Overview. Diagnosing dying. Discuss. Signs of dying. Dianne Boon RN PGD Health Science

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Overview. Diagnosing dying. Discuss. Signs of dying. Dianne Boon RN PGD Health Science"

Transcription

1 Overview Diagnosing dying Dianne Boon RN PGD Health Science Diagnosing Dying what do we mean? Signs of dying Three illness trajectories Barriers to diagnosing dying The multi-disciplinary approach Communication Scenarios Discuss What do nurses see in patients that makes them think they may die in a few days? Nurses often perceive signs and symptoms of dying that may mark the dying phase before physicians do, because of the intensity, frequency, and duration of their contact with patients and relatives (Gertruud, FM, et al, 2012) Signs of dying Withdrawal from the world Reduced cognition Profound weakness reduced level of function Reduced levels of consciousness Retained bronchial secretions Terminal restlessness Poor appetite, diminished intake of food and fluids Respiratory changes Difficulty swallowing medications Peripheral cyanosis Temperature changes at extremities Once you see the signs that a patient/resident may be dying what do you do next? Discuss.. 1

2 Diagnosing Dying Diagnosing dying is the recognition that a person is in the last days/hours of their life. Sometimes referred to as actively or imminently dying This is the time that the MDT review the patient and the plan of care as the focus of care may need to change to meet the needs of the patient and their family The LCP is recognised as an evidenced based gold standard care pathway for dying patients Diagnosing dying is complex Uncertainty is an integral part of dying. Patients can live longer or die sooner than predicted Patients with chronic non-malignant conditions can come close to death on several occasions before they die can be viewed as a failure especially in the acute setting where the focus is diagnosis, treatment, cure Barriers to diagnosing dying What are the barriers to diagnosing dying in the acute setting, residential care and the community? Hope that the patient may get better No definitive diagnosis Pursuance of unrealistic or futile interventions Disagreement about the patient s condition Failure to recognise key symptoms and signs Poor ability to communicate with the patient and family Concerns about withdrawing or withholding treatment Concerns about resuscitation Cultural and spiritual barriers Medico legal issues (Ellershaw & Ward, 2003). Dying in NZ 85% die of a chronic illness, not a sudden event 50% of people near death are not in a position to make their own decisions There is a lack of good quality data on the place of death of those who die in NZ When we become ill many of us are unaware just how seriously and irreversibly sick we are: it is not uncommon to face death unknowingly or unaware that it is not an optional extra (Dr Jonathan Adler, Listener : Nov 2009) In Residential Care Facilities, 20 % of new residents die within 3 months, 40% within 1 year 2

3 Progressive chronic illness Three most common trajectories identified Short Period of evident decline-cancer Long term limitations with intermittent serious episodes-heart Failure & COPD Prolonged Dwindling- Dementia/frailty Malignant Conditions Short period of evident decline-more predictable terminal phase Most weight loss, reduction in performance status and impaired ability for self care occurs in patients last few months. These patients often under palliative care services Long term limitations with intermittent serious episodes- Deterioration associated with increased episodes of uncontrolled symptoms or unpredictable eventinfection, arrhythmia Often results in hospital admission Patient s function can decline with each episode May not respond to treatment can be sudden These patients are often admitted to acute settings Organ Failure Prolonged dwindling- Can succumb to minor physical events Signs of dying can include- Pain, dyspnoea, respiratory congestion, delirium, dysphagia, fever and muscle twitching These patients already have a low baseline of cognitive or physical functioning Often reside in residential care facilities Frailty and Dementia Figure 1: The three main trajectories of decline at the end of life Clinical Indicators for terminal care (Boyd & Murray, 2010) 1. Could the patient be in the last days of life? (signs of dying) 2. Was the patient s condition expected to deteriorate in this way? 3. Is further life-prolonging treatment inappropriate? - -Is further treatment likely to be ineffective or too burdensome, patient or EPOA has refused further treatment or valid advance directive Copyright 2008 BMJ Publishing Group Ltd. Murray, S. A et al. BMJ 2008;336: Have potentially reversible causes of deterioration been excluded? (Infection, dehydration, bleeding, acute renal impairment, drug toxicity). 3

4 Interventions and Treatments? Invasive procedures, investigations and treatments are often continued at the expense of comfort for the patient We ve got so many treatment possibilities that you can overuse them when the patient is dying. (Dr Barry Snow, Listener July 9 th 2011) (Gibbins, McCourbrie, Alexander, Kinzel and Forbes, 2009) Communication vital Important to ensure that end-of-life decisions are consistent with patient s and families values and goals Late decision making for whatever reason reduces patient autonomy and quality end of life care for the patient and family MDT Review and Discussion Clinical judgment, weighing up a complex mix of pathology, clinical findings, therapeutic responses, comorbidities and psychosocial issues Important that the team agree that the patient is dying- otherwise variable management and contradictory advice Communication with the Patient & Family Their understanding of what is happening. The dying process (leaflet) The plan of symptom management and care The goal of the plan of care is on maintaining patient comfort and dignity in the last hours or days of life Identify what is important to the patient and family The quality of communication with the family influences the perceived quality of the patient s death. What if the patient s condition improves This can happen as dying can be difficult to diagnose Important to review the dying patient regularly Consider the question- Is the patient actively dying? Communication with family Review care plan -LCP discontinued if no longer appropriate Ensure a palliative approach continues as part of the plan of care (Ellershaw & Ward, 2003; Al-Qurainy, et al, 2009) 4

