End of Life

Definition/Etiology:

• Transition to death
  • Multidisciplinary team approach
    • Focus:
      • Improve comfort 
      • Improve quality of life 
      • Patients with serious illness close to end of life

Pathophysiology:

• Who qualifies?
  • Patients with serious illness close to end of life (< six months to live)
• Treatment
  • Symptom management
  • Treatment measures stopped (e.g. chemotherapy)
  • Management of chronic conditions okay (e.g. hypertension) if helpful

Noticing: Assessment & Recognizing Cues:

• Team Members
  • Providers
  • Nurses
  • Home health aids
  • Spiritual counselors
  • Social workers
  • Pharmacists
  • Volunteers
  • Physical, occupational, and speech therapy
  • Bereavement counselors
• Support
  • Medical
  • Emotional
  • Spiritual support
  • Patient
  • Caregiver/family
  • Bereavement support to family

Interpreting: Analyzing & Planning:

• Stages of Grief
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Responding: Patient Interventions & Taking Action:

• End of life process
• Activity decreases
• Withdrawn/decreased LOC/Hallucinations
• Decrease food/drink
• Constipation/incontinence
• Pressure wounds
• Vital sign changes
  • BP, RR, HR, Temp irregular/decreases

Reflecting: Evaluating Patient Outcomes:

• Nurse’s Responsibility
  • Encourage patient/family to communicate needs
  • Advocate for patient’s needs
  • Educate on what to expect at end of life
  • Try to start conversation early (advance care planning)- team approach may be good. case managers, clergy, etc)

Linchpins (Key Points):

• Hospice
  • Support-
    • patient and & family
  • Stages of grief-
    • denial, anger, bargaining, depression, and acceptance
  • Physical Changes-
    • everything declines