Medical Surgical Nursing
Chapter 17
End of life care includes: palliative care- comprehensive care for patients whose disease is not responsive to cure; care also extends to patients’ families; management of psychological, social, and spiritual problems as well as control of pain and other physical symptoms; to improve pt and family’s quality of life hospice- care provided to terminally ill patient’s and their families; death has been accepted, bereavement for family; generally associated with palliative care that is delivered at home or in special facilities to pts who are approaching the end of life(type of palliative care provided at end of life) * Death must be accepted * Pain and other symptoms of terminal illness much be managed * The pt and family must be viewed as one unit * Home care of the dying is necessary * Bereavement care must be provided to family members * Research and education should be ongoing
The assessment of end of life beliefs, preferences, and practices should be carried out in short segments over a period of time.
The nurse should help the pt and family clarify their goals, expected outcomes, and values
Keys to effective listening * Resist the impulse to fill the “empty space” in communication with talk * Allow the pt and family sufficient time to reflect and respond after asking a question * Prompt gently “Do you need more time to think about this?” * Avoid distractions * Avoid the impulse to give advice * Avoid canned responses “I know how you feel.” * Ask questions * Assess understanding-your own and the pt’s-by restating, summarizing, and reviewing
Avoiding invasive procedures; if pt has dyspnea- low dose oral morphine is effective in relieving this
Avoiding invasive procedures; if pt has dyspnea- low dose oral morphine is effective in relieving this
End of life: Goal- Symptom management * Pain * Dyspnea * N/V * Weakness * Anxiety * Artificial nutrition/hydration *
End of life care includes: palliative care- comprehensive care for patients whose disease is not responsive to cure; care also extends to patients’ families; management of psychological, social, and spiritual problems as well as control of pain and other physical symptoms; to improve pt and family’s quality of life hospice- care provided to terminally ill patient’s and their families; death has been accepted, bereavement for family; generally associated with palliative care that is delivered at home or in special facilities to pts who are approaching the end of life(type of palliative care provided at end of life) * Death must be accepted * Pain and other symptoms of terminal illness much be managed * The pt and family must be viewed as one unit * Home care of the dying is necessary * Bereavement care must be provided to family members * Research and education should be ongoing
The assessment of end of life beliefs, preferences, and practices should be carried out in short segments over a period of time.
The nurse should help the pt and family clarify their goals, expected outcomes, and values
Keys to effective listening * Resist the impulse to fill the “empty space” in communication with talk * Allow the pt and family sufficient time to reflect and respond after asking a question * Prompt gently “Do you need more time to think about this?” * Avoid distractions * Avoid the impulse to give advice * Avoid canned responses “I know how you feel.” * Ask questions * Assess understanding-your own and the pt’s-by restating, summarizing, and reviewing
Avoiding invasive procedures; if pt has dyspnea- low dose oral morphine is effective in relieving this
Avoiding invasive procedures; if pt has dyspnea- low dose oral morphine is effective in relieving this
End of life: Goal- Symptom management * Pain * Dyspnea * N/V * Weakness * Anxiety * Artificial nutrition/hydration *