End-of-Life Care: Acts, Trajectories, and Nursing Interventions in Palliative and Hospice Settings

What are the three acts of death and grief discussed in the course?

Anticipation, Historical Overview, Illness Trajectories

Why is it important for nurses to understand death?

Confronting death in patients uncovers nurses' own fears and enhances care.

What has historically influenced the way people die?

Most people historically died from communicable diseases and injuries, often at home.

What is the leading cause of death in the US as of 2022?

Chronic illnesses have become the leading cause of death.

How has technology affected end-of-life care?

Technology prolongs life but raises ethical questions about when to stop treatment.

What are common patient perspectives on end-of-life care?

Avoid unnecessary life support, good communication, trust in physician, and managing pain.

What percentage of patients die in hospitals, and what is projected for 2030?

About 50% currently die in hospitals; by 2030, only 1 in 10 will die at home.

What is the role of nurses in end-of-life care?

Nurses provide comfort, information, holistic care, and support to patients and families.

What are the four illness trajectories discussed?

Sudden death, terminal illness, organ failure, and frailty.

What characterizes the sudden death trajectory?

Death occurs without prior warning, often leaving families unprepared.

What defines the terminal illness trajectory?

A condition that leads to death relatively quickly, usually within days to weeks.

Describe the organ failure trajectory.

Organs gradually shut down, leading to exacerbations and hospitalizations.

What is the frailty trajectory?

A slow decline towards death with low functional ability, often requiring significant care.

What is the Quality of Life Model?

It assesses the physical, psychological, social, and spiritual functioning of a person.

What does the Uncertainty in Illness Model address?

It examines the role of uncertainty in a patient's experience with chronic illness.

What are the stages of grief according to Kubler-Ross?

Denial, Anger, Bargaining, Depression, Acceptance.

What is the first stage of grief?

Denial, where patients may seek second opinions and struggle to accept their diagnosis.

What nursing interventions are appropriate during the denial stage?

Actively listen to patients' concerns and provide sensitive support.

What is the significance of end-of-life conversations?

They are crucial for planning and fulfilling patient wishes and are now reimbursable by Medicare.

What is the difference between EOL care and palliative care?

EOL care is specialized care at the end of life, while palliative care focuses on relieving suffering at any stage.

What challenges do families face during the dying process?

Emotional stress, survivor's guilt, and difficulty saying goodbye.

How can nurses assist families during end-of-life care?

By providing resources, education, and emotional support.

What is the importance of advance directives?

They help ensure that patient wishes are respected and fulfilled at the end of life.

What is the role of communication in end-of-life care?

Effective communication builds trust and ensures that patient and family needs are met.

What is a common misconception about patients who cannot be cured?

Families often fear that these patients will receive lower quality care.

What is the impact of chronic illness on the dying process?

Patients often experience prolonged uncertainty and may require complex decision-making.

What is the purpose of seeking a second opinion in healthcare?

To validate the diagnosis and treatment plan, providing reassurance to the patient.

What role does denial play in the grieving process?

Denial acts as a 'shock absorber' for reality, allowing time to process the illness.

What are key nursing interventions during the denial stage?

Actively listen to patients' concerns and provide support, being sensitive to their thoughts.

What characterizes the anger stage of grief?

Patients may lash out at caregivers due to frustration with their diagnosis and impending death.

How can caregivers support patients experiencing anger?

Educate the family about the normalcy of anger and respond to the patient in a non-provoking manner.

What is the bargaining stage in the context of grief?

Patients may internally bargain with a higher power or physicians for a change in their prognosis.

What nursing interventions are appropriate during the bargaining stage?

Provide active listening and emotional support if the patient discusses spirituality.

What is a common emotional response during the depression stage of grief?

Patients may feel sadness due to the realization that life is ending and may experience increased symptoms.

What should nurses avoid saying to patients in the depression stage?

Avoid clichés like 'cheer up' or 'look on the bright side' as they may be unhelpful.

