Myth: Fluids, tube feeding and TPN save lives and can help all patients recover from illness.
Truth: While these methods of nutrition save lives and play a major role in recovery from surgery and protect patients against the transient and toxic effects of cancer treatment, these benefits are not demonstrated in the terminally ill patients.
Myth: Dehydration and starvation lead to a very painful and unpleasant death.
Truth: While dehydration and starvation can be painful ways to die for otherwise healthy individuals, studies have shown that terminally ill patients do not suffer when nutrition and hydration are withdrawn. In fact, it is hypothesized that advanced stages of dehydration may lead to the release of a compound from the brain which causes an analgesic effect. Ketones produced during starvation also produce an analgesic effect.
Myth: There are no benefits to dehydration.
Truth: Dehydration allows for a series of physiologic changes which actually allow for increased comfort in a terminally ill patient. A decrease in urine output results in less need for a bedpan, commode or catheterization and fewer bed-wetting episodes. A decrease in gastrointestinal fluid leads to fewer bouts of vomiting. A decrease in pulmonary secretions leads to less coughing, choking and need for suctioning. Reducing the edematous layer surrounding a tumor diminishes the size of a tumor and reduces the associated pain and symptoms caused by the tumor. Reducing fluids leads to a decrease in painful ascites as well as fluid third spacing and general edema. Dehydration also allows for a decrease in wound and fistula drainage.
Myth: Dehydrated patients feel thirst.
Truth: Studies have proved that dehydrated patients do not feel thirst. As long as the patient’s mouth is kept moist, he or she will not feel thirsty or uncomfortable.
Myth: Artificial hydration allows the patient to live longer and spend more quality time with loved ones.
Truth: Studies have proved that dehydrating a patient does not shorten their life. Sustaining artificial fluids and nutrition requires intravenous lines, wires and pumps and sometimes restrain the patient so that he or she does not pull the lines out. These high-tech devices can be a barrier between the patient and the family and can take away from the closeness between patient and family at the time of death.
Myth: Hydration will increase alertness and comfort at end-of-life.
Truth: While hydration may increase alertness, it decreases the amount of natural analgesics which are released in the blood. This will not only take away from the body’s natural analgesic effect but will make the patient more aware of the pain. Studies have revealed dehydrated patients are often more comfortable than those who are hydrated.
Myth: Dehydrating a terminally ill patient causes abnormalities in blood chemistries and related symptoms.
Truth: Researchers have found surprisingly normal blood levels in dehydrated terminally ill patients.
Myth: Starvation is inhumane and a form of punishment.
Truth: Our society traditionally views food and drink as a symbol of love, nurturing and caring. Food and drink are symbolic and a part of most cultural rituals. Providing food to those who are unable to feed themselves is often viewed as an act of nurturing, and taking food away is viewed as a form of depersonalization. In contrast, the withholding of these traditional symbols has been viewed as punishment reserved for social outcasts and misfits. It is for these reasons that it is so difficult for some families to withdraw nutrition. However, artificial nutrition and hydration are not the “normal” way of eating, it is the medical way and families often see it as antisocial. Withdrawing of nutrition and hydration is not punishment but a humane intervention since it has been shown to produce analgesic effects on the patient.
Myth: Withdrawal of nutrition and hydration is a form of euthanasia.
Truth: Withdrawal of nutrition and hydration is not euthanasia. Artificial nutrition and hydration are considered medical treatments. Patient and families have the right to refuse these treatments and it is not considered murder or suicide. It is the underlying disease that will kill the patient, not the withdrawal of artificial nutrition and hydration.
Myth: Once artificial nutrition/hydration is started it cannot be stopped.
Truth: This statement is false. Stopping these treatments is both legally and ethically acceptable. The law requires that the treatment be terminated if the patient does not want it.
Myth: The health care provider has the right to make decisions regarding withholding/withdrawing hydration and nutrition.
Truth: If individuals have made their wishes known, the health care provider must honor these wishes. If he or she is uncomfortable with the situation, care can be transferred to another provider who will respect the patient’s decision.
