5.3

• Palliation


  Providing care and comfort to a patient, especially one with a terminal illness, without curing the underlying condition
• Caregiving


  A multidimensional concept that encompasses the action or process of helping those who are suffering. Caregiving is made up of actions one does on behalf of another individual who is unable to do those actions for himself or herself.
• Types of loss


  • Actual loss
  • Maturational loss
  • Necessary loss
  • Perceived loss
  • Situational loss
• Types of grief


  • Normal grief
  • Anticipatory grief
  • Disenfranchised grief
  • Ambiguous loss
  • Complicated grief
  • Chronic grief
  • Exaggerated grief
  • Delayed grief
  • Masked grief
• Theories of grief and mourning


  • Stages of Dying (Kubler-Ross)
  • Attachment Theory (Bowlby)
  • Grief Tasks Model (Worden)
  • Rando's "R" Process Model (Rando)
  • Dual Process Model (Stroebe & Schut)
• Factors influencing loss and grief

  • Human development
  • Personal relationships
  • Nature of the loss
  • Coping Strategies
  • Socioeconomic loss
  • Culture
  • Spiritual and religious beliefs
• Nurse's role in grief and loss


  To provide compassion, attentiveness, and patient-centered care
• Caregiving


  The action or process of helping those who are suffering. Caregiving is made up of actions one does on behalf of another individual who is unable to do those actions for themselves.
• The need for family caregivers will dramatically escalate in the coming years because the population is aging, longevity is increased, those with chronic diseases are living longer and have increasingly complex health care needs, and the formal health care system is overwhelmed
• Attributes of caregiving


  • Having the ability to care
  • Adapting to a situation
  • Being a good listener
  • Showing affection
  • Being responsible for someone else
  • Strong, protective, organized, patient, and understanding
  • Advocate
  • Assists with activities of daily living
  • Provides emotional and social support
  • Manages and coordinates health care services
• Common stressors for caregivers

  • Change in roles and relationships
  • Juggling day-to-day activities with caregiving
  • Change in living arrangements
  • Lack of understanding of the time and energy that the demands require
  • Lack of respite or relief from responsibilities
  • Family conflict
  • Inability to meet personal self-care needs
  • Financial depletion of resources
  • Inadequate information or skills needed for caregiving tasks
• Caregiver outcomes


  Positive: Satisfaction, Duty fulfillment

  Negative: Stressed, Depressed, Burdened
• Care for the caregiver


  Encourage the caregiver to care for themselves physically, emotionally, socially, cognitively, and spiritually. Monitor for indications of declining health or emotional distress.
• Palliative care


  Patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.
• Palliative care and hospice care are part of a continuum of care, with palliative care beginning at an earlier point in the illness trajectory and possibly continuing until the end of life.
• Goals of palliative care


  • State of the art, individualized treatment
  • Support for family and/or caregivers
  • Interdisciplinary team approach
• Attributes of palliative care


  • Optimal assessment and management of physical and psychological symptoms
  • Honoring wishes and preferences of families
  • Assisting patient to identify goals of care
  • Promoting communication among patient, families, and members of the interdisciplinary team
  • Promoting continuity of care for transitions to home or other settings
  • Total, active, and individualized care
  • Support for the family
  • Interdisciplinary team approach
  • Effective communication
  • Optimal symptom management
• Seven out of 10 Americans can expect to live with their diseases several years before dying, and by 2030, people aged 65 or over will outnumber the young. The leading causes of death in the United States are now chronic diseases such as cardiovascular problems, COPD, cancer, and dementia.
• Globally, it is estimated that 40 million people will need palliative care as a result of chronic, noninfectious diseases.
• Team-based approach to palliative care

  The plan of care is based first on the patient and family's realistic expectations and goals and second on the team's assessment, recommendations, and support. The family is a member of the team. The interprofessional team is divided into core services and expanded services, with two provider levels: primary and specialty.
• Models of palliative care


  The trajectory of disease has changed, so palliative care consultation at time of diagnosis improves patient satisfaction. The interdisciplinary team continuously evaluates the care plan.
• Clinical signs of impending or imminent death

  • Changes in level of consciousness
  • Decrease in appetite
  • Decrease and changes in output
  • Changes in vital signs
  • Patient may run a fever
  • Heart rate becomes tachycardic, irregular, bounding
  • SpO2 begins to decrease
  • Respiratory rate becomes tachypneic
  • Blood pressure begins to decrease
  • Changes in body temperature
  • Changes in skin integrity
  • Mottling
• Critical thinking in nursing

  Critical thinking requires a synthesis of knowledge, experience, environmental factors, information gathered from patients, critical thinking attitudes, and intellectual and professional standards. It is essential for successful nursing judgment and determining a client's plan of care.
• Nursing process/CJMM


  1. Assessment/Recognize Cues

  2. Analysis and nursing diagnosis/Analyze Cues

  3. Planning and outcomes identification/Prioritize Hypothesis and Generate Solutions

  4. Implementation/Take Action

  5. Evaluation/Evaluate Outcomes
• Nursing interventions in end-of-life care

  • Assist with end-of-life decision making
  • Palliative care
  • Hospice
  • Therapeutic communication approaches
  • Provide psychosocial care
  • Manage symptoms
  • Promote dignity and self-esteem
  • Maintain a comfortable and peaceful environment
  • Promote spiritual comfort and hope
  • Protect against abandonment and isolation
  • Support the grieving family
  • Facilitate mourning
  • Organ and tissue donation
  • Autopsy
  • Postmortem care
• Actual loss


  Tangible or measurable loss that has occurred, such as the loss of a possession, a job, a relationship, or a loved one.
• Maturational loss


  Natural part of growing up and maturing, such as the loss of childhood innocence, dependence on parents, or youth.
• Necessary loss


  Loss that is required for growth or development, such as the loss of a habit, behavior, or belief that is no longer serving you.
• Perceived loss


  Subjective loss that depends on the individual's perception, such as the loss of status, self-esteem, or dignity.
• Situational loss


  Loss that is caused by a specific situation or event, such as the loss of a home due to a natural disaster, a job due to a layoff, or a relationship due to a betrayal.
• Grief is a natural response to loss and involves emotional, physical, social, cognitive, and spiritual aspects.
• Culture


  A pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values that can occur among those who speak a particular language or live in a defined geographic region
• Culture is influenced by many factors, it changes and adapts, and is learned
• Informal learning


  Learning that takes place outside schools and colleges and arises from the learner's involvement in activities not undertaken with a learning purpose in mind
• 97% (95% depending on source) of learning is through incidental learning
• Incidental learning


  Any learning that is unplanned or unintended
• Unconscious bias


  Bias we are unaware of and that happens outside of our control, which is influenced by our personal background, cultural environment, and personal experiences
• Implicit bias


  Bias that we are aware is present
• Culturally congruent care


  Emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values
• Cultural competence


  Professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community