End of Life Care Death is a touchy subject. People pretend it is something that does not happen and refuse to talk about or address it. I am an ICC nurse. I have been for six years. I have dealt with plenty of death, in my own way. Death is a part of life. Whether it is something that is expected or not, it is our destiny. Having dealt with the suicide of my son’s father at a young age, death is something most of us avoid or do not expect. One is never prepared for it. Some refuse to accept it and move forward. Whether it is a loved one battling cancer for multiple years or a sudden suicide/death, it is never acceptable.
Working in the ‘CUE, I have seen many a prolonged death. Family members are never prepared for the death of a loved one. Whether or not my patient is ready to move on, family will do everything possible to prolong the death in hopes that the patient’s condition will improve or a “new’ cure will save their lives. I have gone through spending an hour resuscitating a 20 year old with severe congestive heart failure to taking my time resuscitating a 98 year old riddled with cancer. Regardless of my beliefs, it is never easy for family members to accept their loved ones are no longer among us.
I have mixed views about death regarding a person battling cancer. Many a times I have had a patient who is a “full code,” all life saving efforts to be attempted, that has metastasis of cancer to their liver, brain, and bones requesting all life saving efforts. In the medical community, we know life saving efforts are futile. The patient is in so much pain they can hardly stand it. They have no quality of life. Family members are hopeful that some medication will take effect and the cancer will disappear. But, by law, we are to make every effort possible at resuscitation.
If a person has a good prognosis in surviving cancer, every effort household be made to prolong the person’s life. If the cancer has metastasis and is now affecting other organs, brain, bone tissue, etc. , the plan of care should focus and stress hospice care and comfort measures. Nurses pride themselves in the quality of care they deliver to their patients. In a dying patient, comfort measures are the best care a nurse can provide to their patient. Included in the patient’s plan of care is comforting the family in dealing with the death of a loved one.
At this point in their lives, the patient is aware and has accepted that their death is inevitable. Extensive are must be given to the surviving relatives who must now deal with the death of their loved one. Unfortunately, the age of a patient is a big factor in this decision. If the person is elderly, always dependent on the caregivers definition of elderly, healthcare personnel tend to prolong resuscitative efforts. If the patient is battling cancer and is young, again dependent on the caregivers definition of young, resuscitative efforts will be aggressive. Death and religion are two difficult topics to address.
Everyone, including healthcare personnel, has their own views and beliefs on death. Unfortunately, it is a process of life that we must eventually face. Mrs.. Thomas is facing end-stage breast cancer. After previous attempts, the cancer has metastasis to her lungs. Mrs.. Thomas’ plan of care now includes pain management, , and support. Mrs.. Thomas’ requires education on pain management. Mrs.. Thomas endures near pain because seen does not want to become “addicted to drugs. ” Mrs.. Thomas’ education begins with disproving the belief that she will be “addicted to drugs. “Pain is extremely common in terminal cancer, afflicting 65% to 85% of this population. Agonizing pain is experienced by 20% to 40% of cancer tenants. (Candy, ND) Mrs.. Thomas should be educated on the effects on pain medication and that these will not lead to an addiction to pain management. It is crucial to educate Mrs.. Thomas on pain management. Due to the pain she is experiencing, pain medication will not only control her pain but also allow her to function, allow her to complete tasks that she would not be able to do otherwise because of her pain. When Morphine and other podia analgesics are prescribed for the management of pain, the dose is sometimes raised to be sure that pain is well- controlled 24 hours a day, seven days a week. Voids given to relieve pain generally do not lead to the development of tolerance. As a disease, like cancer, progresses, more voids may be needed to control the pain on a continuing basis. ” 0 Once Mrs.. Thomas’ pain is under control, the dosage of her medication may be reduced. Educating Mrs.. Thomas on the effects of pain medication will help control her pain and improve her quality of life. Support group intervention research indicates that active participation in such a group can contribute significantly to the quality of life and to the survival rate of women with advanced breast cancer. (Kinney, 2003) The Thomas’ will benefit greatly from a breast cancer support group. Support groups will help the Thomas’ cope with the progression of the illness and its inevitable outcome. Support groups provide the Thomas’ a forum to express their fears and concerns, to hear other cancer patient’s stories and an opportunity to hear the different methods others have tried to relieve pain, depression, etc.