5 Scenario One- Residential Care Mrs Brown has a history of congestive heart failure, frailty, osteoporosis, frequent falls, mild cognitive impairment. Her advanced care plan indicates no active treatment or transfer to hospital. It is Friday, 1500 hours and the care assistant reports that Mrs Brown has refused lunch, is sleepy and declining fluids. RN assessment Mrs Brown is febrile, tachypnoeic, consciousness, chest moist & restless. You are the RN working with the caregiver-what do you do? Scenario 2- Acute setting Mr Woodley is 72 years old with a history of COPD, frailty, benign prostatic hypertrophy and was admitted to the ward with pneumonia He has lived with his daughter since his wife died 18 months ago He s had 2 admissions to hospital in the past 3 months with breathing difficulties and end stage COPD He has a NFR order and has openly admitted that he wants to die. His daughter is aware of this He develops respiratory failure, the registrar wants to admit him to ICU for intubation & ventilation. His daughter is upset and questions the management Discuss in small groups- what you think should happen Summary Decline in patients condition leads to MDT review MDT assessment of current symptoms and reversible causes for the decline considered and addressed Communication and agreement within the MDT that the patient is in the last days of life The importance of health care providers communicating effectively the options available to the patient and family Listening to the patient and families needs, goals and wishes and planning appropriate end-of-life care (Ellershaw & Ward, 2003: Al-Quarry, Collis & Feuer, 2009). References Al-Quarry, R., Collis. E. & Feuer, D. (2009). Dying in an acute hospital setting: the challenges and solutions. International Journal of Clinical Practice. 63, (3), Breier-Mackie, S. (2001). Patient autonomy and medical paternity: can nurses help doctors listen to patients? Nursing Ethics. 8, (6), Boyd, K & Murray, S.A. (2010). Recognising and managing key transitions in end of life care. BMJ, 341, Bushinski, R. L. & Cummings, K. M. (2007). Practices of effective end-of-life communication between nurses and patients/families in two care settings. Creative Nursing, 3, 9-12 Ellershaw, J. & Ward, C. (2003). Care of the dying patient: the last hours or days of life. BMJ, 326, References Gertruud FM, van der Werff, Wolter Paans, Roos MB Nieweg. (2012). Hospital nurses views of the signs and symptoms that herald the onset of the dying phase in oncology patients. International Journal of Palliative Nursing. 18, (3) Gibbons, J., McCoubrie, R., Alexander, N., Kinzel, C & Forbes, K. (2009). Diagnosing dying in the acute hospital setting-are we too late? Royal College of Physicians, 9, (2), Murray, S. A., Kendall, M., Boyd, K. & Sheikh, A. (2005). Illness trajectories and palliative care. BMJ,330, Murray, S. A., Sheikh, A. (2008). Making a difference palliative care beyond cancer: care for all at the end of life. BMJ,336, Shotton, L. (2000). Can nurses contribute to better end-of-life care? Nursing Ethics, 7, (2),

OBJECTIVES FOR TODAY

OBJECTIVES FOR TODAY LCP STUDY DAY OBJECTIVES FOR TODAY WHAT IS THE LCP AND HOW DO WE USE IT (Community and Hospital) LOOK AT VERSION 12 COMMUNICATION SKILLS IN END OF LIFE SPIRITUAL CARE HOSPICE CARE SYMPTOM CONTROL IN END

More information

ECOG 0 Fully active, able to carry on all pre-disease activities Score 0 without restriction.

ECOG 0 Fully active, able to carry on all pre-disease activities Score 0 without restriction. Life Choices Program of Palliative Care PALLIATIVE CARE SCREENING TOOL (Not a permanent part of the medical record) Criteria Please consider the following criteria when determining the palliative care

More information

Three triggers for Supportive/ Palliative Care are suggested - to identify these patients we can use any combination of the following methods:

Three triggers for Supportive/ Palliative Care are suggested - to identify these patients we can use any combination of the following methods: Three triggers for Supportive/ Palliative Care are suggested - to identify these patients we can use any combination of the following methods: 1. The surprise question Would you be surprised if this patient

More information

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Identifying Dying

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Identifying Dying Staff Resources Dying & Death in an Acute Hospital End-of-Life Care Resources Identifying Dying Identifying Introduction Dying The information below is from the Hospice Friendly Hospital Programme s Map

More information

Palliative Care. Patricia M. Burhanna, MSN, ANP-C Adult Nurse Practitioner Palliative Care Services

Palliative Care. Patricia M. Burhanna, MSN, ANP-C Adult Nurse Practitioner Palliative Care Services Palliative Care Patricia M. Burhanna, MSN, ANP-C Adult Nurse Practitioner Palliative Care Services Objectives By the end of the session the participant will: Be familiar with the concept of palliative

More information

Guidelines for Appropriate Referral to Nelson Tasman Hospice for Non Malignant Conditions

