Chapter 6 – Caring in the Last Days and Hours Understanding Your Beliefs and Baggage 1. Reflect on and write about your feelings regarding caring for someone in their last days and hours and at the time of death. Compare this reflection to the feelings you identified in exercise 5 and 6 in chapter 2 of this workbook, about working with people who are dying. Your feelings today may be similar to those you identified before or may have changed. When it comes to someone dying my feelings remained the same, I will have a lot of mixed emotions going through my mind, but I won't share them, I will always be professional, kind, caring, compassionate, centre on the patient, be there for the patient and their family, I will talk to the patient, I will address the concerns and the questions directing them back to the supervisor or nurse and report and take it back to my team. 2. PSWs often provide care for a person’s body after death has occurred. For some people this is a sacred ritual; others are not comfortable doing this. Reflect on how you feel about caring for the body after death. If you feel uncomfortable, consider asking a colleague or supervisor to mentor you and help you become more comfortable. You may want to ask for additional opportunities at work to gain experience proving care for the body. Reflect on and write about caring for the body after death. I have never seen a dead body, so I will likely be scared, frightened and trembling the first few times. I know however, that this is part of the cycle of life and part of my job, as a professional PSW I will work through these feeling and always be professional in the presence of the family and the team. I am a kind, compassionate, caring professional and will ask the supervisor for more experiences for caring for the body of a deceased person so that I can overcome my initial feelings and be very professional in this role. Solidifying Concepts 3. Refer to pages 186 to 193 in the text and complete the following chart: Physical changes in the last days and hours Decreased physical strength and increased drowsiness Reduced intake and difficulty swallowing Comfort measures for the dying person Comfort measure for the Family when death is near the dying patient will sleep more than ever I would let the family know that the patient needs rest and that is normal. clear fluid in moderation, small sips I will be compassionate and let the family know that moderation and small sips are all the patient can tolerate at this point. Delirium or confusion Agitation or restlessness if the patient is in a weak or agitated state to check the care plan and with the nurse to have medication to help settle the patient down so the patient doesn't get into frenzy. as a PSW find out why the patient is in distress and find ways to address the discomfort, perhaps some music or an audio book, or a distraction free zone or some guided meditation I will be empathetic to the family and inform them in case of an emergency please phone the nurse I will encourage the family to talk to the nurse to have their questions answered. If I am asked anything or hear any concerns from the family to report it to the nurse. Unresponsive sometimes when a patient is unresponsive, when it comes to the family, I just be there for the patient talk with the would let my team know that the patient in a gentle smooth voice or just let family needs assistant of coping them sleep. with this patient and we would find ways to lessen their stressors. Irregular breathing when a PSW notices a patient is breathing I would ask the family if they can irregularly to watch for breathing patterns each take a turn and sit with the changing, collect information and prepare patient, watch the patient's and share a report with the nurse also breathing, just being there for the change the position of the client to support patient if I'm not there. the client can breathe properly. Congested PSW you should always put the patient in a I would acknowledge what the breathing semi supine position if congested, help family is going through encourage them with their pillow, and by always the family talk to the nurse. attending to their mouth care. Changes in skin when a patient is dying the skin will change I will tell the family to be gentle color and from warm to cold the best thing you can with the patient and gentle touch temperature do provide clean clothes if they are can be therapeutic and helpful sweating and offer a blanket when they're and that just being there for the freezing. patient is the best thing they can do. Dry eyes if the patient's eyes are dry inform the I will tell the family to contact the nurse and put a facecloth over their eyes nurse right away and not wait. to help keep the eyes closed Decreased urinary provide incontinent pads for the patient I would tell the family to provide output according to their preferences incontinent pads and change often when I'm not there. Bowel and bladder provide incontinent pads for the patient I will tell the family to provide incontinence according to their preferences incontinent pads and change often when I'm not there. 4. Identify three things the team can do to prepare to provide best care in the last days and hours a. centering the patient b. Palliative care comfort measures for patient and family c. Controlling pain or managing pain 5. The family asks you “What changes can I expect in the last days and hours?” What are four appropriate ways for you as a PSW to respond? a. Directing the family to talk to the nurse. b. providing pamphlets. c. listening to the family questions and concerns and reporting back to the nurse d. respecting, honoring and responding to their questions giving information you have been delegated to share by the nurse and direct anything more substantial back to the nurse. 6. What physical changes in a person suggest that death is very close? The physical changes in the person that suggest death is very close include a change in breathing pattern, colour and texture of the skin, a change in behaviour restless patients become calm, a change in the quality of voice for those still able to talk, due to laboured breathing voices may get quiet or raspt. 