End of Life Care

1
End of Life Care

• Tiffany Boyd BSN, RN, PCCN
• Staff Development Instructor
• Pinnacle Health System

2
Mrs. Rogers

• If Mrs. Rogers came back into the hospital with
  worsening CHF that was determined to be
  end-stage, what would you do? What priorities
  would you have?

3
The Whole Pie

• Patient
• Family
• Nurse
• Palliative care
• Hospice care
• All important pieces to the end of life pie

4
The Patient

• The most important slice in the care at the end
  of life
• The patient has the control over how they want to
  die
• If the patient is not at terms with the future,
  blocks might be put up

5
The Family

• The family is important to the patient and in
  turn an important slice of the pie
• When treating the patient for end of life care,
  the nurse (or physician) are also treating the
  family
• If the family is not at terms with what the
  patient has chosen, blocks may also be put up

6
The Nurse

• The nurse knows what is needed to comfort a
  patient and the family
• Trained to support all parts of a family and
  respect the patients wishes

7
Palliative Care

• Palliative care is the medical specialty focused
  on relief of the pain and other symptoms of
  serious illness.
• The purpose is to avoid and aid in the pain and
  distress for the patient while being able to
  offer the best possible quality of life for them
  and their families.

http//www.getpalliativecare.org/whatis
8
Palliative Care

• Is appropriate at any point in a serious or
  life-threatening illness.
• Prognosis has no bearing on palliative care being
  able to occur.
• One can receive palliative care at the same time
  as they are receiving life-saving or curing care

9
PHS Palliative Care

• Dr. Arlene Bobonich Sarah Beam, CRNP are our
  palliative care team for PHS
• 231-8349
• Rosemary Schaefer-Administrative
  Assistant-Answers phone calls during day
• Not available yet at CGOH
• At HH, can be a nurse-nurse consult

10
PHS Palliative Care-Mission

• Palliative Care is a unique program that focuses
  on the comprehensive management of the physical,
  emotional, social, spiritual needs of patients
  their families living with progressive,
  life-limiting illnesses, regardless of life
  expectancy or treatment options.

11
PHS Palliative Care Checklist
12
Hospice Care

• Usually need a diagnosis of a terminal illness
  with anticipated death within 6 months
• Can be hospital or home based
• Does incorporate palliative care into hospice
  care
• No longer seeking curative treatment

13
Patient-Family Decision Making

• Family Conference Form
• Level of Intensity
• Turning off ICD
• Cultural issues

14
Family Conference Form

• Developed to use with any family meeting
  discussing a patients condition, care, etc.
• Can be used by case management, physician,
  nursing, etc.
• Helps to determine proper hospital course care

15
(No Transcript)
16
Level of Intensity (LOI)

• Determines what heroic or life-saving
  interventions are warranted
• Can be determined by the patient, POA, or family
  when patient is unable to make their own
  decisions
• Can also be determined by the physician when no
  other avenues are available
• Level I-IV
• Level II-IV (considered DNR)

17
(No Transcript)
18
DNR Armband

• Dont forget, we now have a purple DNR armband
  for patients
• This means the patient is not a LOI I
• If you notice a purple DNR armband on your
  patient, go to the chart and look at the LOI
  sheet for specifics on what LOI the patient is
  and what is or not to be done

19
Turning off the ICD

• The decision to turn off the ICD is one of great
  discussion
• Should be patient driven
• Turning off the ICD does not turn off the Pacing
  function
• The patient will not immediately die when the ICD
  is turned off
• This just means, they wont get shocked for fatal
  rhythms (VT/VFib)
• The patient can live for some time after the ICD
  is turned off as long as not fatal rhythms occur

20
Cultural Issues

• The patients culture can play a role in deciding
  how to treat the patient at the end of life

21
Mrs. Rogers Culture

• Mrs. Rogers is Hispanic
• Large family
• Close knit
• Her entire family must be included in health
  promotion and health teaching to increase
  compliance with health prescriptions and
  interactions

22
Mrs. Rogers Culture

• Mrs. Rogers will be expressive of her pain
• Prayers and lighting candles are traditional
  healing practices
• Her culture believes it is insensitive to tell a
  person the he/she is dying, as it inspires a
  sense of hopelessness and hastens the process

23
The Use of Touch

• The use of touch with palliative care and hospice
  patients has been in debate for some time
• There are few studies large enough to prove a
  point
• It has been shown to decrease pain, anxiety, and
  nausea among other unpleasant side effects with
  cancer patients

24
The Use of Touch contd.

• Could the use of touch help CHF patients?
• Outcomes anticipated
• Improved patient outcomes Reduced pain
  anxiety
• Process improvement Added dimension to PHS
  Palliative Care Program
• Reduced cost Potential to reduce LOS

25
Our Case Study

• CHF clinic
• Palliative care at home
• Eventually could be transferred to Hospice care
• Attempt to keep her at home as long as possible
  without readmissions
• If she is readmitted, get her home as soon as
  possible with available resources

26
Resources at PHS for Stressful Situations

• Crisis Intervention team-Team of staff members to
  assist in debriefing after a stressful situation
• Dr. Corey Rigberg-available to help debrief
• Employee Assistance Program-counseling
• Pastoral Care-Pastors available to talk to
  afterwards

27
Other Resources

• www.hpna.org
• www.eperc.mcw.edu
• www.nbchpn.org/DisplayPage.aspx?TitleWelcome!
• http//www.epec.net/EPEC/webpages/index.cfm
• www.capc.org/palliative-care-professionaldevelopme
  nt/Licensing/sitemap
• www.palliative.uab.edu/hc-pros/palliative-response
  /
• www.medicareadvocacy.org/FAQ/FAQ_MainPage.htm

28
References

• http//www.getpalliativecare.org/whatis
• Zerwekh, J.V. (2006). Nursing Care at the End of
  Life Palliative Care for Patients and Families.
  Philadelphia, PA.