Guidelines for Appropriate Referral to Nelson Tasman Hospice for Non Malignant Conditions Guidelines for Appropriate Referral to Nelson Tasman Hospice for Non Malignant Conditions Admission to the hospice service is NOT diagnosis specific and may include: - Cancer - Heart disease - Kidney disease

More information

Ahlam Wynne Stroke Specialist Nurse

Ahlam Wynne Stroke Specialist Nurse Ahlam Wynne Stroke Specialist Nurse 12-07-2016 End of life is used to define a particular time frame and when likely to die within next 12 months Palliative care focus is on relief of pain and other symptoms

More information

End of life care. Standardised care process. Objective. Why end of life care is important. Care team. Definitions. Acknowledgement

End of life care. Standardised care process. Objective. Why end of life care is important. Care team. Definitions. Acknowledgement End of life care Standardised care process Objective To recognise and respond to the deteriorating resident at end of life. Why end of life care is important The last days and hours of a resident s life

More information

Maryland MOLST. Guide for Authorized Decision Makers. Maryland MOLST Training Task Force

Maryland MOLST. Guide for Authorized Decision Makers. Maryland MOLST Training Task Force Maryland MOLST Guide for Authorized Decision Makers Maryland MOLST Training Task Force May 2012 Health Care Decision Making: Goals and Treatment Options Guide for Authorized Decision Makers Contents Introduction

More information

Three triggers that suggest that patients could benefit from a hospice palliative care approach

Three triggers that suggest that patients could benefit from a hospice palliative care approach Why is it important to identify people nearing the end of life? About 1% of the population dies each year. Although some deaths are unexpected, many more in fact can be predicted. This is inherently difficult,

More information

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily

URN: Part B - Comfort Care Chart To be completed by attending Nursing and Care Staff A new chart is to be commenced daily M F I The Brisbane South Palliative Care Collaborative (BSPCC) RAC EoLCP was developed as part of a project funded by the Department of Health and Ageing. The RAC EoLCP is adapted from the Liverpool Care

More information

Living Well with Dementia Conference Person Centred Approaches

Living Well with Dementia Conference Person Centred Approaches Dr. Suzanne Timmons Consultant Geriatrician Living Well with Dementia Conference Person Centred Approaches Alzheimer s Disease: Memory affected primarily Later will involve all domains of brain function:

More information

national consensus statement: essential elements for safe and high-quality end-of-life care

national consensus statement: essential elements for safe and high-quality end-of-life care national consensus statement: essential elements for safe and high-quality end-of-life care ISBN Print: 978-1-925224-01-6 Electronic: 978-1-925224-02-3 Commonwealth of Australia 2015 This work is copyright.

More information

End of Life Care in Dutch Nursing Homes: Dying with Dignity?

End of Life Care in Dutch Nursing Homes: Dying with Dignity? EAPC Trondheim session End of life care and quality of death End of Life Care in Dutch Nursing Homes: Dying with Dignity? Prof dr Luc Deliens 1/2 Professor of Public Health and Palliative Care 1. Palliative

More information

Are there typical trajectories of social, psychological and spiritual needs in patients with lung cancer and severe heart failure?

Are there typical trajectories of social, psychological and spiritual needs in patients with lung cancer and severe heart failure? Are there typical trajectories of social, psychological and spiritual needs in patients with lung cancer and severe heart failure? Scott A Murray, St Columba s Professor of Primary Palliative Care Marilyn

More information

Health Care Decision Making Worksheet. Instructions

Health Care Decision Making Worksheet. Instructions Health Care Decision Making Worksheet Instructions Use this worksheet either to indicate current treatment preferences (which will be reflected in Maryland MOLST orders) or to clarify wishes for future

More information

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 Recognition and management of the end of life in stroke patients Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 What we shall cover overview of stroke and dying LCP: advantages and

More information

Advance Care Planning

Advance Care Planning Advance Care Planning Planning for the future Having an Advance Care Plan for health care is a smart thing to do. Like all planning for the future, it involves thinking ahead. Most of us make plans for

More information

Karen R. Waters. Advanced Nurse Practitioner and Professor Martin Johnson, University of Salford

Karen R. Waters. Advanced Nurse Practitioner and Professor Martin Johnson, University of Salford Dying with dementia: A retrospective case note analysis of nursing and care home residents who died in hospital. Karen R. Waters. Advanced Nurse Practitioner and Professor Martin Johnson, University of

More information

End of life care for the frail Old Communication and ethics

End of life care for the frail Old Communication and ethics 1 End of life care for the frail Old Communication and ethics Stein Husebø We are born. We grow up. We get old. We die. Some of us are born into privileged societies. We establish our life-projects, like

More information

What to ask your health professional about dementia

What to ask your health professional about dementia What to ask your health professional about dementia Thankyou to Josephine Clayton MBBS PhD FRACP FAChPM; Associate Professor of Palliative Care, Sydney Medical School, University of Sydney; Staff Specialist

More information

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. KGH Patients And Their Families

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. KGH Patients And Their Families Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For KGH Patients And Their Families The goal of this pamphlet is to provide information about cardiopulmonary resuscitation (CPR) so you can be adequately

More information

Hospice Certification, Care Planning and Documentation:

Hospice Certification, Care Planning and Documentation: Hospice Certification, Care Planning and Documentation: Created by: Created by: Brenda Lovelady, Liberty Hospital Hospice Presented by: Robin Carnett, Heartland Hospice Hospice Certification Written certification

More information

One. Choosing the Care You Want: ADVANCE DIRECTIVES

One. Choosing the Care You Want: ADVANCE DIRECTIVES One Choosing the Care You Want: ADVANCE DIRECTIVES At Carolinas HealthCare System, we believe your care should line up with your health goals at each stage of your life. In good health and in sickness,

More information

Degree of Intervention

Degree of Intervention Inglewood Care Centre Degree of Intervention Handbook for Residents and Families Index Introduction..................................................... 2 Beliefs, Values, and Wishes.........................................

