, yearning Bereavement The period following death Things people do to cope with their grief Dual Process Model of
Coping with Bereavement Worden's 4 Tasks of Mourning Adaptive vs. Maladaptive Coping (Stroebe and Schut’s)
Loss oriented stressors > concentrating on the loss, feeling the pain of grief, remembering and longing
Restoration oriented stressors > reengage the mourner with the outer world, overcoming loneliness, mastering skills and roles once performed by the deceased person, finding a new identity and facing practical details of life Oscillation: the process of alternating between the two 1. Accept the reality of the loss
2. Experience the pain of grief
3. Adjust to the environment without the loved one
4. Relocate and memorialize the loved one Every loss must be treated differently according to how they died, who died, nature of the attachment, family history etc. Guidelines Bereavement Take the time you need to grieve
Express your feelings
Establish a structure for each day
Don’t feel that you have to answer questions people ask you
Try to take good care of yourself
Expect setbacks and things that will trigger your grief
If you don’t feel better in few weeks, at least for a little while every day, notify your doctor Experiences Sensations of somatic distress
Preoccupation with the image of the deceased
Guilt
Anger
Change in behavior: depression, disorganization, restlessness
Reorganization of behavior directed toward a new object or activity Maladaptive
Grieving Complicating
Factors Chronic grief, delayed grief, exaggerated grief and masked grief reactions
Proposed diagnostic criteria for complicated grief
Persistent pining for the deceased
Grief that lasts 6 months or more
Bereavement that seriously impairs the mourner’s ability to function in their daily lives and routines Heavy emotional dependence on the deceased
Unresolved conflicts
Young age of the deceased
History or previous losses
Lack of support system
Lack of coping skills
Person who died of social stigma (AIDS, suicide)
Unexpected or unexplained death (murder)
Disenfranchised grief Remind yourself that this is happening to your patients and their families, not you
If you are having a particular strong emotional response, positive or negative, take time to explore that emotion
Avoid working outside of normal hours, giving away your home number and take regular vacations
Make your job clear as to what you can and can’t do for your patients
Mourn in your own way losses you may experience
Make sure you have a way to release stress in your private life Caregivers must remember to focus on the person, not the disease. They are unable to inform us when they are uncomfortable, need to urinate, or when they are hungry. Doing so, provides meaning to the individual’s life, upholds dignity, and provides pleasurable and spiritual experiences. Significant impairments in insight, language, and judgment occur limiting their ability to communicate unmet needs and desires. Dementia is a leading cause of death among older adults in America; therefore, all caregivers should understand the unique approach of increasing comfort and enhancing the quality of life for these palliative dementia patients. Palliative Care for Dementia Patients Aging With Dignity is a secure online resource for implementing the Five Wishes Five Wishes lets your family and healthcare providers know how you want to be treated if you are seriously ill and unable to speak for yourself: Who you want to make health care decisions for you when you can't make them.
The kind of medical treatment you want or don't want.
How comfortable you want to be.
How you want people to treat you.
What you want your loved ones to know. From this secure website, you may:
Create, customize, store, transmit, share, translate or print your Five Wishes
Learn about the Five Wishes and how to communicate with loved ones about this sensitive issue
Access required advanced planning documents of all 50 states http://www.agingwithdignity.org/index.php Review to follow .... References

Aging with Dignity (2013). Retrieved from http://www.agingwithdignity.org/index.php

Varcarolis, E. M., Halter, M. J. (2010). Foundations of psychiatric mental health nursing: A clinical approach (6th ed.). St. Louis, MO: Saunders Elsevier.

Wenger, B., Asakura, Y., Fink, R. M., & Oman, K. S. (2012). Dissemination of the five wishes advance directive at work. Journal of Hospice & Palliative Nursing, 14(8), 551-558.
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