Gail W. Stuart and Penelope Chase 1. Describe effective and compassionate psychosocial and mental health care for patients with a life-threatening illness, their caregivers, and families. 2. Discuss palliative care approaches for managing distressing symptoms to promote a comfortable and humane death. 3. Analyze issues related to transitioning patients and families to end-of-life care and preparing for death. 4. Evaluate personal and professional responses to caring for persons who may not survive their illness. One of the most skillful and valued interventions a nurse can make while caring for these patients and families is the use of presence. Therapeutic presence is a term used to describe the healing, respectful, watchful, and compassionate experience of being present in relationship with another human being in a state of respect, empathy, and positive regard (Finfgeld-Connett, 2006). Presence is an essential part of the therapeutic relationship (see Chapter 2). Presence is also described as “being with” rather than “doing to” (Dettmore and Gabriels, 2011). Using therapeutic presence involves focus, intuition, openness, active listening, and being at ease with silence. Concerns that patients frequently have include the following: • How long do people with this illness usually live? • Will I be able to pay for treatment and other financial obligations? • How will my family and friends be affected? • Will I be a burden or become dependent on others? • Will surgery leave me disfigured? • Am I being punished with this illness? • Why can’t I be in control of what is happening to me? • How can I die when I have so much left to do in my life? • Listen without interrupting or defending. This allows the person to ventilate and feel respected and more in control. See if there is anything you can do to resolve the situation. Be creative. Use your available resources. • Provide what is asked for, if possible, such as asking a dietitian to see the patient about food preferences. • Explain the process of how you dispense medications, and suggest the patient allow as “normal” a certain amount of time between request and delivery before using the call light. • Express genuine regret with the reality of the situation, such as the need to remain fasting for still another test or procedure, despite hunger or thirst. • Use prn medications as ordered. Explain to patients what prn medications have been ordered and when and how to request them. Ask the treating team to write orders to help manage distressful symptoms. • Make time to simply sit with the patient or family members. Give them the opportunity to initiate conversation or speak of nonmedical matters. Patients often associate nurse visits to their bedside as being task oriented and may welcome non–treatment-related presence. Plan this time into your busy schedule. You may discover something significant such as a physical symptom, a death anniversary, another family member who is ill, or financial concerns that can be used in providing care. Patients often share information about their illness with friends or relatives. Patients and family members also seek out information on medical conditions and treatments on the Internet. Nurses should direct them to reputable and accurate websites, such as the National Institutes of Health (www.nih.gov) or the National Cancer Institute (www.cancer.gov). Many of these sites have information in Spanish or other languages. • How would you describe your mood these past few weeks? • Are you feeling sad, “blue,” “down,” or depressed? • Do you find yourself tearful or crying sometimes? • Do you ever feel you or others would be better off without you? If yes, how long have you felt this way? • Have you ever thought of helping yourself to die? • Are you feeling suicidal now? • Have you been treated for depression in the past?
Psychological Care of Patients With a Life-Threatening Illness
Working With Patients and Families with Life-Threatening Diagnoses
Concerns of Patients and Family Members
Psychosocial and Mental Health Care
Depression
Psychological Care of Patients With a Life-Threatening Illness
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