End--of-life care
Learning Objectives:
. Identify barriers to improving care at the end of life (EOL).
. Apply skills for communicating with terminally ill patients and their family
. Implement nursing measures to manage physiologic responses to terminal illness.
. Support actively dying patients and their families.
. Identify components of uncomplicated grief and mourning and implement nursing measures to support the patient and family
Nurses and EOL
American Nurses Association (ANA) highlights nursing s commitment to the diagnosis and treatment of human responses to illness (1995).
Knowledge about end-of-life decisions and principles of care is essential to supporting patients during decision making and in end-of-life closure in ways that recognize their unique responses to illness and that support their values and goals. Education, clinical practice, and research concerning end-of-life care are evolving, and the need to prepare nurses and other health care professionals to care for the dying has emerged as a priority
Definition End of life care( EOL) :
The care focused on the physical and psychosocial need at the end of life of the client and the client’s family
The goals for care are the following:
. To provide comfort and supportive care during the dying process
.To improve the quality of the remaining life
3.To help ensure a dignified death
Glaser and Strauss (1965) discovered that health care professionals in hospital settings avoided direct communication about dying in hope that the patient would discover it on his or her own. They identified four "awareness contexts," described as the patient s, physician s, family s, and other health care professionals awareness of the patient s status and their recognition of each other s awareness:
* Closed awareness: The patient is unaware of his or her terminal state while others are aware.
* Suspected awareness: The patient suspects what others know and attempts to find out.
* Mutual pretense awareness: The patient, the family, and the health care professionals are aware that the patient is dying but all pretend otherwise.
*Open awareness: All are aware that the patient is dying and are able to openly acknowledge that reality.
Kubler Ross(1969):
Stages of Grieving
- Denial
- Anger/bargaining
- Depression
- Acceptance
Grief: is the emotional and behavioral response to loss, is an emotional reaction that is necessary to maintain quality in both emotional and physical well-being.
Mourning : involves a total individual experience associated with the individual thoughts feelings, behaviors , cultural beliefs; and religion.
Bereavement : is an individual ‘s response to loss of a significant person