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Chapter 06:
End-of-Life Issues in Critical
Care
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Recommendations to Improve End-of-Life
Care
See Box 6-1.
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Palliative Care
The goal of palliative care is to provide treatment that
relieves suffering.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Components of Palliative Care
• Advanced care planning
• Symptom management
• Family-centered care
• Holistic care
• Facilitate communication with family, client, and health
professionals
• Provide support to client and family on ethical issues
• Provide care for the caregiver
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Incorporating Palliative Care Throughout
the Patient’s Illness
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Common Symptoms Experienced at the
End of Life
• Pain
• Dyspnea
• Anxiety and insomnia
• Confusion/agitation
• Depression
• Nausea and vomiting
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Nurse’s Role Before and After the Family
Conference
See Box 6-2.
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How to Facilitate a Family Conference
See Box 6-3.
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Question
While discussing end-of-life care with a dying patient,
which of the following should the nurse consider first
when establishing a visiting schedule?
A. Consider the patient’s wishes first.
B. Consider the family’s wishes first.
C. Consider family dynamics first.
D. Consider making a schedule for visiting hours first.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
A. Consider the patient’s wishes first.
Rationale: The nurse needs to establish flexible visiting
hours for a patient at the end of life by considering the
patient’s wishes first because the patient will be more
open to discuss who may visit and who may not visit
when the nurse consults the patient first. The nurse will
need to assess family dynamics and determine a visiting
schedule that meets the patient’s needs and the family’s
needs.
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Question
Which of the following statements about end-of-life
sedation is correct?
A. Hospice uses end-of-life sedation as soon as a patient
enrolls in the program.
B. End-of-life sedation is used instead of pain medications.
C. End-of-life sedation is only used if all other measures
have failed to provide symptom control.
D. End-of-life sedation is used to decrease the amount of
pain medication used.
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Answer
C. End-of-life sedation is only used if all other measures
have failed to provide symptom control.
Rationale: End-of-life sedation is used by hospice or other
health care professionals when a specialist in palliative
care or pain management believes that all measures to
provide comfort have been tried and are ineffective to
provide comfort to the patient. The least amount of
sedation possible is used along with pain medications to
provide comfort. The sedation does not decrease the
need for pain medication.
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Question
Which of the following statements about family presence at
the time of resuscitation is correct?
A. Family members experience increased anxiety and
depression.
B. Family members are more likely to sue the hospital.
C. Hospitals should have a policy on how to deal with
family presence at the time of resuscitation.
D. Family members do not have a right to be present
during resuscitation.
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Answer
C. Hospitals should have a policy on how to deal with
family presence at the time of resuscitation.
Rationale: The AACN recommends that hospitals should
establish a policy on how to deal with family presence at
time of resuscitation. Research shows that family
presence is a right, and that it helps the family during
the grief process. Family members who are present
during resuscitation have not experienced more anxiety
or depression than members who were not present.
There is no evidence that family presence during
resuscitation will result in increased number of lawsuits.
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