communication in End of Life Care Flashcards
1
Q
loss
A
- Actual or potential situation in which something that is valued is
- Changed –> Ex: body change
- No longer available –> Ex: loved one has died
- Gone
2
Q
sources of loss
A
- Aspect of self
- Physical or mental capacities
- External objects
- Money, home, pets
- Familiar environment
- Loved ones
3
Q
types of loss
A
- Situational
- Death of child
- Loss of function
- Developmental
- Empty nest
- Retirement
- can never be prepared for how we feel
4
Q
death and dying – late 1800s
A
- Care = easing of symptoms
- Most deaths occurred at home
- Most die within days of onset of illness
5
Q
death and dying – mid 1900s
A
- Emphasis on disease prevention
- Life saving & life prolonging techniques (CPR)
- Death often equated with medical failure
- abx = 1960s
- went from easing to curing
6
Q
death and dying – 2000s
A
- Americans living longer
- Period of time living with progressive illness prolonged
- Families changing
- Medicalization of care at EOL
- Decreasing disparity between the way people die & how they want to die
7
Q
learning of impending death
A
- Denial
- Protective: need the time to absorb it
- Anger
- Most expressed to those safest & closest
- Bargaining: if you just let me stay alive till my daughter gets married then i’ll do whatever. 2nd opinion
- Depression: mourning what they will lose and what they have lost
- Acceptance
8
Q
what do patients value?
A
- Patient concerns
- Receiving adequate pain & symptom management
- Avoiding inappropriate prolongation of dying
- Achieving a sense of control
- Relieving burden
- Strengthening relationships with loved ones
9
Q
what do patients value?
A
- Goals may shift as EOL nears
- Discuss & continue to discuss
- Greatest risk for non-discussion of dying
- Slow decline from chronic disease
- Metastatic cancer
- Chronic renal failure on dialysis
- ICU patient with underlying disease
- 60-90% of those with life threatening conditions have not discussed EOL care with clinicians
10
Q
advanced directives
A
- General term used to describe documents that give instructions about future medical care and treatments and may indicate who should make decisions
11
Q
types of advanced directives
A
- DNR—Do not resuscitate (physician has to write the order)
- No CPR in event of cardiac or respiratory arrest
- Living Will: only has power if the ppl that need it know where it is
- Specific instructions about what care patient wants and does not want
- Durable power of attorney for health care –> someone so cog impaired they can’t make their own decisions
- Appoints someone to manage health care treatments when patient is
unable to do so
- Appoints someone to manage health care treatments when patient is
- default = do everything possible unless you have a living will
12
Q
general principles of palliative care
A
- Total care of patients whose disease is not
responsive to curative treatment - Patient & family unit of care
- Meet patient/ family’s goals & values
- Attend to physical, psychological, social & spiritual needs
- Education of patient & family
- Bereavement support
13
Q
what does palliative care help with?
A
- helps the pt and family know what options they have and what happens if they stop treatment
14
Q
the hospice concept
A
- Based on medieval concept of hospitality in which community assisted traveler at dangerous points along a journey
- Community—interprofessional team
- Traveler—dying patient & family
15
Q
medicare
A
- Part A eligible
- Must be certified by 2 physicians as having < 6 months to live
- Must wave further treatment for disease (no more treatment to curve me. moving towards comfort)
- Certified for two 90 periods
