Death Dying, and Grieving

Rule of Double Effect:

: allows a physician or advanced practice registered nurse (APRN) to make a decision, such as prescribing adequate pain medication, even though the pain medication might cause the patient to die sooner

Dying with Dignity means...

A fundamental human right Having autonomy and independence valued Having symptoms relieved Being respected Being treated as a person who is worthy of worth, value, and esteem Maintaining meaningful relationships Receiving adequate care by competent care-givers Needing personal space and confidentiality

After Mr. Dietrich dies, his hospice nurse finds that she feels devastated by the loss. Which type of loss does this most accurately describe? Anticipatory grief Complicated grief Dysfunctional grief Disenfranchised grief

ANS: D Disenfranchised grief is a grief experience not congruent with a socially recognized and sanctioned relationship, such as loss of a lover, a pet, a caregiver, or an abortion; loss of a patient for a healthcare worker.

Nurses help patients with...

Advance care planning Life-sustaining therapy, including artificial hydration and nutrition Admission to hospice care Symptom management Use of pain medication

Palliative Care for Patients with Dementia

Anticipate needs Encourage meaningful connections with loved ones Identify patient goals for care Educate family to minimize aggression during care Eliminate medications that may detract from safety or quality of life

Power of Attorney

Appoints another to make medical decision if you cannot

Physician-Assisted Suicide

Arguments for and against Individual liberty Autonomy Quality of care Nonmaleficence Beneficence Slippery slope Professional positions of health care associations

Nursing Interventions (Bad Idea)

Artificial hydration and supplementation Legally a medical intervention Not shown to benefit the dying Can cause edema, pulmonary congestion, ascites, and nausea/vomiting

Persistent vegetative state

Chronic condition in which all basic systems function except cognitive function, which cannot be restored. Reflexes but not awareness of self are in tact.

Signs of Approaching Death (Cont.)

Circulatory changes (increased heart rate, decreased blood pressure) Mottling of skin (grayish-blue splotches on knees, ankles, feet) Decrease in urine production Breathing changes (Cheynes-Stokes respirations)

Developmental Tasks of Dying

Completion of worldly affairs Completion of community relationships Making meaning of one's life Experiencing love of self and others Completion of close relationships; good-byes Acceptance of finality of life Sense of a new personhood beyond loss Sense of meaning of life in general Surrendering to the transcendent; letting go

Major depressive disorder

Constant dysphoria No bouts of humor/happiness Thought content: self-derogatory Thoughts of death: related to feeling worthless

Kübler's 5 Stages of Grief

Denial—shielding from overwhelming emotion. Anger—toward the health care system, God, or even the deceased. Bargaining—attempt to regain control. Depression—sadness, regret, and pain settle in. Acceptance—calm, if somewhat withdrawn, response

Complicated grief

Distress accompanying bereavement fails to follow normative expectations Manifests in functional impairment, which may compromise health

Palliative Care

Focuses on care, not cures

Anticipatory Grief

Future loss is mourned in advance Adjusting life to accommodate the time that is left Foreseeing how the future will be altered by the loss Anger is a common component

Disenfranchised grief

Grief experience not congruent with a socially recognized and sanctioned relationship Examples: Loss of a lover, a pet, a caregiver, or an abortion; loss of a patient for a health care worker

Signs of Approaching Death

Growing weakness (asthenia) Loss of appetite Increasing drowsiness Change in mentation (shortening attention span difficulty processing information)

Key Components of Palliative Care

Honoring the experiences of the patient and family Respecting autonomy and informed choice Allowing care to be directed by the patient (and family) Honoring the dignity of the patient and family

Grief

Intermittent dysphoria Bouts of grief and humor/happiness Thought content: memories; self-esteem preserved Thoughts of death: means of joining the loved one

Living Will

Legal document outlining use of care that keeps you alive, including pain management and organ donation

Brain death

Loss of function of the entire cerebrum and brainstem, resulting in coma, no spontaneous respiration, and loss of all brainstem reflexes, though spinal reflexes may remain. No recovery is possible.

Nursing Care at End of Life

Palliative symptom management Pain management Rule of Double Effect

A patient shows some evidence of having some self-awareness, but no evidence of awareness of his surroundings. He is not expected to improve very much. Which best describes his state?

Persistent vegetative state Minimally conscious state Brain dead Euthanasia (b)

Physician-assisted suicide:

Physician provides patient-requested means to end life but does not act as the direct delivery agent

Mr. Dietrich says, "I want to get it in writing that I won't get any mechanical ventilation or cardiopulmonary resuscitation—none of that nonsense." Which advance care plan is he expressing the most interest in?

Power of attorney Advance directive Living will WWLST (d)

Discussion Topics for Life-Partners

Preferred site of care Life-partner as primary caregiver Acceptable home-based care for both life-partners Common symptoms of end-of-life and how to manage these Normal responses to loss of health Spiritual needs and wishes Financial and legal arrangements Funeral arrangements

Euthanasia

Putting an individual to death to prevent prolonged pain and suffering

Advance directive

Statement of how you want medical decisions to be made if you cannot make them yourself

Questions to Ask..

What is end-of-life? What is an advance care directive? Why is having an advance care directive in place important? Why are conversations about end-of-life care wishes important for life-partners? When and where life-partners can talk together about these important topics? How often these conversations could occur? How to start conversations about end-of-life care? How to seek support from family to allow private time for these discussions to occur?

Grief

a response to bereavement that occurs after a loved one has died.

Bereavement

derived from the Old English word berafian, meaning, "to rob," is the period of grieving following a death.

Mourning

refers to things people do to cope with grief.