Licensed Practical Nurse: A Case Study
Throughout life there are numerous certainties that one will experience. All individuals who are born, must die. Dying is the end stage of life that most individuals fear. People begin to rapidly lose their health, and begin their preparations for their departure. This type of care in the health field is referred to as hospice. As a Licensed Practical Nurse, there are certain standards of care that the nurse is responsible for, as well as taking care of the family.
When a patient is placed in to hospice care, it is because they have less than 6 months to live, according to their physician. As a hospice nurse there are certain standards of care that must be performed when taking care of a patient with hospice needs. An LPN is licensed to assess, create care plans, preform nursing techniques, converse with the doctor on a client’s care, and provide all bedside means necessary for the patient. The Licensed Practical Nurse provides all skilled nursing methods as directed by the Registered Nurse.
There are several stages of dying through which many terminally ill patients will progress. The first is denial. Denial is …show more content…
the psychological defense mechanism by which a person refuse to believe certain information. Second is anger, the emotional response to feeling victimized which occurs because there is no way to retaliate against fate. Clients often displace their anger onto nurses, physicians, and even God. The next stage is bargaining, which is a mechanism for delaying the inevitable. This involves negotiation, usually with God or a higher power. The next stage is depression, this indicates the realization that death will come sooner rather than later. Finally the last stage of death describe by Dr. Elisabeth Ross (1969) is acceptance. Acceptance is an attitude of complacency, this occurs after clients have dealt with their losses and completed unfinished business.
The nurse providing hospice care may assist the patient’s passage through the stages of dying to acceptance. By listening to the clients concerns and emotional state through the stages of dying, the client’s integrity remains and establishes a relationship between the nurse and the patient. According to Fundamental Nursing Skills and Concepts (Timby), “Death is a very individualized experience that is highly influenced by prior experiences, cultural practices, and level of personal development. Many older adults are realistically aware of their pending and inevitable death. Often, they are relieved when health care providers are comfortable discussing death with them. Older adults may benefit from counseling regarding their own death and dying, especially if they have a history of accepting help with coping with challenging issues.”
While providing hospice care for a patient and helping them achieve the goal of acceptance, a nurse may be required to give respite care. Respite care is relief for the caregiver by a surrogate. This type of care is extremely beneficial to the family, especially the primary care provider. This is important because it allows the primary caregiver outside of the home to enjoy a short-lived moment outside of the home. Many caregivers to a hospice patient have families of their own. Respite care allows for the caregivers to take care of themselves and reconnect with their inner household needs.
Most hospice patients live within their own homes or a skilled nursing facility. There are basic needs that become the nurse’s priority to a patient when providing terminal care. It is extremely important when caring for an elder patient to maintain their integrity. The nurse can fully explain every procedure and keep the client on the status of their health, as well as, what may be approaching. These needs include hydration, nourishment, elimination, hygiene, and positioning. Some patients become in content and the nurse will insert a catheter for urinary elimination, and may preform enemas for bowel elimination. Maintaining a client’s dignity is largely effected by their hygiene and appearance. This is also important for the family. The nurse wants to keep the client looking, “as normal as possible.” Nurses also attempt to keep the patient smelling as pleasant as possible.
Numerous elderly adults are realistic when approaching death.
They have lost their family, friends, and many other people there age. According to Fundamental Nursing Skills and Concepts (Timby), “Older adults may read obituaries and death notices in the newspaper daily in an effort to keep up with acquaintances. Families may view this activity as potentially depressing, but it may actually be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death.” Larry Lafferty once said, “You cannot add days to a person’s life, but you can add life to someone’s days.” This concept is vital in hospice care. The patient is terminally ill, and knows that they are soon approaching the end. The nurse is responsible to creating a comfortable environment for the patient that still remains the inaction of the patient’s
integrity.
A licensed practical nurse is responsible for numerous responsibilities during the “approaching death” time. The nurse will get the family to be involved in a phenomenon referred to as, “Waiting for permission.” During this phenomenon, the terminal ill patient will wait for permission from the family to “let go.” Shortly after the patient receives this “permission” from loved ones, death follows. Nurses are there to support the family at this time. After the death of the hospice patient, many family members may feel as if they have inadequately provided for their loved one, resulting in their death.
There are several indicators of an approaching death. The first indication of such is organ failure. This is directly affected by the amount of oxygen that an individual is using to sustain life. When oxygen levels fall below the required amounts, the cellular oxygenation begins to decrees which leads to the degeneration of cells, tissues, organs, and eventually entire organ systems. A patient will go into a state of hypoxia, which is low levels of oxygen on the cellular levels, which will lead to hypoxemia, low levels of oxygen in the blood. Hypoxemia untreated is fatal.
