Self Directed Learning Package - University of Queensland

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154 • The Palliative Approach ToolkitThinking PointAlfred looks like he may die in the next day or so. Heis not eating and drinks only a few sips of water eachshift. He spends most of the time sleeping and needsassistance with all of his ADLs. When he is asked aquestion he sometimes opens his eyes but does notspeak. This has been a significant change for theworse from one week ago.Do you think he is displaying signs of approachingdeath?Key PointReport to a nurse if the resident appears to haveany of the following:• pain• nausea and vomiting• breathing difficulties• agitation• any redness or leaking around a subcutaneouscannula (butterfly needle).When someone is commenced on the RAC EoLCP the followingchanges to their care may occur:• Non-essential medications are stopped.• Changes occur in how other medications are administered.Medication may be administered by injection or under thetongue instead of orally. The medication may target pain,nausea, anxiety or breathing difficulties.• Non-essential clinical interventions and observations arestopped e.g. blood pressure monitoring, weighs, blood sugarmonitoring.• Special equipment may be organised e.g. a special pressurerelieving mattress or other comfort aids.What is the careworker’s role when a residentis on the RAC EoLCP?Your role includes delivering the care listed on the Pathway’scomfort care chart.The chart also sets out common comfort care measures that arereviewed at least every four hours:• comfortable positioning• couth care• eye care• skin care• micturition (urinary elimination)• bowel care.Support for resident and family membersThinking PointAlfred’s daughter Sarah has met you many timeswhen she visits her father. Today she approaches youand starts crying. She asks you how long you think itwill be until Alfred dies. What could you do?You may be asked to fill this in regularly during your shift.
155 • Self Directed Learning Package - CareworkerFamily members often spend many hours with the resident atthis time. They may share with you their sadness and grief. Theymay ask you questions about what is happening.Key PointIt is OK to respond to these questions so longas they are within your scope of practice as acareworker. If you are unsure of what to say (orthe questions are about nursing or medical issues),reassure the family and tell them you will ask thenurse to come and speak with them.When the resident diesWhen death occurs, the resident stops breathing and theheart stops beating. There will be no response to verbalor physical stimulation. The mouth and eyes may be open(the pupils will be large and fixed on one spot). The residentmay have also lost control of their bladder and bowel.Self-careKey PointNo one ever complained that someone cried; butthey have complained that no one seemed to care.Close relationships can develop between careworkers andresidents. It is important to be aware that when a resident dies,you may grieve as well. You are not expected to be a robot, andit is possible that you may feel sad, angry, upset, confused, guiltyor even relieved at this time. Feelings of grief are different foreveryone and are a normal reaction to a loss.The following suggestions may assist you with your grief:• ask the family’s permission to attend the funeral• talk to your supervisor or colleagues about how you arefeeling• seek support from a professional counsellor.If you are the first person to find a resident who has died,immediately notify a nurse. They will contact the doctor whowill need to legally certify that the resident has died.Grief and lossReminisce with family and friends of the deceased resident ifyou feel comfortable to do so. It shows you saw the resident asan individual, not just “another resident”.Acknowledge the grief of those around you. If family membersare visibly upset, you can say ‘It must be hard for you; it is adifficult time…’ Showing family members you are upset e.g.crying is all right.SUCCESS!You have completed Section 2 of the learning package.Please go on with the quiz.
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