Myth: Once the nutrition/hydration are withdrawn or withheld, the patient will be abandoned by the health care team.
Truth: Withdrawal of nutrition/hydration is not synonymous with withdrawal of treatment. Patients still require symptom management and daily care to assure a comfortable death. This care can and should be provided regardless of nutrition and hydration status. It is considered unethical and unprofessional as well as illegal to neglect of abandon a patient.
Posted: March 5, 2018 by trecadmin
NHD DAY 2017
The TREC annual Healthcare Decisions Day event took place on Thursday, April 6, 2017 at the Rowan Medical School in Stratford. Our keynote speaker was Camden County Surrogate Michelle Gentek Mayer speaking on the New Jersey Conversation of Your Life project.
View photos from the event below:
Last Updated: September 13, 2016 by trecadmin
Understanding the Hospice Benefit
What is Hospice?
Who benefits from Hospice?
Where does Hospice provide care?
When is the right time for Hospice Care?
How is Hospice paid for?
How to contact a Hospice?
The Interdisciplinary Group provides for the physical, psychosocial, spiritual, and emotional needs of a terminally ill person and/or their family members, based on individual assessment, goals and plan of care. You may have any of the following involved in your Hospice care:
Physicians: Two physicians generally are involved in your care.
Attending Physician: You will be asked to choose a Doctor when you elect to receive hospice care, as your primary physician; that physician has the most significant role in the determination and delivery of the individual’s medical care. You can choose one of your personal doctors to be in this role.
Medical Director: The Hospice will also have a Medical Director who is educated in areas specific to Hospice (i.e. pain, nausea, comfort measures). This physician will be aware of your situation via report from the rest of the team as well as by reviewing records. They will assist in your care and, at times, visit persons to ensure the hospice team is providing optimal care. The Hospice Medical Director will talk with your physician as needed.
Nurses: RNs and LPNs who are trained in pain and symptom management and end-of-life issues. You will usually be assigned one primary RN case manager who will do most nursing visits and manage your needs. Nurses are available “on-call” during evening and weekend hours.
Social Workers: Licensed Social Workers assist with emotional concerns, address issues causing stress and have information on additional community resources when needed.
Chaplains: Persons trained in a variety of Faiths and Religions are available to address your spiritual needs, provide spiritual comfort and counseling; they can also assist with contacting community clergy if needed/ requested.
Hospice Aides/ Certified Home Health Aides (as needed in NJ): Hospice Aides are assigned on an individualized basis when an RN case manager determines that there is need for this personal care. Hospice strives to allow you to be independent and cared for by loved ones; when additional help is needed the Hospice Aide will assist with bathing, personal hygiene, the person’s personal needs and personal space. They also assist in educating your loved ones on how to provide care while maintaining your dignity, privacy and safety.
Hospice Volunteer Coordinator and Volunteers: These are specially trained persons who will support persons and families as friendly visitors and family support as needed/ requested.
Bereavement Coordinator and counseling: Hospices provide ongoing support to you and your family specific to issues related to grief, loss, and mourning. The Bereavement Coordinator ensures these needs are addressed while you are on Hospice and after.
Dietary Counseling, Alternative Care/ Therapies (Physical/ Speech/ Music/ Pet- The Hospice Interdisciplinary Group works with counselors and therapists to provide comfort to the person. When this is required the Hospice will work with the person and family to find the appropriate Provider to address the identified need.
Hospice is highly individualized care – based on your needs and desires. Any services by Hospice are coordinated with your input and as needed by you.
Last Updated: September 13, 2016 by trecadmin
CPR/DNR: A Guide for Family Members
Most peoples’ understanding of Cardio Pulmonary Resuscitation or CPR is based on what they have seen on television or at the movies. A person collapses from a heart attack and a crash cart, led by doctors and nurses, comes rushing down the hall to bring the victim back to life.
This popular image has led many people to believe that CPR is used to save someone from dying, or to bring a person who has died back to life. This is not a completely accurate picture of CPR.
WHAT IS CPR?
