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46 Cards in this Set
- Front
- Back
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Advanced Directives/ Living Will
main ideas |
legal documents about your wishes should you become incapacitated. This is different from a DNR due to the episodic nature and time limitations of a DNR. Even better are durable power of attorney for medical needs.
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Terminally Ill
definition: |
period from diagnosis of pathology to death
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imminently dying:
definition: |
when the death is about to occur
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brain death:
definition |
no activity on the EEG (electroencephalogram)
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euthanasia
definition |
assisted suicide
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Key points to consider when dealing with a patient who is dying:
uniqueness |
Each patient will experience his own unique experience of dying
_ The key is to look for distinguishing factors and respond respectively to those needs. |
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Key points to consider when dealing with a patient who is dying:
needs |
People who are terminally ill have a different set of needs and react differently than those who are aging in the "natural "process that eventually leads to death . A major obstacle that the HP and pt must pass is trying to defeat the inevitable and deal with the present. Quality versus Quantity
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As a society, we try to deny death
examples of this behavior? |
bodies are displaced to look asleep
children see death on TV and movies but know the person will be back next week |
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what is the common thread in death?
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Death is a personal event. And although we all respond differently to it, the common thread is that we all go through a process.
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Stages of Loss- Kubler Ross
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Denial- not admitting to the problem
Anger- mad about this situation Bargaining- giving up/doing something extra for something in return, i. e.- more time Depression- not seeing family, friends, repressed feelings Acceptance- able to go on and enjoy what is left |
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are the stages of Kuler - Ross linear?
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These stages are not always linear and people will go forward and backward within the sequence until acceptance is achieved.
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as health care providers, how can we best help pts and their families cope with death?
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Be a good listener
Be supportive of their hopes |
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in regards to death, what is an example of an institutional barrier between a pt and their family?
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if the pt is in an ICU and the family can only visit during set times
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when is generally the most stressful time for a pt and their family when dealing with death?
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The time of uncertainty is often the most stressful.
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Fears of the dying pt:
isolation/abandonment: |
feel that people give up on them and are not there to support them
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Fears of the dying pt:
pain: |
can be affected by psychological state/caring
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Fears of the dying pt:
dependence: |
loss of control
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Fears of the dying pt:
financial |
family will not be provided for
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Fears of the dying pt:
actual death |
separation from loved ones, unfinished business, concern for welfare of those left behind, the fear of being totally alone in another world
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Some cultures have customs to achieve immortality:
physical countermeasures: |
providing the corpse with food, drink and maybe spouses to "prolong" physical life
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Some cultures have customs to achieve immortality:
fame |
persons image preserved in poetry or by inscription (monuments)
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Some cultures have customs to achieve immortality:
procreation |
through ones offspring, and eventually by cloning
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Some cultures have customs to achieve immortality:
heirlooms |
passing down your treasures
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Some cultures have customs to achieve immortality:
submersion in ultimate reality |
belief that you become reborn over and over again until perfection is reached "nirvana”
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Some cultures have customs to achieve immortality:
resurrection of individuals |
via souls or cryogenic suspension: frozen and thawed
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Family response to terminal illness varies: most families will draw together, but you see a range of behaviors. At times the families can be difficult for the HP to manage, they can be intrusive and difficult. Families need to be there to cope with their grief. The survivors always suffer the most.
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Family response to terminal illness varies: most families will draw together, but you see a range of behaviors. At times the families can be difficult for the HP to manage, they can be intrusive and difficult. Families need to be there to cope with their grief. The survivors always suffer the most.
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what kind of grief will families suffer while their loved one is dying?
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Families will suffer anticipatory grief which is similar to the acute grief stages.
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Symptoms of Grief
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tendency to sigh
complaints of chronic weakness or exhaustion digestive distress preoccupation with the dying persons image and appearance guilt hostility change in patterns of conduct |
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what are the two views of sharing medical information with the patient?
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harmful or empowering
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what considerations should guide you in your decision in discussing medical info w/ dying patients?
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careful consideration of pts mental status
it may be better coming from someone other than the team say in terms the pt will understand. Use of %’s. |
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as health care providers, how can we treat losses and fears in the dying pt?
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continue to treat the pt to allow as much independence as possible for as long as possible, this also assures the pt. that they are not being abandoned
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help the pt maintain hope- not of a cure, but that they will enjoy the time they have left.
Listen carefully to the pt to help them attain their goals and wishes |
help the pt maintain hope- not of a cure, but that they will enjoy the time they have left.
Listen carefully to the pt to help them attain their goals and wishes |
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When death is imminent:
what determines the way we deal with death? |
the way we react is usually governed by how we feel about death - we withdraw, deny etc.. the more we fear the more difficult it is for our pts.
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When death is imminent:
what can we do about unecessary procedures and rules in the final moments? |
maximize comfort and stop all unnecessary procedures
help relieve suffering bend the rules as need |
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When death is imminent
should the health care provider say goodbye to the pt? |
say good-bye and allow the pt and family to show gratitude, it assists in their grief process
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Accept rejection from the pt if he shuts you out, and do not take it personally. They may be having trouble with good-byes, or have accepted their death, or they are saving time only for their family and close friends, or they may be directing their anger toward you, because you represent the medical world
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Accept rejection from the pt if he shuts you out, and do not take it personally. They may be having trouble with good-byes, or have accepted their death, or they are saving time only for their family and close friends, or they may be directing their anger toward you, because you represent the medical world
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Rejection from pt
ways it can be displayed: |
The threat of physical violence
Incessant demands Manipulative behavior Ingratitude Sexually provocative behavior Non-compliance |
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Rejection from pt
important differentiation to consider... |
Is the patient rejecting your help OR is the patient rejecting you?
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3 of the most frustrating pts to work with are...
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the disruptive (verbal or physical) or the self destructive pts (hurting self and not accepting help) or the manipulative patient.
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Showing respect in difficult situations
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make sure the pt thoroughly understands why you are working with him and what the treatment goal is.
be deliberate and consistent in your approach: set limits make sure the limits are clear, consistent and not arbitrary Focus any negative communication on the behavior not on the person |
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apraxia
def: |
the inability to perform purposeful movement
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agnosia
def: |
, the inability to recognize a sensation or visible stimulus
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aphasia
def: |
the loss of language
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Guidelines for showing respect to difficult pts:
Do not use derogatory labels Use empathetic phrases: I understand you are upset, I know you are frustrated |
Do not have unrealistic expectations
Set up patient contracts Don’t attempt to change things you can’t control |
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Guidelines for showing respect to difficult pts
Take care of your emotional well being and stay in tune with your emotional response toward patients |
Try to change situations and attitudes that lead to devaluating behaviors. People who feel powerless are more likely to act out aggressively.
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Guidelines for showing respect to difficult pts
Don’t finger point or stand with hands on hips; tends to intensify aggressive behavior |
Assure an exit is available for both you and the patient
Work toward good policies and practices that encourage respect |
