Family Centered Care Protecting the Families Trust

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Family Centered Care Protecting the Families
Trust

•  End of Life Care in the ICU

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Questions to Run on?

• What are the roles of the interdisciplinary team
  with respect to the needs of the patient?
• What can you take to your hospital from today to
  better serve your families?

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End of Life Care

• What two things do we all want?
• A Meaningful Life
• A Peaceful, Dignified Death

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A More Compassionate Model of Care

• Focus on the
• Patient Family
• Physical
• Emotional
• Social
• Spiritual

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How do we earn trust?

• Trust Honesty, Integrity, reliance, ability
• Perception comes from the observation over time
  of our
• Attitudes
• Behaviors
• Create an environment of
• Compassion in Action

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End of Life Care Goals

• End of Life Care that provides dignity and
  respect for the patient.
• Timely updates on patients status
• Family/Physician Collaboration
• To inform families of end of life decisions and
  allow them the opportunity of Organ Donation

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What families want to know is

• That there is relief from symptoms.
• To know there is a Plan of Care.
• To receive timely adequate information
• To have control over decision making
• Family/Physician Collaboration

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What we can say?

• In the ER
• Your loved one has suffered a devastating brain
  injury. We are in the process of stabilizing him.
  He is being moved to the ICU. We are caring for
  him and will be examining him to see how he is
  doing. We will then meet and decide together the
  best course of treatment.

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Good patient care requires a team of interfacing
disciplines

• Medical specialties (MD, DO, PA)
• Nursing and Allied Health professions (RN, PT,
  OT, CNA, RPT, MIT, CLS)
• Psychology (Social Worker)
• Pastoral Care Chaplaincy (PCC)
• Philosophy Bioethics
• Community services Onelegacy
• Hospice Palliative Care
• Each discipline contributes a special
  perspective on human experience, which when taken
  together, can lead to a general understanding of
  the healing process.

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Care of the Patient Family
Family Patient
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Care of the Patient Family
Family Patient
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Physicians Role

• Inform Family
• Diagnosis, Prognosis
• Treatment Options
• Medical Catastrophic Brain Injury Guidelines
• Surgical
• DNR, (AND) Allow Natural Death Orders
• Perform Clinical Exams
• Declaration of Death
• End Of Life Decisions
• Withdrawal of Support
• Organ Donation is not a treatment option . It is
  an end of life decision.

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Physician Rules

• Never in the Hallway
• Family is distracted enough
• Team Approach
• Never Alone
• Always have Nurse or Social Worker, Chaplain
• No take backs
• Dont say Brain Death until it has been
  confirmed.

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Nursing

• Initiate the Process
• Timeliness triggers EOL Care Team
• Compassion in Action
• Maintain Patients Vital Signs
• CBIG guidelines
• Prevents extreme variations in Vitals
• Increased chance of patients survival
• Assess Family Needs
• Family guided through the care plan
• Reaffirm information to family

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Respiratory Therapy

• Treat Hypoxemia, Acidosis
• Critical in Maintaining Homeostasis
• Pulmonary Hygiene Protocols
• Apnea Testing
• Pre apnea ABG
• Post Apnea ABG

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Social Services

• Social Worker, Case Manager, Child Life
  Specialist
• Determine Legal Next of Kin
• Medical Aid and Assistance
• Notification Letters
• Supporting Families and children in grief

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Unresolved Issues and Fears

• Old feuds or broken relations
• Last visits, seeing people for the last time
• Lifetime project
• Unfinished business
• Funeral plans
• Financial plans
• Need to forgive or be forgiven
• Loss of control and dignity
• Being a burden
• Physical suffering

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Spiritual Care

• The Hospital Chaplain
• Supporting Families
• Notifying the appropriate Clergy

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End of Life Discussions

• Establish rapport and a caring relationship
• Ask about death-related beliefs and concerns
• Take time to listen
• Communicate empathy and respect
• Be nonjudgmental

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• The uncertainty is not the dying, its the
  preparation. We need to know how to deal with the
  inevitable deaths of loved ones and friends and
  patients.
• Death is the last enemy, but one that need not
  be feared.
• 
  Billy Graham
• Death and The
  Life After

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Life Goals

• A meaningful life
• A peaceful, dignified death
• There is a time for everything,
• and a season for every activity
• under heaven a time to be born
• and a time to die.

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OPOs Role

• Determine if patient is suitable to be a Donor
• Support Family with End of Life decisions
• Collaborative approach
• Designated Requester

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Team Collaboration
Family Organ Donation
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The Peridonation Period

• Families can not hope for their loved one to get
  better and hope that he can be an organ donor at
  the same time.

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Final Thoughts

• As you work to save a life, dont forget the
  family, because they will not forget the way that
  you treat them.
• Everyone of us can help make this difference
  Because that truly is the Right Thing to Do.
• Dr. Kenneth Moritzugo, MD
• US. Deputy Surgeon General