Hospice Care.pptx. .

Hospice care

1. Hospice Care Hospice care do focus on care, comfort, and quality of life of a one with a serious illness and is approaching the end of his/her life, especially where the doctor believes he/she is likely to die in six months if the illness runs its natural course (National Institute on Aging, 2021).

2. Hospice care At times, it may not be possible to cure serious ailments, or a patient may opt not to undergo certain treatments; hospice is designed here for such situations. The patient put on hospice care understands his or her illness is not responding to medical efforts to cure it or to slow the disease's progress. Akin to palliative care, hospice makes available comprehensive comfort care and support for the family, however, in hospice, attempts to cure the person's illness are discontinued. Starting hospice early is likely to give months of meaningful care and quality time with loved ones.

3. Where hospice care is provided and by who Hospice as an approach to care is not tied to a specific place. It can be offered: A t home or in a facility for example a nursing home, hospital, and/ or in a separate hospice center.

4. Hospice Care Hospice care brings a team of people with special skills for example spiritual advisors, nurses, social workers, doctors, and trained volunteers (National Institute on Aging, 2021). These professionals and the family work together with the one who is dying, to provide the medical, emotional, and spiritual support needed. Hospice care may be covered by Medicare and other insurance companies and including the National Hospital Insurance Fund (NHIF) in Kenya.

5. Hospice Care In hospice care stopping treatment aimed at curing an illness does not include discontinuing all treatment. An example is of an older person with cancer. If a doctor determines cancer is not responding to chemotherapy and a patient opts to enter into hospice care, chemotherapy will stop while other medical care will continue as long as it is helpful

6. Benefits of hospice care Families of patients receiving care through a hospice program tend to be more satisfied with end-of-life care than those who did not enroll into hospice services. Hospice patients are more likely to have their pain controlled; less likely to undergo tests and be given medicines which they don't need, in comparison to those who are bot using hospice care (National Institute on Aging, 2021).

7. Living Will Living wills and other “advance directives” refer to written, legal instructions concerning one’s preferences for medical care if he/she is unable to make decisions for self. “ Advance directives ” guides and provides choices for doctors and caregivers if one is in a coma, terminally ill, seriously injured, near the end of life or in the late stages of dementia (Mayo Clinic, 2020).

8. Living Will A living will refer to a written, legal document which spells out medical treatments one would and or wouldn’t want to be used to keep him/her alive, including one’s preferences for various medical decisions, for example pain management or/ and organ donation (Mayo Clinic, 2020) among others. These wishes are determined by one’s values. One may consider how important it is to be independent and self-sufficient, and identify under what circumstances he/she might feel like r life is not worth living and if he/she would you want treatment to extend his/her life in any situation.

9. Living Will One should address various possible end-of-life care decisions in the living will. In so doing one should consult a doctor while making the following medical decisions: Cardiopulmonary resuscitation (CPR), mechanical ventilation, tube feeding, dialysis, antibiotics or antiviral medications, comfort care (palliative care), organ and tissue donations, donating your body (Mayo Clinic, 2020).

10. Do-Not-resuscitate Order (DNR) A do-not-resuscitate order (DNR) is that legally binding order signed by a physician at the request of a patient. Its aim is to inform medical professionals a patient does not want to be resuscitated if he/she suddenly go into cardiac arrest or stop breathing (Morrow, 2022). Chronically ill patients often regard a DNR as a graceful way to exit the world.

11. Do-Not-resuscitate Order (DNR) Details of a DNR are mainly discussed at admission to a hospital, nursing facility, and hospice program. Resuscitate procedures may include: Chest compressions , Intubation , Cardioversion , IV medications . For a patient in cardiac or respiratory arrest, a DNR states that  none  of these tactics will be used.

12. Do-Not-resuscitate Order (DNR) A DNR order may be referred to by other names such as: No code, Allow natural death (AND) orders. DNR order states no endeavors should be made to restart breathing or restart the heart once it stops, however, the same order ensures only comfort measures are taken including withholding or discontinuing artificial feedings, fluids, resuscitation and other measures which would prolong a natural death.

13. Do-Not-resuscitate Order (DNR) The application of DNR order varies in different jurisdictions. DNR orders must: Be written and signed by a doctor and must include the patient’s name; no verbal. To ensure your wishes are respected as a patient: Keep physical order on hand and display to paramedics at all times. One may consider wearing medical jewelry designed specifically with DNR orders.

14. Stages of Death In 1969  Elizabeth Kubler-Ross  wrote  On Death and Dying coming with the Stage Theory by observing a pattern she expressed in the way of stages. Kubler-Ross alleged this to be universal, however, there is room for individual variation; not everyone undergoes through all these stages and the order may vary for each person (Jennings, Gemmill, Bohman & Lamb, n.d ).

15. Stages of Dying 1. Denial and Isolation:   This is considered an impermanent shock response to bad news. When Isolation crops in, sometimes family members also avoid the dying person. One may fall back into this stage when there are no new developments and the one feels he/she can no longer cope.

