Chapter 1  Overview

Hospice care emphasizes palliative treatment rather than curative one; the quality of life rather than the quantity of life. So professional medical care is given, and sophisticated symptom relief is provided. The patient and the family are included in the care plan and emotional, spiritual and practical support are given based on the patient’s wishes and the family’s needs.

Origin and Development  

Hospice is derived from the Latin word hospitium, “hospitality”, an inn for travelers, especially one kept by a religious order. The hospice movement was started by Dr. Cicely Saunders in England in the 1940s, when St. Christopher’s Hospice was opened to provide a quiet place where people could die in peace and dignity. It was staffed by nuns who had a sense of commitment to service.

Hospice care was introduced in the United States in 1974 at Yale in New Haven, Connecticut. Since then, the movement has expanded rapidly, with programs based on several organizational models: all-volunteer, hospital-based, integrated with home health agencies or freestanding community hospices. Though diverse, these programs share a philosophy.

Chapter 2  Dying

Stages of Dying

   The process varies from person to person. Some people may be in one stage for such a short time that it seems as if they skipped that stage. Sometimes a person returns to a previous stage.

Denial and isolation  In the denial and isolation stage, the client denies that he or she will die, may repress what is discussed, and may isolate self from reality. The client may think, “They made a mwww.med126.comistake in the diagnosis. Maybe they mixed my records with some one else’s.”

Anger  The client expresses rage and hostility in the anger stage and adopts a “why me?” attitude. “Why me? I quit smoking and I watch what I ate. Why do this happen to me?”

Bargaining  The client tries to barter for more time. “If I can just make it to my son’s graduation I will be satisfied. Just let me live until then.” Many clients put their personal affairs in order, make wills, and fulfill last wishes, such as trips, visiting relatives, and so forth. It is important to meet these wishes, if possible, because bargaining helps clients move into later stages of d医学三基ying.

Depression  In the depression stage, the client goes through a period of grief before death. The grief is characterized by crying and not speaking much. “I wait all these years to see my daughter getting married. And now I may not be here to see her walk down the aisle. I can’t bear the thought of not being there for the wedding and seeing not my grandchildren.”

Acceptance  When the stage of acceptance is reached the client feels tranquil. She or he has accepted death and is prepared to die. The client may think, “I’ve tied up all the loose ends, made the will and made arrangements for my daughter to live with her grandparents. Now I can go in peace knowing everyone will be fine.”

Meeting the Needs of a Dying Client

Physiologic needs 

Physiologic care of the client involves meeting physical needs such as personal hygiene, pain control, nutritional and fluid needs, movement, elimination, and respiratory care. Personal hygiene includes the cleanliness of the skin, hair, mouth, nose, and eyes. Frequent baths and linen changes may be necessary. The mouth and nose should be kept free of mucus, and secretions should be wiped from the eyes. The physician will determine the medication and dosage needed for pain control, but the client's wishes should be considered.  Some clients prefer and are able to control their own medication. Many dying clients suffer from malnutrition and dehydration, so nutritional and fluid needs must be addressed.

Psychological needs 

When people speak of their fears of death, responses typically include fear of the unknown, pain, separation, leaving loved ones, loss of dignity, loss of control, and unfinished business. Kubler Ross believes that there is still another, more overwhelming and more significant fear that often is repressed and unconscious: the catastrophic destructive force has befallen a person and the person cannot change.

Spiritual needs 

Many terminally ill clients find great comfort in the support they receive from their religious faiths. The nurse should aid in obtaining the services of clergy as each situation indicates.

Chapter 3  Death

Clinical Signs of Death

The definition of death proposed by a Harvard University Committee states that the following characteristics must be present for at least 24 hours before death can be declared:

●   Lack of receptivity and responsiveness

●   Lack of movement or breathing

●   Lack of reflexes

●   Flat encephalogram

Death certificate  

Both U.S. and Canadian laws require that a death certificate be prepared for each person who dies. The laws specify what information needs to be supplied. Death certificates are sent to local health departments, which compile many statistics from the information.

Care of the body 

After the client has been pronounced dead, the nurse is responsible for preparing the body for discharge. The body is placed in normal anatomic position to avoid pooling of body, soiled dressings are placed, and tubes are removed. In most cases, it is unnecessary to wash the body; the mortician normally attends to this. Some religions strictly forbid washing of the body, whereas in others, it must be performed by a special person. In cultures in which the family’s washing of the deceased’s body is considered the last service a family can give a loved one, the family should be  given the necessary supplies and left alone in the room with the body. If an autopsy is to be performed, any tubes that were in place should not be removed. In such cases, the nurse should follow the hospital’s policy.

Care of the deceased (Postmortem care) 

Its goals are keeping the body normal appearance, making it easy to be distinguished, comforting the family, and relieving grief. So the nurse should carry out postmortem care carefully and with a serious attitude, esteem the dead, and appease reasonable request of the family.