HealthStream Regulatory Script
[End-of-Life Care]
Version: [May 2005]
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Lesson 5:
Introduction
Palliative vs. Curative Care
Barriers to Adequate Palliative Care
Addressing the Needs of the Dying Patient
Addressing the Needs of the Family
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on end-of-life care.
IMAGE: 1001.GIF
Death can be frightening. This can be especially true for patients in
the terminal stages of chronic disease. These patients often wish
for a “good death.” However, they often fear that they will die
alone, in pain, abandoned by their caregivers.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
Point 1 of 5
2
1002
Introduction: Role of the Clinician
Clinicians must provide excellent end-of-life care to all dying
patients.
IMAGE: 1002.GIF
In this way, clinicians can:
•
•
Help patients have a “good death.”
Calm the fears of dying patients.
Point 2 of 5
1003
Course Rationale
This course will teach you how to provide excellent end-of-life care.
NO IMAGE
You will learn about:
• Palliative vs. curative care
• Potential barriers to palliative care
• Guidelines for providing palliative care according to a patient’s
wishes for a “good death”
• Guidelines for helping loved ones when a patient is dying
Point 3 of 5
1004
Course Goals
After completing this course, you should be able to:
•
•
•
•
NO IMAGE
Distinguish between palliative and curative care.
Identify potential barriers to adequate palliative care, as
well as methods for overcoming these barriers.
Recognize the key components of a palliative care
consultation, including how to meet patient needs in each
key area.
List the needs typically associated with the family
members of a dying patient, including clinical best
practices for meeting these needs.
Point 4 of 5
1005
Course Outline
This introductory lesson gives the course rationale, goals, and
outline.
FLASH ANIMATION: 1005.SWF/FLA
Lesson 2 presents background information on end-of-life care.
Lesson 3 provides information on potential barriers to adequate
palliative care.
Lesson 4 presents specific guidelines for providing palliative care.
Finally, lesson 5 describes practices and guidelines for addressing
the needs of the family when a patient is dying.
Point 5 of 5
Lesson 2: Curative vs. Palliative Care
2001
Introduction
Welcome to the lesson on curative vs. palliative care.
FLASH ANIMATION: 2001.SWF/FLA
Point 1 of 17
2002
Objectives
After completing this lesson, you should be able to:
•
•
•
NO IMAGE
Distinguish between curative and palliative care.
Recognize key features of palliative care.
List benefits of using palliative and curative care together.
Point 2 of 17
2003
Causes of Death: Acute vs. Chronic
In 1900, most people died of infectious disease. Death was rapid
and certain.
IMAGE: 2003.GIF
Death comes differently in the industrialized world today. Today,
about 70% to 80% of all people die later in life. Death occurs due
to chronic or degenerative disease [glossary].
This type of disease is not rapid.
Instead, patients experience:
• Slow onset of symptoms
• Gradual decline in health
Point 3 of 17
2004
Care of Disease: Acute vs. Chronic
When treating acute infectious disease, the goal is to cure the
patient. If the cure is successful, the patient recovers. If the cure is
unsuccessful, the patient dies.
IMAGE: 2004.GIF
Care of chronic disease tends to be more complex.
Remember: Chronic disease has a slow onset and a long course.
Therefore, care often has two phases:
• Cure
• Comfort
Let’s take a closer look at each.
Point 4 of 17
2005
Cure
In the early stages of chronic disease, the goal is often to cure the
patient.
IMAGE: 2005.GIF
Monitoring, diagnostic tests, and treatment are aimed at:
• Finding the cause of the disease
• Eliminating the cause, if possible
In some cases, curative care is successful. In these cases, the
patient returns to full health.
Point 5 of 17
2006
Comfort
In many cases of chronic disease, curative care is not entirely
successful.
IMAGE: 2006.GIF
Sooner or later:
• The patient’s health continues to decline.
• The patient moves into the terminal stages of the disease.
The focus of care then shifts from cure to comfort.
Point 6 of 17
2007
Palliative Care: Definition
Comfort care for patients near the end of life is commonly called
“palliative care.”
IMAGE: 2007.GIF
The World Health Organization (WHO) definition of palliative care
is:
…the active total care of patients whose disease is not responsive
to curative treatments. Control of pain, of other symptoms, and of
psychological, social, and spiritual problems is paramount. The
goal of palliative care is achievement of the best quality of life for
patients and their families.
On the following screen, let’s take a closer look at the who, what,
when, where, and why of palliative care.
Note: This lesson provides an overview of palliative care. More
detailed guidelines for providing palliative care are presented in
lessons 4 and 5.
Point 7 of 17
2008
Palliative Care: What and Why
Remember: The goal of palliative care it to comfort, not to cure.
IMAGE: 2008.GIF
Comfort means:
• Controlling pain and other physical symptoms
• Treating the dying patient with dignity
• Respecting the dying patient’s cultural beliefs around death
and dying
• Respecting the dying patient’s wishes not to receive lifesustaining treatments that do not improve the quality of life
• Meeting the dying patient’s psychological and spiritual needs
• Meeting the dying patient’s social and interpersonal needs
In short, palliative care treats the whole person.
The goal is to give the patient the highest possible quality of life
during his or her final days, weeks, or months.
Point 8 of 17
2009
Palliative Care: Who (1)
Remember: Palliative care treats the whole person.
IMAGE: 2009.JPG
Therefore, the care team must be multidisciplinary [glossary].
Members of the care team may include:
• Physicians
• Nurses
• Pharmacists
• Social workers
• Counselors
• Clergy
• Physical therapists
• Occupational therapists
• Music therapists
• Art therapists
Point 9 of 17
2010
Palliative Care: Who (2)
All healthcare providers should know about palliative care.
IMAGE: 2010.GIF
However, the group most commonly associated with palliative care
is hospice.
Hospice has a complete range of palliative care services.
For a patient to qualify for hospice:
• The patient must have a terminal illness.
• A medical professional must certify that the patient has no
more than six months to live.
• The patient must agree to give up all curative treatment.
Point 10 of 17
2011
Palliative Care: Where
A patient may receive palliative care:
• In the hospital
• At home
• At a nursing home
• At a dedicated hospice facility
IMAGE: 2011.GIF
Hospice can give palliative care in any of these settings.
In hospitals and other healthcare facilities, all clinical staff should
know how to provide palliative care. This ensures that all patients
will have excellent end-of-life care, whether or not they have
hospice.
