End-of-Life Care. Annual Education End-of-Life Care Mission Health System, Inc.

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1 Annual Education Mission Health System, Inc.

2 Why Cover This Subject? Patients who are near the end of their lives need to receive care that addresses their psychosocial, emotional, and spiritual needs. To provide care that meets these needs, staff involved in patient care require education about the unique needs of the dying patients and their families. The Joint Commission

3 So A patient who is dying (and their loved ones) often anticipate, and experience, enormous loss, which is accompanied by both grief (the feeling caused by anticipating or experiencing this loss) mourn and the need to (to express the related feelings).

4 Phases of Grief Although there is a recognized grief cycle, no two people take the same path: There is no set order No set style Several feelings may present together No set depth No set duration Stages may be revisited again & again

5 Beyond the illness-related impacts of dying, there are physical, social, cognitive, emotional, and spiritual dimensions to loss and grief. Physical Appetite (eating) disturbances Energy, fatigue, lethargy Sleep disturbance Cold (especially for children) Anxiety (sweating, trembling, etc.) Gastrointestinal disturbance Compromised immune response; increased illness Stephen J. Freeman

6 Social Withdrawal Isolation Searching Avoidance Irritability Self absorption Clinging/dependence

7 Cognitive Confusion; what is real? Difficulty concentrating Short attention span Difficulty learning new material; short term memory loss Difficulty making decisions

8 Spiritual Core beliefs may be challenged. The question of Why echoes loudly. Does my life have meaning? Why did God allow this? Will I be remembered, missed? Why were my prayers not answered?

9 When helping someone to grieve Be Aware. Remember that grief is a normal process. Be There. Learn to be with the person, not to solve the problem. Be Sensitive. Allow the pain. Do not try to take it away. Be Human. Allow the expression of feelings (guilt, anger, sorrow) without judgment. Expect tears.

10 When helping someone to grieve continued Be Ready. To hear their story, even when it is told over and over again. Encourage storytelling. Be Patient. Remember that the process of mourning takes time and is different for each individual. Use the power of touch. The dying person s need for physical contact is powerful, as is the message this contact conveys, that the person is not alone.

11 Grieving Patients and Families Need: Respect (including not talking/laughing over a comatose patient as if they are not present) Support and Compassion Someone to listen Comfort (food, drink, a warm blanket, etc.) Honest information given frequently, in a language they can understand Spiritual/religious connections Time with their loved one Gentle guidance and consistency among the healthcare team Permission to do things they re afraid to ask for (playing music at bedside, etc.) Rituals for closure if appropriate Patience & willingness on the part of the medical & nursing staff to repeat information until all persons hear & understand A quiet, private, safe place to grieve

12 How to Respond? Listen more than you talk Allow for silence Answer their questions and refer them appropriately Be genuine and caring Ask if they have special requests Be alert for patients dying without family Remember that every person and every loss is unique