Caring for dying patients

Caring for dying patients: 

        Nurses need to be knowledgeable about the client's death-related rituals, such as last rites, chanting at the bedside, and other practices, such as special procedures for washing, dressing, positioning, shrouding, and attending the dead 

       Identify personal feelings about death and how they may influence interactions with clients. 

       Acknowledge personal fears about death, and discuss them with a friend or colleague. 

       Focus on the client's needs. 

       Provide a caring touch 

Developing a trusting nurse —patient/family relationship: 

·        Meaningful communication 

·        Do not provide false reassurance 

·        Nonverbal communication 

·        Sense of hearing is believed to be the last sense to leave the body. 

  

    Explaining patient's condition and treatment: 

§  All involved health care personal should know exactly what the patient and family  have been told 

§  Explain the condition and treatment 

§  Question them 

§  Prepare for comfortable and dignified death. 

  

              Teaching self-care and promoting self esteem: 

  

§  Encourage the patient to retain independence and make decisions as long as possible 

§  Manage hygiene and self-feeding as long as possible 

§  Respond to dying person as a person of worth Whose life has meaning and value. 

§  Having familiar objects in view can help to make the patient feel more comfortable and secure 

  

            Helping Clients Die with Dignify: 

·        Treat with dignity, with honour and respect. 

·        Dying clients often feel they have lost control over their lives and over life itself. 

·        Maintaining humanity, consistent with their values, beliefs, and culture. 

·        To minimize loneliness, fear, and depression 

·        To maintain the client's sense of security, self-confidence, dignity, and self-worth 

·        To help the client accept losses 

·        To provide physical comfort 

·        ldentify personal feelings about death and how it influences interactions 

·        Focus on client's needs 

·        Talk to the client or the family about how a person usually copes with stress 

·        Establish a communication relationship that shows concern for and commitment to the client. 

·        Ask what you see 

·        Clarify concern 

·        Acknowledge the client's struggle 

·        Provide a caring touch 

·        Determine what the client knows about the illness and its prognosis 

·        Respond with honesty 

·        Make time available for the client to provide support, listen and respond. 

  

            Hospice and palliative care: 

  

·        Hospice care: focuses on support and care of the dying person and family, with the goal of facilitating a peaceful death. 

  

·        Palliative care: As described by the WHO it focuses on the symptom care of clients. It differs from hospice in that the client is not necessarily believed to be dying. 

  

Meeting the needs of dying patients 

•        Personal hygiene 
•        Pain control 
•        Nutritional and fluid needs 
•        Movement 
•        Elimination 
•        Respiratory care 
•        Providing Spiritual Support 

       

I. Meeting the physiological needs

Addressing psychological needs 

                A fear of isolation, of having to face death alone, is a primary concern of the dying patient. 

§  Support the patient 

§  Give full attention 

§  Showing care 

§  Presence of family members 

  

Providing spiritual support: 

·        Nurses should not impose their own religious or spiritual beliefs but should respond to the client in relation to the client's own religion. 

·        Proper communication skills are needed in helping the client to feel cared for and develop trust. 

·        Encourage expressions of feelings, prayer, meditation, reading and discussion with a spiritual leader. 

·        Clients or family may bring objects to the hospital to use in prayer or other religious rituals. Nurses should respect such acts as they usually have a great significance in their lives. 

·        Observe and listen empathetically 

·        Assist them in expressing their feelings. 

  

Addressing the needs of intimacy: 

                    Encourage discussion and suggest ways to meet to be physically intimate that will meet the needs of both patient and the partners. 

Meeting the needs of family: 

·        Listen to the concerns 

·        Nursing care-communication and listening 

·        prepare the family ahead of time 

·        Explain the steps of grieving process 

  

Dying declaration: 

  

      Dying declaration is defined as the written or verbal statement made by a person — likely to die because of some unnatural act done on his body narrating the circumstances responsible for his present state of health or the cause and manner of unlikely death 

       Great solemnity and sanctity is attached to the words of a dying man because on the verge of death, he is not likely to tell a lie 

Who can record? 

