1、Module 8:Final Hours,The Nurse, Dying and Death,Nurses provide support to Veterans, families, staff Interpersonal competence Being present “Bearing witness” Interdisciplinary care,Dying is an Individualized Personal Experience for the Veteran,There is no typical death Less likely to be fearful of dy

2、ing alone vs. non-Veterans Nurses advocate for choices Setting of death Support,Open, Honest Communication,Convey caring, sensitivity, compassion Recognize their helplessness Provide information in simple terms Veteran awareness of dying Maintain presence,What About Artificial Nutrition and Hydratio

3、n at End of Life?,“Starving to death” Enteral feeding does not reduce risk of aspiration or mortality Hydration does not decrease dry mouth Patients who fasted to end their lives experienced peaceful death,Gabriel et al., 2010; HPNA, 2003a,What About CPR?,Discuss futility when death is expected Poor

4、 outcome of CPR predictors Advanced terminal illnesses Dementia Poor functional status,Honoring Veterans:Dignity Conserving Care,The A, B, C, Rousseau, 2004,VHA: The Ethics of Palliative Sedation at the End of Life,First Consider the Following: All possible etiologies and treatments Education of vet

5、eran/family regarding goals and outcomes Informed consent Interdisciplinary team approach Brender et al., 2005; deGraeff NEC, 2006,Palliative Sedation at the End of Life (cont),Treatment Lorazepam Midazolam Ketamine Propofol,Symptoms of Imminent Death,Decreased urine output Cold/mottled extremities

6、Vital sign and breathing changes,Respiratory congestion “Death rattle” Delirium/confusion Restlessness Berry Matzo & Hill, 2010,Management of Imminent Death,Elevate head of bed Begin anticholinergic drugs prn Reduce or withhold IV fluids/enteral feedings Deactivate implantable cardioverter defibrill

7、ator Matzo & Hill, 2010,The Death Vigil,Family presence Common fears Being alone with Veteran Painful death Time of death Giving “l(fā)ast dose”,Nursing Interventions: Support,Collaboration with physician and other team members Reassurance and education Role model comforting Physical comforting Spiritua

8、l care Honor culture,Spiritual/Cultural Considerations,Death rites Rituals,Signs That Death Has Occurred,Absence of heartbeat and respirations Pupils fixed Color Body temperature drops Muscles, sphincters relax,When Death Has Occurred,Communicating the death Open, honest communication with family Pr

9、eparation of family is part of process,Care Following the Death,Prepare the family Care after death Honor culture Bereavement support Plans for burial, embalming Removal of the body Assist with phone calls/notifications, etc,Organ/Tissue Transplantation,Regulations Talking to the family What can be

10、donated?,Honors Available to Deceased Veterans,Presidential Memorial Certificate Military funeral honors Burial flag Possible burial allowance Burial at sea,Death of a Parent or Grandparent Remember the Children,Developmental stage of young child Communicate openly and honestly Need time to ask questions Remember the grandparents Davies & Steele, 2010,Family Members Will Always Remember “The Final Hours”,Nurses have a unique opportunity to be invited to spend these precious moments with Veterans and their families and to ma