Point 11 of 17
2012
Palliative Care: When
Curative care and palliative care are often thought of separately.
IMAGE: 2012.GIF
Remember:
• The WHO definition of palliative care states: Palliative care is
the active total care of patients whose disease is not
responsive to curative treatments.
• Hospice is an option only in the final stages of terminal
disease. Hospice requires patients to give up curative
treatment.
However, palliative care practices may be used throughout a
patient’s treatment. This is true even when the goal of treatment is
to cure.
Let’s take a closer look.
Point 12 of 17
2013
Integration of Palliative Care: Key Elements
IMAGE: 2013.GIF
Even when care is focused on cure, it should also give comfort.
All care should:
• Manage pain and other symptoms.
• Meet the patient’s psychosocial needs.
• Help the patient have the highest possible quality of life.
Point 13 of 17
2014
Integration of Palliative Care: Benefits
When palliative care and curative care are used together:
• Quality of life is a priority throughout treatment, not just near
the end of life.
• Patients see that relieving pain and other symptoms is
important throughout treatment, not just near the end of life.
• Patients are less likely to see a shift in focus toward palliative
care as a sign that healthcare providers have “given up” on
them.
• Terminally ill patients have opportunities to find meaning and
closure throughout the course of the disease, not just hear the
end of life.
•
“Curative” therapies can be used even when palliative care is
the focus. For example, “curative” local radiation may be used
in a palliative way to relieve symptoms of terminal metastatic
cancer.
IMAGE: 2014.GIF
Point 14 of 17
2015
Review
FLASH INTERACTION: 2015.SWF/FLA
Drag and drop the terms from the list at the bottom to their proper
place in the chart.
[Curative]
The focus is on the disease.
This form of care is used mostly in the early stages of
chronic disease.
The main goal is full recovery.
[Palliative]
The focus is on the person.
This form of care is used mostly in the terminal stages of
chronic disease.
The main goals are comfort and quality of life.
Point 15 of 17
2016
Review
Hospice workers can come to hospitals. Therefore, core hospital
staff do not need to know about palliative care.
a. True
b. False
TRUE / FALSE INTERACTION
Correct: B
Feedback for A: Incorrect. This statement is false. All
clinical staff should know how to provide palliative services.
This ensures that all patients who die in hospitals will have
excellent end-of-life care, whether or not they have
hospice.
Feedback for B: Correct. All clinical staff should know how
to provide palliative services. This ensures that all patients
who die in hospitals will have excellent end-of-life care,
whether or not they have hospice.
Point 16 of 17
2017
Summary
You have completed the lesson on curative vs. palliative care.
NO IMAGE
Remember:
• Chronic disease has a slow onset and a long course
Therefore, care often has two overlapping phases: curative
care and palliative care.
• The primary goal of curative care is recovery.
• The primary goal of palliative care is comfort.
• Palliative care treats the whole person. Therefore, the care
team must be interdisciplinary.
• The group most commonly associated with palliative care
is hospice. Hospice has a full range of palliative care
services.
• All clinical staff should know how to provide excellent
palliative care.
• Curative care and palliative care are often thought of
separately. In fact, elements of palliative care should be
used throughout treatment. This is true even when the
primary focus of care is cure.
• Using palliative and curative care together can have many
benefits.
Point 17 of 17
Lesson 3: Barriers to Adequate Palliative Care
3001
Introduction
Welcome to the lesson on barriers to palliative care.
FLASH ANIMATION: 3001.SWF/FLA
Point 1 of 17
3002
Objectives
After completing this lesson, you should be able to:
•
•
NO IMAGE
List three key factors that contribute to inadequate end-of-life
care for many patients.
Identify best practices for providing adequate end-of-life care.
Point 2 of 17
3003
Current State of Palliative Care
All patients should be able to expect excellent end-of-life care.
They should expect to:
• Die without unnecessary pain or other physical suffering.
• Die according to their end-of-life preferences and treatment
decisions.
IMAGE: 3003.GIF
In fact, studies have shown that:
• Many patients have significant pain or other physical
symptoms near the end of life.
• Many clinicians do not know whether their patients want lifesustaining treatment near the end of life.
• Many clinicians do not follow their patient’s end-of-life
treatment decisions.
Point 3 of 17
3004
Reasons for Inadequate End-of-Life Care
Why are so many patients receiving poor care at the end of life?
IMAGE: 3004.GIF
Reasons include:
• Failures in communication
• Bias toward curative care
• Lack of cultural sensitivity
Let’s take a closer look at these reasons.
Point 4 of 17
3005
Communication Failures: What
Patients and clinicians do not always communicate fully.
IMAGE: 3005.GIF
As a result, clinicians often do not understand what patients want
and need near the end of life.
The clinician may not meet the patient’s needs for:
• Pain management
• Spiritual counseling
The clinician may give unwanted life-sustaining treatment that:
• Decreases the patient’s quality of life in his or her last days
• Prolongs the process of dying
• Increases suffering for the patient
• Upsets the patient’s loved ones
Point 5 of 17
3006
Communication Failures: Why
Death and dying are never easy topics to discuss. This is true for
both the clinician and the patient.
IMAGE: 3006.GIF
As a result, clinicians may:
• Offer false hope, instead of giving accurate information.
• Avoid asking patients what they need and want near the end of
life.
When clinicians do not ask, patients may not say what they need
and want. Reasons for this include:
• Confusion over unclear information
• Fear or denial of death
• Incorrect belief that the clinician, family, and friends already
know what they need and want
Point 6 of 17
3007
Communication Failures: Correcting Failures
Clinicians must understand what their patients need and
want.
IMAGE: 3007.GIF
As a clinician, you can find out what patients need and want by:
• Improving communication
• Encouraging patients to complete an advance directive
[glossary]
Let’s take a closer look at each of these methods.
Point 7 of 17
3008
Correcting Communication Failures: Improving Communication (1)
Certain approaches can help
clinicians communicate with
patients near the end of life.
These approaches include:
•
•
•
•
•
Begin with open-ended
questions.
Follow up on the
patient’s initial
responses by asking
more questions. Use the
patient’s own words.
Move on to specific
questions about
palliative care and other
end-of-life choices.
Ask direct questions
about the patient’s
symptoms.
Screen for spiritual or
existential concerns.
Click on each method to learn
more.
CLICK TO REVEAL
Begin with open-ended questions.