16. Stages of dying 2. Anger:  There are various ways in which patients express anger Anger at God coupled with questions like "Why me?" and the feeling that others are more deserving. Envy of others and blame others like “they don't seem to care; they are enjoying life while the dying person experiences pain.” Projected on environment like directing anger towards his/her doctors, nurses, and families.

17. Stages of dying 3. Bargaining:  This brief stage is hard to study since it is habitually between patient and God. They think if God didn't respond to his/her anger, then maybe being "good" will work. They make attempts to postpone by making suggestions in their minds like "If only I could live to see . . ."

18. Stages of dying 4. Depression:  The dying ones mourn for losses such as -Reactive depression (past losses): loss of job, hobbies, mobility. -Preparatory depression (losses yet to come): dependence on family etc.

19. Stages of Dying 5. Acceptance:  It is not a "happy" stage and is void of feelings. It takes time to reach this stage and one who fights until the end shall not reach it. It is principally giving up and appreciating death is inevitable. Hope  is a vital aspect at all stages; one’s hope helps through difficult times.

20. Criticisms of Kubler-Ross There’s no evidence stages exist in coping with death Specifically, evidence exist people coping with their impending death go through all the five stages The Stage Theory prescribe rather than describe  One's whole life could be over-looked at the expense of the stages they are to go through Environmental factors are ignored

21. The Five Stages of Grief Psychiatrist  Elisabeth Kübler-Ross   developed a theory which suggests we go through five stages of grief after the loss of a loved one namely: Denial, anger, bargaining, depression, and lastly acceptance. 1. Denial This is the first stage in this theory, it helps one minimize overwhelming pain of loss. As we internalize the reality of the loss, we are also trying to  survive emotional pain . It may be hard to believe the loss of an important person in our lives. Denial is not only an endeavor to pretend the loss does not exist; one is trying to absorb and understand what is happening (Clarkes, 2021).

22. The Five Stages of Grief 2. Anger Experiencing anger after the loss of a loved one is common. One is trying to adjust to the new reality and is experiencing extreme emotional discomfort. There is a lot to process which anger allows us an emotional outlet.

23. The Five Stages of Grief Anger continued…… Anger does not require one to be vulnerable; it tends to be socially acceptable rather than admitting we are scared. It enables us to express emotion with less fear of rejection or judgment. Anger can leave one feeling isolated in his/her experience and be perceived as unapproachable hence, the risk benefiting from comfort, connection, and reassurance of others.

24. The Five Stages of Grief 3. Bargaining: In coping with loss desperation cause one to be willing to do almost anything to mitigate the pain. There are many ways we may try to bargain. Bargaining can come in a variety of promises including: • "God, if you can heal this person, I will turn my life around." • "I promise to be better if you will let this person live." • "I'll never get angry again if you can stop him/her from dying or leaving me." At bargaining, we direct our requests to a higher power. There is acute awareness of our humanness.

25. The Five Stages of Grief 4. Depression In experience of processing grief, we slowly start to look at the reality of our present situation. We feel the loss of our loved one more. Panic subsides and emotional fog too clears, the loss feels more present and unavoidable. We pull inward as sadness grows. We might retreat, become less sociable, and reaching out less to others about what we are experiencing. Dealing with depression after loss of loved ones can be extremely isolating.

26. The Five Stages of Grief 5. Acceptance When we come to a place of acceptance, it is not that we no longer feel the pain of loss. However, we are no longer resisting the reality of our situation, and we are not struggling to make it something different. Sadness and regret can still be present in this phase, but the emotional survival tactics of denial, bargaining, and anger are less likely to be present.

27. Coping with Grief These suggestions can help one and his/her family deal with grief: Talking about the one who died while referring to the deceased by name, with friends or colleagues, in order to help one understand what happened and remember a friend or family member. Avoidance can lead to isolation and will disrupt the healing process with your support systems. Accept your feelings : You may experience a wide range of emotions from sadness, anger or even exhaustion. All of these feelings are normal and it’s important to recognize when you are feeling this way. 

28. Coping with Terminal Illness Empower Yourself Through Knowledge We fear most what we understand least, so  empower yourself by learning everything you can about how your illness  will affect you. Ask your healthcare provider(s) what physical, mental and/or emotional changes you should expect as your disease progresses. Search online or at a local library or bookstore for information specific to your illness—particularly for accounts by/about those with the same diagnosis—to discover how others have coped. In addition, learn to recognize common end-of-life symptoms so you can treat them, if possible, and improve the quality of your remaining time.

29. Coping with Terminal Illness Forgive Yourself in Advance There is no correct way to deal with a terminal illness, and you will experience a tremendous range of emotions in the weeks or months ahead, from anger and resentment to fear and depression. While such feelings are normal, how you will react to and manage them on any given day will be unique to you. Some days will be better than others, so  forgive yourself in advance for the times when you don’t handle something as well as you’d like  to.

