week4-kamislec1 dying care
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kuliah Dying CareTRANSCRIPT
Dying CareDying Care
Sri Setiyarini, S.Kp., M.Kes.Critical Care Nurse
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)
Dying and DeathDying and Death
Dying (sekarat):Klien ini biasanya mempunyai
berbagai hal atau harapan-harapan tertentu untuk mati
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
Depresion◦Periode grieving sebelum meninggal◦Banyak menangis◦Tidak banyak bicara
Acceptance◦Klien merasa lebih tenag dan damai◦Klien menantikan kematian
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
Nurses role-EOLNurses role-EOL
Advocate Decision making Communication
Care and comfort
(Penny, 2001).
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).
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.
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.
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
Support beribadah dalam kondisi
apapun
Personal Hygiene
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.
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
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.
Nursing Diagnosis-EOLNursing Diagnosis-EOL
Death AnxietyIneffective copingAnticipatory grievinggrievingSpiritual distressHopelessnessAltered family processesCompromised family coping, Stress overload, etc
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)
Gambaran fisik - Dekat kematianGambaran fisik - Dekat kematian
Dilatasi pupilTidak bia bergerakReflek hilangNadi naik kemudian turunRespirasi satu-satuMengorok atau nafas terdengar kasarTekanan darah turun
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
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
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
Conclusion Conclusion
The problem can beprevented by advanced
care planning resolved through ethical
practice and professional standards of care.
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