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CNA Training & Classes | October 20, 2017

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Terminally Ill Residents

Death is a part of everyone’s life. It completes the cycle of life and we all want to leave a trail of legacy that we can be proud of.

Therefore, an elder resident facing such task may need to have someone who can act as an authorized person to make decisions in parts of his life in order to mirror his true desires. This happens especially if the resident has disabilities and limitations which put him in the position where he is not be able to make his own decisions. Such conditions may include near death situations and also mental disabilities.

The authorized person may be instructed by the resident to apply the his wishes in the future time where he will not be able to decide such as power of attorney, last will and testament, or even a surrogate for health.

Right To Refuse Treatment & PSDA

It is everybody’s right to decide for their own life, including the right to refuse any treatment whether they may be medical or surgical and also the right to have a legally authorized person to carry out his last instructions. This right is protected by the law which is inside the Patient Self-Determination Act (PSDA) so that they can exercise their own rights. This right is surrounded by many issues and controversies especially in death situations since some of the loved ones might not agree to the residents’ last will.

Some of these debatable and also controversial issues may include the right of the resident not to have resuscitation as well as euthanasia.

When a resident decides to not be resuscitated in times of a cardiac or respiratory arrest, the doctor will order a do not resuscitate order in the patient’s chart also known as DNR. Since it is our role to carry out their orders then it may become a challenge for us. There are also many debates in the court systems regarding the ethical issues regarding research and development in prolonging of life and also the practice of euthanasia.

Euthanasia

Euthanasia is a term for mercy killing which pertains to the ending the suffering of the resident who are terminally ill. This practice was made legal in Oregon in order to promote dignity and end suffering. This practice has been a controversy for many years in different areas since it involves not only legal but also ethical issues.

Residents who are terminally-ill are often ignored by nursing team and sometimes even by family members as though they are already gone or are excluded in conversations. However, it is the right of the resident to acquire the right care that they need and also the right to be informed of his/her medical condition.

Therefore, residents especially the terminally-ill ones must be treated in par with any other residents who needs care. There are instances that some residents may not be as cooperative and socializing as others would be. These observations should be noted and not be ignored because they could be signs of residents experiencing something like depression or in a great pain.

Comforting measures should be valued since this can affect greatly the resident’s cooperation and their outlook in life. Comfort measures like putting pillows, listening to the them and helping them with their last testament and spending quality time helps them to voice their own fears.

Often, residents who are terminally-ill experience bowel discomforts because of their strong pain killers or analgesics so immediate intervention must be given, before they may experience other problems. Pain relievers side effect is confusion so we should make sure that residents taking them have precautionary measures to prevent falls.

Good nursing assistants should not be afraid of talking about death.There are situations when residents want you to be open to him regarding death consequently it is important to be careful in answering questions but also provide a straightforward and compassionate reply. If you cannot answer some of the resident’s questions say so- it is the best approach in situations where you do not know how to answer it.

Dying residents have fears of pain and the thought of dying alone thus they need to have someone to spend some time with. Most of the time, residents only want somebody to talk to rather than of someone who will answer all their questions. Being with them in that certain moment is very important as it is a way of meeting their emotional needs.

Residents who are already facing death show some signs like decrease in breathing. It may become shallow and irregular. The decrease in breathing and rest periods is also known as Cheyne-Stokes respiration.

Another signs of impending death include a decrease in blood pressure, cyanotic lips, skin, and feet, cold skin, decrease functions of the body parts and others. These signs progress to unconsciousness which can lead to fading vital signs and then death.

If these signs are observed in a resident, report it to the nurse right away and stay with the resident until help arrives. If loved ones of the resident visit the dying resident give them the privacy that they need, assist them and give your condolences.

When giving information to the resident’s loved ones regarding the death, always be honest in giving answers. This should also be observed when other residents especially their roommates are asking questions about the resident’s death since they too can be affected by the loss. But, be also careful in giving out answers and make sure to remain confidential if needed.