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31 Cards in this Set

  • Front
  • Back
Treatment Goals for Cancer
*Cure
*Control
*Palliation
Cure
*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
Nurse/Patient Relationship
*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
Trust
*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
Documents Used in End of Life Care
*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)
Attitudes of Death and Dying
*Elizabeth Kubler-Ross (1969): Stages of Grief and Death Reactions
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
Martocchio (1985)
*Shock and Disbelief
*Yearning and protest
*Anguish, disorganization, despair and identification of bereavement
*Reorganization and restoration
Rando
*Avoidance
*Confrontation
*Accomodation
The Dying Process
*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
Terminal Care
*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
Hospice
*Hospice defines clients with a terminal illness who has a life expectancy of a few hours to a few days as actively dying.
Hospice Care
*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)
Palliative Care
*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
Preparing for Approaching Death
*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
Nursing Process: The Dying Client
*Assessment:
-Physiological
-Safe, effective care management
-Psychosocial Integrity
-Spiritual
-Cultural
Nursing Diagnosis
*Actual
-Treatment/Symptom Related
-Anxiety
-Altered Family Process
-Grieving
Anticipatory
Dysfunctional
Powerlessness
Hopelessness
*Potential
-Impaired Social Interaction
-Altered Sexual Patterns
Expected Outcomes
*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
Interventions
*Physiological
-Meet basic needs
-Focus on specific needs as they relate to past therapies and symptom management
*Psychological
-Self concept
-Sexual issues
-Coping
-Stress
Expected Outcomes
*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
Hope
*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
Needs of the Grieving Family
*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
Stages of Bereavement
*Acute Grief usually lasts 6-8 weeks
*Inappropriate Grieving may last 12 months or a lifetime
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
Work of Mourning
*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
Dysfunctional Grieving
*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
Powerlessness/Hopelessness
*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
Powerless
*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
Hopelessness
*Related Factors
-Prolonged activity restriction
-Deteriorating physical condition
-Chronic stress
-Spiritual distress
*Defining Characteristics
-Passivity
-Decreased verbalization
-Decreased affect
Role of the Nurse
*Acknowledge client feelings
*Provide perspective
*Establish attainable goals
*Provide opportunities to establish control
The Nurse's Role: How to help your client
*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
Self-Care for the Nurse
*Examine our own feelings and beliefs related to death
*Allow time for grieving
*Share the load with others
*Therapeutic separation (saying goodbye)
*Energy conservation
Self-Care for Nurses'
*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