A WINK WILL MAKE YOU THINK…..

“Unique needs of the dying patient.”

Describe the medical stages of dying and the

associated symptoms

Recognize the barriers to effective pain

management

State the importance of establishing a collaborative

relationship with the patient and family during the

dying process

Recommend fundamental principles to respect

persons while improving communication at end-

of-life

Clinical RNs

Clinical Partners

Social Workers

Physical and Occupational Therapists

Respiratory Therapists

is a process

is an irreversible life-ending process experienced

by all individuals

is unique as the individual who is experiencing it

occurs suddenly or over time

Bed bound,

Loss of interest,

Decrease appetite,

Cognitive changes,

Delirium

Further decline in

mental status

Obtunded,

Congestion -“Death

Rattle” (pooled oral

secretions that are not

cleared due to loss of

swallowing reflex),

Fever

Coma,

Fever(due to aspiration)

Altered respiratory

rate (fast or slow),

Cheyne-Stokes

(rapid breaths followed

by absence of breathing),

Skin color changes,

Possible surge of

energy

MID STAGE LATE STAGE

Pain, Dyspnea (difficulty breathing), Constipation, Delirium(hallucination),

Agitation, Nausea, Vomiting, Depression, Anxiety, Anorexia(lack of appetite)

EARLY STAGE

The most feared and undertreated symptom

Pain is “whatever the person says it is, experienced

whenever they say they are experiencing it”

Consider other non medication methods for pain

management –i.e. positioning, aromatherapy, music etc.

Consider other non physical factors attributing to

pain –spiritual, cultural and psychosocial issues

Conduct frequent assessment and reassessment of

pain

Inadequate pain assessment

Inadequate education of pain management

Reluctance to report pain

Inability to report pain

Fear of opioid addiction

Fear and lack of knowledge regarding use of

opioids for pain management

Cultural beliefs regarding pain management

CHECKING PATIENT AND FAMILIES EXPECTATION• Ask for permission to explore a topic

• Ask the patient to describe their current understanding of the

issue

• Allow participation in the decisions concerning their care

• Listen and encourage the patient and family to talk

ASK

SHARING INFORMATION• Straight forward language – avoid medical jargon

• Always give 2-3 pieces of information then check understanding

• Use six-eighth grade level English

• Utilize translators when necessary

INQUIRING EXPLICITLY ABOUT THE PATIENTS REACTION• Allows for clarification when unsure of what patient says/means

and tells the clinician where to go next

• Provides a chance for the patient/family to ask questions

• Keeps the conversation going to allow for expression of feelings

ASK

TELL

aming “some people would be angry…….”“It sounds like you …………” “Respond to humor”

nderstanding“It must be hard going through this alone……”“I am hearing you say……..”

especting-“I am impressed by your commitment to your mother”

upporting “I’ll be available for you…….”“I'll be here for you if you ever want to talk about your feelings …”

xploring/Empathize“Tell me more……..”“It would help me to know more about………..”“I'm sorry” (speak from the heart, be sincere, and compassionate)

To be loved

To be respected

To be accepted

To be free to express feelings

To forgive and be forgiven

No matter how their needs change, the

dying patient will always need the

support of compassionate staff

Treat patient as a living human being

Maintain a sense of hopefulness

Allow expression of feelings and emotions about

death

Allow participation in the decisions concerning

their care

Provide continuing medical care, even

though the goals of care may change

from cure to comfort

Answer all questions honestly and fully

Encourage the need to speak about or seek

spirituality

Ensure timely assessment and interventions for pain

Encourage family (including children and pets)

partnership in patient care

Educate on the process of dying and validate

feelings

Foster peace and dignity

Respect cultural practices and traditions

Policies:

Comfort Measures Only

SMH-IP 7085

Pet Visitation

SMH-IP 2038

Family Visitation

Guidelines

SMH- 2473

Resources via Baptist Health University Registration

Intercultural/Palliative End-of-Life Training Program (up to 11 CEUs)

A blended learning program geared to improve the healthcare provider level of comfort when

dealing with palliative care/end-of-life issues.

Clinical Partner Enrichment Series: The Unsung Heroes in Palliative Care (in-service hours)

Discuss best practice end-of-life care for the culturally diverse population.

Conversation in Ethics (1 CEU for lunch time conferences and 2 CEUs for evening

conferences)

Monthly discussions of current ethical topics of interest presented by various experts

Improving Care at End-of-Life (2 CEUs for RN, RD, OT)

Provides an overview of palliative care /end-of-life information to enhance the healthcare

provider knowledge

Resources Available on the Intranet/Internet

Center to Advance Palliative Care (CAPC) website www.capc.org

Free Interactive online courses for healthcare professional offering many CE/CME Credits

Palliative Care Website http://intranet.bhssf.org/en/departments-and-

directories/PalliativeCare/Pages/default.aspx

1. Click on Department and Directories

2. In the J-Z search box Type in the word “Palliative Care”

3. Browse the Palliative Care webpage