Dying, death, and palliative care

1. the cause of death

2. the age of the person

3. Culture

4. way that person has handled earlier loss and stresses

1. the cause of death

2. the age of the person

3. Culture

4. way that person has handled earlier loss and stresses

Things that can change experience and grieving (there are many and all are challenging: [4]

1. Acute grief (first happens)

2. Middle period (everyday life)

3. ending period (new normal, stable)

Phases of grief: [3]

Anticipatory grief

Type of grief before the actual loss happens. Already grieving when the loved one is not gone yet. Can apply to all loss

Acute grief

Type of grief in crisis period. May not be coping well, finding it difficult to perform ADLs and IADLs. May last 6 months

Persistent or complicated grief

Type of grief lasting longer than 6 months. Evolution towards adjustment is blocked somehow (circumstances of death, other responsibilities, family dynamics).

Disenfranchised grief

Type of grief that is more specific. The loss cannot be openly acknowledged. May be estranged, may be grieving someone you do not know.

1. Shock

2. Denial

3. Anger

4. Depression

5. Testing

6. Acceptance

stages of grief [6]

The living-dying interval

Time between knowing the death will happen and the actual death. Within the person.

1. Care

2. Control

3. Composure

4. Communication

5. Continuity

6. Closure

The six Cs related to caring for people in this situation:

1. give little choices

2. see if family wants to get invovled

How to offer control to dying patients [2]

1. Closed awareness: patient doesn’t know, doesn’t want to know

2. Suspected awareness: knowing something is going on

3. Mutual pretense: Everyone knows but people pretend. Don’t talk about it.

4. Open awareness: everyone knows and everyone is aware and acknowledging

Four types of communication that can happen with patient/family and health care team:

Palliative care

Care that focuses on symptoms rather than disease. Quality of life rather than quantity.

Hospice Palliative care

End of life care in the community rather than the hospital. People can be discharged, can eb temporary.

Virtual Palliative care

Telehealth can provide end of life support over video

They have to be able to disengage but not too much. Care and relate to families without taking it home with them. Must have coping skills and inner strength.

What does it mean when nurses are professional grievers:

Substitute decision maker

Someone who makes decisions for person

Advance care planning

Process of planning for a time when a person does not have cognitive capacity to make decisions about health care

•Choosing substitute decision maker

•Communicating to the decision maker their wishes for future health care, personal care and living arrangements

Advance care planning involves: [2]

Advance directive

a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to health care team

Living will

outlines your instructions and preferences for health care and treatment during incapacity if you're unable to express them yourself at the time

power of attorney

a legal document that gives someone you trust the right to make financial or health care decisions for you

no, but can assist in procedure. Phycision or NP administers.

Can RNs administer MAID medications?

No. put on pause for now due to ethical considerations

Is MAID approved for mental health?

1. Over 18

2. poor prognosis

3. cognitively well

Broad criteria for MAID: [3]