More information

end-of-life decisions Honoring the wishes of a person with Alzheimer's disease

end-of-life decisions Honoring the wishes of a person with Alzheimer's disease end-of-life decisions Honoring the wishes of a person with Alzheimer's disease Preparing for the end of life When a person with severe (late-stage) Alzheimer s a degenerative brain disease nears the end

More information

TRIM: 93267. National Consensus Statement: Essential Elements for Safe and High-Quality End-of-Life Care in Acute Hospitals

TRIM: 93267. National Consensus Statement: Essential Elements for Safe and High-Quality End-of-Life Care in Acute Hospitals TRIM: 93267 National Consensus Statement: Essential Elements for Safe and High-Quality End-of-Life Care in Acute Hospitals Consultation draft January 2014 Commonwealth of Australia 2014 This work is copyright.

More information

Prescribing for end of life care Dr Andrew Williams Associate Specialist in Palliative Medicine 3 rd October 2012

Prescribing for end of life care Dr Andrew Williams Associate Specialist in Palliative Medicine 3 rd October 2012 Prescribing for end of life care Dr Andrew Williams Associate Specialist in Palliative Medicine 3 rd October 2012 objective Illustrate why access to end of life drugs is important Give some guidance on

More information

end-of-life decisions Honoring the wishes of a person with Alzheimer's disease

end-of-life decisions Honoring the wishes of a person with Alzheimer's disease end-of-life decisions Honoring the wishes of a person with Alzheimer's disease Preparing for the end of life When a person with late-stage Alzheimer s a degenerative brain disease nears the end of life

More information

ALLOW NATURAL DEATH/WITHHOLDING AND/OR WITHDRAWING L I F E - S U S T A I N I N G T R E A T M E N T / NON-BENEFICIAL CARE AND RESUSCITATION POLICY

ALLOW NATURAL DEATH/WITHHOLDING AND/OR WITHDRAWING L I F E - S U S T A I N I N G T R E A T M E N T / NON-BENEFICIAL CARE AND RESUSCITATION POLICY PURPOSE SUPPORTIVE DATA To specify the parameters within which decisions regarding the withholding and/or withdrawing of life-sustaining treatment/non beneficial care and/or no initiation of cardiopulmonary

More information

Queensland Guardianship and Administration Tribunal Decisions

Queensland Guardianship and Administration Tribunal Decisions [Home] [Databases] [WorldLII] [Search] [Feedback] Queensland Guardianship and Administration Tribunal Decisions You are here: AustLII >> Databases >> Queensland Guardianship and Administration Tribunal

More information

Philosophy and Meaning of Palliative Care. Deborah Prior

Philosophy and Meaning of Palliative Care. Deborah Prior Philosophy and Meaning of Palliative Care Deborah Prior 1 Objectives Identify the philosophical values that inform the palliative approach Distinguish between populations, primary and specialist models

More information

nicheprogram.org 16th Annual NICHE Conference Forging New Paths and Partnerships 1

nicheprogram.org 16th Annual NICHE Conference Forging New Paths and Partnerships 1 Use of the Palliative Performance Scale Version 2 (PPSv2) in Obtaining Palliative Care Consults Patrice Fedel MS, RN, BC Objectives At the end of this presentation the learner will be able Identify patients

More information

Submission to. Joint Committee on Health & Children. Public Hearings. End of Life Care in Community. November 5 th 2013

Submission to. Joint Committee on Health & Children. Public Hearings. End of Life Care in Community. November 5 th 2013 Submission to Joint Committee on Health & Children Public Hearings On End of Life Care in Community November 5 th 2013 Institute of Community Health Nursing Milltown Park, Sandford Road, Ranelagh, Dublin

More information

leading edge Introduction

leading edge Introduction the voice of NHS leadership leading edge 3rd in a series of papers on community health and care NOVEMBER 2005 ISSUE 12 Improving end-of-life care Key points Some 56 per cent of people would prefer to die

More information

Advance Care Planning Communication Guide: Overview

Advance Care Planning Communication Guide: Overview Advance Care Planning Communication Guide: Overview The INTERACT Advance Care Planning Communication Guide is designed to assist health professionals who work in nursing homes to initiate and carry out

More information

1. Introduction 8. Identification and Documentation for Outpatients

1. Introduction 8. Identification and Documentation for Outpatients OHSU HEALTH CARE SYSTEM CLINICAL POLICY MANUAL Chapter Eight: Expirations & Code 99 Do Not Resuscitate, Advance Directives, Physician Orders for Life-Sustaining Treatment & End-Of-Life Decision-Making

More information

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this

More information

end of life care Preparing for End Stage Dementia Information for the family and carers of people with Dementia.