Support groups allow the Thomas’ to feel like they are not alone in the battle they are facing. A support group will be extremely beneficial to Mrs.. Thomas who has limited contact with her two sons whom live out of state. Although Mr.. Thomas is extremely supportive of his wife, he is battling depression and the acceptance that his wife is facing a life-threatening disease. Mrs.. Thomas’ stress level is compounded due to the limited support she has from her family. “Those who feel more isolated and who perceive limited emotional support from others experience greater adjustment problems. (Kinney, 2003) The final strategy to improve the quality of life of the Thomas’ is focusing on their two sons. The absence of her sons contributes to Mrs.. Thomas’ emotional wellbeing. Due to her advanced illness, it is necessary for Mrs.. Thomas to avoid unnecessary duress and anguish. The nurse, along with a social worker, must contact the Thomas boys and inform them of their mother’s condition and prognosis. Avoiding communication and contact with their mother is of no benefit to either the parent’s or the children. Having the sons present would make Mrs..
Thomas happy. Their presence would contribute positively to her emotional status. It would also benefit Mr.. Thomas for he would have additional help in the caring of his wife. With terminal illness, it is extremely important for families to use the time they have wisely. This time must be spent discussing feelings and emotions, dealing with and overcoming any past issues, and spending time and caring for each other. Death is final. Unresolved issues will lead to feelings of regret, which contribute to difficulty coping Witt the death to a loved one.
For the well-being to the Thomas Tamil, the son’s must visit their parent’s and plan on spending quality, valuable time with their mother. The first goal of Mrs.. Thomas’ action plan is pain management. The control of her pain, or lack thereof, affects her wellbeing and state of mind. Mrs.. Thomas is offering from ‘Chronic pain related to lymphoma and cancer metastasis. ‘ Mrs.. Thomas complains of an increasing level of pain, especially in her dominant right arm. Mrs.. Thomas education will not only include on importance of pain management but also holistic, alternative methods for comfort.
Guided imagery, acupuncture, aromatherapy, hypnosis and music therapy are alternatives, in conjunction with pain medication, which may aid in Mrs.. Thomas’ pain management regime. Elevating the affected arm while laying in bed, avoiding constriction of the arm, and cool compresses are measures that will aid in her comfort. Mrs.. Thomas will urbanize her understanding of the comfort measures explained to her, she will verbalize a reduction in her pain/discomfort and she will appear comfortable. ‘Knowledge Deficit related to disease process and treatment’ is as important as pain management.
Many people have a fear of the unknown, especially a fear of death. Although Mrs.. Thomas has battled breast cancer previously, her cancer has progressed to her lungs and has been given a poor prognosis. Many questions arise regarding “what happens next,” “what can we expect,” ” will she be comfortable. ” Palliative care can educate and address pain management to improve Mrs.. Thomas’ quality of life and prepare the Thomas’ for end of life care. Palliative care will provide information regarding advanced directives, end of life care and preparation for death. The Thomas’ will devise an Advance Directive stating Mrs..
Thomas’ wishes once she is no longer able to make medical decisions. They will also make arrangements for her passing and begin to get their affairs in order. Mrs.. Thomas is also at ‘Risk for Situational Low Self-Esteem/Disturbed Body Image’ related to her diagnosis of cancer and the excision of breast and adjacent tissue altering her body image. Mrs.. Thomas underwent a right mastectomy with the removal of five auxiliary lymph nodes. A therapist or counselor can aid Mrs.. Thomas to express her feelings regarding the lasting effects of her surgery and her ability to function as a woman, sexual partner, and worker.
The nurse will also encourage the family, especially Mr.. Thomas, to provide positive input regarding feelings of love and feeling needed. Community support and resources will be provided to Mrs.. Thomas so she can have additional support from others in her same situation. Mrs.. Thomas will express, vocalizes, and accept her feelings regarding her body image. Mr.. Thomas ill show support and express his feeling regarding his feelings, fears and depression, and the need to feel loved. The Thomas’ are at ‘Risk for Anxiety/Fear related to the diagnosis of cancer.
Mrs.. Thomas’ breast cancer was in remission after a mastectomy followed by chemotherapy. She is out of remission and the cancer has emphasized to her lungs. Mr.. Thomas is battling depression due to the poor prognosis his wife has received from the medical doctors. Mr.. Thomas’ depression is exacerbating Mrs.. Thomas’ anxiety. The Thomas’ also have limited contact with their sons. The Thomas children are upset about their mother’s condition. The community health nurse and counselor may assist the Thomas’ in communicating with their children and vice versa. Mrs..
