Showing posts with label Spiritual and Terminal Care. Show all posts
Showing posts with label Spiritual and Terminal Care. Show all posts

UNDERSTANDING ORGAN AND TISSUE DONATION

Posted by Admin in Wednesday, April 21, 2010

A federal regulation was enacted in 1998 requiring facilities to report all deaths to the regional organ procurement organization. The regulation was enacted so that no potential donor is missed and ensures that the family of every potential donor will understand the option to donate. According to the American Medical Association, about 25 kinds of organs and tissues are being transplanted. Although donor organ requirements vary, the typical donor's age must be between a neonate and age 60 years and be free from transmissible disease. Tissue donations are less restrictive, and some tissue banks will accept skin from donors up to age 75.
Collection of most organs, such as the heart, liver, kidney, or pancreas, requires that the patient be pronounced brain dead and kept physically alive until the organs are harvested. Tissue such as eyes, skin, bone, and heart valves may be taken after death. Contact your regional organ procurement organization for specific organ donation criteria or to identify a potential donor. If you don't know the regional organ procurement organization in your area, call the United Network for Organ Sharing at (804) 330-8500.

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FIVE STAGES OF DYING

Posted by Admin

According to Elisabeth Kübler-Ross, author of On Death and Dying, the dying patient may progress through five psychological stages in preparation for death. Although each patient experiences these stages differently, and not necessarily in this order, understanding the stages will help you meet your patient's needs.
Denial
When the patient first learns of his terminal illness, he'll refuse to accept the diagnosis. He may experience physical symptoms similar to a stress reaction — shock, fainting, pallor, sweating, tachycardia, nausea, and GI disorders. During this stage, be honest with the patient but not blunt or callous. Maintain communication with him so he can discuss his feelings when he accepts the reality of death — but don't force him to confront this reality.
Anger
When the patient stops denying his impending death, he may show deep resentment toward those who will live on after he dies — including you, the hospital staff, and his own family. Although you may instinctively draw back from the patient or even resent this behavior, remember that he's dying and has a right to be angry. After you accept his anger, you can help him find different ways to express it and can help his family to understand it.
Bargaining
Although the patient acknowledges his impending death, he attempts to bargain with God or fate for more time. He will probably strike this bargain secretly. If he does confide in you, don't urge him to keep his promises.
Depression
In this stage, the patient may first experience regrets about his past and then grieve about his current condition. He may withdraw from his friends, family, doctor, and from you. He may suffer from anorexia, increased fatigue, or self-neglect. You may find him sitting alone, in tears. Accept the patient's sorrow, and if he talks to you, listen. Provide comfort by touch, as appropriate. Resist the temptation to make optimistic remarks or cheerful small talk.
Acceptance
In this last stage, the patient accepts the inevitability and imminence of his death, without emotion. The patient may simply desire the quiet company of a family member or friend. If, for some reason, a family member or friend can't be present, stay with the patient to satisfy his final need. Remember, however, that many patients die before reaching this stage.