Open-ended questions can help you:
•
Understand the patient’s view of his or her illness or prognosis.
•
Identify the patient’s values, concerns, and goals for care.
Follow up on the patient’s initial responses by asking more questions. Use the patient’s own
words.
This method:
•
Shows the patient that you are listening.
•
Shows the patient that you understand his or her viewpoint.
•
Encourages the patient to share additional concerns, feelings, fears, etc.
Move on to specific questions about palliative care and other end-of-life choices.
Ask about:
•
Home care vs. hospital care at the end of life
•
Use of life-sustaining treatment
•
Any specific concerns and fears the patient has shared
Ask direct questions about the patient’s symptoms.
To give appropriate palliative care, you must know your patient’s symptoms. Screen for:
•
Pain
•
Fatigue
•
Shortness of breath
•
Symptoms of the illness
•
Depression
Screen for spiritual or existential [glossary] concerns.
Clinicians are not always comfortable discussing spiritual issues. However, dying patients often
have spiritual concerns. If necessary, refer patients to a religious or spiritual advisor.
Point 8 of 17
3009
Correcting Communication Failures: Improving Communication (2)
Other approaches for communication include:
•
•
•
•
Try a less direct approach to screening for distress.
Involve the family.
Make sure all terms are clearly defined and understood.
Click on each method to learn more.
CLICK TO REVEAL
Try a less direct approach to screening for distress.
Some patients will not give useful answers to direct
questions about symptoms and concerns. You may need to
take an indirect approach. For example:
• Ask the patient how family members are dealing with
his or her illness.
• Ask the patient how friends or family members have
dealt with a similar illness.
Involve the family.
Ask the patient for consent to include family members in
the conversation. Family members often raise additional
issues or concerns.
Make sure all terms are clearly defined and
understood.
To avoid any misunderstandings:
• Do not use jargon.
• State diagnoses, prognoses, and care options
clearly.
• Define any terms that may be unfamiliar to
patients.
Point 9 of 17
3010
Correcting Communication Failures: Advance Directives
Patients often do not explain what they need and want near the
end of life, because they think that their family, friends, and doctor
already know.
IMAGE: 3010.GIF
In fact, family members and physicians often do not know what
patients need and want.
Therefore, encourage all adult patients to complete an advance
directive. This could be a living will or a healthcare power of
attorney.
An advance directive helps ensure that a patient’s wishes for endof-life care will be respected, whenever the time comes.
Point 10 of 17
3011
Review
A patient has a prognosis of less than six months to live.
Communicate effectively with this patient by:
a. Reassuring the patient that he should not give up hope for
a full recovery.
b. Informing the patient of his prognosis using medical and
technical jargon.
c. Strongly encouraging the patient to enroll in clinical trials of
a promising new drug.
d. Asking open-ended questions to help identify the patient’s
values, concerns, and goals for care.
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Incorrect. Clinicians often wish to keep
hope alive. However, it is important to provide accurate
information, rather than false hope. The correct answer is
D. Ask open-ended questions to find out what the patient
needs and wants.
Feedback for B: Incorrect. Jargon may make it easier for
the clinician to talk about death and dying. However, the
patient needs clear and accurate information that he can
understand. The correct answer is D. Ask open-ended
questions to find out what the patient needs and wants.
Feedback for C: Incorrect. This is not the best answer. The
patient may wish to try an experimental drug. However, this
should not be the first topic of conversation. The best
answer is D. Ask open-ended questions to find out what
the patient needs and wants.
Feedback for D: Correct. Ask open-ended questions to find
out what the patient needs and wants.
Point 11 of 17
3012
Bias Toward Curative Care
In general, the Western healthcare system has a strong bias
toward curative care.
IMAGE: 3012.GIF
As a result:
• Many clinicians have little experience or training in palliative
care.
• Clinicians may see palliative care as failure. They may think
palliative care is the same as “giving up” on a patient.
This can lead to poor palliative care.
Point 12 of 17
3013
Bias Toward Curative Care: Correcting the Bias
Clinicians must be trained on:
• The importance of palliative care
• How to provide proper end-of-life care
IMAGE: 3013.GIF
Clinicians must understand that many patients value a “good
death.” Many patients do not want “heroic” use of medicine and
technology to prolong life. They would rather have a good death.
Therefore, excellent end-of-life care comes back to:
• Communicating with patients to understand their end-of-life
needs and wants
• Respecting what each patient needs and wants, regardless of
any preexisting biases
Point 13 of 17
3014
Lack of Cultural Competence
There are many cultural norms and taboos [glossary] around death
and dying.
IMAGE: 3014.GIF
For example, a patient’s culture may:
• Forbid the use of certain types of life support.
• Dictate that a patient should not be told of a terminal diagnosis.
• Require that a patient die at home.
• Forbid all talk of death or dying. Speaking of death may be
thought to cause death.
• Choose a particular family member to make all healthcare
decisions for the family.
Clinicians must be aware of their patients’ cultural norms and
values around death and dying. Otherwise, they risk losing their
patients’ trust. They also risk distressing their patients by:
• Breaking taboos
• Providing unwanted or improper end-of-life care
Point 14 of 17
3015
Lack of Cultural Competence: Improving Competence
Remember: Clinicians must understand what their patients need
and want near the end of life.
IMAGE: 3015.GIF
This requires good communication.
To improve communication with a patient from a different culture:
• Educate yourself about the patient’s culture. Use what you
learn as a guide. However, be careful not to stereotype the
patient.
• Talk to the patient’s family before talking to the patient. Find
out who makes healthcare decisions for the family. Find out
whether it is okay to tell the patient about a terminal diagnosis.
If not, find out who should be informed.
• Allow the patient to reveal his or her values, beliefs, concerns,
fears, and goals for care. Do not impose your beliefs and
biases.
• When necessary, use a medical translator. Translators can be
particular useful when discussing end-of-life care. They often
know acceptable euphemisms [glossary] for taboo words and
subjects.
Point 15 of 17
3016
Review
A clinician may take heroic measures to prolong life if he or she
has:
a.
b.
c.
d.
A bias toward curative care near the end of life
A bias toward palliative care near the end of life
Both of these
Neither of these
MULTIPLE CHOICE INTERACTION
Correct: A
Feedback for A: Correct.
Feedback for B: Incorrect. The correct answer is A.
Feedback for C: Incorrect. The correct answer is A.
Feedback for D. Incorrect. The correct answer is A.
