Rite of passage

Christine Anna FebruaryLecturer: Western Cape College of

Nursing/CPUTemail:christinefebruary@8tamail.com

Rite of passage defined

• Why rite of passage???

• Significance for student nurses intraining with particular reference tothe Western Cape??

Background

• Healthcare professionals are sometimes reluctantto care for dying patients (Beck:1997)

• Emotion of helpless experienced by thehealthcare professional.

• Typical example is the practice of transferring thepatient to a side room or back cubicle.

• Withdrawing from the patient and the family, is astrategy that has been used for many years withparticular reference to the hospital.

Aim of the study

• The primary aim of the literature reviewspecifically explores the attitudes of bothInternational and National student nurses incaring for the dying (Frommelt:1991).

• The second aim of the literature review ishighlighting the educational strategies forsupporting the nursing students throughouttheir training.

Physical care

• Inappropriate interventions, for example bloodtest and measurement of vital signs should bediscontinued (Field et al:1997).

• Evidence was found to be limited but doessuggest that continuing artificial fluids in thedying patients is of limited use and should inmost cases be discontinued.

• Patients in the dying phase should not besubjected to “cardiopulmonary resuscitation”, asthis constitutes a futile and inappropriate medicaltreatment.

Physical care (continued)

• Regular observations should be made andgood symptom control maintained includingcontrol of pain and agitation.

• Attention to mouth care is essential in thedying patient , and the family can beencouraged to provide sips of water ormoisten the patients mouth with a sponge.

• Invasive procedures for bowel care are rarelyneeded in the dying phase (Meier:2010).

Community services

• In the community, as required drugs need tobe readily accessible in the patients home.

• Twenty four hour district nursing servicesshould be made available and with thedevelopment of a general practitionercooperative out of hours services for thecontinuity of care (Adamson:2003).

Psychological care

• Patient’s insight into their condition should beassessed.

• Issues relating to dying and death should beexplored appropriately and with sensitivity.

• If family members are told clearly that the patientis dying they have the opportunity for closure andto ask questions (Defillippi:2006).

• It is important to stay with the patient, say theirgoodbyes, contact the relevant people and toprepare themselves for the death.

Psychological care( continued)

• Relatives of patients who are dying in thecommunity should be provided with contacttelephone numbers so that they have accessto help and advice on a 24 hour basis.

Clinical trajectory of care of dyingpatients

• Researcher’s construct

Recommendations

• To effectively and affectively disseminate thismodel of care the call to a greater educationalfocus is needed to address the issues ofdiagnosing and dying .

• Expertise in the care of the dying patientsneeds to be disseminated widely and toinclude the non-cancer population.

• A clear structure for care is needed toempower nurses in training.

Reflection:Relatives andfriends should beenabled to gothrough the deathof someone theylove feeling thatthey areexperiencing a“good death”

To dream this?

To be pain free ?

Do we fear ?

Together we can achieve this!

Thank you

References

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