Nancy Joyner – Nearing The End Of Life: Dare To Care

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Nancy Joyner – Nearing The End Of Life: Dare To Care

Families ask . . . what would you do if this were your loved one? Learn how to reply without bias …
Creative ways to discuss withdrawing or withholding treatment
Manage patient pain and symptoms: Medical marijuana, morphine, palliative sedation or fewer medications?
Tips to guide code status conversations with patients and families
Resolve family dysfunction surrounding end of life decisions
Requests to “humanely euthanize”/hastening death: How to respond?
Hear powerful case studies that provide examples of expert, holistic care

Eleanor is an 83-year-old widowed lady with known chronic heart failure and advanced dementia. She is now hospitalized with a significant stroke and dysphagia. She does not have a healthcare directive and had never discussed what she would want, other than staying at home until she dies. She is full code. Her family still wants resuscitation attempted. Her children admit they are concerned about what is best for their mother.
What are options for Eleanor and her family? Would she benefit from artificial hydration and nutrition? How is she going to receive medications? Can some of her medications be discontinued? Who is going to be her caregiver?
In this compelling seminar, multiple case studies like Eleanor’s will provide you with examples that you can incorporate when care is more important than cure. To deliver expert, holistic care, healthcare professionals need to have a toolbox full of new interventions to promote quality care at the end of life.
Have you ever been asked, “what would you do if this was your family member?” Learn conversation options to use while staying neutral.
Did you know that a patient might enroll on hospice care and be a full code? We will discuss how this is done.
What can we do for patients seeking euthanasia who see this as the best solution? These situations are becoming more frequent. Anticipate how you will respond.
Strategies regarding comfort, communication, choices and control have unique issues and challenges for patients, families and health professionals. We have an obligation to know how to help provide emotional, spiritual, existential, and physical comfort for those who have life-limiting conditions and to support them through difficult decisions. It’s time to think outside the box.

Explain how complementary therapies enhance quality of life for patients.
Evaluate the risks and benefits of medical marijuana.
Acknowledge the eight domains of the National Consensus Project.
Analyze five complications related to artificial hydration and nutrition.
Explore ethical issues often seen at the end of life.
Formulate two strategies to diminish fear of death and dying.
Connect moral resiliency to palliative care.

An Inexact Art & Science

Illness and dying trajectories
Frailty
Dementia
Prognostication and prognostic scales
When to refer to palliative care or hospice (disease specific)

Essentials of Care: Comfort, Communication, Choices, Control

Comfort Always

Morphine: Still the gold standard?
Pain during the final hours of life
Drug misuse: How to avoid it
Opioids for dyspnea
Thirst vs. xerostomia
Medical marijuana

Complementary and alternative therapies

Emotional distress interventions
The role of spirituality
Palliative sedation
Communication: Everyone is Involved
Advance care planning: More than just a form
The terminology matters
Your role in these critical conversations
How much can we share?
Truth vs. hope
Code status discussions
DNR does not mean do not treat
Addressing concerns and needs of the family
Thanatophobia: Is it fear of dying or fear of death?
Premortem surge
Near death awareness
The dying process

Choices: Shared Decision-Making

Nutrition & hydration choices
Voluntarily Stopping Eating and Drinking (VSED): Benefits & burdens
Life-sustaining treatment
Non-beneficial treatment choices
Faith-based influences
Ventilator support
Dialysis or renal palliative care
Devices to extend life
Hastened death request: Why not humanely euthanize?

Allowing Control: Patient-Centered Care

Reframing hope
What do family members want you to consider
Who makes the decision
What about family dysfunction…
Is the focus quality or quantity?
Decision to withhold or withdraw care
Challenging decisions: Honoring patients’ wishes

Cultivating Moral Resiliency

Moral resilience–preserving/restoring integrity
Personal vs. professional grieving
Enabling character and honorable action
Ethical Competency