Term
| What is Kubler-Ross identified stages of grief? |
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Definition
Denial, anger, bargaining, depression, acceptance
Phases do not always occur in succession ; may be experienced within a few minutes |
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Term
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Definition
interdisciplinary approach to assess and address the holistic needs of patients and families to facilitate quality of life and a peaceful death
6 months or less to live |
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Term
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Definition
grew from Hospice movement
A stage in illness when cure is no longer possible or refusal of further tx.
No further efforts will be made to stop the dx or prevent dying, certain symptoms will be treated. |
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Term
| What is the goal of palliative care? |
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Definition
| to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies |
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Term
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Definition
| Multidisciplinary team is made up of the physician, nurse, chaplain, social worker, certified nursing aide, volunteer, and bereavement counselor. |
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Term
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Definition
All medications and supplies related to a terminal diagnosis are covered by Medicare and reimbursed.
Other insurance providers mimic Medicare benefits. |
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Term
| What are the characteristics of hospice care? |
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Definition
Most patients are cared for in the “home.”
Short-term acute in-patient care is available.
Respite periods for caregivers is available.
Patients are perceived as living fully until they die.
Choices and preferences are incorporated in care.
Patient and family are considered the unit of care and both receive counseling and support in anticipatory grief and mourning, as well as in spirituality and meaning making. |
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Term
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Definition
| Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illness. |
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Term
| What does palliative care do? |
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Definition
| It does not replace your primary treatment; palliative care works together with the primary treatment you’re receiving. |
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Term
| What is the goal of palliative care? |
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Definition
| The goal is to prevent and ease suffering and improve your quality of life. |
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Term
| What does palliative care provide? |
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Definition
| Palliative care provides relief from distressing symptoms including pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, problems with sleep and many other symptoms. |
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Term
| What can palliative care help you deal with? |
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Definition
| It can also help you deal with the side effects of the medical treatments you’re receiving. Perhaps, most important, palliative care can help improve your quality of life. |
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Term
| What is the first goal of end of life care? |
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Definition
COMMUNICATION
How do you communicate with someone as you are witnessing the transition from active treatment to dying? |
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Term
| What are the interventions of communication? |
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Definition
Defining goals of communication
Importance of listening
Barriers to communication
Delivering bad news/truth telling
Recognizing family dynamics in communication
Sensitivity to culture, ethnicity, values, and religion
Discussion of options/decisions with patient/family
Collaboration with team members
Responding to requests for assisted suicide |
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Term
| What is the 2nd goal of end of life care? |
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Definition
| Helping Bereaved caregivers make sense of their feelings of grief (an umbrella term of loss) |
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Term
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Definition
| efforts one makes to manage grief |
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Term
| What are the primary emotions of caregivers? |
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Definition
Anger
Sadness
Hurt
Fear and ANxiety
Loss of Control
Bridled Grief |
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Term
| What is the 3rd goal of end of life care? |
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Definition
| Helping people say goodbye |
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Term
| What are Ira Brock's 4 gifts? |
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Definition
1.) Forgiveness
2.) Love
3.) Gratitude
4.) Farwell |
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Term
| What is the 4th goal of end of life care/ |
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Definition
Helping families maintain hope.
Does having hope contradict the fact that the person is dying?
Hope centering around the actual act of dying
Hope that the loved one knows how much they are loved
Hope that they know how important they were in life |
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Term
| What can the nurse ask to help maintain hope? |
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Definition
Ideally how would you like this to work out?
How would you like her to feel about that? |
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Term
| What is the 5th goal of end of life care? |
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Definition
| Intervention of Caring Presence |
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Term
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Definition
seen as an act that is preferred treatment.
Not just the absence of being able to “do something for them”
“We didn’t even speak, but that meant more to me than I can say. I think that is why I want to be a nurse today.” |
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Term
| What is the 6th goal of end of life care? |
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Definition
Facilitating life conversations
Nurses may be more active in this role as some physicians may not feel comfortable or lack training in end of life care. “Prepare for a good death.” |
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Term
| What are the barriers to facilitating end of life conversations? |
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Definition
1) concealing worry and grief
2) feeling confused and fearful
3) cultural preconditions
4) strong psychological defenses
5) cognitive impairment |
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Term
| What is the 7th goal of end of life care? |
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Definition
Assessing spiritual values
Questions to ask yourself:
What is the difference between spirituality and religion?
