nursing.elitecme.com Page 19 Complete Your CE Test Online - Click Here people over 65 years of age in the United States. The rate of mortality from falls rises with increasing age (Tabloski, 2014). To help decrease the likelihood of falls, tripping hazards, such as throw rugs and clutter, should be removed. Grab bars should be installed throughout the house. Older adults’ vision should be monitored and appropriate interventions (cataract surgery, glasses) performed. Decreased vision increases the probability of falling (Alzheimer’s Association, 2014; Tabloski, 2014). End-of-life care According to experts in end-of-life care, viewing death as a natural part of life is critical. To give compassionate end-of-life care, nurses must confront their own feelings about death and seek guidance and mentorship when dealing with the loss of patients (National Institute on Aging, 2017; Tabloski, 2014). Each life, each death is different. Following are suggestions for nurses and other HCPs to help patients die with comfort and dignity (National Institute on Aging, 2017; Tabloski, 2014): ● ● Provide relief of psychosocial distress. ● ● Adhere to treatment regimens to control pain and other symptoms. ● ● Coordinate care across the health care continuum to provide optimal services. ● ● Prepare patients and families for death. ● ● Communicate clearly, and clarify goals of treatment interventions. ● ● Respect patient and family values. ● ● Support the patient’s and family’s decision-making processes. ● ● Explain the benefits and burdens of treatment. What is a “good death?” A good death means something different to different people. Some may want to know diagnosis and prognosis. Others prefer not to know the specifics of prognosis. Some patients want to be surrounded by family and friends as death approaches. Still others may prefer to be alone or only with those closest to them. Nurses should do their best to see that their patients’ end-of-life wishes are fulfilled as much as possible (National Institute on Aging, 2017; Tabloski, 2014). According to the National Institute on Aging (2017), there are four areas of need for patients who are dying: 1. Physical comfort. 2. Mental and emotional needs. 3. Spiritual issues. 4. Practical tasks. Physical comfort Every effort should be made to keep the patient as comfortable as possible. Patients in pain should receive as much pain medication as prescribed without worrying about possible long-term problems of dependence or abuse. Suffering from pain that could be relieved is unnecessary. It can drain the patient of energy and the ability to enjoy being with family and friends and participating in social activities to the best of their abilities (National Institute on Aging, 2017; Tabloski, 2014). Dyspnea at the end of life is common. Oxygen should be used as prescribed, the head of the bed elevated, a vaporizer used, or the window open or a fan used to facilitate breathing (National Institute on Aging, 2017). Meticulous skin care should be provided. Alcohol-free lotion can help relieve dry skin. Patients should be repositioned frequently and the skin examined for redness and breaks in skin integrity every day. A lip balm may relieve dry lip (Durkin, 2013; National Institute on Aging, 2017). Nausea, vomiting, and loss of appetite are common at the end of life. Medications to control nausea, vomiting, and diarrhea may be prescribed. Small frequent feedings are often better tolerated than three large meals (Durkin, 2013; National Institute on Aging, 2017). Temperature intolerance may develop at the end of life. Patients may not be able to inform caregivers that they are too hot or too cold. Nurses and caregivers should be alert to clues, such as if the patient repeatedly tries to remove a blanket or sweater, which could indicate she is uncomfortably warm even though she cannot say so (National Institute on Aging, 2017). Fatigue is very common for people nearing the end of life. Activities should be kept simple. Energy-saving devices, such as shower stools, can help conserve energy (National Institute on Aging, 2017). Mental and emotional needs Persons at the end of life may feel anxious or depressed. Listening to them talk about their concerns is often helpful. A counselor familiar with end-of-life issues may be a good resource for the dying person (National Institute on Aging, 2017). Some patients are afraid of dying alone. This fear may be increased if family and friends, unsure of what to say or do, or who have their own concerns about dying, stop visiting. If this happens, nurses can try to discuss these concerns and facilitate comfort when visiting the dying person (National Institute on Aging, 2017; Tabloski, 2014). Simply physical contact, such as holding a dying person’s hands, can be very comforting to him. Before doing so, the caregiver’s hands should be warmed by rubbing them together or running them under warm water (National Institute on Aging, 2017). Nurses’ behaviors should be soothing and consist of what is most comforting for the patient. Some people who are outgoing and love a crowd may find it most comforting to be surrounded by family members and friends. Others may prefer quiet and solitude and find it most comforting to be with just one or two people. Some experts believe that when death is near, music at low volumes and soft lighting are soothing. Nurses and other caregivers should get to know what is most comforting for their patients before death is imminent so, when the time comes, they can provide the most comforting environment (National Institute on Aging, 2017). Spiritual issues Spiritual needs should be addressed. Many people find comfort in their religious faith. Praying, talking with clergy and others of their faith, reading religious materials, or listening to religious music may be comforting (National Institute on Aging, 2017). Visitors should be encouraged to talk to the dying person even if she seems to be unresponsive. The dying person should always be talked to, not about. All caregivers and visitors should tell the dying person who they are when they enter the dying person’s room. For example, a nurse could say, “Good morning Eleanor. It’s Tracey, your nurse. I’ve come to wash your face and make you more comfortable” (National Institute on Aging, 2017). Practical tasks A dying person may be concerned about many practical matters – who will take care of beloved pets when the person is gone; who will take care of the surviving spouse, especially if this person is elderly; whether the dying person has made a will. These issues may cause a dying person considerable distress and should be addressed. Perhaps a friend can reassure the dying person that he will take care of the patient’s beloved dog. Or a neighbor may be able to tell the dying person that she will make sure his wife has a ride to the grocery store, the doctor’s office. Reassuring the dying person that practical concerns are being dealt with can be a great comfort (National Institute on Aging, 2017). For those people looking for more information about helping the person facing end-of-life issues, Caring Info (National Hospice and Palliative Care Organization) can be a good resource. This organization can be contacted at http://www.caringinfo.org or at 1-800-658-8898. References Š Š Alzheimer’s Association. (2014). Behaviors. Retrieved from https://www.alz.org/national/documents/ brochure_behaviors.pdf Š Š Cleveland Clinic. (2016). When memory is normal & when it is not-so-normal. Retrieved from https:// my.clevelandclinic.org/health/articles/when-memory-is-normal-and-not-so-normal Š Š Cohen, M. (2011). Screening tools for the identification of elder abuse. Journal of Clinical Outcomes Management, 18(6), 261–270. Š Š CPH & Associates. (2017). Nurses and mandatory reporting laws. Retrieved from http://www.cphins. com/nurses-and-mandatory-reporting-laws/ Š Š Durkin, M. T. (Ed.). (2013). Professional guide to diseases (10th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Š Š MacDonald, D. K. (2015). Assessing elder abuse with the caregiver abuse screen (CASE). Retrieved from http://dustinkmacdonald.com/assessing-elder-abuse-with-caregiver-abuse-screen-case/