The questioning is appropriate in the situation of Helen. As a nurse, you need to ensure that the client is treated with dignity, that is, with honor and respect. Dying clients often feel they have lost control over their lives and over life itself. Helping Helen die with dignity involves maintaining their humanity, consistent with their values, beliefs, and culture. By introducing available options to the Helen and significant others, I can restore and support feelings of control. Some choices that Helen's family can make are location of care (home, hospital or hospice), time of appointments with health professionals, activity schedule, use of health resources, and times of visit (Matzo and Sherman, 2004). The family of Helen wants `to be able to manage the events preceding death so she can die peacefully. I can help Helen to determine her own physical, psychological, and social priorities. Dying people often strive for self fulfillment more than for self preservation, and may need to find meaning in continuing to live while suffering. Part of the nurse's challenge is to support the client's hope and will (Smeltzer, 2009). Nevertheless, the communication between Helen's family may not solve all decisional differences, her mother insist on interventions that health care professionals consider inadvisable. In case like this, the initial step is for all parties to focus on having clear goals of care.
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The decision of Helen's family for home care with hospice support focuses on symptoms control and pain management. Hospice care is always provided by a team of both health professionals and nonprofessionals to ensure a full range of care services. In the case of Helen, palliative care will be the option. This care may be given to meet her physiological need (Matzo, 2005). Ventilatory support for Helen can improve her respiratory functioning and relieve symptoms of respiratory distress using mechanical ventilation. While the decision made by the mother wanting her daughter to be vented are often reached by consensus with the patient and her family, patient do have an opportunity to designate a family member as a healthcare proxy.
2. What interventions would be most effective with Helen's family members?
The reaction of any person to another person's impending death depends on all factors regarding loss and the development of the concept of death. In spite of the individual variations in person's view about the cause of death, spiritual beliefs, availability of support systems, or other factor, responses tend to cluster in the process.
To help the family, spiritual support is of great importance in dealing with death. Although not all clients identify with specific religious faith or belief, most have a need for meaning in their lives, particularly as they experience a terminal illness. Establish a communication relationship that shows concern for and commitment to the family and client. There are also communication strategies that let Helen and her family knows that you are available to talk about death (Smeltzer, 2009). Caring for Helen's family members is an important intervention in caring for the terminally ill patient. Family-centered interventions and care is focused on the goal, needs and values of the family and patient including their understanding of the treatment options, illness, prognosis and their preferences and expectations for decision making and treatment (Matzo and Sherman, 2004).
The skills most relevant to this situation of the family are attentive listening, silence, open and close questioning, clarifying and reflecting feeling. Less helpful to the family are responses that give advice and evaluation, those that interpret and analyze, and those that give unwarranted reassurance. To ensure effective communication, the nurse must make an accurate assessment of what is appropriate for the client. Communication with the family needs to be relevant to their feeling and situation. Whether the clients are angry or depressed affects how the client hears messages and how the nurse interprets the client's statement (Matzo, 2005).
In facilitating nursing interventions, the nurse must explore and respect the family's ethnic, cultural, religious and personal values inn their expressions of feelings. Teach the family what to expect in the process, such as certain thought and feelings and that labile emotions, feeling of sadness, anger, guilt, loneliness and fear will lessen or stabilize over time. Knowing what to expect may lessen the intensity of some reactions. Encourage her family to express their thoughts and feelings, not to push the family to move on or enforce their own expectations of inappropriate reactions. Encourage the family to resume normal activities after death on schedule that promotes psychological and physical health. Some family member may also try to return to normal activities too quickly. However, a prolonged delay in return may indicate dysfunctional grieving (Matzo and Sherman, 2004).
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3. What specific symptom(s) clusters need to be addressed in Helen's case?
Nursing management of the client experiencing a loss is important. Physiological need must be addressed first including palliative care such as pain management and life support. The goal of management in end-of-life care for Helen is the prevention or alleviation of dyspnea, pain and other distressing symptoms. Hygiene and psychological support is also important factor to consider. To gather a complete database that allows accurate analysis and identification of appropriate nursing diagnoses for dying client and their family, the nurse first needs to recognize the states of awareness manifested by the client and the family members (Smeltzer, 2009). In case of Helen, the state of awareness shared by the dying person and the family affects the nurse ability to communicate freely with clients and other health care team members and to assist in the grieving process. The nurse must also need to be knowledgeable about the client's death related rituals such as last rites, chanting at the bedside and other rituals. The nurse must also recognize the states of awareness manifested by the client and family members. As nurses, we also need to maintain physiologic and psychological comfort and achieving a peaceful and dignified death, which includes maintaining personal control and accepting declining health status (Matzo and Sherman, 2004). The roles of health care team in care management of dying patient are very important. This implies the vital responsibilities of nurse to do the best and competent care to achieve the peaceful death of the patient. The primary role is to ensure that the patient received the highest possible intervention best suited for her. Nurses must include the family of the patient in the care management, emphasizing nurses' role as essential factor to maintain dignity of dying client (Matzo, 2005).