Point 16 of 17
3017
Summary
You have completed the lesson on barriers to palliative care.
NO IMAGE
Remember:
• All terminally ill patients should expect to die without
unnecessary pain. They should expect to die according to their
end-of-life preferences.
• Instead, many patients suffer significant pain near the end of
life. Many clinicians do not follow their patients’ end-of-life
preferences.
• Patients and clinicians do not always communicate fully.
Therefore, clinicians often do not understand and meet their
patients’ needs and wants near the end of life.
• Clinicians must be willing to talk about end-of-life issues
directly and openly. They must provide accurate information.
They also must ask the right questions.
• All adult patients should be encouraged to complete an
advance directive.
• Clinicians must be willing to put aside their bias toward
curative care near the end of a patient’s life. They must
understand that many patients value a “good death” over
heroic measures to prolong life.
• Clinicians must act with cultural sensitivity when providing care
to patients near the end of life.
Point 17 of 17
Lesson 4: Addressing the Needs of the Dying Patient
4001
Introduction
Welcome to the lesson on addressing the needs of the dying
patient.
FLASH ANIMATION: 4001.SWF/FLA
Point 1 of 17
4002
Objectives
After completing this lesson, you should be able to:
•
•
NO IMAGE
List the parts of the palliative care consultation.
Identify the function and goal of each part.
Point 2 of 17
4003
The Palliative Care Consultation
Remember: Good communication is one of the keys to excellent
end-of-life care.
IMAGE: 4003.GIF
Communication should be ongoing throughout treatment. This
communication does not always need to be highly formal.
When a patient nears the end of life, however, a structured
palliative care consultation is often a good idea.
This consultation should address:
• Prognosis
• Personal goals for end-of-life care
• Physical symptoms
• Psychological, social, and spiritual needs
• Support systems
• Discharge planning
Let’s take a closer look at each of these elements.
Note: The following screens describe a palliative care consultation
with the patient actively involved. When the patient is a minor or a
non-competent adult:
• The patient’s legal representative should be involved.
• The patient’s advance directive should be consulted.
Point 3 of 17
4004
Prognosis
Remember: Terminally ill patients need accurate information.
IMAGE: 4004.GIF
Accurate information includes an estimate of “time left.”
This information can help patients:
• Make treatment decisions.
• Set goals for end-of-life care.
• Prepare psychologically for death.
• Draw upon support services. For example, hospice will not
provide services unless a patient has a certified prognosis of
no more than six months left to live.
Point 4 of 17
4005
Prognosis: Time Left
Clinicians often do not like to answer the question, “How much
time do I have left?”
IMAGE: 4005.GIF
The answer can never be exact or certain.
Remember: Patients often need and want this information.
Therefore, provide an estimate. Then explain that predictions of
“time left” are always uncertain. This is especially true:
• For prognoses beyond three to six months
• If multiple health factors are involved
• If the clinician making the prediction is inexperienced
• If the prognosis is for a disease other than cancer
Point 5 of 17
4006
Personal Goals for End-of-Life Care
The patient knows his or her prognosis.
IMAGE: 4006.GIF
The next step is for the patient to decide on personal end-of-life
care goals.
This often requires input or help from clinicians and family
members.
The patient may consider goals such as:
• Managing pain and other physical symptoms
• Taking care of psychological, spiritual, or social issues and
concerns
• Avoiding unwanted postponement of dying
• Maintaining control over the course of care by completing an
advance directive
• Creating a comfortable inpatient environment
• Returning home
• Avoiding future hospitalization
Point 6 of 17
4007
Personal Goals for End-of-Life Care: Maximizing Comfort and Minimizing Burden
In general, end-of-life care goals should focus on:
• Maximizing comfort
• Minimizing burden
IMAGE: 4007.GIF
Therefore, patients who remain hospitalized may wish to stop
routine care such as:
• Monitoring vital signs
• Standard labs and tests
Note: For some patients, vitals, labs, and tests may be a burden.
For others, this routine may provide psychological comfort. As
always, communicate with patients to meet their needs and wants.
Point 7 of 17
4008
Physical Symptoms
Managing pain and other physical symptoms is often an end-of-life
care goal.
IMAGE: 4008.GIF
End-of-life symptoms should be assessed and addressed during
the palliative care consultation.
Ask about:
• Pain
• Dry mouth
• Nausea
• Water retention and swelling
• Lack of appetite
• Constipation
• Shortness of breath
Point 8 of 17
4009
Physical Symptoms: Management
Drugs are used to treat most physical symptoms. In general,
opioids are used.
IMAGE: 4009.GIF
In some cases, more aggressive treatment options may be
available. For example, local radiation can relieve symptoms of
terminal metastatic [glossary] cancer.
However, aggressive treatment can have unpleasant side effects.
Patients should be fully informed of the treatment options
available. They should know all possible risks, side effects, and
benefits. This will help the patient make informed treatment and
care decisions.
Point 9 of 17
4010
Physical Symptoms: Terminal Sedation
Terminal sedation refers to the use of drugs to cause a terminally
ill patient to lose consciousness. This method is sometimes used
to relieve unmanageable physical pain or other symptoms.
IMAGE: 4010.GIF
Patients who request terminal sedation usually have refused life
support. Therefore, terminally sedated patients die of dehydration,
starvation, or respiratory failure.
U.S. Supreme Court decisions have indirectly supported the
legality of terminal sedation. However, the ethics of this
practice remain controversial.
Consult your supervisor or organizational policies for your facility’s
position on terminal sedation.
Point 10 of 17
4011
Psychosocial and Spiritual Needs
Common psychosocial and spiritual issues near the end of life are:
• Fear or denial of death
• Concerns about finances, especially the financial stability of
the patient’s family after his or her death
•
Wanting to find closure or meaning
•
Wanting to strengthen relationships with loved ones
IMAGE: 4011.GIF
Meet these needs through:
• Discussion
• Referral to a social worker, counselor, clergyperson, etc.
Point 11 of 17
4012
Support Systems
Patients near the end of life often fear dying alone.
IMAGE: 4012.GIF
Help the patient think about possible sources of physical,
emotional, and spiritual support.
These sources may include:
• Family
• Friends
• Coworkers
• Church
• Neighborhood
• Hospital volunteers
Point 12 of 17
4013
Support Systems: Fear of Being a Burden
Patients near the end of life do not wish to die alone.
