Tabloski ch11 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Care at the End of Life

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

2. Explain changes in demographics, economics, and service delivery that require improved nursing interventions at the end of life.

3. Understand how pain and adverse symptoms affect dying.

Learning Objectives

4. Discuss the diverse settings for end-of-life care and the role of the nurse in each setting.

5. Explore pharmacological and alternative methods of treating pain.

6. Identify the signs of approaching death.

Learning Objectives

7. Implement appropriate nursing interventions when caring for the dying patient.

8. Describe postmortem care.9. Discuss family support during the grief

and bereavement period.

Introduction

• Nurses are uniquely qualified to provide comprehensive, effective, compassionate, and cost-effective care to persons at the end of life because of their holistic focus.

• Informed understanding of the patient’s values, wishes, and goals allows the nurse to attend to the patient’s physical, emotional, psychosocial, and spiritual needs.

Introduction

• Viewing death as a natural process—not a medical failure—is of utmost importance.

Introduction

• The nurse provides the following attention to pain and symptom control:– Relief of suffering.– Coordinated care across settings with

high-quality communication between healthcare providers.

– Preparation of the patient and family for death.

Introduction

• The nurse provides the following attention to pain and symptom control:– Clarification and communication of goals

of treatment and values.– Support and education during the

decision-making process, including the benefits and burdens of treatment.

The Changing Face of Death

• There have been changing demographic and social trends surrounding death in the years 1900 and 2010.

Table 11-2 Cause of Death and Demographic/Social TrendsSources: Adapted from Administration on Aging, 2010; Arias, 2011;

National Center for Health Statistics (NCHS), 2011.

The Changing Face of Death

• Older adults are spending less time in the hospital at the end of life.

• Increasing numbers of older adults are choosing hospice care at the end of life.

• Many barriers to the provision of excellent end-of-life care exist.

Hospice Care

• Hospice care provides support for persons in the last phase of life-limiting illness through expert medical care, pain and symptom management, and emotional and spiritual support so that they may live as fully and comfortably as possible.

• All hospices encourage family involvement and promote death with dignity.

Palliative Care

• Palliative care is “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and treatment of pain and other problems, physical, psychosocial and spiritual”.

Stages of the Dying Process

• Death and dying is a unique experience, and each person and family progresses through the process differently.

• The nurse should remain objective and not quickly jump to conclusions that “one size fits all.”

Box 11-1 Kubler-Ross Stages of Grief and Dying

The Nurse’s Role

• The nurse’s assessment guides the interdisciplinary team in providing individualized care with respect for the patient’s wishes.

Best Practices

• Geriatric nursing and informal caregivers may be at increased risk for depression, fatigue, and changes in social interaction with prolonged caregiving.

Pain at the End of Life

• Merciful relief of pain is essential for quality end-of-life care in the older patient.

• Pain assessment guides the development of a comprehensive pain management plan.

• Accurate pain assessment is the basis of pain treatment and should be done in a systematic and ongoing manner.

Pain During the Dying Process

• Total pain recognizes that pain at the end of life is more than just physical suffering, but also includes associated emotional, social, and spiritual suffering.

The Dying Process

• The nurse’s views, knowledge, emotional development, and cultural background help determine how effectively he or she may deal with the death process.

Advance Care Planning

• Decision making around the time of death raises many legal and ethical questions.

• Healthcare professionals must work within the limits of the law and their professional standards of practice.

Preparing for Death

• It is part of the nursing role to attempt to allay the fears of patients and families at this time.

• Nurses must also remember to support themselves through this difficult period.

Preparing for Death

• The nurse should utilize an interdisciplinary team of physicians, nurses, social workers, volunteers, and grief and bereavement counselors to facilitate the grief and bereavement process.

Tabloski ch11 lecture

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