end of life care Preparing for End Stage Dementia Information for the family and carers of people with Dementia. end of life care Preparing for End Stage Dementia Information for the family and carers of people with Dementia. A guide to planning ahead for relatives and carers on behalf of a person with end stage

More information

GOALS OF CARE A TOUR OF THE INDIVIDUAL S LIFE

GOALS OF CARE A TOUR OF THE INDIVIDUAL S LIFE GOALS OF CARE A TOUR OF THE INDIVIDUAL S LIFE CHARLES CRECELIUS MD, PHD, FACP, CMD LEARNING OBJECTIVES To develop an understanding of the meaning of goals of care To increase knowledge of how goals of

More information

USING THE INDIANA POST * FORM Guidance for Health Care Professionals

USING THE INDIANA POST * FORM Guidance for Health Care Professionals USING THE INDIANA POST * FORM Guidance for Health Care Professionals 2013 Edition *Physician Orders for Scope of Treatment 1 CONTENTS INTRODUCTION... 3 OVERVIEW: HOW TO IMPLEMENT THE POST FORM... 4 WHO

More information

LIFE CARE planning. Advance Health Care Directive. my values, my choices, my care OREGON. kp.org/lifecareplan

LIFE CARE planning. Advance Health Care Directive. my values, my choices, my care OREGON. kp.org/lifecareplan Advance Health Care Directive OREGON LIFE CARE planning kp.org/lifecareplan 60418810_NW All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite

More information

A GUIDE TO ADVANCE CARE PLANNING

A GUIDE TO ADVANCE CARE PLANNING A GUIDE TO ADVANCE CARE PLANNING Advance Care Planning is a process that ensures your family and treating healthcare team understand what is important to you and how you want to be treated if you become

More information

Why and how to have end-of-life discussions with your patients:

Why and how to have end-of-life discussions with your patients: Why and how to have end-of-life discussions with your patients: A guide with a suggested script and some basic questions to use The medical literature consistently shows that physicians can enhance end-of-life

More information

Health Care Directive

Health Care Directive PATIENT EDUCATION Health Care Directive Honoring Choices My Health Care Directive I created this document with much thought to give my treatment choices and personal preferences if I cannot communicate

More information

Cognitive Impairment in Older Adults: Identification and Clinical Implications

Cognitive Impairment in Older Adults: Identification and Clinical Implications Cognitive Impairment in Older Adults: Identification and Clinical Implications This presentation was delivered by Valerie T. Cotter, Director of the Adult Health and Gerontology Nurse Practitioner Programs,

More information

HEFT Care of the dying pathway for use in adults in the last days of life

HEFT Care of the dying pathway for use in adults in the last days of life HEFT Care of the dying pathway for use in adults in the last days of life Clinical Director Directorate Manager Sign... Sign... Name Name 1 Disclaimer: These guidelines are only valid for use in Birmingham

More information

Challenges in Providing Palliative Care. Virginia Bender RN Lyn Ceronsky APRN Shiri Etzioni MD Fairview Health Services

Challenges in Providing Palliative Care. Virginia Bender RN Lyn Ceronsky APRN Shiri Etzioni MD Fairview Health Services Challenges in Providing Palliative Care Virginia Bender RN Lyn Ceronsky APRN Shiri Etzioni MD Fairview Health Services Objectives Define palliative care Differentiate palliative care from hospice Describe

More information

Emergency Room (ER) Visits: A Family Caregiver s Guide

Emergency Room (ER) Visits: A Family Caregiver s Guide Family Caregiver Guide Emergency Room (ER) Visits: A Family Caregiver s Guide Your family member may someday have a medical emergency and need to go to a hospital Emergency Room (ER), which is also called

More information

Caring About Palliative Care An overview

Caring About Palliative Care An overview Caring About Palliative Care An overview Developed by the Palliative Care Consultation Team at VH and C. Talbot, Palliative Care Consultation Team at UH Presented by: Lee Ann Craig NP, Palliative Care

More information

Hospice and Palliative Care What s the right choice for my patient? Learning objectives. My palliative care education 9/18/2015

Hospice and Palliative Care What s the right choice for my patient? Learning objectives. My palliative care education 9/18/2015 Hospice and Palliative Care What s the right choice for my patient? Sharon Benjamin, ANP, MSN, ACHPN Providence Hospice Learning objectives Participants will be able to Describe the relationship between

More information

Appendix G: Sample COPD Assessment Form

Appendix G: Sample COPD Assessment Form Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) Appendix G: Sample COPD Assessment Form CHRONIC OBSTRUCTIVE PULMONARY DISEASE CLINIC RETURN

More information

The Weight of COPD: A Personal Account

The Weight of COPD: A Personal Account The Weight of COPD: A Personal Account Despite the fact that millions of Americans suffer from COPD, family, friends, and healthcare providers often fail to realize the full impact that COPD has on people

More information

GSF Dementia Care Training Programme - End of Life Care qualifications mapping template

GSF Dementia Care Training Programme - End of Life Care qualifications mapping template GSF Dementia Care Training Programme - End of Life Care qualifications mapping template GSF Programme Learning outcome Content of session & activities Core Units Core Qualification Learning outcome Assessment

