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31 Cards in this Set
- Front
- Back
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Treatment Goals for Cancer
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*Cure
*Control *Palliation |
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Cure
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*Patients completing adjuvant therapy may celebrate or mourn the end of treatment
*The role of the clinician is support and educate *Patients and families may exhibit signs of fear, powerlessness, and separation anxiety |
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Nurse/Patient Relationship
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*When the goal is CONTROL, a long-term relationship is the expectation
*Allows for care and connection to develop over a period of time *The patient and care-giver may be changed if both are open to the relationship |
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Trust
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*Trust is the essence of this relationship
*Trust is fostered through "being present" for the client and the family (The nurse does not judge or react to negative behavior) *Trust is also born of confidence and sensitive honesty |
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Documents Used in End of Life Care
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*Advanced directives (Ex: No breathing tube)
*Directives to physicians *Do not Resuscitate Order *Durable power of attorney for health care *Living Will *Medical Power of Attorney *Five Wishes (patient's wishes for end of life care) |
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Attitudes of Death and Dying
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*Elizabeth Kubler-Ross (1969): Stages of Grief and Death Reactions
-Denial -Anger -Bargaining -Depression -Acceptance |
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Martocchio (1985)
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*Shock and Disbelief
*Yearning and protest *Anguish, disorganization, despair and identification of bereavement *Reorganization and restoration |
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Rando
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*Avoidance
*Confrontation *Accomodation |
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The Dying Process
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*Develop an awareness of impending death
*Balancing hope and fear *Relinquishing the will to live *Letting go of autonomous control *Detaching from former experiences and relationships *Achieving spiritual preparation |
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Terminal Care
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*An individual is considered "Terminally ill" when life expectancy is six months or less to live.
*Life expectancy is a general term based on gathered data from the experiences of other clients with similar illness and the experiences of the provider |
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Hospice
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*Hospice defines clients with a terminal illness who has a life expectancy of a few hours to a few days as actively dying.
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Hospice Care
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*This concept developed in the 70's with the goal of providing compassionate, supportive palliative care, usually in the home.
*Hospice care requires careful explanation to clients and families *Hospice can be confused with the insurance benefit 1. Goal of care 2. Benefit of care (insurance) |
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Palliative Care
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*Aimed at symptom management and supportive care
*Heavily focused on symptom management of the disease *Palliative care is the framework for hospice care but may take place independently *May be instituted with therapy aimed at control |
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Preparing for Approaching Death
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*Physically
-The body begins the process of failing systems -Changes in the CNS, skin, cardiovascular, renal, respiratory systems -Ends when all functions cease *Mentally -That which may be considered the spirit of the person is less available -Is not always synchronous with the physical state |
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Nursing Process: The Dying Client
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*Assessment:
-Physiological -Safe, effective care management -Psychosocial Integrity -Spiritual -Cultural |
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Nursing Diagnosis
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*Actual
-Treatment/Symptom Related -Anxiety -Altered Family Process -Grieving Anticipatory Dysfunctional Powerlessness Hopelessness *Potential -Impaired Social Interaction -Altered Sexual Patterns |
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Expected Outcomes
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*Client will demonstrate awareness of dying as evidenced by communication verbally, life review, putting affairs in order, expressing farewells, planning funeral
*Client will identify feelings of denial, anger, bargaining, depression and acceptance as normal phases of dying |
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Interventions
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*Physiological
-Meet basic needs -Focus on specific needs as they relate to past therapies and symptom management *Psychological -Self concept -Sexual issues -Coping -Stress |
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Expected Outcomes
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*Client demonstrates awareness of dying by talking about it, reviewing his/her life, putting affairs in order, expressing farewells, giving keepsakes to significant others, planning funeral
*Client identifies feelings of denial, anger, bargaining, depression, and acceptance as normal phases of dying, not signs of weakness *Client demonstrates control of fear and expressing realistic and appropriate aspects of hope in the situation |
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Hope
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*Hope and Honesty are not incompatible
*What does the client hope for? -What does quality of life mean to them? *Compassion is an irreplaceable gift Goal: Try to find what the person would hope for |
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Needs of the Grieving Family
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*Hope
-Best possible care -Resolution of pain and suffering -Participation assisting in care -Unlimited access to a loved one -Sharing in decision making -Being informed -Support -Spiritual Needs |
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Stages of Bereavement
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*Acute Grief usually lasts 6-8 weeks
*Inappropriate Grieving may last 12 months or a lifetime -Denial -Anger -Bargaining -Depression -Acceptance |
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Work of Mourning
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*Acceptance of the reality of the loss
*Resolution of the pain or grief *Adjust to the environment in which the deceased is no longer present *To emotionally withdraw energy from the deceased *To rebuild philosophical systems that were challenged by the loss |
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Dysfunctional Grieving
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*Risk Factors
-History of dysfunctional coping or psychiatric disorder -Dysfunctional family patterns -Repression of feelings *Pattern -Acute grief persists past 6-8 weeks -Grieving persists past 1-2 years -Psychosomatic symptoms |
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Powerlessness/Hopelessness
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*Powerlessness
-Perception that one's own actions will not significantly effect and outcome -Perceived lack of control (good place for nurse to intervene) *Hopelessness -An extreme state -Unable to mobilize energy on his/her own behalf -Client is unable to identify personal choices or alternatives |
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Powerless
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*Tasks and Challenges
-Maintain normalcy -Adjust to lifestyle & routine -Obtain knowledge & skills for self-care -Maintain positive self concept -Engage in grieving process *Interventions -Facilitate communication -Education -Modify environment as needed -Set achievable goals -Being present |
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Hopelessness
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*Related Factors
-Prolonged activity restriction -Deteriorating physical condition -Chronic stress -Spiritual distress *Defining Characteristics -Passivity -Decreased verbalization -Decreased affect |
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Role of the Nurse
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*Acknowledge client feelings
*Provide perspective *Establish attainable goals *Provide opportunities to establish control |
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The Nurse's Role: How to help your client
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*Acknowledge your client's feelings of hopelessness
*Provide new perspectives *Help your client see he/she has someone to live for *Call attention to esthetic experiences *Respond to clients' use of reality surveillance *Establish attainable goals *Help client re-establish control |
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Self-Care for the Nurse
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*Examine our own feelings and beliefs related to death
*Allow time for grieving *Share the load with others *Therapeutic separation (saying goodbye) *Energy conservation |
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Self-Care for Nurses'
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*Be aware of your strengths and weaknesses in facing death
*Explore your own grief response *Ask a co-worker for help *Talk with a trusted friend *Use agency support systems *Assess your constraints: time & energy *Draw on your resources: spiritual *Monitor for signs of burnout: lack of compassion *Know the support systems available to you |
