The Department of Health’s 2008 End of Life Care Strategy, provides a comprehensive framework aimed at promoting high quality care for all adults approaching the end of life in all care settings in England. It sets out what adults reaching the end of their lives, and their carers can expect from the services provided to them and one of the key aims is to ensure as far as possible their needs and preferences for future care are met. The common factors include: Being treated as an individual, with dignity and respect
Being without pain and other symptoms
Being in familiar surroundings
Being in the company of close friends and family
The national institute for Clinical Excellence (NICE) End of Life Care Quality Standard, emphasises these expectations. The key points are: 1. A diagnosis that is arrived at as quickly as possible, with information about prognosis and treatment options explained sensitively, appropriately and in a jargon-free way. 2. Information that is provided as and when it is needed, in a format that is appropriate to their needs and abilities. 3. Regular assessment and care planning that includes discussion about current and future care, is person-centred, and takes account of practical, physical, psychological, spiritual, social and religious needs and preferences. 4. Support for carers and family members including children, recognising the impact of bereavement upon them. 5. Care and support delivered seamlessly, by multidisciplinary teams working together to meet identified needs. 1.2
When an individual is at the end of life, usually you are aware due to the documentation that is present.(which is a legal requirement) In my job role I would read and acknowledge the rights and wishes of the individual, including any religious beliefs to ensure they are cared for according to their wishes. 2
Often times, people feel uncomfortable talking to and interacting with a person who is dying. This is at least partly because we have no way to understand their perspective, and what they are experiencing mentally, emotionally, and spiritually. Studying the Kubler-Ross theory and other approaches to the dying process can help us become more comfortable by increasing our understanding and adding insight into the perspective of the dying person. Hopefully this can begin to help increase communication and interaction during a dying person's last days. Kubler-Ross Theory In 1969 Elizabeth Kubler-Ross wrote On Death and Dying. Research and interviews began in 1965 and encountered problems because there is no real way to study the psychological aspects of dying and patients were often willing to talk but it was hard to convince the doctors. Stage Theory: From this research, Kubler-Ross saw a pattern emerging that she expressed in the way of stages. These stages begin when the patient is first aware of a terminal illness. While Kubler-Ross believed this to be universal, there is quite a bit of room for individual variation. Not everyone goes through each stage and the order may be different for each person. Stages of Dying
Denial and Isolation: Used by almost all patients in some form. It is a usually temporary shock response to bad news. Isolation arises from people, even family members, avoiding the dying person. People can slip back into this stage when there are new developments or the person feels they can no longer cope. Anger: Different ways of expression -Anger at God: "Why me?" Feeling that others are more deserving. -Envy of others: Other people don't seem to care, they are enjoying life while the dying person experiences pain. Others aren't dying. -Projected on environment: Anger towards doctors, nurses, and families. Bargaining: A brief stage, hard to study because it is often between patient and God. -If God didn't respond to anger, maybe being "good" will work. -Attempts to postpone: "If only I could live to see . . ." Depression: Mourning for losses.
Care of the dying-...
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