CPR is an emergency method of life saving under certain limited circumstances, usually an event which causes the heart to stop beating in a person who otherwise has normally working organs such as the heart, kidneys, liver and brain.
If these organs are significantly damaged, the body cannot sustain itself and the heart stoppage is usually a result of the deterioration of the body in general.
CPR involves artificial respiration (breathing into the person’s mouth) and external heart massage, usually after a sudden event such as a cardiac arrest, drowning or high voltage electric shock in a body that is otherwise reasonably healthy. No matter what the cause, if the heart is stopped for too long permanent brain damage or death will occur.
HOW EFFECTIVE IS CPR?
CPR’s effectiveness depends on the previous health of the person, the cause of the heart stoppage and the speed with which CPR can be administered. CPR is most effective if begun within a few minutes after a cardiac arrest and if there is follow-up care in a hospital intensive care unit. It is most successful when the victim is a reasonably healthy person who has had a sudden loss of normal heart function. In these situations, attempting CPR may be very worthwhile, with a survival rate ranging from 10 to 40 percent.
WHAT IS THE ROLE OF CPR IN A LONG-TERM CARE SETTING?
People who become patients and residents in long term care settings such as nursing homes, homes for aged and chronic care hospitals usually have many chronic health problems affecting many organs of the body including the heart, kidneys, liver and brain. Research and experience have shown that CPR is unlikely to have a positive outcome for most of these individuals, especially when they are also very elderly. When someone with many chronic health problems has a cardiac arrest, it is not an isolated event nor is it likely to be reversible. The cardiac arrest is usually part of a complex process. Many parts of the body are already affected by disease and a cardiac arrest is often the final step in a progressive and complex process of deterioration leading to death.
WHAT ARE THE CHANCES OF SURVIVING CARDIAC ARREST?
The odds of long term care residents and in-patients surviving a cardiac arrest are slight. Even under the best circumstances with the least compromised individuals, only 2 to 3 percent whose hearts stop suddenly survive after receiving CPR. If there are pre-existing medical conditions, studies have shown that the likelihood of surviving CPR for those individuals is closer to zero.
WHY NOT TRY CPR ANYWAY?
If CPR were a simple, painless and dignified procedure that was readily available, there would be no reason to recommend against using it in the long term care setting. However, CPR requires intense treatment by doctors, nurses and other staff members, and the procedure itself may cause painful damage to the chest wall, ribs and internal organs.
CPR involves placing a person on a hard surface, either on a board if in bed or directly on the floor, pumping the chest vigorously and forcefully and at the same time breathing for the person. A breathing tube may be inserted into the windpipe and oxygen delivered to assist in breathing. In many cases, an intravenous line must be quickly inserted to deliver medications, and it is often necessary to apply a number of electrical shocks to the heart through paddles placed on the chest.
Some people residing in long term care settings respond at first to the CPR treatment. It is then usually necessary to transfer them to an intensive care unit at an acute care hospital to be maintained on a respirator. However, the vast majority of people who survive at first in these circumstances die within a few hours or days.
WHAT IS A DNR ORDER?
A DNR order will protect the person from unnecessary attempts at CPR which will offer virtually no medical benefit. When a person has agreed to a DNR order, this order is written into the health care record (the chart) by the physician. It tells the medical and nursing staff that, in the event of disorder affecting the heart such as a heart attack or other cause of cardiac arrest, certain resuscitative procedures are not to be started.
A DNR order applies only to the process of CPR and not to any other medical treatments. All other treatments can be considered and decisions about them will be made as usual, based on the person’s needs and interests and potential benefits.
References
Last Updated: September 13, 2016 by trecadmin
Myths and Truths About Artificial Hydration and Nutrition
Myth: Fluids, tube feeding and TPN save lives and can help all patients recover from illness.
Truth: While these methods of nutrition save lives and play a major role in recovery from surgery and protect patients against the transient and toxic effects of cancer treatment, these benefits are not demonstrated in the terminally ill patients.
Myth: Dehydration and starvation lead to a very painful and unpleasant death.
