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Course: Fundamentals of Nursing

Topic: Nurse’s Role in End of Life Care

The Nurses International Community

Contact info: info@nursesinternational.org

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Module Goals

Learners will be able to:

Identify the various aspects of providing support and comfort to the terminally ill clients and their families.
Describe nurse’s role in end-of-life planning and Advanced Directives.
Provide insights on Legacy and Life Review Projects.
Describe a nurse’s role in respect to funeral practices, rituals, and legalities.

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

The following characteristics of caregivers are important in the care of dying clients:

Competence:

Skillful caregivers allay anxiety and allow the best possible medical outcome.
Dying clients are greatly comforted when they feel that their physician is knowledgeable and has developed a comprehensive plan of care.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Concern:

True empathy and connection are necessary to provide good care for dying clients and their families.
Family members and clients may avoid talking about painful feelings of impending loss. However, by discussing their own feelings about the client's loss and by asking how others are dealing with the impending loss during meetings with clients and families, can show their own concern and allow clients and families to grow closer.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Comfort

Physical discomfort can contribute to psychological distress and inhibit a healthy grief process.
Treatment of pain with narcotics, nonsteroidal anti-inflammatory drugs (NSAIDs), adjunctive agents, acupuncture, biofeedback, and other remedies is crucial in the care of the dying.
Treatment of low energy, shortness of breath, and psychiatric symptoms.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Communication

Communication with the dying should focus on careful listening rather than on speaking.
The conversation should be to help clients tell the story of their life (their accomplishments, their interests, their regrets, their hopes, the people in their life, and the details of their spiritual life).
Spend time with the client, listen intently-this helps gives the client meaning about life and death.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Huffman & Stern, 2003

The following are four ways in which a clinician can be helpful to a client who is terminally ill:

Aid the psychological and spiritual coping process.
Assess and treat psychiatric illness.
Maximize comfort.
Treat the treaters and family members.

Contact info: info@nursesinternational.org

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What would the nurse do?

A nurse is caring for a 72 years old client with terminal cancer. The client is in last stage of his life. Which of the following actions taken by the nurse can help provide psychological support to the client? Select all that apply.

The nurse can spend quality uninterrupted time with the client.
The nurse can actively listen to client’s concerns
The nurse can encourage the client to verbalize his feelings.
The nurse can tell the client the needs to sleep as much as possible.

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Huffman & Stern, 2003

Aid the psychological and spiritual coping process

Engage in discussions that allow the client to reveal the important psychological, social, and spiritual aspects of their life.
The nurse might ask about some of the following:

Life story
Relationship
Coping
Spirituality

Contact info: info@nursesinternational.org

life story:What are you proudest of? What legacy would you like to leave? What would you like your family to remember about you? Do you have any regrets? Is there anything you would like to accomplish with the remainder of your life?

Relationship:Whom do you cherish most? Have you been able to tell them? Is there anyone you would like to reconcile with? Are there any friends you hope to see? How can you help your family prepare for your death?

Coping:What are your biggest strengths? What difficult things have you gotten through in your life, and how did you get through them?

Spirituality:Are you a religious person? Do you believe in God? What is your relationship with God? Do you feel able to communicate with him? What do you imagine will happen to you when you die? Do you feel that God is happy with you, angry with you, or feels some other way? Why?

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Providing Support and Comfort to Terminally Ill

Assess and treat psychiatric Illness

Psychiatric illness is common among clients with terminal illness.
Major depression is experienced by approximately one fourth of clients with cancer.
Furthermore, one quarter of terminally ill clients also experience significant anxiety symptoms.
Delirium is also common in clients with terminal illness and it often goes unrecognized.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to the Terminally Ill

Maximize Comfort

Pain control most importance in the care of the dying client:

Higher doses of narcotics and adjuncts to narcotic medications (e.g., NSAID), tricyclic antidepressants, anticonvulsants, physical therapy, biofeedback, and massage) may be needed
Discomfort from nausea, hiccups, or dyspnea must be treated.
Adequate food, drink, and hygienic care can lead to significantly improved mood, self-esteem, and dignity.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Providing Support and Comfort to Terminally Ill

Treat the caregivers and family members

Caregivers can feel tremendous grief with the loss of a client with whom they have had a long relationship or a strong alliance.
Psychiatric consultants can help caregivers to identify their grief and can encourage them to share these feelings of loss with the client, with other colleagues, and with supervisors.

Huffman & Stern, 2003

Contact info: info@nursesinternational.org

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Advance Care Planning and Advance Directives

Advance care planning (ACP) is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.
The goal of ACP is to help ensure that people receive medical care that is consistent with their values, goals, and preferences.

Silveira, 2021

Contact info: info@nursesinternational.org

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Advance Directive

“Advance directives (ADs) are the documents a person completes while still in possession of decisional capacity about how treatment decisions should be made on they behalf in the event they lose the capacity to make such decisions”

Silveira, 2021

Contact info: info@nursesinternational.org

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Advance Directive

Client characteristics associated with a higher likelihood of completing an AD include:

Older age
History of a chronic disease, including AIDS and cancer
Higher socioeconomic status
Prior knowledge about AD and end-of-life care option
Higher level of education
Higher levels of functional impairment

Silveira, 2021

Contact info: info@nursesinternational.org

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Advance Directive

The Living Will (LW):

A document summarizing a person’s preferences for future medical care.