7. You enter a person’s room and notice that the person is not breathing. Create a list of tasks to complete if this occurred in a home setting and in a long-term care facility. Care of the Body House setting position the dead body in supine position cover their eyes facecloth Care of the Body Long-term care Facility position the dead body in a supine position cover the eyes with a facecloth wash the whole body, start with the face and the hands and the body wash the whole body, start with the face, move down to the hands, and wash the body return the dentures back to the family dress the body in gown or fresh clothes Change the soiled lines, and open window to get fresh air give the dentures back to the family dress the dead body fresh clothes or a gown change the soiled lines, and open window Ways to support Family At all Locations provide the family nourishment drinks and food family a safe space and their privacy so they can talk privately without interruption; attend to any family rituals; and spiritual needs be there for the family but give them a breather answer the questions and concerns from the family and direct it back to the nurse be empathetic and compassionate be kind and compassionate and notify the nurse if the family needs anything 8. It is always important to know what a person’s DNR status is before entering their home. True or False Explain your answer: If you arrive at the home and the person is not breathing and has a DNR in place, there is limited help you can give. 9. Describe four ways you can support the family after the death of their loved one. a. being there for the family understand that they went through a tragedy b. notify the nurse or call the supervisor and find out ways that the team can support the family c. respect, and honor, by letting the family have their rituals. d. if the family is going through grief, suggest to the nurse to help them. 10. List three ways you can show respect and support for people whose cultural traditions or spiritual practices are different from yours. a. respect b. no judgement c. be professional 11. Review page 202 in the text and fill in the blanks in the paragraph below. When a person’s death is sudden, unexpected, or occurs within 24 hours of admission to a hospital, the coroner is notified. The role of the coroner is to confirm the identity__ of the person who dies and the probable _cause___ and time_ of death. The coroner classifies the death as natural, accidental, suicide, homicide, or undetermined. Integrating into Practice 12. Describe two reasons why it is important to explore the family’s understanding when they are asking how long the person might live. a. Because the team needs to know the family’s preference b. It's very important for the family to know what different stages that the patient will go through, and it's very important that the nurse or the team address these concerns. 13. Discuss the topics below in small groups or with a colleague discussed in class a. Supporting a family whose traditions and practices in caring for the body after death are different from what you know. I will be professional, create a safe environment for the family to talk, I will remove medical equipment, change linens, tidy up the room, take the garbage out, and put fresh clean linens on the bed. b. Ways to support the family when they participate in a cultural practice that does not have meaning for you or seems unnecessary. To me is very important to respect everyone’s culture and not to judge, it's important to be professional and support the family no matter what. Again, we are all human beings no matter where we come from, what walks of life, while our beliefs and rituals may be different, we must be professional and support a family in need by respecting their culture, beliefs, and rites of passage. Our main goal is to be caring, compassionate and respectful. 14. Reflect on the following scenario: You have been providing care for an Indigenous person (or a person from a culture different from yours) for almost seven months and they are nearing their last days and hours. Because the family knows you and is comfortable with you, they ask you to find space for rituals and traditional ceremonies and for many members of the community to meet as the person dies and after death. In small groups, discuss how you would respond to this request in a culturally safe manner. Consider different care locations (e.g., long-term care, acute care, hospice, home) and brainstorm ways to create space and privacy in these locations for the person, their family and their community as they provide rituals and ceremonies for their dying loved one. If you do not have personal experience in these locations, ask your instructor to provide a brief overview of the different caregiving spaces in your community. If the patient dies in Long-term care, they may have a meeting room that the family can use as long as the home is not in an outbreak. If the patient dies at home family could call at home. If the family would prefer a neutral location, you could provide them with a list (name, address, phone number, website and email address) of local community centers, cultural centers, Canadian Legion Branches, Navy Clubs, Heritage centers, libraries, restaurants or conventions centers that my rent or give space for this type of thing. Depending on their beliefs you might suggest contacting a local church or synagogue who have spaces that are not the main worship space where the family could gather to meet others. And of course, don’t forget local funeral homes. Meet with the larger group and share your ideas for providing space. discussed in a small group 15. When you are at work or during a practicum, refer to the agencies or facility’s policy and procedures manual and look up care of the body following death. When I start working in placement, I would look at the facility’s policy and procedures manual, familiarize myself with its contents and follow the policies and procedures.
