This document discusses communication skills and ethics in clinical practice, with a focus on end-of-life care. It outlines the need for effective communication skills when interacting with patients, families, and colleagues. Key principles of medical ethics around autonomy, informed consent, privacy, and justice are also covered. The document then examines approaches to communicating with patients and obtaining consent. It provides examples of communicating in difficult situations and applying ethical considerations. Finally, it discusses end-of-life care, including identifying patients nearing end of life, components of end-of-life care, common problems, and ensuring quality care through the dying process.
Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders. Relationship between patients and doctors are often unstated, and thy are dynamic
As conditions change, the kind of relationship that works best for a patient may change. Doctors and patients should choose a “relationship fit” . Effectiveness of the patient-physician relationship directly relates to health outcomes.
AETCOM module: Bioethics for Undergraduate Medical Studentslavanyasumanthraj
The Attitude, Ethics & Communication module introduced by the National Medical Commission is being followed in Medical Colleges. Here's a simple understanding of aspects on Bioethics & solution to Phase 2 MBBS modules
Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders. Relationship between patients and doctors are often unstated, and thy are dynamic
As conditions change, the kind of relationship that works best for a patient may change. Doctors and patients should choose a “relationship fit” . Effectiveness of the patient-physician relationship directly relates to health outcomes.
AETCOM module: Bioethics for Undergraduate Medical Studentslavanyasumanthraj
The Attitude, Ethics & Communication module introduced by the National Medical Commission is being followed in Medical Colleges. Here's a simple understanding of aspects on Bioethics & solution to Phase 2 MBBS modules
The undergraduate medical education program is designed with a goal to create an
“Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes,
values and responsiveness, so that he or she may function appropriately and
effectively as a doctor of first contact of the community while being globally relevant.
AETCOM module is a manifestation of this realization that endeavors to strike a balance between the five identified roles of an ‘Indian Medical Graduate (IMG)’ viz; Clinician, Leader & Member of health care team, Communicator, Life- long learner and Professional; right from the 1st professional year of training.
Medical Ethics is what every physician and healthcare worker should know. We need to understand Ethics and its application in various cultures, societies and its changes according to norms and values. Once society will be given health education regarding Medical Ethics many issues can be resolved in a decent manner. It ultimately gives a very positive impression of all the actions which a healthcare worker performs otherwise at times seems inappropriate by society. This is not for the sake of healthcare worker or for the patients it is primarily for the whole community.
What are the rights of patient? role of ethical committee and parameters of a physician all need to be addressed properly.
The lecture is about the ethical guidelines in the doctor-patient relationship. this is the lecture for the beginners that is for first-year medical students.
Bioethics- Case study on Autonomy and Decision making in medicineavi sehgal
Bioethics- A case study on Autonomy and Decision making in medicine. Forensic Medicine PowerPoint for medical (MBBS/MD) students trying to understand AETCOM.
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
The presentation explains the principles of medical ethics and describes important terms on the subject. Brief descriptions of codes of medical ethics are covered but for details actual documents may be referred.
Now-a-days public are expecting Skills, Knowledge as well as Ethical behaviour from Doctors. This PPT gives the 2 basic principles of Bio-ethics in brief & apt form
Medical ethics is the discipline that deals with what we believe to be good or bad, right or wrong about the ends of Medicine and the means used to achieve those ends.
It is not about what we can do in a given set of circumstances. It is about what we should do in those circumstances.
Learning Objectives of this Presentation:
1. Appreciate the ethos of contemporary clinical ethics
2. Understand the function and responsibilities of ethics committees
3. Appreciate the clinical context of the core principles of medical ethics
4. Understand the relationship of ethics, science, law, politics, and professionalism
5. Examine different theories of ethics
Presentation by: Richard L. Wasserman, M.D., Ph.D.
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
2009
AETCOM (Attitude, Ethics and Communication module)Karun Kumar
Hello friends. In this PPT I am talking about AETCOM (Attitude, Ethics and Communication module) of Pharmacology. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way
The undergraduate medical education program is designed with a goal to create an
“Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes,
values and responsiveness, so that he or she may function appropriately and
effectively as a doctor of first contact of the community while being globally relevant.
AETCOM module is a manifestation of this realization that endeavors to strike a balance between the five identified roles of an ‘Indian Medical Graduate (IMG)’ viz; Clinician, Leader & Member of health care team, Communicator, Life- long learner and Professional; right from the 1st professional year of training.
