Goals of Care

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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

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

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