Nursing AssistantUNIT 4 CHAPTER 22: CARING FOR PEOPLE WHO ARE TERMINALLY ILL

Caring for the Terminally Ill

People die from many different causes at many different ages

Terminal Illness

Illness or condition for which there is no cure

AIDS

Cancers

Certain heart conditions

Chronic respiratory disorders

Kidney disorders

Liver disorders

Caring for the Terminally Ill

In the past, most people with a terminal illness received care at home

All caregivers could do was make patient comfortable

We must allow person to live and die with dignity

When taking care of a dying person you should be aware of the power of listening and touch

Stages of Grief

Grief

Mental anguish, specifically associated with loss

Dr. Elisabeth Kubler-Ross (1926-2004)

Psychiatrist

Wrote famous book, On Death and Dying

Worked specifically with terminally ill people

Identified distinct stages of grief

Stages of Grief

Stage I: Denial

Occurs when the person is told they have a terminal illness

Person refuses to accept the diagnosis or feels a mistake has been made

Denial helps protect a person emotionally from overwhelming grief

This stage may last only a few minutes or until the person actually dies

Not your place to convince the patient that the illness exists

Be honest but neutral

Stages of Grief

Stage II: Anger

Occurs when the person realizes that they are actually going to die

People may feel angry for different reasons

Each person handles anger differently

Some people are angry with themselves, and some make take it out on others

Do not take anger personally

Stages of Grief

Stage III: Bargaining

Typically done on a very private basis by the patient

Person wants to “make a deal” with someone who has control over their fate

Person may want to live long enough to accomplish a goal or witness a specific event

The will to live can be a very powerful life force and may extend the persons life for many months

Allow the person to experience the feeling of hope that comes with this stage

Stages of Grief

Stage IV: Depression

When the person fully realizes that death will be the end result

Person will be sad and may have regrets about things they were not able to do

Some are quite withdrawn and quiet

Normal part of process

Be supportive

Some people require medical intervention

Stages of Grief

Stage V: Acceptance

When a person comes to terms with the reality of their own death

Is at peace with this knowledge

Complete unfinished business

Says goodbyes

Plan funeral service

Usually want to talk about their death

Some people gain acceptance months or years before it happens

Wills

A will is a legal statement that expresses a person’s wishes for the management of their affairs after death

Person must be deemed competent when will is made to be valid

Many health care facilities offer assistance

You may witness wills

By signing you are just saying you watched the person sign

Dying with Dignity

Advance Directives

Allows a person to make wishes know about health care decisions

Many pertain to “end of life issues”

May elect to avoid “life sustaining treatments”

Respiratory ventilation

CPR

Feeding Tubes

Dying with Dignity

Advance Directives

May elect to have supportive care only

Will not prolong life but will make person more comfortable

Oxygen

Pain medication

ROM

Grooming

Hygiene

Dying with Dignity

Advance Directives

DNR (do not resuscitate)

Also called a no-code

Only means CPR will not be performed to save a persons life

Dying with Dignity

Hospice Care

Hospice organizations have the mission of offering the terminally ill person the best quality of life possible

Care is provided by a multidisciplinary care team

Doctors

Nurses

CNA’s

Clergy

Social Workers

Mental Health Professionals

Dying with Dignity

Hospice Care

Team not only takes care of the patient, but takes care of family as well

After patient’s death, hospice provides grief counseling and other types of assistance to the family

Available to patient’s and families 24 hours a day 7 days a week

Care provided in patient’s home, long term care center, hospital, and hospice houses

Dying with Dignity

Hospice Care

Care given is palliative care

Focused on relieving uncomfortable symptoms

Pain medications

Chemotherapy

Radiation

Oxygen

Surgery

In no way is a terminally ill person is told to give up hope for recovery

Dying with Dignity

Hospice Care

Can also assist with equipment

Hospital bed

Bedside commode

Mechanical lifts

Focus of hospice team is to honor the wishes of the patient and family

Effects of Caring for the Terminally Ill on the Caregiver

Caring for a terminally ill person will affect you

We actually go through the grief process

May feel inadequate when we watch others grieve

Make sure to take time for yourself

Use clergy and counseling services available

Openly talk about your feelings on death with friends and family