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End of Life Care

Overview

Palliative Care and End-of-Life Care

To say the least, talking about dying with a loved one is difficult. Being the health or social care professional in charge of discussing an end-of-life care plan with a dying or severely sick patient's family members, on the other hand, is a tremendous professional difficulty.

It will be difficult – for everyone involved – but well-planned and executed end-of-life care will be extremely gratifying. Working with someone who is nearing the end of their life necessitates being knowledgeable, skilled, and empathetic. We'll look at the following to assist you grasp what's expected:

  • Palliative care and end-of-life care
  • What end-of-life care looks like?
  • As a professional, be aware of the following principles.
  • What to expect once a patient passes away
Palliative Care

Palliative Care

Palliative care aims to provide the best possible quality of life to those who are dying sooner than expected. It provides social support and attempts to restore a sense and daily functions. Working with someone who is towards the end of their life, on the other hand, is about making them as comfortable as possible while they die.

Palliative care is a type of care that provides support, care and treatment to those who are facing a terminal disease. You may have heard phrases like "life-threatening," "terminal," or "advanced" used in the same context. The following are some examples of life-threatening conditions:

  • Cancer
  • Chronic hepatitis is a type of liver disease
  • Motor neuron disease (MND) is a type of neurodegenerative disease

Palliative care will address not only a person's needs, but also their emotional, social and spiritual needs, with a focus on quality of life. Pain management is one of the first things that comes to mind, but social needs such as washing and dressing, as well as providing support to your patient's family and friends, are equally crucial.

End of Life

End of Life Care

Palliative care includes end-of-life care. Its goal is to make a person as comfortable as possible at the end of their life. Because we never know when someone will die, end-of-life care may be provided for weeks or even months. It's usually given to someone who a doctor believes is in their final year of life.

End-of-life care, whether provided at home or in a facility, focuses on meeting physical and emotional requirements. It is critical to ensure that your patient is handled with decency and respect.

Care Plan

What End-Of-Life Care Looks Like

An End-of-Life Care is a plan that outlines the tasks that will be done by various experts as a patient approaches the end of his or her life. It refers to the efforts that must be performed to ensure that your patient is at ease in both their mind and body.

An End-of-Life Care is designed and implemented in six steps:

1
Start a discussion — You'll need to speak with the patient, their family, and their friends so that everyone is aware of what to expect and who will be making decisions.
2
Assessment, planning & evaluation — Recognize the patient's wishes as well as their medical requirements. Take into account any cultural or religious requirements, as well as whether they prefer at-home care.
3
Care coordination — Each patient will have unique requirements. Plan ahead of time to have the right personnel on hand, such as nurses, care assistants, or doctors, who can fill in as needed.
4
Delivery — Care should be given wherever it is safest and as close to the patient's wishes as possible, with consent always obtained.
5
Final days — Get a sense of what death looks like so you can prepare for it. You can make a person's final days comfortable rather than stressful if you know what to expect.
6
After passing — It is equally crucial to facilitate funeral desires and to support the patient's loved ones in making decisions.
Principles

Principles of End-Of-Life Care

Working on an end-of-life care plan necessitates familiarity with a few key concepts:

Individuality — there is no such thing as a one-size-fits-all approach to caring.
Culture — a patient's cultural, religious, and ethnic needs.
End-of-life care at home should always be a possibility.
Contact must be sensitive and compassionate.
Obtain the patient's consent and if necessary, the consent of the individuals they have appointed.
Professionals, patients and crucial people all require communication routes.
Signs

Signs of Someone Dying

It takes time and practice to recognize a dying individual. Knowing how to recognize end-of-life indicators will help you prepare the patient and their loved ones for what is to come. Here's an overview of the five end-of-life symptoms and what you may do to ease the pain:

Loss of Appetite

Energy requirements decrease as the body closes down. Foods that are difficult to chew or digest, such as meat, may be rejected by your loved one. It's typical for people to refuse meals or only eat a few bites. This can be a difficult period for the family emotionally. Our natural reaction is to suggest that our loved one eat, but this can be counterproductive near the end of life.

Near the very end
When people have trouble swallowing, they will begin to avoid beverages and food.
What you can do to help
  • Modified (softer) foods that are easy to digest are available.
  • Give your loved one extra time to eat and never rush them.
  • Protein smoothies and other high-protein supplements are available.
  • If beverages are being denied, try providing popsicles.
  • To aid in comfort keep your loved one's mouth and lips moist.
  • Be patient and recognize that this is all part of the natural death and dying process, as difficult as it may be.
Physical Weakness

Simple activities such as sitting on the side of the bed, lifting one's arms to change clothes and having a short conversation become difficult when food intake is reduced.

Near the very end
It may take a lot of effort for your loved one to drink from a straw, elevate their head or shift in bed. Movement may slow to the point where you must assist your loved one in making even the smallest of movements.
How you can help
  • Recognize the need for energy conservation. Break up duties into smaller intervals because your loved one will not be able to tolerate personal care for long amounts of time.
  • Tasks should be scheduled in 15-minute increments.
  • Prioritize keeping the person at ease over completing the task.
Poor Breathing

Most people begin to notice changes in their breathing as they get closer to the end of their lives. Air hunger is a term used to indicate shortness of breath — a terrified urge to breathe better. The body is informing the heart and lungs that more oxygen is required, which can cause worry and anxiety.

Near the very end
Excessive secretions (moisture in the mouth and throat) can cause a loud gurgling sound known as the "death rattle" during breathing.
What you can do to help
  • Understand that this is a normal part of the dying process, and your loved one will be unconscious of the changes in breathing at this stage.
  • Consult your hospice nurse about medicinal patches that can help to dry up some secretions.
  • Position your loved one so that it takes less effort to breathe — elevating the head or slightly sitting up with cushions.
  • Using a wet towel, moisturizer or lip balm, keep the lips and mouth moist.
  • Suctioning the secretions is not recommended as it triggers a physiological response that causes the body to create more secretions.
Bladder Incontinence

Dehydration from reduced oral intake lowers blood pressure, resulting in reduced renal function (lower urine production) and finally, renal failure. Urine will darken, becoming brownish, reddish or tea-colored. It may have a strong odor that isn't always caused by infection.

Near the very end
Urine and other waste materials build in the body as a result of kidney disease. As a result, mental acuity suffers even more. Your loved one will eventually enter a calm twilight or comatose state.
What you can do to help
  • New onset incontinence might be embarrassing if your loved one is still aware.
  • It can also be difficult for family members — aiding in the normalization of the situation and providing understanding and comfort is critical to your loved one's care.
Swelling to Feet & Hands

Coolness or water retention in the hands and feet is common near the end of life. As circulation slows, the extremities may become swollen, cool to the touch, or mottled in appearance.

What you can do to help
  • Soak feet in cool water to relieve discomfort.
  • Use leg and calf compression gently where appropriate.
  • Keep the patient comfortable and warm with light blankets.