Sunday, November 4, 2007

This presentation is part of : End-of-Life Strategies
Family Perceptions of Changes in Patient Condition at the End of Life
Nancy Henne Batchelor, MSN, RNc, CNS, College of Nursing, University of Cincinnati, Cincinnati, OH, USA
Learning Objective #1: discuss signs and symptoms of the dying process.
Learning Objective #2: identify family perceptions related to nutrition, hydration and changes in level of consciousness at the end of life.

Misperceptions may occur as families vigil at the bedside of a loved one who approaches death. They struggle as they observe symptoms indicating that the natural conclusion of the life cycle is imminent. The patient who enters the process of active dying exhibits many physical and emotional changes. The nurse working with these individuals has the opportunity to care for and connect with the patient and family. The hospice nurse addresses many care issues: the dying process, symptoms of impending death, nutrition, hydration, medication and social withdrawal. All are frequent subjects that warrant clarification and discussion. Families exhibit concern about nutrition and hydration even as level of consciousness declines. Food is seen as a comfort measure when there is illness. Many refer to the Terry Schiavo case and question natural dehydration and a painful death due to a lack of intake.  Hospice nurses provide detailed information regarding the “benefit vs burden” of forced intake as the body naturally shuts down in preparation for death. Decline in level of consciousness and the inward focus are changes which families may attribute to overmedication, thus request withholding medication with the hope of increasing social interaction between patient and family. Nurses who care for the dying patient educate the family about symptom management and provide family support during the last days and hours of life.A caring educational approach in clarification of misperceptions about the dying process can produce a positive and lasting outcome. Hospice nurses have the opportunity to assist the family in coping with death of a loved one and promote personal growth while bestowing a caring and compassionate presence.