Assisting With End-of-Life Care



Assisting With End-of-Life Care



Key Abbreviations


DNR Do Not Resuscitate


ID Identification


OBRA Omnibus Budget Reconciliation Act of 1987



Objectives



• Define the key terms and key abbreviations listed in this chapter.


• Describe palliative care and hospice care.


• Describe the factors affecting attitudes about death.


• Describe the 5 stages of dying.


• Explain how to meet the needs of the dying person and family.


• Describe 3 advance directives.


• Identify the signs of approaching death and the signs of death.


• Explain how to assist with post-mortem care.


• Perform the procedure described in this chapter.


• Explain how to promote PRIDE in the person, the family, and yourself.



Key Terms










End-of-life care describes the support and care given during the time surrounding death. Sometimes death is sudden. Often it is expected. Some people gradually fail. End-of-life care may involve days, weeks, or months.


Your feelings about death affect the care you give. You will help meet the dying person’s physical, psychological, social, and spiritual needs. Therefore you must understand the dying process. Then you can approach the dying person with care, kindness, and respect.



Terminal Illness


Many illnesses and diseases have no cure. The body cannot function after some injuries. Recovery is not expected. The disease or injury ends in death. An illness or injury from which the person will not likely recover is a terminal illness.



Types of Care


Terminally ill persons can choose palliative care or hospice care. The person may opt for palliative care and then change to hospice care.



• Palliative care. Palliate means to soothe or relieve. Palliative care involves relieving or reducing the intensity of uncomfortable symptoms without producing a cure. The focus is on relief of symptoms. The illness is also treated. The intent is to improve the person’s quality of life and provide family support.


• Hospice care. The focus is on the physical, emotional, social, and spiritual needs of dying persons and their families (Chapter 1). Often the person has less than 6 months to live. Hospice care does not involve cure or life-saving measures. Pain relief and comfort are stressed. The goal is to improve quality of life. Follow-up care and support groups for survivors are hospice services. Hospice also provides support for the health team to help deal with a person’s death.



Attitudes About Death


Many people fear death. Others do not believe they will die. Some look forward to and accept death. Attitudes about death often change as a person grows older and with changing circumstances.



Cultural and Spiritual Needs


Practices and attitudes about death differ among cultures. See Caring About Culture: Death Rites. In some cultures, dying people are cared for at home by the family. Some families prepare the body for burial.



image Caring About Culture


Death Rites


In Vietnam, dying persons are helped to recall past good deeds and to achieve a fitting mental state. Death at home is preferred. In some areas, a coin, jewels (a wealthy family), or rice (a poor family) is put in the dead person’s mouth. The belief is that they will help the soul go through encounters with gods and devils and the soul will be born rich in the next life.


The Chinese have an aversion to death and anything concerning death. Autopsy and disposal of the body are not prescribed by religion. Donating body parts is encouraged. The eldest son makes all arrangements. The body is buried in a coffin. After 7 years, the body is exhumed and cremated. The urn, with the ashes, is buried in the family tomb. White, yellow, or black clothing is worn for mourning.


In India, Hindu persons are often accepting of God’s will. The person’s desire to be clear-headed as death nears must be assessed in planning treatment. A time and place for prayer are essential for the family and the person. Prayer helps them deal with anxiety and conflict. The Hindu priest reads from Holy Sanskrit books. Some priests tie strings (meaning a blessing) around the neck or waist. After death, the son pours water on the mouth of the deceased. Blood transfusions, organ transplants, and autopsies are allowed. Cremation is preferred.


From D’Avanzo CE: Pocket guide to cultural health assessment, ed 4, St Louis, 2008, Mosby.


Spiritual needs relate to the human spirit and to religion and religious beliefs. Many people strengthen their religious beliefs when dying. Religion provides comfort for the dying person and the family.


Attitudes about death are closely related to religion. Some believe that life after death is free of suffering and hardship. They also believe in reunion with loved ones. Many believe sins and misdeeds are punished in the afterlife. Others do not believe in the afterlife. To them, death is the end of life.


There are also religious beliefs about the body’s form after death. Some believe the body keeps its physical form. Others believe that only the spirit or soul is present in the afterlife. Reincarnation is the belief that the spirit or soul is reborn in another human body or in another form of life.


Many religions practice rites and rituals during the dying process and at the time of death. Prayers, blessings, scripture readings, and religious music are common sources of comfort. So are visits from a minister, priest, rabbi, or other cleric.


See Focus on Communication: Cultural and Spiritual Needs.