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POSTMORTEM CARE

Posted by Admin

After the patient dies, care includes preparing him for family viewing, arranging transportation to the morgue or funeral home, and determining the disposition of the patient's belongings. In addition, postmortem care entails comforting and supporting the patient's family and friends and providing for their privacy.
Postmortem care usually begins after a physician certifies the patient's death. If the death occurs within 24 hours of admission, or if the patient died violently or under suspicious circumstances (for example, an accident, a suicide, or a homicide), postmortem care may be postponed until the medical examiner completes an autopsy. Be aware that if an autopsy is necessary, it will influence the postmortem care.
Equipment
Gauze or soft string ties • gloves • chin straps • ABD pads • cotton balls • plastic shroud or body wrap • three identification tags • adhesive bandages to cover wounds or punctures • plastic bag for patient's belongings • water-filled basin • soap • towels • washcloths • stretcher.
A commercial morgue pack usually contains gauze or string ties, chin straps, a shroud, and identification tags.
Implementation
  • Document any auxiliary equipment, such as a mechanical ventilator, still present. Put on gloves.
  • Place the body in the supine position, arms at sides and head on a pillow. Then elevate the head of the bed 30 degrees to prevent discoloration from blood settling in the face.
  • If the patient wore dentures and your facility's policy permits, gently insert them; then close the mouth. Close the eyes by gently pressing on the lids with your fingertips. If they don't stay closed, place moist cotton balls on the eyelids for a few minutes, and then try again to close them. Place a folded towel under the chin to keep the jaw closed.
  • Remove all indwelling urinary catheters, tubes, and tape, and apply adhesive bandages to puncture sites. Replace soiled dressings.
  • Collect all the patient's valuables to prevent loss. If you're unable to remove a ring, cover it with gauze, tape it in place, and tie the gauze to the wrist to prevent slippage and subsequent loss.
  • Clean the body thoroughly, using soap, a basin, and washcloths. Place one or more ABD pads between the buttocks to absorb rectal discharge or drainage.
  • Cover the body up to the chin with a clean sheet.
  • Offer comfort and emotional support to the family and intimate friends. Ask if they wish to see the patient. If they do, allow them to do so in privacy. Ask if they would prefer to leave the patient's jewelry on the body.
  • After the family leaves, remove the towel from under the chin of the deceased patient. Pad the chin, and wrap chin straps under the chin and tie them loosely on top of the head. Then pad the wrists and ankles to prevent bruises, and tie them together with gauze or soft string ties.
  • Fill out the three identification tags. Each tag should include the deceased patient's name, room and bed numbers, date and time of death, and physician's name. Tie one tag to the deceased patient's hand or foot, but don't remove his identification bracelet to ensure correct identification.
  • Place the shroud or body wrap on the morgue stretcher and, after obtaining assistance, transfer the body to the stretcher. Wrap the body, and tie the shroud or wrap with the string provided. Then attach another identification tag
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    to the front of the shroud or wrap, and cover the shroud or wrap with a clean sheet. If a shroud or wrap isn't available, dress the deceased patient in a clean gown and cover the body with a sheet.
  • Place the deceased patient's personal belongings, including valuables, in a bag and attach the third identification tag to it.
  • If the patient died of an infectious disease, label the body according to your facility's policy.
  • Close the doors of adjoining rooms if possible. Then take the body to the morgue. Use corridors that aren't crowded and, if possible, use a service elevator.

Special considerations
  • If the patient is a trauma victim, the victim of a violent crime (such as a gunshot wound or stabbing), or has been in the hospital less than 24 hours, don't remove tubing or wash the patient until it's confirmed that an autopsy won't be done. If an autopsy is to be performed, keep all I.V. and other patient tubes intact and document as such.
  • Give the deceased patient's personal belongings to his family or bring them to the morgue. If you give the family jewelry or money, make sure a coworker is present as a witness. Obtain the signature of an adult family member to verify receipt of valuables or to state their preference that jewelry remain on the patient.
  • Offer emotional support to the deceased patient's family and friends and to the patient's facility roommate, if appropriate.
Documentation
Although the extent of documentation varies among facilities, always record the disposition of the patient's possessions, especially jewelry and money. Also note the date and time the patient was transported to the morgue.