30. Coping with Terminal Illness Set Your Priorities You know yourself best, and only you can determine the things most important to you in the time you have left. Depending upon the nature and extent of your illness, and after discussions with your healthcare provider(s) and loved ones, ask yourself if you wish to pursue all of the  treatment options available to prolong your life.

31. Coping with Terminal Illness Set Your Priorities Or would you rather focus on enhancing the quality of your remaining time and spending it with your family and friends? Somewhere in between? Making  an informed decision about how you wish to chart your remaining course can help  alleviate feelings of helplessness and fear.

32. Coping with Terminal Illness Plan for a "Good Death“ one in which you decide to  die on your own terms and as comfortably as possible —but you should also choose where you wish to die. While the nature and extent of your illness, treatment methods and the priorities you set will influence your decision, there are many  options  available to you. While many others would prefer to die at home, others might choose a hospital, nursing home or hospice facility, which can offer a greater level of skilled treatment.

33. Coping with Grief Talk Openly About It With so much thought and attention focused on you and your illness, it might be easy to forget that your loved ones will also experience a wide range of emotions as they attempt to cope with the thought of losing you. Your family and friends might also feel awkward or uncertain about what to say or how to act around you as they worry about uttering the wrong thing or reminding you about your illness.

34. Coping with Terminal Illness Establish a Practical Support Network The previous task helped improve the emotional support that you and your family will require in the days and months ahead, but you should also focus on creating a "practical support network" as soon as possible. Again, depending on the nature, extent, and physical, mental and/or emotional changes you anticipate as your illness progresses,  ask yourself if and for how long you want to continue handling daily chores , assuming you still can.

35. Coping with Terminal Illness Establish a Practical Support Network If you were responsible for cutting the lawn, picking up groceries, doing the laundry, paying bills, preparing meals, etc., consider who could or should assume those responsibilities when you're no longer able or simply wish to let go of them so you can devote your time to something else.

36. Coping with Terminal Illness Process that Paperwork Hopefully, you have taken the time to  create/update your will and insurance paperwork , but, if not, make that a priority and then let your family know where those documents are. You should also consider creating an advance healthcare directive, which puts your specific desires about your future healthcare in writing. This legally binding document encompasses two parts. The first is a  durable power of attorney  for health care, in which you will name someone (a  proxy ) who can make medical decisions for you should you become unable to do so.

37. Coping with Terminal Illness Preplan Your Funeral Attitudes toward funeral and memorial services and various forms of bodily disposition have changed over the years. One should preplan own funeral or memorial service  to ensure his/her wishes are met and make things slightly easier on your loved ones. You may speak to someone in your family to let them know what form of final disposition you would like (burial, cremation entombment, etc.) and the type of service you prefer (a traditional funeral in a church or funeral home, private cremation and a memorial service later, etc.).

38. Coping with Terminal Illness Say What Needs to be Said In the days and weeks ahead,  make a point of telling your friends and family members the things you'd like them to know —that you're proud of them or that you love them—and don't be surprised when they respond in kind.

39. Coping with Terminal Illness Carpe Diem Throughout our lives, we are often told to "seize the day" or "make every day count." Yet, given the pace of life as we hurry from one thing to another, too few of us understand that the most profound and memorable moments of our lives don't just happen on exotic vacations or big events but all around us, every day, whether we see them or not.

40. Coping with Terminal Illness Carpe Diem In the weeks or months ahead, if you find yourself overwhelmed with some of the preceding tasks listed here, or by the other items on your list, tell yourself it's okay to just stop and take time for yourself. Watch the sunset. Hold your spouse's hand or that of your child. Listen to the birds sing. Do whatever you need to do to find a simple moment of joy. You might not have the gift of time, but you certainly can  make the most of the time that you have .

41. References Clarkes, J. (2021, February 12th). Stages of Bereavement. Retrieved March 8th, 2022, from Very Well Mind: https://www.verywellmind.com/five-stages-of-grief-4175361 Jennings, B., Gemmill, C., Bohman , B., & Lamb, K. ( n.d ). Kubler-Ross and other Approaches. Retrieved March 8th, 2022, from University of Kentuky : https://www.uky.edu/~cperring/kr.htm

42. References Mayo Clinic. (2020, August 22nd). Living Wills and Advance Directives for Medical Decisions. Retrieved March 7th, 2022, from Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303 Morrow, A. (2022, February 4th). Overview of Do Not Resuscitate Orders. Retrieved March 7th, 2022, from Very Well Health: https://www.verywellhealth.com/hands-off-do-not-resuscitate-1132382

43. References National Institute on Aging. (2021, May 14th). What Are Palliative Care and Hospice Care? Retrieved March 7th, 2022, from National Institute on Aging: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care Watson, L. R., Fraser, M., & Buslovich , S. (Eds.). (2022). Dealing with loss. Retrieved March 8th, 2022, from University of Rochester Medical Center: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=1746

44. THE END I remain grateful to the group for having given me the honor an opportunity to serve as the secretary compiling this work though, while soaked in my own tears grieving the loss of my beloved son Raygram Deuloh Okong’o : the one I named after my Dad!