Medical Ethics is what every physician and healthcare worker should know. We need to understand Ethics and its application in various cultures, societies and its changes according to norms and values. Once society will be given health education regarding Medical Ethics many issues can be resolved in a decent manner. It ultimately gives a very positive impression of all the actions which a healthcare worker performs otherwise at times seems inappropriate by society. This is not for the sake of healthcare worker or for the patients it is primarily for the whole community.
What are the rights of patient? role of ethical committee and parameters of a physician all need to be addressed properly.
The lecture is about the ethical guidelines in the doctor-patient relationship. this is the lecture for the beginners that is for first-year medical students.
Bioethics- Case study on Autonomy and Decision making in medicineavi sehgal
Bioethics- A case study on Autonomy and Decision making in medicine. Forensic Medicine PowerPoint for medical (MBBS/MD) students trying to understand AETCOM.
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
The presentation explains the principles of medical ethics and describes important terms on the subject. Brief descriptions of codes of medical ethics are covered but for details actual documents may be referred.
Now-a-days public are expecting Skills, Knowledge as well as Ethical behaviour from Doctors. This PPT gives the 2 basic principles of Bio-ethics in brief & apt form
Medical ethics is the discipline that deals with what we believe to be good or bad, right or wrong about the ends of Medicine and the means used to achieve those ends.
It is not about what we can do in a given set of circumstances. It is about what we should do in those circumstances.
Learning Objectives of this Presentation:
1. Appreciate the ethos of contemporary clinical ethics
2. Understand the function and responsibilities of ethics committees
3. Appreciate the clinical context of the core principles of medical ethics
4. Understand the relationship of ethics, science, law, politics, and professionalism
5. Examine different theories of ethics
Presentation by: Richard L. Wasserman, M.D., Ph.D.
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
2009
AETCOM (Attitude, Ethics and Communication module)Karun Kumar
Hello friends. In this PPT I am talking about AETCOM (Attitude, Ethics and Communication module) of Pharmacology. If you like it, please do let me know in the comments section. A single word of appreciation from you will encourage me to make more of such videos. Thanks. Enjoy and welcome to the beautiful world of pharmacology where pharmacology comes to life. This video is intended for MBBS, BDS, paramedical and any person who wishes to have a basic understanding of the subject in the simplest way
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
medication Adherence defined as the act of filling a new prescription for the first time.
The extent to which the patients take medications as prescribed by the prescriber.
Basic principles, interview style, various components and their significance, how to take history of present illness, past history,family and personal history, substance history, premorbid personality
Similar to Communication Skills and Ethics-1.pdf (20)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Outline
• The need for the skills
• What to look for or do
• Clinical scenarios/application
• End of life care
- aging population
- growing role of geriatric medicine
3. Communication
• Develop listening,
questioning, explanatory,
teaching skills
• Employ expressed, non-
verbal and implicit
information
Combines
-Effective exchange of
information
-Teaming
With:
Patients, their relations,
professional and work
colleagues and
associates
4. Ethics
Anchored on:
Autonomy
Voluntary participation and withdrawal
Full understanding
Informed consent
Privacy & confidentiality
Respect for the community
Consent form
Beneficence
Benefit individual & society
Monitoring – good changes
Non-maleficence
No harm
Monitoring – bad changes
Justice
Equal burden & benefits
Protection of weak and vulnerable
Correct conduct
of and values of
relationships
Practitioner and
• Patient
• Patient’s relations
• Other members of health
team
• Authorities
• Public
• The Law
5. Curriculum requirements
• Be able to demonstrate punctuality,
responsiveness, maintenance of good relations
and establishment of efficient communication
with other members of the health team; be able
to maintain good relations and communicate
effectively with patients, patients’ relations and
the community; demonstrate professionalism,
observance of medical ethics and confidentiality;
be able to determine the need for coroner’s
attention; be able to recognise limitations and
the need for appropriate referral.
6. Approach
• Introduce self adequately
• Establish the purpose of the meeting
• Obtain agreement to continue
• Reassure patient/subject
• Explore patient’s/subject’s concerns, fears and
expectations
• Show understanding and empathy
• Use verbal and non-verbal skills
7. Approach (cont)
• Appropriate questioning; probe and take leads
and hints
• Use clear language and provide clear
expectations
• Confirm patient’s/subject’s understanding
• Agree a course of action
• End the meeting appropriately
• Show knowledge of the use of ethics and the
law
• Show overall common sense
9. Explaining
• Explain 24 hr urine collection
• Teach instrument use e.g. glucometer, inhaler
• Explain lifestyle changes
• Explain the need for admission
10. Obtaining consent
• For procedure e.g liver biopsy, LP
• HIV testing
• Therapeutic procedure e.g HD cannulation, CV
line insertion
• Cancer chemotherapy, radiotherapy
• Indeed for virtually any procedure.