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CARE OF THE DYING PATIENT

Posted by Admin

A patient needs intensive physical and emotional support as he approaches death. Signs and symptoms of impending death include reduced respiratory rate and depth, decreased or absent blood pressure, weak or erratic pulse rate, lowered skin temperature, decreased level of consciousness (LOC), diminished sensorium and neuromuscular control, diaphoresis, pallor, cyanosis, and mottling.
Emotional support for the dying patient and his family usually means reassurance and the nurse's physical presence to help ease fear and loneliness. More intense emotional support is important at much earlier stages, especially for patients with long-term progressive illnesses, who can work through the stages of dying. (See Five stages of dying, page 112.)
Respect the patient's wishes about extraordinary means of supporting life. The patient may have signed a living will. This document, legally binding in most states, declares the patient's desire for a death unimpeded by the artificial support of defibrillators, respirators, life-sustaining drugs, auxiliary hearts, and other artificial means. If the patient has signed such a document, the nurse must respect his wishes and communicate the physician's “no code” order to all staff members.
Equipment
Clean bed linens • clean gowns • gloves • water-filled basin • soap • washcloth • towels • lotion • linen-saver pads • lemon-glycerin swabs • petroleum jelly • suction and resuscitation equipment, as necessary • optional: indwelling urinary catheter.
Implementation
  • Assemble equipment at the patient's bedside as needed.
Meeting physical needs
  • Take vital signs often, and observe for pallor, diaphoresis, and decreased LOC.
  • Reposition the patient in bed at least every 2 hours because sensation, reflexes, and mobility diminish first in the legs and gradually in the arms. Make sure the bed sheets cover him loosely to reduce discomfort caused by pressure on arms and legs.
  • When the patient's vision and hearing start to fail, turn his head toward the light and speak to him from near the head of the bed. Because hearing may be acute despite loss of consciousness, avoid whispering or speaking inappropriately about the patient in his presence.
  • Change the bed linens and the patient's gown as needed. Provide skin care during gown changes, and adjust the room temperature for patient comfort if necessary.
  • Observe for incontinence or anuria, the result of diminished neuromuscular control or decreased renal function. If necessary, obtain an order to catheterize the patient, or place linen-saver pads beneath the patient's buttocks. Put on gloves and provide perineal care with soap, a washcloth, and towels to prevent irritation.
  • With suction equipment, suction the patient's mouth and upper airway to remove secretions. Elevate the head of the bed to decrease respiratory resistance. As the patient's condition deteriorates, he may breathe mostly through his mouth.
  • Offer fluids frequently, and lubricate the patient's lips and mouth with petroleum jelly or lemon-glycerin swabs to counteract dryness.
  • If the comatose patient's eyes are open, provide eye care to prevent corneal ulceration. Such ulceration can cause blindness and prevent the use of these tissues for transplantation should the patient die.
  • Provide ordered pain medication as needed. Keep in mind that, as circulation diminishes, medications given I.M. will be poorly absorbed. Medications should be given I.V., if possible, for optimum results. Some medications can be given
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    sublingually or rectally if the patient can't swallow or has no I.V. access.

Meeting emotional needs
    • Fully explain all care and treatments to the patient even if he's unconscious because he may still be able to hear. Answer any questions as candidly as possible without sounding callous.
    • Allow the patient to express his feelings, which may range from anger to loneliness. Take time to talk with the patient. Sit near the head of the bed, and avoid looking rushed or unconcerned.
    • Notify family members, if they're absent, when the patient wishes to see them. Let the patient and his family discuss death at their own pace.
    • Offer to contact a member of the clergy or social services department, if appropriate.
    Special considerations
    • If the patient has signed a living will, the physician will write a “do-not-resuscitate (DNR)” order on his progress notes and order sheets. Know your state's policy regarding the living will. If it's legal, transfer the DNR order to the patient's chart or Kardex and, at the end of your shift, inform the incoming staff of this order.
    • If family members remain with the patient, show them the location of bathrooms, lounges, and cafeterias. Explain the patient's needs, treatments, and care plan to them. If appropriate, offer to teach them specific skills so they can take part in nursing care. Emphasize that their efforts are important and effective. As the patient's death approaches, give them emotional support.
    • At an appropriate time, ask the family whether they have considered organ and tissue donation. Check the patient's records to determine whether he completed an organ donor card. (See Understanding organ and tissue donation.)
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    Documentation
    Record changes in the patient's vital signs, intake and output, and LOC. Note the times of cardiac arrest and the end of respiration, and notify the physician when these occur.

