Manual Being Present: A Nurses Resource for End-of-Life Communication

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  1. Being Present: A Nurse's Resource for End-of-Life Communication
  2. End of Life Communication - Oxford Research Encyclopedia of Communication
  3. Services on Demand
  4. Maureen P. Keeley
  5. The 3 Things You Never Stop Learning As a Nurse

Being Present: A Nurse's Resource for End-of-Life Communication

When the death is imminent, the family must be informed that death is near. As mentioned before, sometimes this is shocking to the family, despite knowing that their loved one is dying.

This has to be communicated to the family in a sensitive and calm manner. Each nurse will have their own way to exchange this information, but it is very important that the family be told that death can occur at any time so that they can prepare. There may be family in the area or out of town that would like to come and see the patient and who is waiting until the patient gets closer to death.

It is important to educate families during the dying process that the final phase may progress very quickly as a way to encourage loved ones to come sooner rather than later. The imminent phase is also the time when some families may want clergy or pastoral care present. Depending on their religious affiliation, some patients and families may want sacraments or special blessings performed before death occurs. It is important to tell the family that the process leading to death has begun, and that if they would like clergy present they should begin that process now. The nurse can assist families with obtaining pastoral care if the family does not have their own.

The coordination of spiritual support may be extremely important to the family at this time and the nurse should be sure to evaluate for this as part of their assessment. There are two ways that death can be classified: clinical death and biological death. Circulation of the blood and respiration also stops once there is a cessation of heart beat.

It is during this time that individuals can be revived by way of CPR. Oxygen can be given, the blood can be kept circulated and the heart beat could be potentially restored.

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End of Life Communication - Oxford Research Encyclopedia of Communication

Most patients who are at the end of life opt for a do-not-resuscitate order, and therefore CPR is rarely given. There is a 4 to 6 minute window in which patients can be revived with CPR. Without CPR, in approximately minutes after clinical death the cessation of heart beat , brain cells will begin to die from lack of oxygen.

This is called biological death and is called the point of no return, meaning that once the brain dies, CPR will not be able to bring that person back. It is at this time that the cells in other organs, such as kidneys or eyes, will also begin to die. Several hours after biological death occurs, rigor mortis occurs.

Rigor mortis is defined as the temporary rigidity of muscles occurring after death Merriam Webster, Rigor mortis will begin to set in several hours following death and be at its peak hours following death. Rigor mortis will disappear 48 hours following death.

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As mentioned before, respirations can become quite erratic, very shallow with extended periods of apnea in between breaths. This time period can seem like an eternity for both the family and the nurse. Take extreme caution when determining whether or not the last breath has been taken. Extended periods of apnea close to death can last up to a minute or more. Be certain that death has occurred before proceeding to assess for signs of life. The pulse in the carotid artery may still be palpable, although very faint and thready, until the heart catches up with the absent respirations.

This may take a minute or two. Be sure to listen for a heartbeat with a stethoscope for a full minute. In hospice this is performed for two reasons: to ensure that the patient has died, and also to provide the family with the extra peace of mind knowing that their loved one is really gone.


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The nurse should make sure that the patient is covered with a light sheet up to below the shoulders. It is atypical for the deceased patient to be completely covered including face and head, so refrain from doing so unless otherwise directed by the family. Following the death of a patient, the nurse should offer their condolences to the family and extend assistance with contacting any other family members or individuals the family requests.


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Depending on the location of the death, the nurse would contact the medical examiner to notify them of the death, as well as the physician and other clinicians who were involved with the patient. The nurse can also contact the funeral home for the family as requested. The nurse would assist the family in removing any jewelry or other items from the patient. Be sure to maintain the highest dignity and respect for the deceased patient during this post-mortem care. Bate-Smith, E.

Maureen P. Keeley

Rigor mortis and adenosine-triphosphate. Berry, P. Planning for the actual death. New York: Oxford University Press. End of Life Nursing Education Consortium ELNEC — core curriculum training program. Imminent [Def. Merriam-Webster Online. In Merriam-Webster. Rigor mortis [Def. Skip to content Increase Font Size. Be the first to review this product.

The 3 Things You Never Stop Learning As a Nurse

More Views. Add to Cart. Description Details To Comfort Always is an award-winning handbook for nurses on how to care for patients at the end of life.

English for Nurses: End-of Life Care

Includes: Educating your patients, their families, and yourself about illnesses Guiding patients and families through the stages of dementia Conducting pain assessments Advocating for the needs of patients and families Assessing and engaging when death is near Understanding the specific needs of a dying child About the Author Linda Norlander, MS, BSN, RN, is the Director of Clinical Services for Franciscan Hospice in Tacoma, Washington. Product Tags Add Your Tags:.

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