Can one be spiritual without pronouncing a religion? |
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Term
| How do you assess spiritual values? |
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Definition
1) Start the conversation (allowing yourself not to be the expert; listening ; not to ‘fix’ the person)
2) Listen to the patient’s story (learn and support them)
3) Refer to a chaplain or priest
4) Seek the unspoken
5) be empowered by the process. |
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Term
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Definition
Is the ability to be with someone who is suffering.
Is less like a feeling and more like a human capacity that is developed and sustained in relationship to others |
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Term
| How do we become compassionate? |
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Definition
| Remembering that compassion is developed throughout life and that we can grow in our abilities is important. (Hoisington, 2007) Think of compassion as a practice or a habit of thought and action that meaningfully connects us with others. |
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Term
| What are the myths about grief and loss? |
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Definition
Grief and mourning are the same experience
There is a predictable order of progression
Move away from grief rather towards it
After a death—you need to get over it
Tears are an expression of weakness |
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Term
| What are the common phenomena experienced in bereavement? |
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Definition
Shock and Disbelief
Denial
Somatic sensations
Preoccupation with image of deceased
Guilt
Anger
Change in behavior (depression, disorganization, restlessness)
Reorganization of behavior directed at a new object or activity |
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Term
| What do you say when you sense sorrow? |
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Definition
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Term
| What do you say when you hear anger? |
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Definition
| I hear anger in your voice. Most people go through periods of anger when their love one dies. Are you feeling angry now? |
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Term
| What do you say when you discern guilt? |
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Definition
| “Are you feeling guilty? This is a common reaction many people have. What are some of your thoughts about this?” |
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Term
| What do you do if you sense feaR? |
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Definition
| “it must be scary to go through this.” |
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Term
| What do you do if the bereaved becomes confused? |
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Definition
| “This can be confusing at times.” |
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Term
| What do you do in almost any painful situation? |
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Definition
| This must be very difficult for you |
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Term
| What do you need to assess? |
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Definition
The grief process
Is there complicated grieving? (see assessment history p. 488)
Identify cultural beliefs |
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Term
| What are the nursing diagnoses r/t grief? |
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Definition
Complicated Grieving, Grieving,
Risk for complicated grieving |
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Term
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Definition
| Building a relationship with the patient and family |
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Term
| What do you do during a death event? |
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Definition
| Presence is possible to help in understanding of physical symptoms. Post mortem care |
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Term
| What do you do during bereavement? |
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Definition
| : a time of about 3 months to “retell the story” |
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Term
| What interventions are using during end of life care? |
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Definition
-PCA drops
-Nutrition and hydration
-Changes in consciouness/delerium
-Dyspnea
-Secretions |
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Term
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Definition
Wasting away.
Solved w/ Dexamethasone, Megestrol, Dronabinol |
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Term
| What is done for a change in consciousness? |
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Definition
benzodiazepines- lorazepam,
neuroleptics-Haloperidal |
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Term
| What do you do for secretions? |
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Definition
terminal bubbling -gentle sx.
anticholinergics drugs |
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Term
| What do you do for dyspnea? |
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Definition
| diurectics, opoids, erthropoiten |
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Term
| What is palliative sedation? |
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Definition
NOT Euthanasia
Benzodiazepine and barbiturates |
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Term
| What are the signs of death? |
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Definition
Less eating or drinking
Decreased urinary output
Sleeps more
Mental confusion
Vision and hearing and speech impaired
Secretions
Breathing irregular
Restless
Hot and cold
Loss of bladder and bowel
Vision |
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Term
| What is an advanced directive? |
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Definition
| Written document prepared by a competent individual specifying what, if any, extraordinary actions the person would want when no longer capable of decisions about personal health care |
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Term
| What is a durable power of attorney? |
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Definition
| legal document assigning decision-making power to another person to make his or her health care decisions in the event he or she becomes incapable of making decisions |
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Term
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Definition
| legal document that instructs physicians and family members about what life-sustaining treatment a person does or does not want at some future time if he or she becomes unable to make decisions |
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Term
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Definition
| an order to not attempt resuscitation of the patient, follow agency policies and advanced directives |
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