week4-kamislec1 dying care

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Dying Care Dying Care Sri Setiyarini, S.Kp., M.Kes. Critical Care Nurse

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Page 1: Week4-KamisLec1 Dying Care

Dying CareDying Care

Sri Setiyarini, S.Kp., M.Kes.Critical Care Nurse

Page 2: Week4-KamisLec1 Dying Care

Nurses…Nurses…

the International Council of Nurses' 1997 mandate that nurses have a unique and primary responsibility for ensuring that individuals at the end of life experience...

a peaceful deathKhusnul Khotimah (Islam)

Page 3: Week4-KamisLec1 Dying Care

Dying and DeathDying and Death

Dying (sekarat):Klien ini biasanya mempunyai

berbagai hal atau harapan-harapan tertentu untuk mati

Page 4: Week4-KamisLec1 Dying Care
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Tahap Dying (Kubler Ross)Tahap Dying (Kubler Ross)Denial dan isolasi

◦Menyangkal◦Merepresikan kenyataan◦Mengisolasi diri terhadap kenyataan

Anger◦Mengekspresikan kemarahan dan permusuhan◦Bersikap menyalahkan takdir

Bergaining◦Tawar-menawar◦Mempunyai harapan-harapan

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Depresion◦Periode grieving sebelum meninggal◦Banyak menangis◦Tidak banyak bicara

Acceptance◦Klien merasa lebih tenag dan damai◦Klien menantikan kematian

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patient's perspectiveof qualitypatient's perspectiveof quality

end-of-life care.end-of-life care.5 domains of quality end-of-life care: receiving adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control,

relieving burden, and strengthening relationships with loved ones.  

Singer P.A, Martin D.K, Kre Patients‘ Perspectives .JAMA  Vol. 281

No. 2, January 13, 1999  

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Nurses role-EOLNurses role-EOL

Advocate Decision making Communication

Care and comfort

(Penny, 2001).

Page 10: Week4-KamisLec1 Dying Care

1. Advocate1. Advocate Recognize dynamic changes in population

demographics, health care economics, and service delivery that necessitate improved professional preparation for end-of-life care.

clarify of personal: values one's own attitudes, feelings, expectations about death and the individual, cultural, and spiritual diversity existing in these beliefs and customs

Ethical and Legal issues, ethical dilemamas in EOL (comfort, consent, prolonging life, withdrawing

treatment; euthanasia, and allocation of resources; advance care planning, advance directives, and decision making at the end of life

(Penny, 2001).

Page 11: Week4-KamisLec1 Dying Care

2.Facilitating Decision Making2.Facilitating Decision Making

assessing the decisional capacity of patients

to determine how much the patient already knows and how much s/he wants to know.

to ensure that patients retain their rights to know the truth about their condition.

Page 12: Week4-KamisLec1 Dying Care

3. 3. CommunicationCommunication

Make sure - Information to pt’s adequatCommunication will be open and honest Nr Competencies:

◦Communicate effectively & compassionately ◦Collaborate with interdisciplinary team

members while implementing the nursing role in end-of-life care.

Page 13: Week4-KamisLec1 Dying Care

4. care and comfort4. care and comfortCare: ADLsto provide quality care, minimize discomfort,

and promote dignity to the pts.Promote psycho & spiritual needsKolaboratif: pain management prepare the patient and care for the time of

death. Nursing care at the time of death care after death

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Support beribadah dalam kondisi

apapun

Personal Hygiene

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Improving end-of-lifeImproving end-of-life care. care.

Providing a "good death" Suggestions for providing a good death included :facilitating dying with dignity; not allowing patients to be alone while dying; managing patients’ pain and discomfort; knowing, and then following, patients’ wishes for

end-of-life care; promoting earlier cessation of treatment or not

initiating aggressive treatment at all; communicating effectively as a health-care team. Educational initiatives for professionals and the

public were also suggested.

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Facilitators to Providing a Good Facilitators to Providing a Good DeathDeathMaking Environmental Changes to Facilitate

Dying With DignityManaging Pain and Discomfort. Knowing and Following Patients’ Wishes for

End-of-Life Care. Promoting Earlier Cessation of Treatments or

Not Initiating Aggressive Treatments, Especially When Care Seems Futile. American Journal of Critical Care. 2006;15: 38-45

Renea L. Beckstrand, et al. Providing a "Good Death": Critical Care Nurses’ Suggestions for Improving End-of-Life Care. American Journal of Critical Care. 2006;15: 38-45

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nurse's responsibility…nurse's responsibility…to assure that: 1) personal values and

morals are separated from the patient's and family's decision making process

2) the patient and family fully understand available options

3) patient wishes are communicated to the interdisciplinary team.

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Nursing Diagnosis-EOLNursing Diagnosis-EOL

Death AnxietyIneffective copingAnticipatory grievinggrievingSpiritual distressHopelessnessAltered family processesCompromised family coping, Stress overload, etc

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ELNEC curriculumELNEC curriculum ELNEC (The End-of-Life Nursing Education Consortium )

Focuses: Peaceful Death:◦ Nursing Care at the End of Life◦ Pain Management◦ Symptom Management◦ Ethical/Legal Issues◦ Cultural Considerations in EOL Care◦ Communication◦ Grief, Loss, Bereavement◦ Achieving Quality Care at the End of Life◦ Preparation and Care for the Time of

Death(AACN's, 1998)

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Gambaran fisik - Dekat kematianGambaran fisik - Dekat kematian

Dilatasi pupilTidak bia bergerakReflek hilangNadi naik kemudian turunRespirasi satu-satuMengorok atau nafas terdengar kasarTekanan darah turun

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Death (kematian)Death (kematian)Kondisi terhentinya fungsi jantung jantung

paru secara menetap atau terhentinya kerja otak secara menetap (Enchepalogram datar: aktifitas listrik terhenti)

Pergerakan otot tidak adaSebelum kematian diskusikan beberapa

hal:◦Donor organ◦Otopsi◦Euthanasia◦Wasiat semasa hidup

Page 24: Week4-KamisLec1 Dying Care

Perubahan tubuh setelah Perubahan tubuh setelah kematiankematian

Rigor mortis (kaku): 2-4 jam setelah kematian

Algor mortis (dingin): suhu turun perlahan-lahan

Livor mortis: perubahan warna pada daerah tertekan

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Intervensi terhadap keluargaIntervensi terhadap keluargaMendengarkan ekspresi

keluarga mengenai berduka, kehilangan dan tak berdaya

Beri kesempatan keluarga untuk memastikan bersama-sama jenazahnya

Bagi yang belum siap◦Siapkan ruangan khusus◦Pahami syok yang dialami◦Bantu keluarga untuk membuat

keputusan◦Follow up proses duka keluarga

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Conclusion Conclusion

The problem can beprevented by advanced

care planning resolved through ethical

practice and professional standards of care.

Page 27: Week4-KamisLec1 Dying Care

Memfasilitasi dan mensupport pasien di akhir hidupnya – untuk menggapai SurgaNYA merupakan salah satu

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