Download Textbook For Nursing Assistants

Textbook For Nursing
Assistants
Chapter 21 - Caring for People
Who Are Terminally Ill
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 1
Introduction To Caring for
People Who Are Terminally Ill
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 2
Introduction To Caring for People Who Are Terminally Ill
A terminal illness is an illness or condition for
which there is no cure
Examples of terminal illnesses:
Acquired immunodeficiency syndrome (AIDS)
Certain cancers
Some chronic respiratory disorders
Some heart conditions
Some chronic kidney disorders
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 3
Stages of Grief
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 4
Stages of Grief
Stages of grief are:
Denial
Anger
Bargaining
Depression
Acceptance
Hope
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 5
Stages of Grief: Denial
Denial occurs when a person is told that he or she has a
terminal illness
The person may:
Refuse to accept the diagnosis
Feel that a mistake has been made
Ask for a second opinion
Act as if nothing is wrong
Avoid returning to the doctor for a period of time
Denial helps to protect a person emotionally from
overwhelming grief
This stage of grief can last only a few minutes, or it may
last until the person actually dies
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 6
Stages of Grief: Denial
Responsibilities of a nursing assistant:
Avoid convincing the person that his or her illness
exists
Avoid arguing with the person about treatment or care
issues
Recognize that denial is a normal part of the grieving
process
Respond to the person in an honest yet neutral way
Communicate your observations to the nurse if the
person refuses medication or other medical treatment
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 7
Stages of Grief: Anger
Anger occurs when the person realizes that he is
actually going to die
The person may:
Be angry with himself for
 Not seeking help sooner
 Making a lifestyle choice that contributed to the illness
Become moody and withdrawn
Become uncooperative and hostile
Yell, or throw objects
Lose faith in religion
Take his or her anger out on
 Family members
 Health care professionals
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 8
Stages of Grief: Anger
Responsibilities of a nursing assistant:
Avoid taking the anger personally because
 It can hurt your emotional well being
 It can affect your ability to care for the person
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 9
Stages of Grief: Bargaining
Bargaining is typically done on a very private basis by the
terminally ill person
The person may
Wants to “make a deal” with someone he or she feels has control over
his or her fate, such as:
 God
 A health care provider
 Family members
Want to live long enough to accomplish a goal, or to witness a specific
event, such as:
 The birth of a child
 A wedding
 An anniversary celebration
The will to live can be a very powerful force, and may, in fact, extend
the person’s life by a few months
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 10
Stages of Grief: Bargaining
Responsibilities a nursing assistant:
Explore ways to help the person maintain the
will to live
Allow the terminally ill person to experience
the feeling of hope that accompanies this
stage of grieving
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 11
Stages of Grief: Depression
Depression occurs when a person fully realizes
that death will be the end result of the illness
The person may:
Feel sad
Have regrets about things he or she was not able to
accomplish during his or her lifetime
Feel withdrawn
Talk very little
Openly mourn for his or her loss
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 12
Stages of Grief: Depression
Responsibilities of a nursing assistant:
Recognize that depression is a normal part of
the grieving process
Be supportive of your resident or patient
Let the person know that it is all right for him
to be feeling the way he is feeling
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 13
Stages of Grief: Depression
Responsibilities of a nursing assistant:
Tell the nurse if a grieving person’s
depression causes the person to:
Cry constantly
Refuse food
Fail to sleep
Some people will require medical intervention
to treat their depression
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 14
Stages of Grief: Acceptance
Acceptance occurs when:
A person comes to terms with the reality of his or her
own impending death
He or she is finally at peace with this knowledge
The person may:
Demonstrate acceptance by completing unfinished
business and saying goodbye
Plan her funeral service
Write a poem or letter to be read after she is gone
Want to talk about her death, in an effort to help
family members accept it
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 15
Stages of Grief: Hope
Throughout the grieving process, the one thing
that usually persists is hope
Even the most realistic and accepting patients
hold onto the hope that a cure will be found
Hope is what helps a terminally ill person face
another day or another painful treatment
Hope is what drives the person to keep up with
normal activities, such as eating and praying
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 16
Stages of Grief: Hope
Responsibilities of a nursing assistant:
Be responsive to, and nurture, a person’s
hope, without being unrealistic
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 17
Stages of Grief
Terminally ill people may not pass through
all the stages of grief, and they may not
pass through them in order
Many people work through the first five
