Enjoy a safe and Happy St. Patrick's Day.
Saturday, March 17, 2012
Sunday, February 19, 2012
Important Terms Affecting End-of-Life Decisions
When a diagnosis is bad and the prognosis perhaps even worse, the ability to cope and deal with a new set of terms and tasks can be overwhelming.
End-of-life care choices will be some of the most important decisions of a lifetime for anyone choosing to control how and where they will die. Choices made will guide and drive the matters that are most important to ensuring a peaceful, comfortable death with dignity and maximizing the quality of life up until the end.
Some of these decisions can be made long before end-of-life care ever comes into play. If these choices no longer fit they can be changed or revoked anytime. Understanding some important terms used in end-of-life decision making is vital to making appropriate choices.
Advance Directives
Advance directives or healthcare directives are general end-of-life care terms describing:
- A Healthcare Proxy or Durable Power of Attorney for Health Care (DPOAHC) is a person (such as your spouse or adult child) you appoint to act on your behalf in the event you are unable to make decisions for yourself.
- A list of instructions regarding your medical care wishes such as resuscitation (CPR) or inserting tubes i.e. to help you breath with artificial help (ventilator) or a feeding tube in the event you cannot swallow. These instructions can be as detailed as desired. Beware that advance directives can be treated differently by individual states or provinces. They do help to reduce the burden on family members.
Withdrawing Care
When everything possible has been done, the physician or nurse may mention the term “withdrawing care.” This important term means that the current course of aggressive care and treatment will end. For instance, treatments such as chemotherapy and radiation will be stopped. In advanced stages of illness or dying this can mean withdrawing various levels of life support measures such as ventilators, artificial feedings and dialysis.
What withdrawing care does NOT mean is that these measures should ever be abruptly ended and the patient sent home to die without any support systems in place. Hospice or palliative care should be brought in to help make this transition. For instance, even patients who have been on a ventilator won’t usually die immediately upon its withdrawal. They may experience some air hunger, which is a subjective experience of not being able to breathe in enough air. Comfort medications, such as low doses of morphine can help with the breathing difficulty, or Ativan to control the anxiety and panic associated with not being able to breathe adequately. These medications need to be available to ease these symptoms and allow the natural dying process to take its course.
Comfort Measures
Comfort measures is a term for the care which will be implemented to assist the patient as he moves into the next stages of dying. This may be accomplished with a variety of medications and treatments to manage such symptoms as pain, anxiety, depression, constipation or breathing difficulties. Comfort measures can also include non-medical techniques as massage, therapeutic touch and guided imagery along with spiritual and emotional support for the patient, family and caregivers.
Symptom Management
Hospice and palliative care often get the bad rap of “immediately putting patients on a morphine IV drip so they will die quickly.” Any quality hospice or palliative care organization does not do this. If this is the case for you or a loved one, you have the right to revoke and call in another team.
Over-the-counter medications may be used for mild pain in the beginning; as the pain increases, stronger medications can be used. Stronger comfort medications like Vicodin, Norco, dilaudid and morphine are commonly used for moderate to severe pain and/or advanced breathing difficulties. These medications are carefully titrated (doses increased in small increments) from very minute amounts until effective symptom management is achieved. Symptoms can often be controlled for a long time with very small doses.
For patients who might not be used to anything stronger than aspirin or ibuprofen, changing the strength (dose) of these stronger medications in small increments should be as slow as needed to achieve symptom control while maintaining the desired level of alertness for quality of life. This is just one reason why it is highly recommended to start palliative care or hospice early enough so that symptoms aren’t so far out of control and the patient is the stage of actively dying. It can take some time to reach proper symptom management.
Antidepressants, anti-anxiety medications, anti-nausea medications and bowel regimens (including medications, increased fiber and fluids, and daily habits) are useful in helping control other common end-of-life symptoms, such as depression, anxiety, nausea/vomiting and constipation or diarrhea.
End-of-life care and the dying process have so many unknowns that make it a scary experience for many people. Through knowledge and education many of these unknowns and fears can be conquered. The journey can become a more pleasant time to share the gift of spending the time left in peace and comfort in the company of family and friends.
SOURCES:
Jeanette R. Stevens RN, BSN, CCRN, CHPN, “Care Until the End.” Nurseweek West, October 10,2011.
Mayo Clinic Staff; “End of Life: Caring for a Dying Loved One.” MayoClinic.com
http://www.mayoclinic.com/health/cancer/CA00048
“Pain Control Methods and Standards of Care.” Hospice Patients Alliance. http://www.hospicepatients.org/hospic29.html
Thursday, January 26, 2012
Advance Directives Allow Choices and Support Medicare Savings
All the hoopla about “death panels” during the 2010 battle for healthcare reform spooked too many older adults into thinking they would be deprived of curative healthcare because they were older and the care too costly.