IMAGE: 4013.GIF
At the same time, they may fear burdening their loved ones.
The palliative care consultation should address this fear. It is best
to do so with the patient’s loved ones. The goal should be to:
• Reassure the patient that his or her care can be arranged in a
way that does not create too much of a burden on loved ones.
• Identify resources for family members, for support if and when
they feel overwhelmed.
Point 13 of 17
4014
Discharge Planning
For inpatients, discharge planning is an essential last step in the
palliative care consultation.
IMAGE: 4014.GIF
Various options should be considered, in light of:
• The patient’s end-of-life care goals
• The patient’s symptom-management regimen
• The patient’s need for medical and emotional support
• Finances and insurance coverage
Based on these factors, options may include:
• Staying in the hospital
• Transferring to a long-term care facility
• Transferring to a hospice facility
• Going home
Point 14 of 17
4015
Review
A terminally ill patient asks, “How much time do I have left?” A
straightforward answer to this question can help the patient:
MULTIPLE CHOICE INTERACTION
Correct: D
a.
b.
c.
d.
e.
Prepare psychologically for death.
Make informed treatment decisions.
Set personal goals for end-of-life care.
All of the above
None of the above
Feedback for A: Not quite. The best answer is D. Many clinicians
prefer not to give estimates of “time left.” However, knowing their
“time left” can help patients make treatment decisions, set goals
for end-of-life care, and prepare psychologically for death.
Feedback for B: Not quite. The best answer is D. Many clinicians
prefer not to give estimates of “time left.” However, knowing their
“time left” can help patients make treatment decisions, set goals
for end-of-life care, and prepare psychologically for death.
Feedback for C: Not quite. The best answer is D. Many clinicians
prefer not to give estimates of “time left,. However, knowing their
“time left” can help patients make treatment decisions, set goals
for end-of-life care, and prepare psychologically for death.
Feedback for D: Correct. Many clinicians prefer not to give
estimates of “time left.” However, knowing their “time left” can
help patients make treatment decisions, set goals for end-of-life
care, and prepare psychologically for death.
Feedback for E: Incorrect. The best answer is D. Many clinicians
prefer not to give estimates of “time left.” However, knowing their
“time left” can help patients make treatment decisions, set goals
for end-of-life care, and prepare psychologically for death.
Point 15 of 17
4016
Review
Terminal sedation has been upheld in case law. However, it
remains ethically controversial.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: A
Feedback for A: Correct. U.S. Supreme Court decisions
have indirectly supported the legality of terminal sedation.
However, the ethics of this practice remain controversial.
Be sure to check with your supervisor regarding your
facility’s policy.
Feedback for B: Incorrect. This statement is true. U.S.
Supreme Court decisions have indirectly supported the
legality of terminal sedation. However, the ethics of this
practice remain controversial. Be sure to check with your
supervisor regarding your facility’s policy.
Point 16 of 17
4017
Summary
You have completed the lesson on addressing the needs of the
dying patient.
NO IMAGE
Remember:
• When a patient nears the end of life, a structured palliative
care consultation is often a good idea.
• Knowing their “time left” can help patients set goals for end-oflife care. It can also help them prepare psychologically for
death.
• In general, end-of-life care goals should focus on maximizing
the patient’s comfort and minimizing the patient’s burden.
• Common end-of-life symptoms include pain and shortness of
breath. Both can usually be treated with drugs.
• Terminal sedation refers to the use of drugs to cause a
terminally ill patient to lose consciousness. This method is
sometimes used to relieve unmanageable physical symptoms.
U.S. Supreme Court decisions have indirectly supported the
legality of terminal sedation. However, the ethics of the
practice remain controversial.
• Meet the psychosocial and spiritual needs of dying patients
through discussion or referral.
• Dying patients may need help in identifying support systems.
They also may need to know that their illness and dying does
not create too much of a burden on loved ones.
• For inpatients, discharge planning is an essential last step in
the palliative care consultation.
Point 17 of 17
Lesson 5: Addressing the Needs of the Family
5001
Introduction
Welcome to the lesson on addressing the needs of the dying
patient’s family.
FLASH ANIMATION: 5001.SWF/FLA
Point 1 of 17
5002
Objectives
After completing this lesson, you should be able to:
•
•
NO IMAGE
List the needs of a dying person’s family.
Identify clinical best practices that can help meet these needs.
Point 2 of 17
5003
Palliative Care and the Family
The WHO definition of palliative care states:
IMAGE: 5003.JPG
The goal of palliative care is achievement of the best quality of life
for patients and their families.
This definition recognizes that death does not happen in a vacuum.
Instead, death and dying have far-reaching consequences. The
patient’s family is profoundly affected.
Therefore, end-of-life care must consider the needs of the family,
as well as those of the patient.
Point 3 of 17
5004
Needs of the Family
When a person is dying, typical needs of the family include:
•
•
•
•
•
•
•
•
FLASH ANIMATION: 5004.SWF/FLA
To be with the person
To be helpful to the person
To be informed of the person’s changing condition
To understand what is being done to the patient, and why
To know the patient is comfortable
To express their emotions and be comforted
To be reassured that they have made the right decision (when
family members make decisions to withhold or withdraw life
support)
To find meaning in the death of the person
On the following screens, let’s take a look at clinical best practices
that can help you address each of these needs.
Point 4 of 17
5005
To Be with the Person
When patients die in hospitals or other facilities, staff should
encourage and support the presence of family members.
FLASH ANIMATION: 5005.SWF/FLA
If at all possible, the patient should be placed in a private room.
This allows the patient to have physical and emotional intimacy
with family members.
Restrictions on visiting hours should be relaxed as much as
possible. Clinicians should be prepared for large groups at the
bedside.
If the death involves withdrawal of life support, the withdrawal
should be planned so that distant family members have enough
time to arrive.
During withdrawal of life support, distractions and barriers should
be removed. Unless it is against organizational policy:
• Monitors should be turned off.
• Leads, cables, and catheters should be removed.
• Bedrails should be lowered.
Point 5 of 17
5006
To Be with the Person
Consider providing simple amenities [glossary]. This can help
make the family’s stay more comfortable.
IMAGE: 5006.GIF
A pager or cell phone can allow family members to leave the
bedside briefly, without fear of missing the patient’s last moments.
Other amenities include:
• Tissues
• Chairs
• Blankets/pillows
• Coffee
• Water
• Telephone
Point 6 of 17
5007
To Be Helpful to the Person
Family members often have a strong desire to be helpful to the
dying person. This is especially true of parents of a dying child.