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BELIEFS AND PRACTICES OF SELECTED RELIGIONS

Posted by Admin

A patient's religious beliefs can affect his attitudes toward illness and traditional medicine. By trying to accommodate the patient's religious beliefs and practices in your care plan, you can increase his willingness to learn and comply with treatment regimens. Because religious beliefs may vary within particular sects, individual practices may differ from those described here.
RELIGION BIRTH AND DEATH RITUALS DIETARY RESTRICTIONS PRACTICES IN HEALTH CRISIS
Adventist None (baptism of adults only) Alcohol, coffee, tea, narcotics, stimulants; in many groups, meat is also prohibited Communion and baptism performed. Some members believe in divine healing, anointing with oil, and prayer. Some regard Saturday as the Sabbath.
Baptist At birth, none (baptism of believers only); before death, counseling by clergy member and prayer Alcohol; in some groups, coffee and tea is also prohibited Some believe in healing by laying on of hands. Resistance to medical therapy occasionally approved.
Christian Scientist At birth, none; before death, counseling by a Christian Science practitioner Alcohol, coffee, and tobacco prohibited Many members refuse all treatment, including drugs, biopsies, physical examination, and blood transfusions, and permit vaccination only when required by law. Alteration of thoughts is believed to cure illness. Hypnotism and psychotherapy are prohibited. (Christian Scientist nurses and nursing homes honor these beliefs.)
Church of Christ None (baptism at age 8 or older) Alcohol discouraged Communion, anointing with oil, laying on of hands, and counseling by a minister.
Eastern Orthodox At birth, baptism and confirmation; before death, last rites (For members of the Russian Orthodox Church, the arms are crossed after death, the fingers are set in a cross, and the unembalmed body is clothed in natural fiber.) For members of the Russian Orthodox Church and usually the Greek Orthodox Church, no meat or dairy products on Wednesday, Friday, and during Lent Anointing of the sick. For members of the Russian Orthodox Church, cross necklace is replaced immediately after surgery and shaving of male patients is prohibited, except in preparation for surgery. For members of the Greek Orthodox Church, communion and Sacrament of Holy Unction.
Episcopal At birth, baptism; before death, occasional last rites For some members, abstention from meat on Friday, fasting before communion (which may be daily) Communion, prayer, and counseling performed by a minister.
Jehovah's Witnesses None Abstention from foods to which blood has been added Typically, no blood transfusions are permitted; a court order may be required for an emergency transfusion.
Judaism Ritual circumcision on eighth day after birth; burial of dead fetus; ritual washing of dead; burial (including organs and other body tissues) occurs as soon as possible; no autopsy or embalming For Orthodox and Conservative Jews, kosher dietary laws (for example, pork and shellfish are prohibited); for Reform Jews, usually no restrictions Donation or transplantation of organs requires rabbinical consultation. For Orthodox and Conservative Jews, medical procedures may be prohibited on the Sabbath—from sundown Friday to sundown Saturday—and special holidays.
Lutheran Baptism usually performed 6 to 8 weeks after birth None Communion, prayer, and counseling performed by a minister.
Mormon At birth, none (baptism at age 8 or older); before death, baptism, and gospel preaching Alcohol, tobacco, tea, and coffee are prohibited; meat intake is limited Belief in divine healing through the laying on of hands; communion on Sunday; some members may refuse medical treatment. Many wear a special undergarment.
Moslem If spontaneous abortion occurs before 130 days, the fetus is treated as discarded tissue; after 130 days, it's treated as a human being. (Before death, confession of sins with family present; after death, only relatives or friends may touch the body.) Pork is prohibited; daylight fasting during 9th month of Islamic calendar Faith healing for the patient's morale only; conservative members reject medical therapy.
Orthodox Presbyterian Infant baptism; scripture reading and prayer before death None Communion, prayer, and counseling performed by a minister.
Pentecostal Assembly of God, Foursquare Church None (baptism only after age of accountability) Abstention from alcohol, tobacco, meat slaughtered by strangling, any food to which blood has been added and, sometimes, pork Belief in divine healing through prayer, anointing with oil, and laying on of hands.
Roman Catholic Infant baptism, including baptism of an aborted fetus without signs of clinical death (tissue necrosis); before death, anointing of the sick Fasting or abstention from meat on Ash Wednesday and on Fridays during Lent; this practice is usually waived for the hospitalized Burial of major amputated limb (sometimes) in consecrated ground; donation or transplantation of organs allowed if the benefit to recipient outweighs potential harm to donor. Sacraments of the Sick also performed when patients are ill, not just before death. Sometimes performed shortly after admission.
United Methodist None (baptism of children and adults only) None Communion before surgery or similar crisis; donation of body parts encouraged.

