June 2017

SENIORS
Let’s Talk About
Death and Dying
by Rose Tucker MSN, RN
Death and the dying process is probably the last topic
anyone wishes to discuss. But whether we like it or
not, we may be asked to make end-of-life decisions
for our loved ones without knowing their preferences.
It can be both emotionally draining on family to make these
choices and confusing as physicians and health-care
professionals use medical terms we may not fully understand.
As a registered nurse for nearly 30 years, I have had the
privilege to care for many people at the end-of-life and offer
support and guidance to their family members. The following
is some advice I have for anyone asked to make such difficult
decisions for a loved one admitted to the hospital and I also
discuss some common misconceptions about end-of-life care.
Our bodies are so complex and weaken differently that each
situation is approached differently. But one general question
that will need to be addressed in all end-of-life situations is
code status. When a person is admitted to the hospital they
will be asked if they have a “living will.” This is a document
that the patient may have signed prior to their decline in health
that indicates they do not wish to be kept alive artificially if
their condition is terminal. Unfortunately, not many of us have
prepared a living will in advance and now these decisions are
left to a spouse or close relative, or some other adult who has
been designated to act as the patient’s health care surrogate.
The options for
code status are ‘full
code’ or ‘do not
resuscitate’ (DNR).
A full code means
that as respirations
and heart function
become impaired
and will soon stop,
cardiopulmonary
resuscitation is
performed. CPR consists of compressing the patient’s chest
two inches at a rate of 100 times per minute until the patient is
either revived or the heart is unable to be restarted and death
ensues. If resuscitation is resumed, the patient will be on what
is often called ‘life-support.’ This means that the patient will now
be on a ventilator that will be breathing for them. The patient will
then be transferred to a critical care area of the hospital if not
already there.
96
JUNE 2017
A DNR code status means that CPR will not be performed
when respirations and heart function are impaired and close to
stopping, thus allowing death to occur. Different cultures and
religious beliefs may dictate these decisions. Because end-oflife
decisions are
so emotionally
difficult,
consulting with
a religious or
spiritual advisor
is suggested.
Another
recommendation
is to ask for a
family meeting
with the physician
and other health care professionals when overwhelmed with
decisions that need to be addressed.
As care is ongoing, I recommend the health care surrogate
consider goals for care. Often, a primary goal is comfort care
and pain management requested for the patient. Food and
water may be provided through tubes inserted in the body.
While a health care surrogate may feel hydrating the body will
only prolong the dying process, others would not consider
withholding water and nutrition when the patient is unable to eat
and drink on their own. Tests and procedures may be ordered
by a physician but of course, can be refused if it is believed
the tests and procedures are futile or causing unnecessary
discomfort to the patient.
A hospice consult may be suggested also. I urge
anyone not familiar with hospice to accept the consult
and listen with an open mind to the hospice nurse.
Hospice care can always be refused by the health care
surrogate when the consult is complete.
There are many options that are available when planning for
our loved one’s end-of-life care. Knowing what to expect and
clarifying any misconceptions can be discussed throughout
the admission. Expressing any concerns and asking questions
is strongly advised. Health care professionals have experience
with end-of-life care and can offer guidance when loss of a
loved one is near. So, let’s open the lines of communication and
start talking. P