That talk has died down for the most part; however, the idea continues to haunt many when they think about end-of-life choices and hope their wishes will be honored and not limited to palliative care alone.
The results of a recent University of Michigan study, published in the Journal of the American Medical Association, show promise that advance directives and other end-of-life care choices have not had an impact on the quality of care provided. Nor have older Americans been denied curative care if they desired it, according to the study.
In regions of the country where curative care is the norm, the cost of medical care has surprisingly declined (and Medicare savings have increased) because of growth in the number of patients choosing palliative care instead of more costly aggressive care. The Michigan study showed that patients in those regions with advance directives received quality comfort care according to their final wishes. Many died at home instead of in hospitals, as was their wish.
The study’s results may encourage people to strongly consider their quality of life concerns and make their end-of life choices known to their families and their healthcare team. Even many study participants who chose treatment-limiting instructions also allowed for limited trials of intubation (inserting breathing or feeding tubes) and mechanical ventilation if needed. But their instructions also made it easier for their proxy (appointed person who has the legal power to make healthcare decisions if you cannot) to stop the treatments if they weren’t effective.
End-of-life care decisions require careful consideration; they can be as specific as you want or need them to be. Although impossible to address every scenario, it’s imperative to discuss the scope of your wishes with your family; your spokesperson and your healthcare team so that your intentions can be met. For instance, do you want everything possible done or do you want quality of life and freedom from pain and suffering (palliative care) if there is no hope of a cure?
If you would like to help people make important decisions in their healthcare, consider any of the online healthcare degrees.
That talk has died down for the most part; however, the idea continues to haunt many when they think about end-of-life choices and hope their wishes will be honored and not limited to palliative care alone.
The results of a recent University of Michigan study, published in the Journal of the American Medical Association, show promise that advance directives and other end-of-life care choices have not had an impact on the quality of care provided. Nor have older Americans been denied curative care if they desired it, according to the study.
In regions of the country where curative care is the norm, the cost of medical care has surprisingly declined (and Medicare savings have increased) because of growth in the number of patients choosing palliative care instead of more costly aggressive care. The Michigan study showed that patients in those regions with advance directives received quality comfort care according to their final wishes. Many died at home instead of in hospitals, as was their wish.
The study’s results may encourage people to strongly consider their quality of life concerns and make their end-of life choices known to their families and their healthcare team. Even many study participants who chose treatment-limiting instructions also allowed for limited trials of intubation (inserting breathing or feeding tubes) and mechanical ventilation if needed. But their instructions also made it easier for their proxy (appointed person who has the legal power to make healthcare decisions if you cannot) to stop the treatments if they weren’t effective.
End-of-life care decisions require careful consideration; they can be as specific as you want or need them to be. Although impossible to address every scenario, it’s imperative to discuss the scope of your wishes with your family; your spokesperson and your healthcare team so that your intentions can be met. For instance, do you want everything possible done or do you want quality of life and freedom from pain and suffering (palliative care) if there is no hope of a cure?
If you would like to help people make important decisions in their healthcare, consider any of the online healthcare degrees.
Thursday, January 5, 2012
What is Palliative Care?
Palliative Care is about managing symptoms for those with chronic or fatal illnesses. It's something we're going to hear more about in the next few years.
Quality of life and managing pain and other symptoms instead of just prolonging life will help us all be comfortable in our last days.
Palliative Care also helps those with chronic symptoms of pain, nausea, shortness of breath, etc., from diseases such as Rheumatoid Arthritis, MS, and COPD, to live more comfortable lives with a better quality of life. Here's a great article to help you understand more about Palliative Care.
Quality of life and managing pain and other symptoms instead of just prolonging life will help us all be comfortable in our last days.
Palliative Care also helps those with chronic symptoms of pain, nausea, shortness of breath, etc., from diseases such as Rheumatoid Arthritis, MS, and COPD, to live more comfortable lives with a better quality of life. Here's a great article to help you understand more about Palliative Care.
Saturday, December 31, 2011
Friday, December 23, 2011
Thursday, December 1, 2011
Relax, Prioritize and Enjoy Your Holiday Season
I hope everyone had a great Thanksgiving and got to spend some quality time with loved ones. As we move into the major holiday season, stress and panic are two words that come to mind quickly. This is especially true of those involved in caregiving situations and those in the sandwich generation between being son or daughter and mom or dad as well as just being you and all that that entails.