More information

AN ADVANCE CARE DIRECTIVE A GIFT OF PREPAREDNESS

AN ADVANCE CARE DIRECTIVE A GIFT OF PREPAREDNESS Rhode Island Durable Power Of Attorney For Health Care AN ADVANCE CARE DIRECTIVE A GIFT OF PREPAREDNESS INTRODUCTION YOUR RIGHTS Adults have the fundamental right to control the decisions relating to their

More information

Conservative Treatment

Conservative Treatment Does everyone choose to have dialysis treatment? You have the right to make your own choices about how you are treated for kidney failure. That means you can choose not to start dialysis. It is important

More information

Don t Delay Hospice Care Referrals

Don t Delay Hospice Care Referrals Don t Delay Hospice Care Referrals Timely hospice admissions provide greater benefits. Among the Medicare population, about nine out of 10 deaths are associated with chronic illnesses, such as cancer,

More information

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health

Deciding About. Health Care A GUIDE FOR PATIENTS AND FAMILIES. New York State Department of Health Deciding About Health Care A GUIDE FOR PATIENTS AND FAMILIES New York State Department of Health 1 A GUIDE FOR PATIENTS AND FAMILIES Introduction Who should read this guide? This guide is for New York

More information

EPEC-O. Education in Palliative and End-of-life Care - Oncology

EPEC-O. Education in Palliative and End-of-life Care - Oncology The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC -O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided

More information

Seeking consent: working with older people

Seeking consent: working with older people Seeking consent: working with older people Contents Page Introduction 1 Seeking consent: people with capacity 3 When adults lack capacity 9 Research 13 Withdrawing and withholding life-prolonging treatment

More information

Palliative care in acute stroke: research findings and recommendations

Palliative care in acute stroke: research findings and recommendations Palliative care in acute stroke: research findings and recommendations S. Payne 1, C. Burton 2, J. Addington-Hall 3 and A. Jones 4 1. Lancaster University, 2. University of Bangor, 3 University of Southampton,

More information

Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice

Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice Priorities of Care for the Dying Person Duties and Responsibilities of Health and Care Staff with prompts for practice Published June 2014 by the Leadership Alliance for the Care of Dying People 1 About

More information

Caring for the Patient with End-Stage Dementia

Caring for the Patient with End-Stage Dementia Caring for the Patient with End-Stage Dementia a program of Morningside Ministries presented by Thomas Weiss MD DEMENTIA Exceedingly common among the elderly Alzheimer s Disease 6 th leading cause of death

More information

Palliative Nursing. An EssEntiAl REsouRcE for HospicE And palliative nurses

Palliative Nursing. An EssEntiAl REsouRcE for HospicE And palliative nurses Palliative Nursing An EssEntiAl REsouRcE for HospicE And palliative nurses American Nurses Association Silver Spring, Maryland 2014 American Nurses Association 8515 Georgia Avenue, Suite 400 Silver Spring,

More information

Meeting the Needs of Aging g Persons. Developmental Disabilities. Bridging the Networks - Needs of Older Caregivers of Individuals with

Meeting the Needs of Aging g Persons. Developmental Disabilities. Bridging the Networks - Needs of Older Caregivers of Individuals with Meeting the Needs of Aging g Persons with Developmental Disabilities Cross Network Collaboration for Florida Bridging the Networks - Needs of Older Caregivers of Individuals with Developmental Disabilities

More information

Service delivery interventions

Service delivery interventions Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P

More information

Guideline for Estimating Length of Survival in Palliative Patients

Guideline for Estimating Length of Survival in Palliative Patients Guideline for Estimating Length of Survival in Palliative Patients Cornelius Woelk MD, CCFP Medical Director of Palliative Care Regional Health Authority - Central Manitoba 385 Main Street Winkler, Manitoba,

More information

Oncology Competency- Pain, Palliative Care, and Hospice Care

Oncology Competency- Pain, Palliative Care, and Hospice Care Pain, Palliative Care, and Hospice Care Palliative medicine relieves suffering and improves the quality of life for patients with advanced illness. The goal is achievement of the best quality of life for

More information

TEXAS MEDICAL POWER OF ATTORNEY

TEXAS MEDICAL POWER OF ATTORNEY TEXAS MEDICAL POWER OF ATTORNEY NAME DATE BHS 80000246 v1 11/13 baptisthealthsystem.com That s Baptist Care. Page 1 of 5 INFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY THIS IS AN IMPORTANT LEGAL

More information

The development of EAPC Guidelines on the management of patients with neurological disease

The development of EAPC Guidelines on the management of patients with neurological disease The development of EAPC Guidelines on the management of patients with neurological disease Dr David Oliver Consultant Physician, Wisdom Hospice Honorary Reader, University of Kent Taskforce Dr David Oliver

More information

Power of Attorney for Health Care For

Power of Attorney for Health Care For Power of Attorney for Health Care For Name: Date of Birth: Address: Telephone: This document is on file at Copies of this document have been given to my health care agent(s) and: 1. 2. 3. 4. 5. Courtesy

More information

Belfast Breathing Better: A COPD Collaborative. Anne Marie Marley Respiratory Nurse Consultant BHSCT