Focus on Communication


Cultural and Spiritual Needs


You may have different cultural or religious practices and beliefs about death. You must not judge the person by your standards. Do not make negative comments or insult the person’s beliefs. Respect the person as a whole. This includes his or her beliefs and customs.



Age


Infants and toddlers do not understand the nature or meaning of death. They know or sense that something is different. They sense a caregiver’s absence or a different caregiver. They also sense changes in when and how their needs are met. They may feel a sense of loss.


Between 2 and 6 years old, children think death is temporary. It can be reversed. The dead person continues to live and function in some ways and can come back to life. These ideas come from fairy tales, cartoons, movies, video games, and TV. Children this age often blame themselves when someone or something dies. To them, death is punishment for being bad. They know when family members or pets die. They notice dead birds or bugs. Answers to questions about death often cause fear and confusion. Children who are told “He is sleeping” may be afraid to go to sleep.


Between 6 and 11 years old, children learn that death is final. They do not think they will die. Death happens to others, especially adults. It can be avoided. Children relate death to punishment and body mutilation. It also involves witches, ghosts, goblins, and monsters. Understanding increases as children grow older and have more experiences with death.


Adults fear pain and suffering, dying alone, and the invasion of privacy. They also fear loneliness and separation from loved ones. They worry about the care and support of those left behind. Adults often resent death because it affects plans, hopes, dreams, and ambitions.


Older persons know death will occur. They have had more experiences with dying and death. Many have lost family and friends. Some welcome death as freedom from pain, suffering, and disability. Death also means reunion with those who have died. Like younger adults, many fear dying alone.



The Stages of Dying


Dr. Elisabeth Kübler-Ross described 5 stages of dying. They also are called the “stages of grief.” Grief is the person’s response to loss.



• Stage 1: Denial. The person refuses to believe that he or she is dying. “No, not me” is a common response. The person believes a mistake was made.


• Stage 2: Anger. The person thinks: “Why me?” There is anger and rage. Dying persons envy and resent those with life and health. Family, friends, and the health team are often targets of anger.


• Stage 3: Bargaining. Anger has passed. The person now says: “Yes, me, but.…” Often the person bargains with God or a higher power for more time. Promises are made in exchange for more time. Bargaining is usually private and spiritual.


• Stage 4: Depression. The person thinks: “Yes, me” and is very sad. The person mourns things that were lost and the future loss of life. The person may cry or say little. Sometimes the person talks about people and things that will be left behind.


• Stage 5: Acceptance. The person is calm, at peace, and accepts death. The person has said what needs to be said. Unfinished business is completed. This stage may last for many months or years. Reaching the acceptance stage does not mean death is near.


Dying persons do not always pass through all 5 stages. A person may never get beyond a certain stage. Some move back and forth between stages. For example, Mr. Jones reached acceptance but moves back to bargaining. Then he moves forward to acceptance. Some people stay in one stage.



Comfort Needs


Comfort is a basic part of end-of-life care. It involves physical, mental and emotional, and spiritual needs. For spiritual needs, see “Cultural and Spiritual Needs” on p. 497. Comfort goals are to:



Dying persons may want family and friends present. They may want to talk about their fears, worries, and anxieties. Some want to be alone. Often they need to talk during the night. Things are quiet, distractions are few, and there is more time to think. You need to listen and use touch.



Some people may want to see a spiritual leader. Or they want to take part in religious practices. Provide privacy during prayer and spiritual moments. Be courteous to the spiritual leader. The person has the right to have religious objects nearby—medals, pictures, statues, writings, and so on. Handle these valuables with care and respect.


See Focus on Communication: Comfort Needs.


See Focus on Older Persons: Comfort Needs.



Focus on Communication


Comfort Needs


You may not know what to say to the dying person. That is hard for many experienced health team members. Unless you have been near death yourself, do not say: “I understand what you are going through.” The statement is a communication barrier. Instead you can say:




Focus on Older Persons


Comfort Needs


Persons with Alzheimer’s disease (AD) become more and more disabled. Those with advanced AD cannot share their concerns, discomforts, or problems. And it is hard to provide emotional and spiritual comfort.


Focusing on the person’s senses—hearing, touch, sight—can promote comfort. Comforting touch or massage can be soothing. So can soft music or sounds from nature—birds chirping, gentle breezes, ocean waves, and so on.

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Nov 5, 2016 | Posted by in MEDICAL ASSISSTANT | Comments Off on Assisting With End-of-Life Care

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