•         Executive or honorary magistrate  

•         But if the magistrate is not available or there is not enough time for him, it can be recorded by the 

-         Treating doctor  

-         A police officer 

-         Or even a village head. 

              Where the life of patient is ebbing fast in the patient and that there is no time to call the magistrate or the police, the doctor is indeed duty-bound to record the dying declaration of the deceased. 

              However the doctor is expected to record a certificate that the declarant was conscious, in a fit mental condition and in his senses before recording the dying declaration 

  

                A will or testament is a legal declaration by which a person, the testator, names one or more persons to manage his/her assets and provides for the transfer of his property at death 

Wills Act 1837 and broadly require that: 

§  The testator must sign the Will, or another person must sign it in his presence and at his direction 

§  The testator must intend by his signature to give effect to the Will. 

§  The signature must be either made or acknowledged in the presence of at least two witnesses present at the same time. 

§  Each witness must sign the Will, or acknowledge his signature, in the presence of the testator.                                                                                                                                                                                          

Medico legal issues 

      Advance health care directives: It includes a variety of legal and lay documents that allow persons to specify aspects of care they wish to receive when they become unable to make or communicate their preference 

     Client and the family need to be reassured that even if they make a decision and have an advance directive, they will always have the option to change their decision. For example client may have decided not to have ventilator support if they were terminally ill, but if and when the actual situation occurred they have the right to change their mind or take more time to make the decision 

         2 types 

                     The living will 

   Health care proxy or surrogate 

Living will: Provides specific instructions about what medical treatment the client choose to omit or refuse in the event that the client is unable to make those decisions. 

The health care proxy: 

·        Durable power of attorney for health care 

·        It is a witnessed statement appointing someone else (relative or trusted friend) to manage health care treatment decision when the client is unable to do so. 

  

Euthanesia: It is the act of painlessly putting to death a person's suffering from an incurable or distressing disease. Euthanasia is illegal except in countries where right to die will exists 

Other terms: 

"good dying" It is the act of painless putting to death , persons suffering from incurable or distressing disease. 

Mercy killing 

2 types: 

     Active  

     Passive 

Active euthanasia is taking specific steps to cause a patient's death. 

       Passive euthanasia is defined as with drawing medical treatment with the intention 

Of causing the patient's death. 

Drugs used in Euthanasia are: 

·         Sodium thiopental 

·         Pancuronium bromide 

·         Potassium chloride 

Assisted suicide: (which could be considered a form of active euthanasia), clinician provide the patient the means to case his or her own death. 

Do-not resuscitate or no code orders: A do not resuscitate order means that no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating. 

·        This is to prevent the improper use of CPR in patients who are in a stage of terminally ill, irreversible illness expecting death. 

·        Client's choices and values should be given top priority. 

·        When the client is incompetent advance directive or-the proxy decision makers should make treatment decisions. 

·        Order should be clearly documented, reviewed and update. 

·        A DNR order is separate from other aspects of client care. 

Comfort measures only order: 

         Patient may request a comfort measures only order, which  indicate that the goal of treatment is a comfortable, dignified death and that further life sustaining measures are no longer indicated  

         Nurses should be familiar with the pertinent laws and policies in their institution or agency concerning these kind of measures 

Terminal weaning: 

         Terminal weaning is the gradual withdrawal of mechanical ventilation from a patient with terminal illness or an irreversible condition with poor prognosis. 

Nurse's role 

·         Participate in decision making 

·         Support family and patient 

·         Manage sedation and analgesia 

  

Inquest: 

         Is a legal enquiry in to the cause or manner of death. Done under the jurisdiction of a coroner or medical examiner. E.g. accidents, suicides etc 

 Certification of death: 

         Determination of death is performed by physician. By law a death certificate must be made when person dies. It is usually signed by the attending physician and is filed with a local health or other government. The family is usually copy to use for legal  matters, such as insurance claims.