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Goals of Care

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Presentation on End of Life Care

Presentation on End of Life Care

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  • Ask question: Have you ever been caught in the middle of family members disagreement /or what you want for a patient might not be what they want?
  • Ask the audience
  • Ask for examples of Caregivers that were not clear of what the patient/resident wanted.
  • Ask about examples of statements they have heard and were not ever made to the family or MD or the nurses.
  • CURE THE DISEASE, CONTROL IT, OR PROVIDE COMFORT TO MANAGE SYMPTOMS
  • GLORIA KOCH, FAMILY DECIDED TO JUST GO FOR COMFORT MEASURES , WE HAVE THAT RIGHT .DR. HAD OTHER PLANS
  • Treatments may be making life at this point a living hell
  • Funeral and financial arrangements while a person is still able
  • Mr Finch Dialysis, Heather blood transfusion liver cancer tapped for comfort because of fluid retention
  • SE
  • Cremation wishes vereses what family wants

Goals of Care Goals of Care Presentation Transcript

  • Beaches, Steel MagnoliaTerms of Endearment
    GOALS OF CARE AND ETHICAL ISSUES AT END OF LIFE
    Your role as a nursing assistant
  • INTRODUCTIONS
    Tell me a little about you
    • OBJECTIVES
  • Goals of Care
    Describe Why it is important to communicate family goals and wishes.
    Describe many of the decisions at end of life
    Explore how decisions are made at end of life
    The definition of a Advance Directive
    Describe the different types of AD
  • GOALS OF CARE
    Why do we believe it is so important to document the goals of care?
  • TAKING CONTROL
    MAKING SURE WHAT YOU WANT IS PUT IN PLACE( MEDS,TREATMENTS)
    We don’t want to use treatments the patient /resident does not want , this puts a burden on families.
    Making sure that we provide the type of care that matches the patient and families goals and values.
    Indivuals have the right to choose the healthcare that they want or don’t want
    They also can appoint a family member or another person to make decisions for them if they are unable.
  • PAIN CONTROL
  • NURSING ASSISTANTS ROLES
    Your major role when families and patients are at the decision making table you listen.
    Your responsibility is to communicate the goals and wishes to the other team members.
    Encouraging families and patients to talk about their goals, values and choices with the other team members.
  • GOALS OF MEDICAL THERAPIES
    Cure
    Control
    Comfort/Palliative
  • VALUES AND BELIEFS
    Who should speak for me
    What makes my life worth living
    What are personal beliefs that influence decisions
    The hope for recovery.
  • DECISIONS AT THE END OF LIFE
    Do I want to keep receiving treatments to cure my disease?
    Do I want to have the healthcare team focus on my quality of life , and to keeping me comfortable.
  • DECISIONS AT THE END OF LIFE
    If my condition gets worse or I develop a medial problem:
    Do I want to go to a hospital or be cures for at home or nursing center
  • DECISIONS AT THE END OF LIFE
    If I can no longer make decisions for myself, who should make them for me?
  • DECISION MAKING
  • DECISIONS AT THE END OF LIFE
    What decisions do I need to make to get my affairs in order?
  • DECISIONS AT THE END OF LIFE
    If I needed machines and other medical treatments to stay alive
    Would I want to receive these treatments
    OR
    Do I want nature to take it’s course
  • DISCONTINUING LIFE SUPPORT
  • TREATMENT OPTIONS
    Older adults and their family decision makers need to know the risks and possible benefits of therapy.
    CPR/MECHANICAL VENTILATION
    KIDNEY DIAYLIS
    DIAGNOSTIC TEST
    HOSPITALIZTION
    ANTIBIOTICS
    BLOOD TRANFUSIONS
  • CONT TREATMENT OPTIONS
    TUBE FEEDINGS /INTRAVENOUS FLUIDS
    SYMPTOM MANAGEMENT
  • ADVANCE DIRECTIVE
    This is written instructions to a health care provider before medical treatment.
    This ensures your wishes are followed in case a future accident or illness makes it impossible for you to communicate your wishes.
    With an ADVANCE DIRECTIVE , you can refuse or consent to future treatment.
  • SEVERAL TYPES OF ADVANCE DIRECTIVES
    Living Will
    Durable Power Of Attorney
    No Code/DNR
    Do not Hospitalize/DNH
    Organ Donation
  • PURPOSE OF ADVANCE DIRECTIVES
    TO make sure a person have the right to choose what happens even if they are unable to speak.
    THIS also gives power to the health care team honor ones wishes.
    IS a guide to families and caregivers providing care.
    Decreases family or any kind of conflict.
  • CAN PATIENT OR FAMILY DECISION MAKERS CHANGE THEIR MINDS
    YES THEY CAN!!!!!!!!!!!!!!!!!!!!!!!!
    REMEMBER TO WRITE EVERYTHING DOWN
  • DECISION MAKING IS A PROCESS
    Continue to listen and talking to your families
    People do change their minds
    Listen carefully
    Report important conversations concerning choices and values about healthcare
  • Patients/Residents Who Can Make Decisions
    Understand the information given
    Think clearly about treatment options
    Can tell others what they want
  • Those Who Might Not Be Able to Make Decisions Include Those:
    Advanced Dementia
    Who have strokes that decrease their ability to understand or speak
    Who are in a coma
    Who have a serious illness
  • Patients/Residents Can Make Decisions Even If:
    They may act strange or odd
    They do not speak your language
    They are not well educated
    They are physically handicapped
    They are deaf
    They disagree with their family and or their healthcare team
  • PATIENT /RESIDENT WHO MAKES DECISIONS IS FULL INFORMED
    Not everyone wants to be fully informed about their disease and prognoses
    Many older adults are treated like they can’t make decisions, and they can
    In some cultures older adults are suppose to make decisions
    People can choose not to hear the information , but the physician needs to make sure the person chooses not to know
  • REMEMBER
    The patient should not feel forced or pressured to make decisions.
    Some cultures may be much less familiar with an advance directive, some cultures may withhold some information even if the patient does understand.
    Decisions to refuse life prolonging or curative therapies may frighten families.
    Aggressive comfort measures our available at end of life
  • REMEMBER CON’T
    When patients/ residents decide to cease all life prolonging therapies , it does not mean we care less.
    Comfort care is not giving up, were changing our focus of care.
  • SAYING GOODBYE
  • MY HISTORY
    NAME
    WHERE I LIVE
    OCCUPATION
    PLACE OF EMPLOYMENT/EDUCATION
    FAMLY
    DREAMS
    THANKS FOR COMING