What does the acceptance stage of grief entail?

Patients may not be happy about their situation but have made peace with their circumstances.

What nursing interventions can support patients in the acceptance stage?

Provide non-verbal communication, anticipate needs, and offer emotional support.

What is the primary focus of palliative care?

To improve the quality of life for patients with life-limiting illnesses through comfort measures.

How does hospice care differ from palliative care?

Hospice care is for patients at the end of life, focusing on comfort rather than cure.

What is the average length of stay (LOS) on hospice care?

77.9 days.

What types of support does hospice care provide?

A team approach including medical, emotional, and bereavement support for patients and families.

What is a common misconception about stopping curative treatments in hospice care?

Stopping curative treatments does not mean stopping all treatments; supportive medications may continue.

What are the goals of care in end-of-life discussions?

To understand what the patient wants regarding their illness, focusing on comfort versus cure.

What challenges do patients face when discussing prognosis?

Patients often want honest answers but may overestimate their remaining time.

What are the benefits of treatment at the end of life?

Cure, symptom relief, and improved quality of life.

What burdens might patients face from treatment at the end of life?

Progression of illness, worsening symptoms, and emotional burdens from treatment.

What is the Patient Self Determination Act of 1991?

A law that ensures patients have the right to make their own healthcare decisions.

What is an advanced directive?

A legal document that outlines a patient's treatment preferences.

What are common physical symptoms experienced by patients nearing death?

Pain, dyspnea, nausea, constipation, fatigue, and depression.

What types of pain classifications exist in end-of-life care?

Somatic, visceral, and neuropathic pain.

What is the PQRST method used for?

To assess pain by evaluating Provocation, Quality, Region, Severity, and Timing.

What are some examples of adjuvant medications used in pain management?

Steroids, antidepressants, anticonvulsants.

What is the recommended approach for providing pain medications?

Prompt delivery of routine and prn meds for breakthrough pain, around-the-clock dosing, and no ceiling dose if properly titrated.

List some non-pharmacologic methods for pain management.

Heat, cold, cognitive techniques, music, distraction, massage, aromatherapy.

What are common barriers to adequate pain management?

Fears about addiction, adverse effects, lack of access to pain specialists, and pharmacies not having needed medications.

How is dyspnea managed at the end of life?

Managed with opioids, benzodiazepines, cool fans, elevating the head of the bed, and supplemental oxygen.

What are the common causes of nausea and vomiting at the end of life?

Multifactorial causes from CNS and GI systems; anxiety may also contribute.

How can constipation be managed in end-of-life care?

Identify causes, use laxatives and stool softeners, and address nutrition and hydration.

What is the significance of fatigue in end-of-life care?

Fatigue is common in advanced illnesses and requires education on energy conservation and assistance with activities of daily living.

What is the approach to managing seizures in end-of-life patients?

Treat the underlying cause, prevent with medications, and ensure safety precautions.

What are the emotional and spiritual considerations for patients at the end of life?

Addressing emotional distress, fostering hope, and discussing spiritual topics are crucial.

What types of loss are recognized in end-of-life care?

Actual loss, perceived loss, anticipatory loss, developmental loss, and situational loss.

Define actual loss.

Loss that can be recognized by others, such as loss of a limb, child, job, or home.

What is anticipatory loss?

Loss experienced before the actual event occurs, such as when a loved one is terminally ill.

What is the impact of suffering in end-of-life care?

Suffering involves severe distress that can affect mind, body, and spirit, compounded by pain.

What are some fears commonly experienced by the terminally ill?

Fears of loneliness and meaninglessness.

What are the basic ethical principles in end-of-life care?

Autonomy (respect for self-determination) and beneficence (to do good and prevent harm).

How should nurses approach the topic of hope with terminally ill patients?

Nurses should foster hope without encouraging false hope, recognizing the patient's changing needs.

What interventions can help manage anxiety in terminally ill patients?