If the patient is showing signs of an approaching death, the nurse must make the family aware of this approaching time. While a LPN, may inform the family of this time, only a RN may pronounce a time of death. If the death of the patient has already taken place before a nurse is able to speak with the family, it is the physician’s responsibility for reaching out the family. The news of a loved one’s death is tragic. In many circumstances, the nurse or physician will wait until the family arrives at the facility to deliver the horrible news. Delaying this information will prevent traffic accidents and possible suicides. Nurses are responsible for post mortem care. This involves numerous post mortem preparations such as cleaning the body to keep the appearance of the patient as “normal” as possible. Keeping the patient as “normal” as possible is a nursing implication done for the serving family. This also ensures proper identification for the family, and funeral home. After the death of the hospice, or terminally ill patient, the surviving family members will experience grief. Greif is defined as, the feelings of acute sorrow over a loss. Numerous individuals experience what is called anticipatory loss, grieving that beings before the loss occurs. According to The Fundamental Nursing Skills and Concepts (Timby), “The longer that people have to anticipate a loss, the sooner they eventually resolve it.” The nurse will offer counseling series to the family as well as education of resources for the family to utilize after the traumatizing loss of their loved one. According to The Fundamental Nursing Skills and Concepts (Timby), “Research has shown that some people develop life threating illnesses and die 6 months of the death of a spouse. Encouraging older adults who have experienced the death of a close friend or family member to express feelings associated with grieving is important. Referrals for individual counseling or grief support groups are appropriate.”
There is no “normal” amount of time for grieving. Each individual experiences loss for numerous amounts of times, in numerous different ways. The nurse has a responsibility to the family to recognize when a person is experiencing “pathologic grief”. Pathologic grief is when an individual cannot cope with a person’s death. Survivors of the deceased may hold on to possessions, or hold séances, or keep their rooms closed off as a shield. The nurse again, should offer resources for counseling to the family members. Emotional support is forever a part of nursing, and an essential component to hospice nursing. Hospice nursing is challenging and rewarding. The nurse is able to have to occasion to make an individual’s passing as contented as permutable. The nurse is able to add “life” to a patients remaining days, provide medical attention under the direction of a RN or physician, assist the family with emotional support and respite care, while maintaining the integrity of the client.
Bibliography
Timby, B. K. (2013). Fundamental Nursing Skills and Concepts. Philadelphia: Lippincott Williams& Wilkins.
When a patient is placed in to hospice care, it is because they have less than 6 months to live, according to their physician. As a hospice nurse there are certain standards of care that must be performed when taking care of a patient with hospice needs. An LPN is licensed to assess, create care plans, preform nursing techniques, converse with the doctor on a client’s care, and provide all bedside means necessary for the patient. The Licensed Practical Nurse provides all skilled nursing methods as directed by the Registered Nurse.
There are several stages of dying through which many terminally ill patients will progress. The first is denial. Denial is …show more content…
the psychological defense mechanism by which a person refuse to believe certain information. Second is anger, the emotional response to feeling victimized which occurs because there is no way to retaliate against fate. Clients often displace their anger onto nurses, physicians, and even God. The next stage is bargaining, which is a mechanism for delaying the inevitable. This involves negotiation, usually with God or a higher power. The next stage is depression, this indicates the realization that death will come sooner rather than later. Finally the last stage of death describe by Dr. Elisabeth Ross (1969) is acceptance. Acceptance is an attitude of complacency, this occurs after clients have dealt with their losses and completed unfinished business.
The nurse providing hospice care may assist the patient’s passage through the stages of dying to acceptance. By listening to the clients concerns and emotional state through the stages of dying, the client’s integrity remains and establishes a relationship between the nurse and the patient. According to Fundamental Nursing Skills and Concepts (Timby), “Death is a very individualized experience that is highly influenced by prior experiences, cultural practices, and level of personal development. Many older adults are realistically aware of their pending and inevitable death. Often, they are relieved when health care providers are comfortable discussing death with them. Older adults may benefit from counseling regarding their own death and dying, especially if they have a history of accepting help with coping with challenging issues.”
While providing hospice care for a patient and helping them achieve the goal of acceptance, a nurse may be required to give respite care. Respite care is relief for the caregiver by a surrogate. This type of care is extremely beneficial to the family, especially the primary care provider. This is important because it allows the primary caregiver outside of the home to enjoy a short-lived moment outside of the home. Many caregivers to a hospice patient have families of their own. Respite care allows for the caregivers to take care of themselves and reconnect with their inner household needs.
