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Exam 1: Chronic & Palliative Care
Terms in this set (52)
What is hospice care?
A type of care that is given to patients at the end of a terminal illness focused on symptom management and not curative treatment as well as addressing their personal, emotional, psychological, and spiritual needs as the end comes near
Eligibility for hospice care
1. Having 6 months or less to live
2. Client chooses hospice and not curative treatment
3. Client enrolls in medicare approve hospice program
Who was the mother of modern hospice care?
Dame Cicely Saunders
What is "personhood"?
Each person is a holistic being with dynamic, interrelated dimensions that are affected by the changes and adaptations experiences with progressive illness and dying
How is care directed in hospice care?
It is patient and family driven by their choices and values about end of life and the care they want to receive
It is directed to meet the physical, psychological, social, and spiritual needs
What is palliative care?
Provides similar services as Hospice to patients with likely incurable chronic conditions but who have more than 6 months to live and who are still receiving curative treatments., provides symptom management as well
The continuum of care
It has shift from a sharp transition from curative care to hospice care to one that is continuous, transition from palliative/curative to hospice as they move closer to death
What is "autonomy"?
A person's right to self-determination, unrestricted by the control of others
What are the 2 greatest fears patients have at the end of life?
1. Being abandoned
2. Being in pain
What are informed decisions?
These are decisions that the patient and family make built on the information given based ethical principle of veracity and openness from healthcare providers
How can nurses provide families and pt with respect?
Accept them "where they are", provide information and truth telling, let them process on their own terms, be supportive
3 broad areas of hospice nursing
1. Care from a client-family base
2. Experience in end-stage dz and symptom control
3. Applying nursing process within an interdisciplinary team
4 levels of Medicare hospice benefit
1. Routine care
2. Continuous care
3. Inpatient care
4. General inpatient care
Costs of hospice care
About $200+/day which includes all services and meds related to diagnosis and any durable equipment
What if a patient can't pay?
They must still offer all services!
What is suffering?
A state of severe distress that threatens intactness of the person
What is chronic disease?
A long lasting illness or condition which often becomes a person's identity
Who is at higher risk of chronic disease?
Those with low SES
Progressive illness course
Continually or generally symptomatic with increasing severity
Chronic illness course
The initial event occurs then biological condition stabilizes
Relapsing illness course
Back and forth between episodic course and exacerbations to stablity
What are some patient feelings about chronic disease?
Uncertainty, incapacitation, fear, powerlessness, control issues around treatment
What is a major issue with treatments for chronic disease?
Iatrogenic consequences can come from these treatments (ex. chemo = hair loss, nausea, fatigue)
External locus of control
Belief that someone or something else controls what happens to you, only external factors influence what happens
Internal locus of control
Belief that you control what happens to you, only internal factors influence what happens
What is helplessness?
Cycle of powerlessness, depression, immobility and inescapable situations which leads to generalized feeling of being helpless
What is "stigma"?
A social process of attaching meaning to behavior and individuals based on certain traits or atributes
What are some pt responses to stigma about their chronic illness?
Disregard, isolation, secondary gains
What the symptom does for the internal state of the patient
Pt gets extra attention due to a learning disability (some people use stigma to their advantage), reward value of having a psychological or physical symptom, such as release from ordinary responsibilities
What constitutes a "good" death?
Relief from suffering, autonomy and dignity, relief from pain, resolved intrapersonal issues, acceptance of death, surrounded by people you love, peaceful env't
What constitutes a "bad" death?
Sudden, hooked up to machines, in pain, bad env't, without loved ones, with anger/without acceptance
Issue with death in the US today?
There is a large disparity in how people die vs. how they WANT to die
What % of people die at home?
What % of people WANT to die at home?
What % of hospitals have EOL care programs?
Prediction or outlook of a disease
How large is the overestimation of prognoses?
Goals during prognosis delivery
Reduce psychological stress to pt and family, facilitate timely EOL planning, focus on improving QOL, find out what the patient wants/needs
What are some barriers to quality care at the EOL?
Failure to acknowledge limits of medicine, inappropriate use of curative treatment, difficulties with prognosis
When is the most money spent during the last year of life?
In the last month
"Exceptional" psychological wellbeing
People who are proactive, assertive, and information seekers, these people often have better outcomes that clients who are more passive in decision making
What influences how a person views their illness and death?
Physical and social attributes, past experience, coping strategies, religion, culture
How is a person's social wellbeing threatened with chronic illness?
Social structure and integrity of family and friends may be threatened, caregivers are overwhelmed, children may act out, visitors may stop visiting, financial concerns, sexual expression is changes, relationships are disrupted
Presence with dying and families is to allow oneself to enter into another's world and to respond with compassion, this can be a nurse's greatest gift to a patient
When faced with overwhelming loss of autonomy and independence and individual retains freedom to choose outlook on life and search for meaning
When the caregiver steps outside their own experience to participate in experience that is greater than them, to become more deeply connected without succumbing to destructive, controlling and self-centered forms of helping
What's the primary difference between malignant and non-malignant disease?
Lies with the acceptance by physicians that other non-malignant diseases may not have a cure
What are the 4 elements of communication?
1. Imparting info
3. Info gathering
4. Presence and sensitivity/cultural competence
Nurse's responsibility in advance care planning
According to the ANA the nurses have responsibility to facilitate informed decision-making including but not limited to advanced directives
DNR/DNI, artificial hydration/nutrition, g-tube placement, tracheotomy placement, health care proxy, etc.
What are emotional responses to terminal illness?
Anxiety, sadness, fear, depression, loneliness, denial/acceptance, distress associated with symptoms, hopelessness, guilt/anger
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