FLASH ANIMATION: 5007.SWF/FLA
Allow family members to be helpful by teaching them how to
perform:
• Mouth care
• Bathing
• Repositioning
• Assessing pain
Also, encourage family members to bring meaningful personal
articles that might comfort the patient psychologically.
Point 7 of 17
5008
To Be Informed of the Person’s Changing Condition
Clinicians should take the time to explain the process of dying to
family members. This should include a clear description of:
• How the patient will die
• What the process of dying will look like
FLASH ANIMATION: 5008.SWF/FLA
Clinicians often need to anticipate and answer questions that
family members are unable to put into words.
It is especially important to describe the signs and symptoms of
imminent death. These include:
• Decrease in consciousness
• Increase in confusion or restlessness
• Visions
• Changes in breathing sounds or patterns
• Cool or bluish arms or legs
• Inability to respond to touch or sound
Family members often wish to be present in the final moments of
the patient’s life. Describe the above signs and symptoms to these
family members both:
• Before the signs develop
• As the signs develop
This ensures that family members will not leave the bedside at a
critical moment.
Point 8 of 17
5009
To Be Informed of the Person’s Changing Condition
Remember: Family members should be informed about the
process of dying.
FLASH ANIMATION: 5009.SWF/FLA
However, avoid making firm predictions about a patient’s exact
clinical course.
These predictions are:
• Difficult to make
• Often inaccurate
When a loved one is dying, family members need to feel the
utmost trust in the knowledge, expertise, and competence of the
care team. Inaccurate predictions about a patient’s death can
cause family members to lose trust.
Point 9 of 17
5010
To Understand What Is Being Done To the Person and Why
All members of the care team should give the family consistent
information about the patient’s care.
FLASH ANIMATION: 5010.SWF/FLA
In most cases, it is best to choose a single member of the care
team to communicate all messages. This helps prevent any mixed
messages.
Point 10 of 17
5011
To Be Assured of the Patient’s Comfort
Clinicians should be able to tell family members that the patient is
comfortable. This message should be honest and believable.
FLASH ANIMATION: 5011.SWF/FLA
This requires:
• Ongoing assessment and reassessment of the patient’s
physical pain and suffering
• Drugs and treatments for relieving pain, to be used as needed
Very close to death, patients may moan or grunt as they breathe.
Family members may fear that the patient is in pain.
Explain that these breathing patterns usually do not have to do
with pain. Provide this assurance even if family members do not
ask.
Point 11 of 17
5012
To Express Their Emotions and Be Comforted
Clinicians often feel the need to “do” or “fix.”
FLASH ANIMATION: 5012.SWF/FLA
One of the most comforting things you can “do” for a dying
patient’s family is simply to “be” present at the patient’s bedside.
Stay with the family. Allow family members to:
• Sit in comfortable silence.
• Review the patient’s life.
• Express feelings of loss and grief.
Immediately after the patient’s death, be sure to:
• Express your sympathy. “I’m sorry for your loss” is perfectly
adequate.
• Give family members as much time and space as they need to
say final goodbyes.
Point 12 of 17
5013
To Be Reassured That They Have Made the Right Decisions
Choosing to withdraw life support can be an agonizing decision for
family members.
FLASH ANIMATION: 5013.SWF/FLA
This is especially true if the patient does not have an advance
directive.
Be certain to address any doubts or guilt by emphasizing:
• The care team shares responsibility with family members for all
treatment decisions.
• All decisions were made after giving careful thought to the best
interests of the patient.
Point 13 of 17
5014
To Find Meaning
After the patient’s death, give family members a chance to think
about the patient’s life.
FLASH ANIMATION: 5014.SWF/FLA
Honor the patient’s life and death by bathing and handling the body
according to the family’s wishes. Be sure to follow any cultural
rules or customs.
Point 14 of 17
5015
Review
FLASH INTERACTION: 5015.SWF/FLA
When patients die in hospitals or other facilities, staff should
encourage and support the presence of family members.
How can staff help family members be present with their dying
loved one?
Type your thoughts in the space provided. Then click Submit to
check your answer.
Did you mention some or all of the following?
1. Place the patient in a private room, to allow for physical
and emotional intimacy.
2. Relax restrictions on visiting hours as much as possible.
3. Be prepared for large groups at the bedside.
4. Plan the withdrawal of life support so that distant family
members have time to arrive.
5. During withdrawal of life support, remove all distractions
and barriers. Turn off monitors. Remove leads, cables, and
catheters. Lower bedrails.
6. Provide simple amenities:
• Pager or cell phone
• Tissues
• Chairs
• Blankets and pillows
• Coffee
• Water
• Telephone
Point 15 of 17
5016
Review
Family members should be informed about the process of dying.
However, clinicians should not make firm predictions about a
specific patient’s clinical course.
a. True
b. False
TRUE / FALSE INTERACTION
Correct: A
Feedback for A: Correct. Predictions about a specific
patient’s clinical course are notoriously inaccurate.
Inaccurate predictions can lead to a loss of trust, at a time
when family members need to feel the utmost confidence
in the care team.
Feedback for B: Incorrect. This statement is true.
Predictions about a specific patient’s clinical course are
notoriously inaccurate. Inaccurate predictions can lead to a
loss of trust, at a time when family members need to feel
the utmost confidence in the care team.
Point 16 of 17
5017
Summary
You have completed the lesson on addressing the needs of the family.
NO IMAGE
Remember:
• A patient’s death profoundly affects the family. End-of-life care must consider
the needs of the family, as well as those of the patient.
• When patients die in hospitals or other facilities, staff should encourage and
support the presence of family members.
• During withdrawal of life support, all distractions and barriers should be
removed.
• Allow family members to be helpful to the dying person. This is especially
important for parents of a dying child.
• Explain the process of dying to family members. Clearly describe how the
patient will die, and what this will look like.
• Do not make firm predictions about a specific patient’s clinical course.
Inaccurate predictions can lead to a loss of trust, at a time when family
members need to feel the utmost confidence in the care team.
• All clinicians should give family members a consistent message about the
patient’s care.
• Clinicians should be able to tell family members that the patient is
comfortable. The ability to give this reassurance is based on ongoing pain
assessment and use of pain medication as needed.
• Allow family members to express feelings of loss and grief.
