Definition of ICN

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

Terminal Illness
Any disease that cannot be cured and will result in death. Everyone reacts differently to news of a terminal illness. Some react with fear and anxiety. Many fear pain, abandonment, loneliness, and the unknown. They may become anxious about their loved ones, unfinished work, or dreams.

Respiratory System
1.Unable to oxygenate the body enough for adequate gas diffusion 2.Respirations become stridorous or noisy, leading to death rattle 3. Cheyne-Stokes respiration sign of pulmonary system failure Consists of alternate hyperpneic and apneic phases

Cardiovascular System
Heart unable to pump strongly enough to keep blood moving Decreased blood causes decreased circulation to the body Skin becomes cool to the touch, pale Person appears cyanotic, possibly mottled Failure of peripheral circulation frequently results in a drenching sweat cooling the body surface. Pulse becomes weak and thready, ultimately irregular A stronger pulse typically means death is hours away A weak, irregular pulse typically means that death is imminent in the next couple of hours. An apical pulse might be required.

Other Changes
Metabolism rates decrease. The person might retain feces or become incontinent. Urinary output decreases. Dying person may turn toward light as sight diminishes. Dying person may hear only what is distinctly spoken. Dying person may remain consciousness or become unconscious/comatose

Other Changes
Some dying people rally in clarity and consciousness just prior to their death A persons eyes might be open even if unconscious Dying people might turn toward or speak to someone who is not visible to anyone else in room Pain might be present Pain medication should not be withheld as person nears death.

Right to Die
Most people with terminal illness believe that someone with a terminal illness should be allowed to refuse measures that would prolong their life.
This is the right to die. Respirators, pacemakers, and other medical devices can be withheld and the person can die with dignity. DNR Do Not Resuscitate Order

Emotional and Physical Reasons People May Fear Death.

Helplessness Dependence on others Physical faculties Mutilation by surgery or disease

Uncontrollable pain
Being unprepared for death

Social Reasons People May Fear Death

Fear of separation from family or home

Fear of leaving behind unfinished tasks or responsibilities

Loss
Occurs when a valued person, object, or situation is changed
Actual Loss Perceived loss Anticipated loss

Physical loss Psychological loss

Grief or Grieving-Grief is the Emotional

Reaction to Loss
Bereavement- state of grieving during which a person goes through grief reaction.
Mourning-period of acceptance of loss and grief during which the person learns to deal with the loss.

Engels 6 Stages of Grief Reaction

Shock and disbelief

Developing awareness
Restitution Resolving the loss

Idealization
Outcome

5 Stages of Grief

Kubler-Ross Model
(Five Stages of Grief)
a process by which people deal with grief and tragedy, especially when diagnosed with a terminal illness or catastrophic loss.

Elisabeth-Kbler Ross
-Swiss-born psychiatrist and the author of the groundbreaking book On Death and Dying.

- Discussed the KblerRoss Model

Denial
People refuse to accept that the diagnosis of death is real
Temporary defense

Replaced with heightened awareness of situations and individuals that will be left behind after death

Denial
Usually occurs when the person is first told of the illness. Individuals may say,
The tests are wrong. This cant be happening to me. I dont believe it.

Others dont talk about it. Health care workers should listen without confirming or denying it.

Anger
Anger at death itself and the feelings of helplessness to change things Misplaced feelings of rage and envy Any individual that symbolizes life or energy is subject to projected resentment and jealous

This stage occurs when the patient can no longer deny death.
The patient may blame themselves, their loved ones, or health care workers for their illness.

Health care workers must understand this is not a personal attack.

Bargaining
A dying person tries to make a deal with doctors or even with God Hope that death can be postponed or delayed Extended life in exchange for reformed lifestyle Patients turn to religion and spiritual beliefs during this period. They want to see their child gradate, get married, or hold a grandchild. Making promises to God to try and obtain more time sometimes occurs.

Depression
Sadness from losses already experienced and those yet to come Begins to understand the certainty of death Disconnect oneself from things of love and affection This stage occurs when the patient realizes that death will come soon and they wont be with their families any longer. They realize that some goals they set will not be met. Health care workers need to let the patient know that depression is OK.

Acceptance
The patient understands that they are going to die. Feelings and physical pain may be non-existent End of the dying struggle This is normally the final stage. May complete unfinished business and try to help those around them deal with death. Patients will slowly get farther away from the world and other people.

They need emotional support during this stage.

Five Principles of Palliative Care (Hospice

care)
Respects the goals, likes and choices of the dying pt. Looks after medical, emotional, social, and spiritual needs of the dying person
Supports the needs of the family members

Helps pt gain access to needed healthcare providers and appropriate settings Builds ways to provide excellent end of life care

Ethical and Legal Dimensions

Managed death,
Legalized physician assisted suicide, Physician administered lethal injections (aid in dying) create ethical dilemmas.

Patients look to nursing for information, advice and support.

The nurse patient relationship is key to helping patients grieve

Next Meeting
End-of Life Care Nursing
Palliative Care Nursing