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Giving the Best End of Life Care

Geriatric care

During end of life events, care providers and family members work together to deliver physical and emotional support for the patient. Preserving basic physical necessities, such as a comfortable room temperature and airflow, helps provide relief. Emotionally, family member presence facilitates the deep introspection often desired by the patient during this time. By encouraging family members to prepare for an end-of-life event as soon as possible, care providers can help them make best use of precious and limited time with loved ones.

When Loved One’s Pass On
When a patient’s condition declines rapidly, there is little time to make preparations. Helping families pinpoint when this process begins is sometimes difficult, as final life stages may emerge gradually. [1] However, care providers familiar the patient’s health condition can help the patient and their family members prepare for the event. Duly, nurses and caregivers listen prudently to physician statements that indicate an oncoming patient mortality. While every occurrence varies, common signs are:

  • Anxiety
  • Depression
  • Dyspnea (shortness of breath)
  • Exhaustion
  • Mental confusion
  • Reduced appetite

When these symptoms occur, care providers focus solely on patient pain relief and comfort.

Discussing Final Days with Empathy

Rapport fosters an environment that builds trust. Care providers build rapport by carefully considering how declining health affects the patient and family members. To understand this, care providers sensitively initiate conversations about patients’ current conditions. While doing so, they approach the situation confidently but sympathetically. This dialogue establishes a precedent for ongoing discussion during patients’ declining stages.

Comforting Patients During Terminal Illnesses

Terminally ill patients typically suffer from several conditions that cause discomfort. These conditions may include:

  • Breathing difficulty
  • Digestion issues
  • Exhaustion
  • Skin discomfort
  • Temperature sensitivity

Palliative care encompasses improving the quality of life for patients and families coping with symptoms caused by fatal illnesses. [2] The practice involves relieving patient suffering by recognizing pain early and providing physical, emotional and spiritual comfort.

During end-of-life events, care providers administer as much medication as the patient needs for relief. [3] Care providers might administer morphine or rise bed elevation, room humidity and air circulation to increase patient comfort. Elderly patients may experience skin irritation during terminal events, which care providers relieve with alcohol-free lotion or balm.

During terminal illnesses, patients may contemplate their spirituality and reflect on their lives. A patient’s faith or family can bring comfort to the terminally ill. For patients experiencing spiritual crises, leaders from their faith-tradition are often available to provide guidance and comfort.

Open Discussion Provides Clarity

Many patients find comfort and reassuring support when reminiscing about positive familial moments and connections, even during haziness. Therefore, care providers encourage family members to talk about positive moments and connections. During this vigil, it is important for family members to speak to the patient directly and not inadvertently lapse into a conversation amongst each other.

Relaying negative health related information clearly and empathetically is difficult but critical as the patient’s condition worsens. [2]. Care providers must often repeat this process several times for patients and family members to absorb the implications, as the significance grows clearer after each explanation. Patients and family members must understand exactly what negative prognoses mean, because it is human nature to retain any hope for recovery during illnesses. During this process, care providers speak in plain language. This is especially important during stressful situations when patients’ and family members’ concentration and comprehension lapses.

Establishing End of Life Goals

Most patients nearing death will want to finish accomplish several tasks. However, it takes time for patients and family members to accept approaching death. Care providers wait patiently for this acceptance, then initiate a sensitive and appropriate dialogue about what the patient wants to accomplish before passing away. Many patients want to spend time with their family, minimize unnecessary health care services, reduce suffering and maintain as much independence as possible. As the patient moves closer to passing away, the tasks typically reduce to one or two key items.

A patient or family member may request that care providers take all actions to prolong life. While rare, care providers must consider the motivations behind the request and the patient’s condition to make an ethical decision about subsequent care delivery.

Options for End of Life Care

Modern medicine presents patients and care providers with many end-of-life options. If possible, it is best to include the patient in this process while they are still fully cognizant and relatively comfortable physically.

After discovering an untreatable condition, care providers may suggest that the patient discuss their desires, such as whether to prolong life and where to deliver hospice service. The provider may also recommend that the patient host a private family meeting to talk over or update a living will. Knowing this information in advance helps care providers understand the patient’s and family member’s needs.

An advanced directive is the best way to relay instructions to care providers and family members during a terminal illness. [4] Living wills and health care power of attorney letters express important patient requests. Care providers can offer advice on what to include in advanced directives, as they understand the circumstances that arise during terminal illnesses.

Advanced directives cannot account for every circumstance. Therefore, it is important to advise patients to appoint someone to make decisions on their behalf during severe illnesses and remind patients to review their advanced directives regularly, as an individual’s state of affairs changes over time.

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Sources:

[1] https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/what-happens-when-someone-dies

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495357/

[3] http://www.who.int/cancer/palliative/definition/en/

[4] http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3287