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SPIRITUAL CARE

Posted by Admin

Religious beliefs can profoundly influence a patient's recovery rate, attitude toward treatment, and overall response to hospitalization. In certain religious groups, beliefs can preclude diagnostic tests and therapeutic treatments, require dietary restrictions, and prohibit organ donation and artificial prolongation of life. (See Beliefs and practices of selected religions, pages 108 to 110.)
Consequently, effective patient care requires recognition of and respect for the patient's religious beliefs. Recognizing his beliefs and need for spiritual care may require close attention to his nonverbal cues or to seemingly casual remarks that express his spiritual concerns. Respecting his beliefs may require setting aside your own beliefs to help the patient follow his. Providing spiritual care may require contacting an appropriate member of the clergy in the facility or community, gathering any equipment that may be necessary to help the patient perform rites and administer sacraments, and preparing him for a pastoral visit.
Equipment
Clean towels (one or two) • teaspoon or 1-oz (30-ml) medicine cup (for baptism) • container of water (for emergency baptism).
Some facilities, particularly those with a religious affiliation, provide baptismal trays. The clergy member may bring holy water, holy oil, or other religious articles to minister to the patient.
Preparation of equipment
For baptism, cover a small table with a clean towel. Fold a second towel and place it on the table, along with the teaspoon or medicine cup. For communion and anointing, cover the bedside stand with a clean towel.
Implementation
  • Check the patient's admission record to determine his religious affiliation. Remember that even patients who claim to have no religious beliefs may desire spiritual or pastoral care. So watch and listen carefully for subtle expressions of this desire.
  • Evaluate the patient's behavior for signs of loneliness, anxiety, or fear—emotions that may signal his need for spiritual counsel. Also consider whether the patient is facing a health crisis, which may occur with chronic illness and before childbirth, surgery, or impending death. Remember that a patient may feel acutely distressed because of his inability to participate in religious observances. Help such a patient verbalize his beliefs to relieve stress. Listen to him and let him express his concerns, but carefully refrain from imposing your beliefs on him to avoid conflict and further stress. If the patient requests, arrange a visit by an appropriate member of the clergy. Consult this clergy member if you need more information about the patient's beliefs.
  • If the patient faces the possibility of abortion, amputation, transfusion, or other medical procedures with important religious implications, try to discover his or her spiritual attitude. Also try to determine the patient's attitude toward the importance of laying on of hands, confession, communion, observance of holy days (such as the Sabbath), and restrictions in diet or physical appearance. Helping the patient continue his normal religious practices during hospitalization can help reduce stress.
  • If the patient is pregnant, find out her beliefs concerning infant baptism and circumcision, and comply with them after delivery.
  • If a neonate is in critical condition, call an appropriate clergy member immediately. To perform an emergency baptism, the minister or priest pours a small amount of holy water into a teaspoon or a medicine cup and sprinkles a few drops of water over the infant's head while saying, “(Name of child), I baptize you in the name of the Father, the Son, and the Holy Spirit. Amen.” In an extreme emergency, you can perform a Roman Catholic baptism, using a container of any available water. If you do so, be sure to notify the priest because this sacrament must be administered only once.
  • If a Jewish woman delivers a male infant prematurely or by cesarean birth, ask her whether she plans to observe the rite of circumcision, or bris, a significant ceremony performed on the eighth day after birth. (Because a patient who delivers a healthy, full-term baby vaginally is usually discharged quickly, this ceremony is normally performed outside the facility.) For a bris, ensure privacy and, if requested, sterilize the instruments. (For more information, see “Circumcision,” page 775.)
  • If the patient requests communion, prepare him for it before the clergy member arrives. First, place him in Fowler's or semi-Fowler's position if his condition permits. Otherwise, allow him to remain supine. Tuck a clean towel under his chin, and straighten the bed linens.
  • If a terminally ill patient requests the Sacrament of the Sick (Last Rites) or special treatment of his body after death,
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    call an appropriate clergy member. For the Roman Catholic patient, call a Roman Catholic priest to administer the sacrament, even if the patient is unresponsive or comatose. To prepare the patient for this sacrament, uncover his arms and fold back the top linens to expose his feet. After the clergy member anoints the patient's forehead, eyes, nose, mouth, hands, and feet, straighten and retuck the bed linens.
Special considerations
  • Handle the patient's religious articles carefully to avoid damage or loss. Become familiar with religious resources in your facility. Some facilities employ one or more clergy members who counsel patients and staff and link patients to other pastoral resources.
  • If the patient tries to convert you to his personal beliefs, tell him that you respect his beliefs but are content with your own. Likewise, avoid attempts to convert the patient to your personal beliefs.
Documentation
Complete a baptismal form and attach it to the patient's record; send a copy of the form to the appropriate clergy member. Record the rites of circumcision and last rites in your notes. Also, record last rites in red on the Kardex so it won't be repeated unnecessarily.

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