• Choosing to withdraw life support can be an agonizing decision for family
members. Address any doubts or guilt.
• After the patient’s death, give family members the time and space they need
to reflect on the patient’s life and say their final goodbyes.
Point 17 of 17
Course Glossary
#
Term
Definition
advance directive
amenity
credibility
euphemism
legal document stating a patient’s preferences for end-of-life treatment and care
something intended to make circumstances more pleasant
the quality of being believable or trustworthy
an agreeable or inoffensive expression used to replace one that might offend or suggest
something unpleasant
relating to or dealing with existence (especially with human existence)
a channel for communication between groups
something excluded from use or mention
long-term
treatment
existential
liaison
taboo
chronic
therapeutic interventions
multidisciplinary
jargon
metastatic cancer
degenerative
involving professionals from more than one specialty
characteristic language used by a particular group
cancer that has spread from its initial site to other parts of the body
relating to a progressive deterioration of a tissue or organ
[End-of-Life Care]
Pre-Assessment
1. In the industrialized world today, the majority of people die as a result of:
a. Accidents
b. Heart attacks
c. Acute infectious disease
d. Chronic or degenerative disease
Correct Answer: Chronic or degenerative disease
Answer Rationale: In the industrialized world today, an estimated 70% to 80% of all people die of chronic or degenerative disease.
2. The main focus of curative care is:
a. Maximizing quality of life
b. The psychosocial aspects of illness
c. Managing pain and other symptoms
d. Eliminating the underlying cause of disease
Correct Answer: Eliminating the underlying cause of disease
Answer Rationale: The main focus of curative care is identifying and eliminating the underlying cause of disease. The goal is to restore full health.
3. Providing some palliative care even in the earliest stages of curative care shows patients that:
a. Quality of life is important throughout treatment, not just near the end of life.
b. Relieving pain is important throughout treatment, not just near the end of life.
c. A shift in focus toward more palliative care is not a sign that healthcare providers have “given up” on a patient.
d. All of these answers are correct.
e. None of these answers is correct.
Correct Answer: All of these answers are correct.
Answer Rationale: Using palliative and curative care together has all of these benefits.
4. A patient has not discussed end-of-life care with anyone. __________ is (are) likely to know what type of care the patient needs and wants near
the end of life.
a. The patient’s primary care physician
b. The patient’s closest family members
c. Both of these
d. Neither of these
Correct Answer: Neither of these
Answer Rationale: Physicians and family members often do not know what type of care a patient would need and want near the end of life.
5. You are talking to a terminally ill patient about end-of-life care. You ask the patient about his most immediate fears and concerns. The patient
says, “I’m afraid I won’t be alive for my daughter’s college graduation.” To keep lines of communication open, the best response would be:
a. “Try to keep your hopes up. We’ll do our best to make sure you see your daughter graduate!”
b. “I can understand why you would want to be alive for your daughter’s graduation. What frightens you the most about not being there for
your family?”
c. “I’m sorry, but it’s very likely that you will not live to see your daughter graduate. Why don’t we talk about the important things you have
seen in your life?
Correct Answer: “I can understand your desire to be alive for your daughter’s graduation. What frightens you the most about not being there for
your family?”
Answer Rationale: This response validates the patient’s desire to see his daughter graduate. It does not give false hope or empty reassurances. It
invites the patient to continue to explore his fear.
6. Western healthcare has a bias toward:
a. Comfort care
b. Curative care
c. Palliative care
d. Symptom management
Correct Answer: Curative care
Answer Rationale: Western healthcare has a strong bias toward curative care.
7. You are treating a patient from an unfamiliar culture. The patient’s diagnosis is terminal. It would be a good idea to:
a. Tell the patient about the diagnosis.
b. Make direct references to death and dying.
c. Identify the patient’s values, beliefs, and concerns.
d. All of these answers
e. None of these answers
Correct Answer: Identify the patient’s values, beliefs, and concerns.
Answer Rationale: Depending on the patient’s culture, direct references to death and dying may be taboo. Also, it may be more appropriate to tell
a designated family member about the terminal diagnosis. Regardless of culture, it is a good idea to find out about the patient’s values, beliefs,
and concerns.
8. Terminally ill patients often fear:
a.
b.
c.
d.
e.
Dying alone
Dying in pain
Burdening their loved ones
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: All of these are common fears for patients near the end of life.
9. The “fifth vital sign” is:
a. Pain
b. Skin color
c. Hydration status
d. Responsiveness to touch
Correct Answer: Pain
Answer Rationale: Pain has been designated the “fifth vital sign.” It is important to monitor and chart pain to ensure adequate pain management
at all times.
10. Opioids are most often used to relieve pain and suffering in the terminally ill.
a. True
b. False
Correct Answer: True
Answer Rationale: This statement is true.
11. End-of-life care should address the needs of the family, as well as those of the dying patient.
a. True
b. False
Correct Answer: True
Answer Rationale: Death and dying profoundly affect the patient’s family, as well as the dying patient. Therefore, end-of-life care should address
the needs of the family, as well as those of the patient.
12. A terminally ill patient has requested withdrawal of life support. The patient is expected to die shortly after the withdrawal of support. The
patient’s family has gathered to be with him during his final moments. For the withdrawal of life support:
a. The patient’s monitors should be turned off.
b. The patient’s bedrails should be lowered.
c. Leads, cables, and catheters should be removed.
d. All of these answers are correct.
e. None of these answers is correct.
Correct Answer: All of these answers are correct.
Answer Rationale: During withdrawal of life support, all distractions and barriers should be removed. This allows the family to have access to the
patient in his final moments.
13. One of your patients is dying. Her family members have gathered to be with her in her final moments. You are educating the family members
about the process of dying. You should:
a. Keep your description as brief as possible. Provide extra information only if family members specifically ask.
b. Describe only the physiologic process of dying. Do not frighten the family members by describing how the patient will look.
c. Provide a complete physiologic and visual description of the process of dying. Anticipate and answer any questions that family members
may be afraid or unable to verbalize.
d. Avoid describing the specific signs and symptoms of imminent death. This will ensure that family members do not become too upset when
the patient begins to show these symptoms.
Correct Answer: Provide a complete physiologic and visual description of the process of dying. Anticipate and answer any questions that family
members may be afraid or unable to verbalize.
Answer Rationale: Family members of a dying patient should be fully informed of the process of dying. This should include a clear description of
how the patient will die, and what this process will look like. Clinicians describing the process of dying should anticipate and answer any questions
that family members may be afraid or unable to verbalize.
