Unit 1: End of Life and Postmortem Nursing Care

End of Life Care

• Integral part of nursing practice, often under-discussed in Western culture.
• Recommendations for improvement:
  • Access to palliative care services.
  • Improved provider communication.
  • Emphasis on advanced care planning (living wills, power of attorney).
  • Education for healthcare professionals on palliative vs. hospice care.
  • Public engagement and education.

Palliative Care

• Not always end-of-life care; focuses on quality of life.
• Aims to prevent suffering, coordinate interdisciplinary care.
• Benefits include improved quality of life and life extension.
• Addresses psychological, social, spiritual issues, pain, and physical symptoms.
• Should be available in various settings:
  • Inpatient care.
  • Skilled nursing facilities (limited access).
  • Outpatient for non-hospice eligible patients.

Hospice Care

• For patients with serious, progressive illnesses not responsive to cure.
• Eligibility:
  • Terminal illness with limited life expectancy (<6 months).
  • Informed choice for palliative over curative care.
  • Acceptance of death.
• Requires certification by physicians for terminal illness.
• Involves interdisciplinary management, pain, and symptom management.
• Patient and family are a unit of care.
• Includes bereavement care for families, research, and education.
• Common diagnoses include cancer, heart disease, lung disease, and dementia.

Challenges in Hospice and Palliative Care

• Difficulties in making terminal prognosis.
• Advances in curative treatments can delay hospice referral.
• Financial pressures may affect provider decisions.
• Extensive resources required for home care.

Compassionate and Comfort Care

• Terms are used interchangeably.
• Education and understanding needed for current practices.
• Hospice includes palliative care; palliative care supports quality of life for chronic conditions without end-of-life implications.

Communication in End of Life Care

• Importance of therapeutic communication:
  • Assess understanding.
  • Restate and summarize communication.
  • Avoid distractions and impulsive advice.
  • Use open-ended questions.
  • Avoid canned responses.

Spiritual Care

• Differentiates between spirituality and religiosity.

• Spiritual Assessment (FICA):

  • Faith or beliefs.
  • Importance/influence.
  • Community.
  • Addressing beliefs.

• Additional Resources: Unit 1 resources include a link to the FICA spiritual assessment tool.