Presentation on End of Life Care

1. Beaches, Steel MagnoliaTerms of Endearment GOALS OF CARE AND ETHICAL ISSUES AT END OF LIFE Your role as a nursing assistant

2. INTRODUCTIONS Tell me a little about you

4. GOALS OF CARE Why do we believe it is so important to document the goals of care?

5. 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.

6. PAIN CONTROL

7. 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.

8. GOALS OF MEDICAL THERAPIES Cure Control Comfort/Palliative

9. 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.

10. 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.

11. 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

12. DECISIONS AT THE END OF LIFE If I can no longer make decisions for myself, who should make them for me?

13. DECISION MAKING

14. DECISIONS AT THE END OF LIFE What decisions do I need to make to get my affairs in order?

15. 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

16. DISCONTINUING LIFE SUPPORT

17. 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

18. CONT TREATMENT OPTIONS TUBE FEEDINGS /INTRAVENOUS FLUIDS SYMPTOM MANAGEMENT

19. 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.

20. SEVERAL TYPES OF ADVANCE DIRECTIVES Living Will Durable Power Of Attorney No Code/DNR Do not Hospitalize/DNH Organ Donation

21. 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.

22. CAN PATIENT OR FAMILY DECISION MAKERS CHANGE THEIR MINDS YES THEY CAN!!!!!!!!!!!!!!!!!!!!!!!! REMEMBER TO WRITE EVERYTHING DOWN

23. 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

24. Patients/Residents Who Can Make Decisions Understand the information given Think clearly about treatment options Can tell others what they want

25. 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

26. 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

27. 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

28. 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

29. 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.

30. SAYING GOODBYE

31. MY HISTORY NAME WHERE I LIVE OCCUPATION PLACE OF EMPLOYMENT/EDUCATION FAMLY DREAMS THANKS FOR COMING