Loss
actual or potential situation in which something that is valued is...
-changed
-no longer available
-gone
sources of loss
-aspect of self (physical/mental capacities)
-external objects (money/home)
-familiar environment
-loved ones
types of losses
situational
-death of a child
-loss of function
developmental
-empty nest
-retirement
death and dying in america...
late 1800s
-care=easing of symptoms
-most deaths occurred at home
-most die within days of illness onset
mid 1900s
-emphasis on disease prevention
-life saving and life prolonging techniques
-death often equated with medical failure
2000s
-americans livin
learning of impending death
-denial
-anger
-bargaining
-depression
-acceptance
JAMA 1999
-adequate pain and symptom management
-avoiding inappropriate prolongation of dying
-achieving a sense of control
-relieving burden
-strengthening relationships with loved ones
what do patients value?
goals may shift as EOL nears
-things they were once responsible for will be taken care of by others
-the survivors will survive without them
-all is forgiven
-their life had meaning
-they will be remembered
advanced directive
-general term used to describe documents that give instructions about future medical care and treatments and may indicate who should make decisions.
types: DNR, living will, durable power of medical attorney
general principles of palliative care
-total care of patients whose disease is not responsive to curative treatment
-patient & family are unit of care
-meeting patient & family goals and values
-attend to physical, psychological, social & spiritual needs
-education of patient & family
-bereav
hospice concept
based on medieval concept of hospitality in which community assisted a traveler at dangerous points along journey
-community = interdisciplinary team
-traveler = dying patient & family
*affirms life and regards dying as normal process.
*hospice neither ha
eligibility & financing for hospice
medicare
-part A eligible
-must be certified by 2 physicians as having less than 6 months to live
-must wave further treatment for disease
-certified for two 90 day periods
*many insurance plans also cover hospice
hospice providers
-medicare certified
-can be in home, in patient, or in nursing home
-physicians services
-nursing care (intermittent, 24 hour on call)
-outpatient drugs
-short term acute inpatient care, respite care
-home health aide
-PT, OT, Speech Pathology
-Medical so
what hospice DOES NOT cover
-treatment for the terminal illness (not related to symptom control/pain control)
-care given by another healthcare provider that wasn't arranged by hospice
-care from another provider which duplicates care the hospice is required to provide
key contribution of hospice
-helps patient and family re-establish control
-extensive assessment at intake
-mean total days in hospice = 71
-25% of hospice spend less than one week before death
-families need help with "lane shift
communication for shifting lanes
gaining consensus
-family conference/health care conference
timing transitions
-ascertain readiness
-expect anger, fear, regret, guilt
timing transitions
shifting gently
-instill confidence about HC teams ability to provide support
-break bad news "well
breaking bad news
setting
-privacy, comfort
perception
-what does patient/family know?
invitation
-how much does patient/family want to know.
knowledge
-give info in small, understandable chunks
-NEVER say there is nothing more we can do
-ask family to summarize