Issues of dying patients and their families (🐇Hospice Patients…
Issues of dying patients and their families
Living Wills and Advance Directives for Medical Decisions
¨Choosing a person to act as your health care agent is important. Even if you have other legal documents regarding your care, not all situations can be anticipated and some situations will require someone to make a judgment about your likely care wishes.
¨The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill the role.¨
¨A medical or health care power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so.¨
🦔- Scholar Journals
Care of the dying patient: the last hours or days of life
Coming to the end of life of a family member, some family could be thinking ahead and cause conflict. Such as what the patient said in their will and what they get out of it, or conflict between the family while having a ill family member.
When you are taking care of a patient who is going to and will die, you should be very careful with your words and how you words things when talking with the family because there could be miscommunication.
¨If relatives are told clearly that the patient is dying they have the opportunity to ask questions, stay with the patient, say their goodbyes, contact relevant people, and prepare themselves for the death.¨
Hospice Patients Alliance
¨The assertive and sometimes aggressive family members in such a conflicted family may take over and maneuver themselves into positions of power over the patient's care as well as keeping information to themselves. They may utilize intimidation or even lie to other family members (or the hospice staff) in order to establish their position of power during the end of life phase. Hospice workers can do much good by making sure that it is actually the patient's wish for certain individual members of the family to be actively taking part in the planning of care or actual care giving.¨
¨Hospice workers sometimes may personally witness family members arguing directly in front of a patient who is actively dying, even when the patient can no longer respond or speak to the family. Hospice workers have ample evidence that support the conclusion that most patients are able to hear right up to the very end, even though the patient may no longer be able to speak to anyone. Sometimes these patients may be able to blink an eye in a "yes and no" fashion in response to questions put to them, and in this way hospice workers verify that these patients are still fully conscious and hearing what is going on around them.¨
¨It is not unheard of for family members to argue while in the presence of the terminally ill patient. Although this is shocking behavior for loving families, other families find conflict and dysfunctional relationships to be the norm. Sadly, in only very rare cases are family members with long-standing interpersonal problems — who are assembled in one place by the imminent death of the hospice patient — actually brought together in spirit. Sometimes these family members may argue about just about anything, including who will inherit which portion of the patient's belongings and estate. ¨
¨Sometimes family members will try to hide the facts about a family member's history of drug or alcohol abuse, and not mention a family member's addiction...as part of a pattern of "family secrets." When narcotics come up "missing" or "short," then the RN case manager will have to determine the cause of the missing narcotic. This is why very careful records about amounts of narcotics used are kept, and why any sudden changes in the usage of narcotic dosages must be analyzed by the RN case manager.¨
¨When there is a history of drug or alcohol abuse in the family, narcotics may need to be "locked up" or secured in some other way so as to prevent the drug addict or alcoholic in the family from accessing the narcotics.¨
Drug addiction problems in family
¨In other cases, a family member may actually take the patient's dose and not give the medication to the patient at all! If a patient is suddenly experiencing a pain crisis, it is normal for the RN to consider calling the physician for an increase in dosage due to increased pain.¨
Challenges Facing Families at the end of life in three stages
¨Family members are often intimately involved in the care of individuals and face numerous challenges and difficulties at the end of the patient's life. These challenges are related not only to the emotional response to the dying process and the demands of the care giving role, but also to unmet needs in service delivery systems.¨
¨Family members are often challenged by the emotional feelings of helplessness associated with the progression of the illness, the difficulties of bearing witness to the changes, and the acceptance of the reality of death or comprehension of death.¨
¨Family members express fundamental needs including good communication between the family and the healthcare team, respect for the patient, and the desire to be present at the time of death.¨
Dying in America
¨Many people nearing the end of life may not be physically or mentally cable of making their own care decisions. In, addition family members and clinicians may not be able to accurately guess what a persons care preferences may be. Therefore, advance care planning is critically important to ensure that patients goals and needs are met.¨
Hospice plays a important role in palliative care for the patients needs when they don´t have a long life expectancy and for the patients family.
¨The Institute Of Medicine committee believes a person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority.¨
Coping with Death and Grief
¨Death is inevitable, yet the loss of a close friend or family member always showers us with a range of emotions. One day we might desperately try to avoid the pain, anxiety and feelings of helplessness we feel when a loved one dies. Other days, we feel like life has returned to normal—at least until we realize that our life has changed irrevocably.¨
Denial: “This can’t be happening to me.”
Anger: “Why is this happening? Who is to blame?”
Bargaining: “Make this not happen, and in return I will
Depression: “I’m too sad to do anything.”
Acceptance: “I’m at peace with what has happened.”
¨Besides understanding how stress can take a toll on us physically, emotionally and spiritually, we need to understand the practical guidelines to ease the process. These include taking care of our bodies, spending time with others and reaching out to the church community.¨
Grief: Coping with the loss of your loved one
¨Loss is understood as a natural part of life, but we can still be overcome by shock and confusion, leading to prolonged periods of sadness or depression.¨
How Depression affects your body
"Depression is a brain disorder that can lead to much emotional anguish. Changes in how your brain functions also can have a big effect on your body." It can affect many things not just your emotions or moods, it can affect anything from your heart to your immune system.
Symptoms of depression: decreased appetite, decreased interest in sexual activity, aches and pains, chronic fatigue, insomnia/ lack of sleep or oversleeping.
"Depression increases your risk of a number of diseases and other conditions"
"Depression can affect the immune system, making it harder for your body to fight infection"
serious issues or conditions that coexists with depression: Heart attack, Parkinson disease, stroke, HIV/AIDS, Coronary artery disease, Autoimmune diseases, Cancer, Stroke, Arthritis, Diabetes, Kidney diseases.
¨Everyone reacts differently to death and employs personal coping mechanisms for grief. Research shows that most people can recover from loss on their own through the passage of time if they have social support and healthy habits. It may take months or a year to come to terms with a loss.¨
¨Human beings are naturally resilient, considering most of us can endure loss and then continue on with our own lives. But some people may struggle with grief for longer periods of time and feel unable to carry out daily activities. Those with severe grief may be experiencing complicated grief. These individuals could benefit from the help of a psychologist or another licensed mental health professional with a specialization in grief.¨