Finally found this

I have been wanting to post something on here that could serve as a sort of reference tool for those of you who have not yet cared for a patient at the end of their life.  It can be difficult to know exactly what to do for the patient and/or the family if you have no idea what to anticipate (as was the case for me when I cared for my first end of life patient and family).  While this site is geared more toward patients being cared for at home, it does provide some useful information for beginning nurses as well.

"Caregiving in the final stages of life

While the symptoms in the final stages of life vary from patient to patient and according to the life-limiting illness, there are some common symptoms experienced near the end of life that caregivers can provide comfort for. It’s important to remember, though, that experiencing any of these symptoms does not necessarily indicate that the patient’s condition is deteriorating or that death is close.

Common Symptoms in End-of-Life Care
Symptom	How to provide comfort
Drowsiness	Plan visits and activities for times when the patient is most alert.
Becoming unresponsive	Many patients are still able to hear after they are no longer able to speak, so talk as if he or she can hear.
Confusion about time, place, identity of loved ones	Speak calmly to help to re-orient the patient. Gently remind the patient of the time, date, and people who are with them.
Loss of appetite, decreased need for food and fluids	Let the patient choose if and when to eat or drink. Ice chips, water, or juice may be refreshing if the patient can swallow. Keep the patient's mouth and lips moist with products such as glycerin swabs and lip balm.
Loss of bladder or bowel control	Keep the patient as clean, dry, and comfortable as possible. Place disposable pads on the bed beneath the patient and remove them when they become soiled.
Skin becoming cool to the touch	Warm the patient with blankets but avoid electric blankets or heating pads, which can cause burns.
Labored, irregular, shallow, or noisy breathing	Breathing may be easier if the patient's body is turned to the side and pillows are placed beneath the head and behind the back. A cool mist humidifier may also help.
Source: National Cancer Institute" Retrieved from http://helpguide.org/elder/alzheimers_disease_dementia_caring_final_stage.htm One thing I always try to do is leave the patient's hands out from under the blankets so families can hold the patient's hands.  I find that families always seem to do that, and it makes me feel better to allow them that access to their loved one, even once the patient has passed away.  Another useful site is http://www.hospicefoundation.org/pages/page.asp?page_id=62884 which also gives signs/symptoms at the end of life that the caregiver (nurse or otherwise) may see.  What are your thoughts after reading and visiting these sites?  If you have cared for a dying patient, have you witnessed any of the signs/symptoms?

Thoughts

Hello learners:  I was thinking today of other content I could include for you that we are not already touching upon in class.  Rather difficult I must say.  However, I found some information that I had used in another class, and thought one of the quotes would be helpful here: “anticipating a loss is an important part of experiencing that loss...for those who will survive the loss of a loved one; it is the beginning of the grieving process.  Such anticipation may help us brace ourselves for what is to come, but we should be aware that the anticipation of an event may be just as powerful as the event itself” (Kubler-Ross & Kessler, 2005, p.4).

What do you think about this quote?  I have found much useful information in the work of Elisabeth Kubler-Ross and would highly recommend any of her books, or information you can access from the web.  Have you found any other 'experts' on death and dying you would like to share?

Kubler-Ross, E. & Kessler, D.  (2005).  On grief and grieving: Finding the meaning of grief through the five stages of loss.  New York: Scribner.   

Suggested viewing

Hello all-  I was trying to find some relevant and informative videos for you which may help you understand more about end of life care.  In looking, I found a YouTube video featuring a pediatric hospice RN, Beth Josolowitz.  Her words about the intimacy of caring for a dying patient can also be applied when the death occurs in the acute care setting.  I like how she describes caring for the patient and family.  See what you think. 

http://www.youtube.com/watch?v=JxdtCXjEp3I&feature=related

I also searched for some words of wisdom from Elisabeth Kubler-Ross, considered to be an expert on death and dying due to her years of work with dying patients.  I found a short video from 1983 which starts out with her narration of her work, then transitions into her speaking with a dying patient in the patient's home.  Again, I want you to keep in mind that these types of authentic interactions can occur in any setting, whether or not it is the patient's home or an acute care facility. 

http://www.youtube.com/watch?v=tIZ97OALEfE&feature=relmfu

Feel free to search around after you view these videos to see what else you can find out there.  As always, remember to share your finds with the rest of the class. 

Let me hear from you

As students, you may or may not have experienced a patient death.  I would like to hear from all of you regardless.  If you have experienced a death, please share with us the experience (as much as you are comfortable sharing); if you have not had the experience, let us know what you imagine it will be like or what fears you may have about dealing with your first patient death.

I have included an article written by a student nurse for all of you to review.  I believe it is very well written and has some great information for other students.  http://nursing.advanceweb.com/Article/Care-of-a-Dying-Patient-The-Nurses-Role.aspx

Webpages of interest to get you started

Here is the address for the AACN (American Association of Critical Care Nurses) page on palliative and end of life care: http://www.aacn.org/WD/Palliative/Content/PalAndEOLInfo.pcms?menu=Practice
This is a great resource with links to other sites as well. 

Also, here is the ENA (Emergency Nurses Association) Position Statement on End of Life Care in the ED: http://www.ena.org/SiteCollectionDocuments/Position%20Statements/EndofLifeCareintheEmergencyDepartment.pdf
as well as the ENA web page for further information: http://www.ena.org/Pages/default.aspx

Let me know what thoughts you have after visiting these resources.

Introductory post

Hello everyone, here is a little more information about me: I have been employed as an ICU and/or ER RN for my entire nursing career.  In that time, I have encountered many end of life situations...which means I have acquired real life experience with this topic.  However; that does not mean that I consider myself an expert by any means because each situation is unique to itself, as is each patient and each family that we encounter as RNs.

I have created this blog in order for us to share our thoughts, experiences, concerns, questions, insights, etc, regarding the provision of end of life care in the hospital setting.  I will be posting here throughout the course so please check back at least weekly for additional information.  I also expect that you will respond at least twice during the course to information presented here.  I want this to be a shared space where we can all benefit from each other's knowledge and experiences, and perhaps gain some valuable insight or suggestions on how we can better handle this unique and very important aspect of providing nursing care.  Please feel free to include any websites or pages you believe may be relevant and helpful for everyone to view.

As always, your suggestions and comments are welcome.