Thomas tells like seen is “bothering” them whereas a nurse may relay the severity to her condition. In doing so, the nurse will assist travel arrangements to bring the family together. The therapist or counselor will encourage the Thomas’, including children, to express their feelings regarding their fears, anger, and anxiety by reassuring them these feelings are normal. Expressing their feelings may alleviate some of the stress the Thomas’ are experiencing. The Thomas family will express ND face their fears about Mrs.. Thomas’ diagnosis and prognosis.
This will allow the Thomas family to enjoy and cherish the final months they have with their mother and wife, making their final moments memorable. Lastly, among others, Mrs.. Thomas’ spirituality must be addressed. “Disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature. ” (Giuliani, 2003) ‘Spiritual Distress related to terminal illness’ is a normal feeling in patients diagnosed with terminal cancer. Most people believe in a greater being or power.
Spiritual distress is evident when a person begins to lose hope, question their belief and value systems and the meaning of life. The community health nurse may contact a spiritual advisor, priest, pastor, depending on Mrs.. Thomas’ religious or spiritual beliefs. The spiritual advisor will provide Mrs.. Thomas an avenue to express her anger with God or higher being, questions she may have regarding the meaning of life, hope, death, and life after death. The spiritual advisor will acknowledge Mrs.. Thomas’ fears and provide hope, aid in the arrangement of spiritual rites or rituals, and assist Mrs..
Thomas with any “unfinished cuisines” to provide resolution, closure, and peace of mind. Multiple options are available to manage a patient’s pain, symptoms, and their overall quality of life. Not only are medical options available but also holistic forms of therapy have proven effective. Mrs.. Thomas is experiencing intense pain due to her cancer which renders her immobile. In conjunction with prescription medication, a warm shower/bath, a heating pad, or warm washcloths can contribute to pain control and management. Heat relaxes muscles and this can reduce Mrs..
Thomas’ pain level, giving her a sense of relief and comfort. Caution needs to be heeded regarding the imperative of the heating pad. Because of her repeated exposure with chemotherapy and radiation, an extremely hot heating pad may burn her already fragile skin. Along with heat, cool washcloths may assist Mrs.. Thomas with her pain management. Cool washcloths may be beneficial for the treatment of the pain she is experiencing in her right arm due to the lymphoma. Cool water aids in the inflammation and/or swelling caused by the lymphoma.
Once Mrs.. Thomas’ pain is under control, she will have the energy and motivation necessary to assist her husband in her care, ADDLES (activities of daily living), light exercise, and perhaps castrating activities. Exercise will prevent mobility limitations, allowing Mrs.. Thomas to perform Addles. Distractions can take her mind off her pain, improving her quality of life. Taking walks, visiting with friends, attending church service are a few examples of activities that may aid in distracting Mrs.. Thomas from focusing on her pain. Considering Mrs..
Thomas’ advanced disease process, hospice planning is important. Mrs.. Thomas disease is progressing and reaching the end of life. Hospice/ Palliative care may be suggested to the Thomas’ if they have come to terms with Mrs.. Thomas’ illness. Hospice is not a form of “giving up” but rather a meaner to provide the most appropriate care in the patient’s Tindal phase to elite. “… Most providers will agree that patients should be allowed to die with dignity, surrounded by loved ones and free of pain, with everything having been done that could have been done. (Giuliani, 2003) Palliative care provides support in the comforts of the patient’s home where they can be surrounded by loved ones in a familiar environment. They provide all the tools the patient will need to be treated at home: medical supplies and equipment, personnel, and palliative therapies and drugs. Hospice can reduce anxiety in both the terminally ill patient and his or her family by helping them make the most of the time remaining and achieve some level of acceptance. ” (Robinson, 2012) Hospice is covered by Medicare, which will alleviate Mr.. Thomas’ anxiety regarding paying for hospital benefits.
An interdisciplinary team consisting of nurses, home health aides, physical and occupational therapists, dieticians, social worker, among others, will aid family members in providing end of life care. A registered nurse will regularly visit the patient’s home to monitor pain educations and symptoms while continuously educating the patient and family on pain management. Home health aides will take care of Mrs.. Thomas’ personal hygiene and care. The aides will ensure Mrs.. Thomas is bathed and cleaned, change soiled linens, complete personal hygiene (brushing teeth, nail care, etc), and maintain Mrs..