11. Communication with third parties
• Explaining to a spouse/relation
• Report to senior colleague/higher authority
• Obtaining information from a witness
• Explaining through an interpreter
12. Difficult/Sensitive situations
• Attending to a complaining patient
• Break bad news
• Broaching a sensitive topic e.g ED, STD
• Dealing with a talkative patient
• Dealing with a difficult (e.g rude) patient
• Do not resuscitate order
13. Ethics and legality
• Often embedded in/combined with other matters
• Respect for patient/person – autonomy
• Maintain confidentiality
• Provide information fully
• No coercion/force
• Show beneficence
• Show non-maleficence conduct
• Safety of health personnel & the public
• Recognise institutional responsibility
• Show justice
• Relevant knowledge of the law
• Requirements of the medical council
14. Attitude
• Often embedded in/combined with other matters
• Key issues to be observed
-Confidentiality
-Autonomy
-Legal obligation
-Respect for life
-Duty to society
15. Examples of attitude testing
• Hepatitis-B/HIV/Ebola virus infection and
procedures
• Potentially criminal behaviour
• Return to work after seizures
• Refusing admission/treatment
• Terminal care
18. Identification of end of life
Recognised in the following settings
• Patient likely to die in next 12 months
• Presence of advanced incurable disease
• Presence of life threatening acute condition
• Sudden deterioration in existing condition
22. Location
May sometimes be determined by patient
• In hospital
• At home
• In care homes
• In a hospice
-always palliative, life expectancy <6 months
23. Initial discussions
• Begin early
• Assess patient’s understanding of illness
• Discuss patient’s expectations
• Future investigations and treatment
• Assess patient’s relationship with family
members – identify who should participate in
decision making
• Assess patient’s limits of acceptance
24. Initial discussions (cont)
• Respect dignity, encourage settling of issues,
wills
• Inquire about patient’s concerns
• Clarify all again and agree on important steps
• May need to give more time and revisit
• Use clear language, avoid jargon
25. Physician’s actions
• Discuss and explain
• Obtain the services of interdisciplinary team
• Nursing interventions
• Satisfy spiritual/religious needs
• Use prophylactic analgesia
• Discontinue procedures/treatment producing
negligible effects
• Avoid heroic measures
• Referral to palliative care physician
26. Common problems in end of life care
• Pain
• Cough
• Oro-pharyngeal secretions
• Dyspnoea
• Dry mouth
• Constipation
• Nausea and vomiting
28. Signs of impending death
• Mottling of skin
• Clammy skin
• Deep set eyes
• Accumulating secretions in throat - Death rattle
• Persistently low BP
• Cheyne-Stokes breathing
• Prolonged coma
29. Barriers to Quality End-of-Life Care
• Failure of healthcare providers to
acknowledge the limits of medical
technology
• Lack of communication among decision
makers
• Disagreement regarding the goals of care
• Failure to implement a timely advance
care plan
30. Barriers to Quality End-of-Life Care (cont)
• Lack of training about effective means of
controlling pain and symptoms
• Unwillingness to be honest about a poor
prognosis
• Discomfort telling bad news
• Lack of understanding about the valuable
contributions to be made by referral and
collaboration with comprehensive
hospice or palliative care services
31. Causes of Inadequate Care at End of
Life
• Disparity in access to treatment
• Insensitivity to cultural differences
– Attitudes about death
– Attitudes about end-of-life care
– African-Americans prefer aggressive life-
sustaining treatments
– Mexican-Americans, Korean-Americans, and
Euro-Americans prefer less aggressive
treatment
– Nigerians generally would want to prolong
life
32. Causes of Inadequate Care at End of
Life
• Mistrust of the healthcare system
• Pain is subjective and self-report is
considered accurate
33. Do-not-resuscitate order
In consultation with patient, relations, other
personnel.
Indications
• No likelihood of successful resuscitation
• Extremely poor quality of life
Expectations/results
• Saving resources
• Relief of tension on patients relations and staff
• Opening of discussions on end of life
34. Death issues
• Signs of death
• Certification
• Breaking the (bad)news
• Autopsy?
• Death Certificate
35. Death certificate
• Name
• Age at death
• Date, time of death
• Place of death
• Cause of death
-immediate disease (not mode) leading to death
-disease leading to immediate disease…
-disease leading to disease leading to…
-comorbities contributing to death
• Whether seen/not seen after death
• Coroner not needed
36. References
• Dornan T and O’Neill P. Core Clinical Skills for
OSCEs in Medicine. Edinburgh:Churchill
Livingstone. 2008