14. Choosing to withdraw life support can be an agonizing decision for family members. This is especially true if a non-competent terminally ill
patient does not have _________.
a. A spousal consent
b. A promissory note
c. An advance directive
d. A last will and testament
Correct Answer: An advance directive
Answer Rationale: An advance directive is the legal document that records a patient’s end-of-life care preferences. Decisions to withhold or
withdraw life support are generally easier for family members when they have an advance directive to guide and reassure them.
15. Inpatients near the end of life:
a. May take psychological comfort in routine care activities (vitals, labs, tests)
b. May find routine care activities (vitals, labs, tests) to be an unnecessary burden
c. Either of these answers
d. Neither of these answers
Correct Answer: Either of these answers
Answer Rationale: Some inpatients near the end of life may find routine care to be an unnecessary burden. Others may take psychological
comfort in the routine. This illustrates the importance of communication to meet the needs and wants of the patient.
Final Exam
Question Title: Question 1
Question: In the industrialized world today, how many people die as a result of chronic or degenerative disease?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
An estimated 15% to 20% of all people
An estimated 30% to 40% of all people
An estimated 50% to 70% of all people
An estimated 70% to 80% of all people
Correct Answer: An estimated 70% to 80% of all people
Answer Rationale: In the industrialized world today, an estimated 70% to 80% of all people die of chronic or degenerative disease.
Question Title: Question 2
Question: Palliative care addresses:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Psychological distress
Spiritual or existential concerns
Pain and other physical symptoms
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: Palliative care addresses physical, psychological, social, and spiritual issues.
Question Title: Question 3
Question: Palliative care should be part of the treatment of chronic disease starting from:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
The time the patient is diagnosed with the disease.
The time the patient has a prognosis of less than one year to live.
The time the patient has a prognosis of less than one week to live.
The time the patient has a prognosis of less than six months to live.
Correct Answer: The time the patient is diagnosed with the disease.
Answer Rationale: The main focus of treatment may shift over time (from curative to palliative). However, certain aspects of palliative care are
important even in the earliest stages of curative care.
Question Title: Question 4
Question: Patients often believe that their family, friends, or physician automatically know and understand their end-of-life needs and wants.
Answer 1: True
Answer 2: False
Correct Answer: True
Answer Rationale: Many patients mistakenly believe that their family, friends, or physician know and understand their end-of-life needs and wants.
This is true even if the patient has never talked about or planned for end-of-life care.
Question Title: Question 5
Question: A patient wants to make sure that she will get she treatment she needs and wants near the end of life. Her best option is to:
Answer 1: Document her wishes in an advance directive.
Answer 2: Assume that a trusted physician knows, understands, and will comply with her wishes.
Answer 3: Assume that close family members know, understand, and will comply with her wishes.
Correct Answer: Document her wishes in an advance directive.
Answer Rationale: Physicians and family members are poor predictors of the treatment a patient would need and want near the end of life. All
adult patients should be encouraged to complete an advance directive.
Question Title: Question 6
Question: Lack of cultural competence on the part of clinicians can lead to:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Breaking cultural taboos
Patient distress and distrust
Providing unwanted or improper end-of-life care
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: All of these could happen when a clinician is not culturally competent.
Question Title: Question 7
Question: End-of-life predictions for _______ patients tend to be most accurate. This is due to the amount and type of data available for this
disease.
Answer 1:
Answer 2:
Answer 3:
Answer 4:
AIDS
Cancer
Congestive heart failure
Chronic obstructive pulmonary disease
Correct Answer: Cancer
Answer Rationale: End-of-life predictions are inherently uncertain. For cancer patients, however, these predictions tend to be somewhat more
accurate. This is due to the large amount of data available.
Question Title: Question 8
Question: A common end-of-life symptom is:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Increased appetite
Shortness of breath
Increased salivation
All of these answers
None of these answers
Correct Answer: Shortness of breath
Answer Rationale: Shortness of breath is very common near the end of life. This can be very distressing to patients. Other end-of-life symptoms
include decreased appetite and salivation.
Question Title: Question 9
Question: The only option for pain management in terminally ill patients is medication.
Answer 1: True
Answer 2: False
Correct Answer: False
Answer Rationale: Other options are sometimes available. For example, local radiation may be used to relieve cancer pain.
Question Title: Question 10
Question: Possible sources of support for patients near the end of life include:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Neighbors
Coworkers
Hospital volunteers
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: Neighbors, coworkers, and hospital volunteers are all possible sources of support.
Question Title: Question 11
Question: A patient is dying in the hospital. Staff should encourage and support the presence of this patient’s family members by:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Placing the patient in a private room
Relaxing restrictions on visiting hours
Providing simple amenities, such as chairs, pillows, and coffee
All of these answers
Answer 5: None of these answers
Correct Answer: All of these answers
Answer Rationale: When patients spend their last days in the hospital, staff should encourage and support the presence of family members.
Methods for doing so may include placing the patient in a private room, extending visiting hours, and providing simple amenities.
Question Title: Question 12
Question: Family members often have a strong desire to be helpful to the dying person. It is especially important to meet this need for:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Parents of a dying child
Children of a dying parent
Siblings of a dying patient
Grandchildren of a dying grandparent
Correct Answer: Parents of a dying child
Answer Rationale: Parents of a dying child have a particularly strong need to be helpful and nurturing. This need should be met in whatever ways
possible.
Question Title: Question 13
Question: Family members can fulfill the need to be helpful to a dying person through care activities such as bathing and repositioning.
Answer 1: True
Answer 2: False
Correct Answer: True
Answer Rationale: Teach family members how to perform non-technical care activities. This will help them fulfill the need to be helpful to the dying
person.
Question Title: Question 14
Question: Very close to death, patients may moan or grunt as they breathe. True or False: These sounds usually have to do with pain. Additional
pain medication should be given.
Answer 1: True
Answer 2: False
Correct Answer: False
Answer Rationale: Near the end of life, moaning or grunting sounds usually do not have to do with pain.
Question Title: Question 15
Question: When a patient dies, family members should be given as much time and space as they need to say their final goodbyes.
Answer 1: True
Answer 2: False
Correct Answer: True
Answer Rationale: Immediately after the death of a patient, be sure to give family members enough time and space to reflect on the life of their
loved one, and to say their final goodbyes.