Encouraging introspection, accepting rituals, and assisting in making amends.

What is the role of spiritual distress in end-of-life care?

Patients may reflect on spirituality, becoming more spiritual or feeling anger towards a higher power.

What is the significance of loss intensity in end-of-life experiences?

Intensity of loss is determined by the client's perception of value, memory, and relationship with the lost entity.

What are some strategies for managing terminal restlessness or delirium?

Use medications like haloperidol and lorazepam, and provide comfort and education to the family.

What is the importance of assessing support systems for terminally ill patients?

Support systems can help address emotional and spiritual needs, reducing feelings of loneliness.

What are some common symptoms at the end of life that require management?

Dyspnea, cough, nausea, vomiting, constipation, fatigue, dysphagia, seizures, depression, and anxiety.

How can nurses assist patients experiencing grief and loss?

By providing support, recognizing the grieving process, and addressing emotional needs.

What role does education play in managing end-of-life symptoms?

Education helps patients and families understand what to expect and how to cope with symptoms.

What does nonmaleficence mean in nursing ethics?

Refraining from causing unnecessary harm, with moral justification required for any harm caused.

What is the nurse's obligation regarding life termination according to the ANA Code of Ethics?

Nurses may not deliberately terminate life but must provide interventions to relieve symptoms in dying patients, even if it may hasten death.

What principle involves social fairness in resource allocation?

Justice

What is informed consent in the context of patient autonomy?

Patients have the right to make informed decisions based on factual information regarding their care.

What does capacity refer to in patient decision-making?

The ability of a patient to understand their choices and make decisions about their care.

What is the role of nurses in family decision-making during difficult situations?

Nurses witness family decision-making, which may not align with their own values.

What does withholding or withdrawing interventions entail?

Cessation of medical interventions, which can range from stopping non-life-sustaining medication to removing mechanical ventilation.

What are advance directives and why are they important?

Advance directives guide family decision-making and can prevent unwanted treatments.

What does a Do Not Resuscitate (DNR) order signify?

The patient has decided they do not want CPR in the event of cardiac arrest.

What is the purpose of comfort care in the context of allowing natural death?

To provide comfort measures while allowing the patient to die naturally.

What is the Physician Orders for Life-Sustaining Treatment (POLST)?

A medical order for patients with about a year or less to live, outlining treatment preferences.

What is the principle of double effect in medication administration?

Medications given to reduce suffering may also hasten death, requiring consideration of the intended effect.

What is terminal or palliative sedation?

A last resort measure to ease suffering at the very end of life by sedating the patient.

What distinguishes assisted dying from other end-of-life options?

Assisted dying involves intentionally hastening death through a drug or lethal substance.

What does the term 'comfort-care-autonomy-dignity' refer to in nursing for terminally ill patients?

Providing good medical treatment while respecting patient autonomy and dignity.

What should nurses do to facilitate communication with terminally ill patients?

Allow time for reflection, avoid distractions, and assess understanding through restating and summarizing.

What are the key aspects of nursing care for the dying?

Providing physical and psychological care, controlling pain, and respecting spiritual practices.

What is the significance of the phases of dying in patient care?

Understanding the phases helps manage symptoms and provide appropriate support to patients and families.

What occurs during the imminent phase of dying?

The body is shutting down, and multi-system organ failure occurs, making death a reality for everyone involved.

What is the difference between clinical death and biological death?

Clinical death is when the heart stops beating, while biological death occurs when brain cells start to die, marking death as permanent.

What is the nurse's role after a patient's death?

Allow family members to spend time with the deceased and provide privacy.

What is clinical death?

Clinical death occurs when the heart stops beating.

What is biological death?

Biological death is when brain cells start to die, marking death as permanent.

What is rigor mortis and when does it begin?

Rigor mortis begins within 2-4 hours after death and is fully developed by 6-12 hours due to loss of ATP, causing muscle stiffness.