Most hospice patients live within their own homes or a skilled nursing facility. There are basic needs that become the nurse’s priority to a patient when providing terminal care. It is extremely important when caring for an elder patient to maintain their integrity. The nurse can fully explain every procedure and keep the client on the status of their health, as well as, what may be approaching. These needs include hydration, nourishment, elimination, hygiene, and positioning. Some patients become in content and the nurse will insert a catheter for urinary elimination, and may preform enemas for bowel elimination. Maintaining a client’s dignity is largely effected by their hygiene and appearance. This is also important for the family. The nurse wants to keep the client looking, “as normal as possible.” Nurses also attempt to keep the patient smelling as pleasant as possible.
Numerous elderly adults are realistic when approaching death.
They have lost their family, friends, and many other people there age. According to Fundamental Nursing Skills and Concepts (Timby), “Older adults may read obituaries and death notices in the newspaper daily in an effort to keep up with acquaintances. Families may view this activity as potentially depressing, but it may actually be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death.” Larry Lafferty once said, “You cannot add days to a person’s life, but you can add life to someone’s days.” This concept is vital in hospice care. The patient is terminally ill, and knows that they are soon approaching the end. The nurse is responsible to creating a comfortable environment for the patient that still remains the inaction of the patient’s
integrity.
A licensed practical nurse is responsible for numerous responsibilities during the “approaching death” time. The nurse will get the family to be involved in a phenomenon referred to as, “Waiting for permission.” During this phenomenon, the terminal ill patient will wait for permission from the family to “let go.” Shortly after the patient receives this “permission” from loved ones, death follows. Nurses are there to support the family at this time. After the death of the hospice patient, many family members may feel as if they have inadequately provided for their loved one, resulting in their death.
There are several indicators of an approaching death. The first indication of such is organ failure. This is directly affected by the amount of oxygen that an individual is using to sustain life. When oxygen levels fall below the required amounts, the cellular oxygenation begins to decrees which leads to the degeneration of cells, tissues, organs, and eventually entire organ systems. A patient will go into a state of hypoxia, which is low levels of oxygen on the cellular levels, which will lead to hypoxemia, low levels of oxygen in the blood. Hypoxemia untreated is fatal.
If the patient is showing signs of an approaching death, the nurse must make the family aware of this approaching time. While a LPN, may inform the family of this time, only a RN may pronounce a time of death. If the death of the patient has already taken place before a nurse is able to speak with the family, it is the physician’s responsibility for reaching out the family. The news of a loved one’s death is tragic. In many circumstances, the nurse or physician will wait until the family arrives at the facility to deliver the horrible news. Delaying this information will prevent traffic accidents and possible suicides. Nurses are responsible for post mortem care. This involves numerous post mortem preparations such as cleaning the body to keep the appearance of the patient as “normal” as possible. Keeping the patient as “normal” as possible is a nursing implication done for the serving family. This also ensures proper identification for the family, and funeral home. After the death of the hospice, or terminally ill patient, the surviving family members will experience grief. Greif is defined as, the feelings of acute sorrow over a loss. Numerous individuals experience what is called anticipatory loss, grieving that beings before the loss occurs. According to The Fundamental Nursing Skills and Concepts (Timby), “The longer that people have to anticipate a loss, the sooner they eventually resolve it.” The nurse will offer counseling series to the family as well as education of resources for the family to utilize after the traumatizing loss of their loved one. According to The Fundamental Nursing Skills and Concepts (Timby), “Research has shown that some people develop life threating illnesses and die 6 months of the death of a spouse. Encouraging older adults who have experienced the death of a close friend or family member to express feelings associated with grieving is important. Referrals for individual counseling or grief support groups are appropriate.”
There is no “normal” amount of time for grieving. Each individual experiences loss for numerous amounts of times, in numerous different ways. The nurse has a responsibility to the family to recognize when a person is experiencing “pathologic grief”. Pathologic grief is when an individual cannot cope with a person’s death. Survivors of the deceased may hold on to possessions, or hold séances, or keep their rooms closed off as a shield. The nurse again, should offer resources for counseling to the family members. Emotional support is forever a part of nursing, and an essential component to hospice nursing. Hospice nursing is challenging and rewarding. The nurse is able to have to occasion to make an individual’s passing as contented as permutable. The nurse is able to add “life” to a patients remaining days, provide medical attention under the direction of a RN or physician, assist the family with emotional support and respite care, while maintaining the integrity of the client.
Bibliography
Timby, B. K. (2013). Fundamental Nursing Skills and Concepts. Philadelphia: Lippincott Williams& Wilkins.