Health Care Proxy: A signed legal document authorizing another person to make medical decisions on the client’s behalf in the event the client loses decisional capacity.
The Durable Power of Attorney for Health Care (DPAHC):

A signed legal document authorizing another person to make medical decisions on the client’s behalf in the event the client loses decisional capacity and also has the legal capacity to make financial decisions on behalf of the client.

Silveira, 2021

Contact info: info@nursesinternational.org

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Legacy and Life Review Projects

"Legacy work" is the process of transforming the thoughts into action

Act of sitting down and taking time to purposefully create something for the people you love and care about.

Legacy project could take any form: elaborate or simple all are meaningful.

A scrapbook (with pictures/keepsakes related to a particular time in clientlife, a loved one, a favorite vacation destination, etc.)
A collection favorite recipe
A life review worksheet
A video montage
A poem or a song created specifically for the loved one

Griffith, 2011

Contact info: info@nursesinternational.org

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Critical Thinking Question

Which of the following statements best describe the reason healthcare team should address a terminally ill client’s advance directives status?

The terminally ill client may move to a condition where he can not make medical decisions that will support their personal values, life goals, and preferences regarding future medical care
The terminally ill client may become more ill with each passing hour and not be able to make his own decisions.
The terminally ill client will be the best one to make decisions about his own healthcare, thus an advance directive is not necessary.
The terminally ill client can only make decisions about his health care choices prior to a terminal diagnosis.

Contact info: info@nursesinternational.org

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Nurse’s Role in Dying Process

Cancer Council Victoria

Atmosphere

Use soft lighting
Have their favorite music playing in the background to create a gentle and peaceful atmosphere.
Quietly read a favourite poem, passage from a book, or spiritual or religious text.

Contact info: info@nursesinternational.org

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Nurse’s Role in Dying Process

Cancer Council Victoria

Comfort

Apply lip balm to dry lips, and keep the mouth moist with ice cubes.
Add incontinence sheets under the bed sheets.
Use a vaporiser in the room.
Keep the person warm with a blanket and use cushions to make them more comfortable.
Help the person change positions frequently.

Contact info: info@nursesinternational.org

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Nurse’s Role in Dying Process

Gentle presence

Sit with the person and talk or hold their hand. Often just being there is all that is needed so that they don’t feel alone.
Gently massage their hands or feet with a non-alcohol- based lotion
Don’t force-feed even though you may be distressed by their loss of interest in eating.
Speak gently, and occasionally remind the person of the time, place and who is with them.

Cancer Council Victoria

Contact info: info@nursesinternational.org

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Nurse’s Role in Dying Process

Rituals

Ask the person whether a clergy member or other spiritual leader should be at the bedside and what rituals or ceremonies are important to perform.

Funeral home

Notify the chosen funeral home that a death is expected soon. Some people want to keep vigil after the person has died –and may want the body at home for a few days. Let the funeral home know of this wish.

Cancer Council Victoria

Contact info: info@nursesinternational.org

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Nurse’s Role in Dying Process

Contact list

Ask the person who they would like to have visit in the final days and who to call after the death.

Ceremony

Find out what the person would like done with their body after death. Some people have strong views about whether they want to be buried or cremated, what sort of ceremony they want, and what type of memorial they would like.

Cancer Council Victoria

Contact info: info@nursesinternational.org

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Nurses Role in the dying process

Support the family’s emotional and spiritual needs.
Provide information to the family about resources available to them to care for their dying family member.
Inform the family about the impending signs of eminent death.
Assess the client for signs of discomfort and provide appropriate interventions.
Hospice nursing is a specialty that works with client’s and their families to support a comfortable dying process in the client’s home.

Contact info: info@nursesinternational.org

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What would the nurse do?

What techniques can the nurse use in providing comfort to a client that is actively dying? Select all that apply.

Sit with the person and talk or hold their hand
Play their favorite music in the background
Play a movie at medium volume
Apply lip balm to dry lips, and keep the mouth moist with ice cubes

Contact info: info@nursesinternational.org

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References:

Cancer Council Victoria, (n.d.). Facing End of Life. Facing End of Life. https://www.cancervic.org.au/get-support/facing-end-of-life/caring-for-someone-nearing-the-end-of-life

Griffith, W. (2011). Making Memory Last: The Art of Legacy Work. MD Anderson Cancer Center. The University of Texas. https://www.mdanderson.org/cancerwise/making-memories-last-the-art-of-legacy-work.h00-158673423.html

Huffman, J. C., & Stern, T. A. (2003). Compassionate Care of the Terminally Ill. Primary care companion to the Journal of clinical psychiatry, 5(3), 131–136. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC406380/

Silveira, M. J. (2021). Advance care planning and advance directives.UpToDate. Retrieved from: https://www.uptodate.com/contents/advance-care-planning-and-advance-directives

Contact info: info@nursesinternational.org

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