Nurses – Prepare families for declining condition and death of their loved ones

Is it difficult to raise the topics of death, declining health, and dying, with members of the family and loved ones. You are not alone! However, we need to open the door to these discussions! Families expect that when their loved one is dying, that the health care team will inform them.

KM Davidson wrote a superb article about preparing families before the death of a nursing home resident. “Family preparedness and end of life support before the death of a nursing home resident” by KM Davidson. (For summary of the article see http://guideline.gov/content.aspx?id=13965 )

Davidson states,   “The Registered Nurse (RN), who is usually the team leader and most prevalent front line professional, is ideally situated to take accountability for implementing and coordinating family preparedness and end of life support interventions.” (In Canada this role is often filled by LPNs RPNs working at full scope.)

Guidelines for preparing families:

  1. Educate front line workers
  2. Identify nursing home residents who are approaching end of life, using clinical indicators of mortality
  3. Ensure ongoing involvement of the nursing home resident’s physician in determining approaching end of life and communicating with residents and family members about dying and death
  4. Ensure open communication for the course of end of life care and implementation of palliation including incorporation of advance care planning documents
  5. Assist the family caregivers to recognize disease progression, dying trajectory, and the dying process
  6. Maintain close contact with family caregivers
  7. Understand that length of time as a family caregiver does not predict acceptance of the dying process
  8. Re-evaluate and possibly discontinue grief support initiatives
  9. Coordinate signing and sending a sympathy card to the family
  10. Acknowledge that nursing homes are de facto hospices

Retrieved July 26th from: http://guideline.gov/content.aspx?id=13965

My two favorites are the first and the last.  My passion, as those who know Life and Death Matters can guess, is in educating the front line staff!  And, my pet peeve is that Long Term Care facilities are expected to care for the dying, but without the funding and resources of a hospice!  Crazy Making!

Each one of these guidelines would make an excellent blog… any offers to help address these topics?What are your thoughts on these guidelines?  What is your experience?

Kath

 

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