Thomas’ skin integrity. Aides may also perform housekeeping and cooking duties. They are beneficial in providing family members or caregivers excellent pointers on turning and repositioning techniques, ensuring Mrs.. Thomas is comfortable. Physical therapists will aid in maintaining Mrs.. Thomas’ mobility: liking, dressing, and feeding herself. Once Mrs.. Thomas reaches the stage of immobility, physical therapy will educate her caregivers on ROOM exercises. A dietician will provide information on the foods necessary to maintain Mrs.. Thomas’ nutritional needs. Hospice will partially alleviate the stress Mr..
Thomas is experiencing by providing care for his wife. In doing so, Mr.. Thomas will have the opportunity to spend more time with his wife and cherish those last moments. Mr.. Thomas is a loving and supportive husband. Mr.. Thomas is doing everything within his meaner to take care of his wife’s medical and financial needs. Mr.. Thomas is facing the loss of his partner of 31 years, the responsibility of being the breadwinner, and the responsibility of providing financial, medical, and spiritual support to his ill wife. Mr.. Thomas has consumed his life with caring for his wife, he forgets about his well-being and his medication.
As the disease progresses, Mr.. Thomas is becoming excessively overwhelmed, stressed, and depressed. The Thomas’ children live out of state and are unable to assist and support Mr.. Thomas. Although Mr.. Thomas is employed, he is unable to provide care to his wife and work daily as a police officer. The community health nurse informs Mr.. Thomas of the Paid Family Leave Act, which allows him to take the time necessary to care for his ill wife. This also allows him to continue providing the necessary finances of the household. Mr.. Thomas requires extensive education regarding his depression and medication.
Mr.. Thomas is experiencing feelings common to caregivers. His sadness, anger, grief, guilt and loneliness are contributing to the depression he is experiencing. It is essential for the community health nurse to contact the Thomas’ children and request their presence. Having his sons around will alleviate, partially, he burden Mr.. Thomas is enduring as his white’s caregivers. The sons will also provide a support group not only for Mr.. Thomas but also Mrs.. Thomas. Mrs.. Thomas needs to be surrounded by her loved ones. The nurse may also suggest a caregiver support group to Mr..
Thomas. Caregivers assist and very often take on the responsibility of feeding, bathing, dressing their loved ones. These responsibilities, coupled with providing financial, medical, and daily support, can become overwhelming. Joining a support group, Mr.. Thomas can hear the experiences and coping mechanisms of other caregivers. The support group may also provide Mr.. Thomas with groups or agencies that provide home health aides that may alleviate the burden of household maintenance. It is necessary for Mr.. Thomas to realize it is okay to feel the way he does.
It is okay to ask for help. Asking for help or experiencing anger, guilt, and frustration are not signs of inadequate care or love. Mr.. Thomas should be encouraged to take time for himself. His wife’s needs by far surpass his own needs that can lead to feelings of resentment, anger, frustration, and depression. The community health nurse may offer the services of a home health aide a few days a week. This will allow Mr.. Thomas to focus on himself and distract himself. Lunch with a friend, beginning or finishing a project, or taking a walk would provide Mr..
Thomas a guilt free break. Having an aide will dispel Mr.. Thomas’ feelings of guilt for leaving his wife. Distraction will aid in the treatment of Mr.. Thomas’ depression. Lastly, Mr.. Thomas and his sons would benefit from spiritual and emotional counseling. Counseling provides a forum for the Thomas’ to express their feelings freely, without guilt or remorse. It also provides information on coping mechanisms for caregivers and dealing with the death of a loved one Having his son’s next to him could provide tremendous moral and emotional support for Mr.. And Mrs.. Thomas.
The family will have a chance to discuss their fears, accept and overcome them, and truly enjoy the last moments they have with their mother and wife. Thus far, there have been 1,638,910 newly diagnosed cancer cases and 577,190 cancer related deaths in the United States. (cancer. Org) Of those deaths, 39,510 were attributed to breast cancer. (cancer. Org) Unfortunately, there is not a cure for cancer despite extraordinary advances in medical technology. In some instances, death is inevitable. The patient and loved ones experience a wide array of emotions ranging room self-pity, depression, anger and resentment.