Belfast Breathing Better: A COPD Collaborative. Anne Marie Marley Respiratory Nurse Consultant BHSCT Belfast Breathing Better: A COPD Collaborative Anne Marie Marley Respiratory Nurse Consultant BHSCT Stage 1a Primary Care Primary prevention Health promotion and education Stage 1b General Practice Accurate

More information

PATIENT AND FAMILY-CENTERED CARE (PFC)

PATIENT AND FAMILY-CENTERED CARE (PFC) Principles: Providing care and services that are responsive to the needs and exceed the expectations of those we serve. The patient and family is the unit of care. The hospice interdisciplinary team, in

More information

Grainne McGettrick Policy and Research Manager Dementia Palliative Care: Context Setting/Background. PCA Conference 14 September 2012

Grainne McGettrick Policy and Research Manager Dementia Palliative Care: Context Setting/Background. PCA Conference 14 September 2012 Grainne McGettrick Policy and Research Manager Dementia Palliative Care: Context Setting/Background PCA Conference 14 September 2012 Dementia Care in Ireland Lacking policy attention Underdeveloped services

More information

DOM Admission Service Guidance

DOM Admission Service Guidance Acute Care for the Elderly (ACE) Who to Call Who to admit Admission exclusion criteria Ideal Admission Location 1. Age > 75 with indication for general medicine admission (i.e. no medical or surgical specialty

More information

ADVANCE DIRECTIVE. A LIVING WILL A Directive To Withhold Or To Provide Treatment. A Durable Power Of Attorney FOR HEALTH CARE

ADVANCE DIRECTIVE. A LIVING WILL A Directive To Withhold Or To Provide Treatment. A Durable Power Of Attorney FOR HEALTH CARE ADVANCE DIRECTIVE A LIVING WILL A Directive To Withhold Or To Provide Treatment and A Durable Power Of Attorney FOR HEALTH CARE Name Date of Birth Form # 8-0553 (7-07) LIVING WILL AND DURABLE POWER OF

More information

How can we make a difference? Annual Conference 2009

How can we make a difference? Annual Conference 2009 Palliative Care: How can we make a difference? Annual Conference 2009 Make a difference to the majority of people with palliative care needs: people with non-malignant conditions Jacquelyn Chaplin: Project

More information

Hospice Care. To Make a No Obligation No Cost Referral Contact our Admissions office at: Phone: 541-512-5049 Fax: 888-611-8233

Hospice Care. To Make a No Obligation No Cost Referral Contact our Admissions office at: Phone: 541-512-5049 Fax: 888-611-8233 To Make a No Obligation No Cost Referral Contact our Admissions office at: Compliments of: Phone: 541-512-5049 Fax: 888-611-8233 Office Locations 29984 Ellensburg Ave. Gold Beach, OR 97444 541-247-7084

More information

A CATHOLIC ADVANCE DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES

A CATHOLIC ADVANCE DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES A CATHOLIC ADVANCE DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES THIS IS AN IMPORTANT LEGAL DOCUMENT KNOWN AS AN ADVANCE DIRECTIVE. ITS PURPOSE IS TO COMMUNICATE YOUR WISHES REGARDING LIFE-SUSTAINING

More information

Handbook for improving safety and providing high quality care for people with cognitive impairment in acute care: A Consultation Paper

Handbook for improving safety and providing high quality care for people with cognitive impairment in acute care: A Consultation Paper Handbook for improving safety and providing high quality care for people with cognitive impairment in acute care: A Consultation Paper Commonwealth of Australia 2013 This work is copyright. It may be reproduced

More information

Finding Meaning and Purpose in Palliative Care

Finding Meaning and Purpose in Palliative Care Finding Meaning and Purpose in PALLIATIVE CARE WHAT IS IT? Jeffrey Rubins, MD Director, Palliative Medicine Hennepin Health Services deriv. from pallium, to cloak How do you pronounce palliative? medical

More information

Diagnosing Dying. Dr Rachel Wilkins Community Consultant in Geriatric Medicine Southern Health NHS Foundation Trust

Diagnosing Dying. Dr Rachel Wilkins Community Consultant in Geriatric Medicine Southern Health NHS Foundation Trust Diagnosing Dying Dr Rachel Wilkins Community Consultant in Geriatric Medicine Southern Health NHS Foundation Trust Learning Objectives Barriers to diagnosing dying Predicting End of Life situations Gold

More information

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Definition from the Greek word, iatros,, meaning healer, iatrogenesis means brought forth by a healer

More information

Family name: Given name(s): Address:

Family name: Given name(s): Address: State of Queensland (Queensland Health) 2014 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Facility:...»» The CgDp aims to support but does not replace clinical judgement»»

More information

Dehydration in Long Term Care: The Nurse s Role in Guiding the Interdisciplinary Team

Dehydration in Long Term Care: The Nurse s Role in Guiding the Interdisciplinary Team Dehydration in Long Term Care: The Nurse s Role in Guiding the Interdisciplinary Team Welcome to the Elizabeth McGown Training Institute Cell Phones and Pagers Please turn your cell phones off or turn

More information

Module 4 The POLST Conversation POLST Script

Module 4 The POLST Conversation POLST Script Module 4 The POLST Conversation POLST Script The POLST Script provides detailed information in order to develop comfort and competence when facilitating a POLST conversation. The POLST conversation utilizes