stages of grief, only to “relapse” and
experience some of the earlier stages
again
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 18
Stages of Grief
The family of a terminally ill person will also go
through the stages of grief as they prepare for
their loss
Sometimes the family members may be upset
and they may direct their anger at you
Report your observations of family turmoil to the
nurse
Arrange for the assistance of clergy or other
professionals experienced in grief counseling
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 19
Wills
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 20
Wills
A will is a legal statement that expresses
a person’s wishes for the management of
his or her affairs after death
For a will to be valid, at the time it is made
the person must be deemed:
Competent, and
Of sound mind
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 21
Wills
If you are asked to sign a will as a witness,
your signature means:
You saw the person sign the document
To the best of your knowledge the document
acurately expresses that person’s wishes
You should never sign a will as a witness if
you have been named as a benefactor of
the will
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 22
Dying with Dignity
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 23
Advance Directives
An advance directive is:
A document where a person makes his
wishes regarding health care known
Made in case the time comes when he is no
longer able to make those wishes known
himself
Advance directives include:
Living wills
Durable powers of attorney for health care
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 24
Advance Directives
A living will requests that death not be
artificially postponed
A durable power of attorney for health
care transfers the responsibility for
handling a person’s affairs and making
medical decisions to a family member,
friend, or other trusted person in the event
that the person is no longer able to make
these decisions on his own behalf
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 25
Patient Self-Determination Act of 1990
This act ensures that the wishes of patients and
patients’ family members are followed
The wishes are regarding measures to be taken
on their own behalf (or on the behalf of their
loved one)
This act requires health care facilities and
providers to:
Educate patients and residents about advance
directives
Offer them the opportunity to establish either a living
will, a durable power of attorney, or both
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 26
Supportive Care
Supportive care offers treatments that will not
prolong life, but will make a person more
comfortable
Examples of supportive care are:
Oxygen therapy
Nutritional supplementation
Pain medication
Range-of-motion exercises
Grooming and hygiene
Positioning assistance
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 27
Life-Sustaining Treatments
Life-sustaining treatments tend to be more
aggressive
Examples are:
Respiratory ventilation
Cardiopulmonary resuscitation (CPR)
The placement of a feeding tube or
intravenous (IV) line for the provision of
nutrition
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 28
No-code or do not resuscitate (DNR) order
Written on the chart of a person who wants to
receive only supportive care at the end of his life
Means that the usual efforts to save the person’s
life will not be made
Helps to ensure that the person will pass on with
the compassion and dignity he has requested
Entire health care team should be aware of this
order
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 29
Hospice Care
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 30
Hospice Care
Hospice agencies are organizations
founded to:
Offer the terminally ill person the best quality
of life possible
Ensure his or her comfort and dignity as death
approaches
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 31
Hospice Care
Hospice care is provided by a
multidisciplinary team, consisting of:
Nurses
Nursing assistants
Social workers
Doctors
Mental health providers
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 32
Hospice Care
After the person’s death, hospice provides
grief counseling and assistance for the
family
People are eligible for hospice care when
their doctors say they have approximately
6 months left to live
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 33
Palliative Care
Palliative care focuses on relieving
uncomfortable symptoms, not curing the
problem that is causing the symptoms
Palliative care includes:
Administration of medications to control pain
Use of chemotherapy or radiation to shrink a tumor
Use of oxygen therapy to help keep a person with
breathing problems comfortable
Surgical procedures to remove a tumor that is
interfering with the functioning of an organ system
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 34
Effects of Caring for the
Terminally Ill on the Caregiver
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 35
Effects on the Nursing Assistant
Caregivers go through grief similar to that
of the patient and the family
Caregivers may feel inadequate when
there is little they can do to relieve a
person’s suffering
Caregivers may even question their
professional calling
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 36
Effects on the Nursing Assistant
Take time for yourself
Talk to your supervisor, a clergy member,
or another person you trust about your
feelings
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 37
End of Presentation
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing
Assistants.
Slide 38