Take time every single day to stop and close your eyes and take a few deep breaths -- in through your nose and out through your mouth. This doesn't take long and can be done several times a day. Deep breathing helps to improve your circulation. It will relax you and help clear your mind. When you feel the stress building or panic sneaking up to overcome you. STOP!! Close your eyes and breath deeply. It will help to stall the stress or panic and allow you to gain control over the situation again.
If you already have a great relaxation routine be sure to practice it regularly. And if you don't, these deep breathing moments can help you to begin to find a way to stop the dreaded stress and panic that can steal time and precious memories.
Make lists and prioritize tasks. As you cross them off your list, re-prioritize as the importance of some items may have changed. See which items you can delegate to someone else or work together to accomplish. Look at you list with an eye to how important in the long scheme of things this matter will be five years from now...that just might change how urgent it can seem right now. And then again it may add importance to the matter, but remember to prioritize things.
Another important tip to remember is to figure out which things you pushed to the bottom of the list because you really dread doing them. Sometimes if you get some of these things done first, the rest of your To-Do list seems much easier and less stressful. The more we procrastinate doing something we dread, the more it weighs us down knowing we have to get to it eventually. We don't really have a chance to enjoy the things in between because we have this nagging task lurking out there somewhere. Just do it and move on. It will take a huge load off your shoulders when you do. Or see if someone is willing to share the burden and work with you to get it done.
Caregiving can be a very thankless job. So be sure to build in some little rewards for yourself on a regular basis. Look for silver linings, but also make sure you get a little time to enjoy something you like to do too. Take time to read, watch TV, or rent a movie. Hire some respite care if needed and get out for a meal.
As the holidays approach, it's a time for reflection. Encourage family members who may be gathering to bring a list of questions fro your elder(s) to discuss. These may be directly related to your family, or just things in general. The population in their 80's plus has seen a lot in their lifetime. They didn't grow up with television, they listened to the radio. They saw air travel develop. They lived through the Great Depression. How did it compare to our economic situation now? They lived through several wars and may have been in the armed services. There's no better source of history than first hand information. Take the opportunity to fill in a few gaps. Record your conversations. And perhaps if you have several elders present you'll get a collection of history to pass on.
Most of all take time to enjoy the holiday season!!
photo from morguefile.com
Take time every single day to stop and close your eyes and take a few deep breaths -- in through your nose and out through your mouth. This doesn't take long and can be done several times a day. Deep breathing helps to improve your circulation. It will relax you and help clear your mind. When you feel the stress building or panic sneaking up to overcome you. STOP!! Close your eyes and breath deeply. It will help to stall the stress or panic and allow you to gain control over the situation again.
If you already have a great relaxation routine be sure to practice it regularly. And if you don't, these deep breathing moments can help you to begin to find a way to stop the dreaded stress and panic that can steal time and precious memories. Make lists and prioritize tasks. As you cross them off your list, re-prioritize as the importance of some items may have changed. See which items you can delegate to someone else or work together to accomplish. Look at you list with an eye to how important in the long scheme of things this matter will be five years from now...that just might change how urgent it can seem right now. And then again it may add importance to the matter, but remember to prioritize things.
Another important tip to remember is to figure out which things you pushed to the bottom of the list because you really dread doing them. Sometimes if you get some of these things done first, the rest of your To-Do list seems much easier and less stressful. The more we procrastinate doing something we dread, the more it weighs us down knowing we have to get to it eventually. We don't really have a chance to enjoy the things in between because we have this nagging task lurking out there somewhere. Just do it and move on. It will take a huge load off your shoulders when you do. Or see if someone is willing to share the burden and work with you to get it done.
Caregiving can be a very thankless job. So be sure to build in some little rewards for yourself on a regular basis. Look for silver linings, but also make sure you get a little time to enjoy something you like to do too. Take time to read, watch TV, or rent a movie. Hire some respite care if needed and get out for a meal.
As the holidays approach, it's a time for reflection. Encourage family members who may be gathering to bring a list of questions fro your elder(s) to discuss. These may be directly related to your family, or just things in general. The population in their 80's plus has seen a lot in their lifetime. They didn't grow up with television, they listened to the radio. They saw air travel develop. They lived through the Great Depression. How did it compare to our economic situation now? They lived through several wars and may have been in the armed services. There's no better source of history than first hand information. Take the opportunity to fill in a few gaps. Record your conversations. And perhaps if you have several elders present you'll get a collection of history to pass on.
Most of all take time to enjoy the holiday season!!
photo from morguefile.com
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