More information

Family Caregiver s Guide to Hospice and Palliative Care

Family Caregiver s Guide to Hospice and Palliative Care Family Caregiver Guide Family Caregiver s Guide to Hospice and Palliative Care Even though you have been through transitions before, this one may be harder. If you have been a family caregiver for a while,

More information

Treatment and care towards the end of life:

Treatment and care towards the end of life: Treatment and care towards the end of life: good practice in decision making The duties of a doctor registered with the General Medical Council Patients must be able to trust doctors with their lives and

More information

Windsor & Maidenhead Integrated Primary Care Team

Windsor & Maidenhead Integrated Primary Care Team Windsor & Maidenhead Integrated Primary Care Team Meeting the LTC challenge through IPCT GP Older Peoples Mental Health Team District Nurse Practice Nurse Comm. Matron Care Coordinator Social Worker The

More information

Exhibit A. Psychiatric Home Health Adult & Child Level of Care Guidelines Revision

Exhibit A. Psychiatric Home Health Adult & Child Level of Care Guidelines Revision Exhibit A Psychiatric Home Health Adult & Child Level of Care Guidelines 2013 Revision Table of Contents A. HOME CARE NURSING SERVICES Medication Administration, Pre-Pour and Skilled Nursing Visits (Adult

More information

How to Complete This Power of Attorney for Health Care

How to Complete This Power of Attorney for Health Care Overview How to Complete This Power of Attorney for Health Care The attached Power of Attorney for Health Care form is a legal document developed to meet the legal requirements for the State of Wisconsin.

More information

CHAMPLAIN REGIONAL HOSPICE PALLIATIVE CARE PROGRAM PLAN BY THE PLANNING COUNCIL OF THE CHAMPLAIN HOSPICE PALLIATIVE AND END OF LIFE NETWORK

CHAMPLAIN REGIONAL HOSPICE PALLIATIVE CARE PROGRAM PLAN BY THE PLANNING COUNCIL OF THE CHAMPLAIN HOSPICE PALLIATIVE AND END OF LIFE NETWORK CHAMPLAIN REGIONAL HOSPICE PALLIATIVE CARE PROGRAM PLAN BY THE PLANNING COUNCIL OF THE CHAMPLAIN HOSPICE PALLIATIVE AND END OF LIFE NETWORK MAY 19 TH, 2010 ACKNOWLEDGEMENTS We would like to thank the many

More information

Simplified Advance Care Plan and Living Will (Optional)

Simplified Advance Care Plan and Living Will (Optional) Simplified Advance Care Plan and Living Will (Optional) Basic information for patients and families This handout helps you say how you want to be treated if you get very sick and cannot make decisions.

More information

Engaging Spirituality in Social Work for Palliative Care and Hospice

Engaging Spirituality in Social Work for Palliative Care and Hospice Engaging Spirituality in Social Work for Palliative Care and Hospice Conversations about Comfort, Support, and Quality of Life written by Palliative Care Consulting Team and Hwi-Ja Canda Lawrence Memorial

More information

End-of-life decisions. Advance Directives. Living Will and Durable Power of Attorney for Health Care

End-of-life decisions. Advance Directives. Living Will and Durable Power of Attorney for Health Care End-of-life decisions Advance Directives Living Will and Durable Power of Attorney for Health Care Health Care Directive Providence Health Care respects the right of individuals to make their wishes known

More information

End of Life Care in Chronic Kidney Disease

End of Life Care in Chronic Kidney Disease 1 st March 2011 Page - 1 Number of Policy 31 Transplantation, Urology and Nephrology Directorate GUIDELINES ON END OF LIFE CARE IN CHRONIC KIDNEY DISEASE Document Number: 31 Original Date of Approval:

More information

Release: 1. HLTEN515B Implement and monitor nursing care for older clients

Release: 1. HLTEN515B Implement and monitor nursing care for older clients Release: 1 HLTEN515B Implement and monitor nursing care for older clients HLTEN515B Implement and monitor nursing care for older clients Modification History Not Applicable Unit Descriptor Descriptor This

More information

Title: Resuscitation Policy: Code Status and Do Not Attempt Resuscitation (DNAR) Orders

Title: Resuscitation Policy: Code Status and Do Not Attempt Resuscitation (DNAR) Orders Title: Resuscitation Policy: Code Status and Do Not Attempt Resuscitation (DNAR) Orders I. POLICY It is the policy of [HOSPITAL NAME] to provide resuscitative efforts, including but not limited to cardiopulmonary

More information

DURABLE POWER OF ATTORNEY FOR HEALTH CARE FOR CHRISTIAN AFFIRMATION OF LIFE

DURABLE POWER OF ATTORNEY FOR HEALTH CARE FOR CHRISTIAN AFFIRMATION OF LIFE DURABLE POWER OF ATTNEY F HEALTH CARE F Name: CHRISTIAN AFFIRMATION OF LIFE Life is a gift of God which I treasure and wish to live to the fullest. As a person created by God and in God's image, I have

More information

Cancer and Advance Care Planning

Cancer and Advance Care Planning Cancer and Advance Care Planning You ve been diagnosed with cancer. Now what? You have a lot to think about and it can be difficult to know where to start. One important thing you should think about is

More information