Truth: While dehydration and starvation can be painful ways to die for otherwise healthy individuals, studies have shown that terminally ill patients do not suffer when nutrition and hydration are withdrawn. In fact, it is hypothesized that advanced stages of dehydration may lead to the release of a compound from the brain which causes an analgesic effect. Ketones produced during starvation also produce an analgesic effect.
Myth: There are no benefits to dehydration.
Truth: Dehydration allows for a series of physiologic changes which actually allow for increased comfort in a terminally ill patient. A decrease in urine output results in less need for a bedpan, commode or catheterization and fewer bed-wetting episodes. A decrease in gastrointestinal fluid leads to fewer bouts of vomiting. A decrease in pulmonary secretions leads to less coughing, choking and need for suctioning. Reducing the edematous layer surrounding a tumor diminishes the size of a tumor and reduces the associated pain and symptoms caused by the tumor. Reducing fluids leads to a decrease in painful ascites as well as fluid third spacing and general edema. Dehydration also allows for a decrease in wound and fistula drainage.
Myth: Dehydrated patients feel thirst.
Truth: Studies have proved that dehydrated patients do not feel thirst. As long as the patient’s mouth is kept moist, he or she will not feel thirsty or uncomfortable.
Myth: Artificial hydration allows the patient to live longer and spend more quality time with loved ones.
Truth: Studies have proved that dehydrating a patient does not shorten their life. Sustaining artificial fluids and nutrition requires intravenous lines, wires and pumps and sometimes restrain the patient so that he or she does not pull the lines out. These high-tech devices can be a barrier between the patient and the family and can take away from the closeness between patient and family at the time of death.
Myth: Hydration will increase alertness and comfort at end-of-life.
Truth: While hydration may increase alertness, it decreases the amount of natural analgesics which are released in the blood. This will not only take away from the body’s natural analgesic effect but will make the patient more aware of the pain. Studies have revealed dehydrated patients are often more comfortable than those who are hydrated.
Myth: Dehydrating a terminally ill patient causes abnormalities in blood chemistries and related symptoms.
Truth: Researchers have found surprisingly normal blood levels in dehydrated terminally ill patients.
Myth: Starvation is inhumane and a form of punishment.
Truth: Our society traditionally views food and drink as a symbol of love, nurturing and caring. Food and drink are symbolic and a part of most cultural rituals. Providing food to those who are unable to feed themselves is often viewed as an act of nurturing, and taking food away is viewed as a form of depersonalization. In contrast, the withholding of these traditional symbols has been viewed as punishment reserved for social outcasts and misfits. It is for these reasons that it is so difficult for some families to withdraw nutrition. However, artificial nutrition and hydration are not the “normal” way of eating, it is the medical way and families often see it as antisocial. Withdrawing of nutrition and hydration is not punishment but a humane intervention since it has been shown to produce analgesic effects on the patient.
Myth: Withdrawal of nutrition and hydration is a form of euthanasia.
Truth: Withdrawal of nutrition and hydration is not euthanasia. Artificial nutrition and hydration are considered medical treatments. Patient and families have the right to refuse these treatments and it is not considered murder or suicide. It is the underlying disease that will kill the patient, not the withdrawal of artificial nutrition and hydration.
Myth: Once artificial nutrition/hydration is started it cannot be stopped.
Truth: This statement is false. Stopping these treatments is both legally and ethically acceptable. The law requires that the treatment be terminated if the patient does not want it.
Myth: The health care provider has the right to make decisions regarding withholding/withdrawing hydration and nutrition.
Truth: If individuals have made their wishes known, the health care provider must honor these wishes. If he or she is uncomfortable with the situation, care can be transferred to another provider who will respect the patient’s decision.
Myth: Once the nutrition/hydration are withdrawn or withheld, the patient will be abandoned by the health care team.
Truth: Withdrawal of nutrition/hydration is not synonymous with withdrawal of treatment. Patients still require symptom management and daily care to assure a comfortable death. This care can and should be provided regardless of nutrition and hydration status. It is considered unethical and unprofessional as well as illegal to neglect of abandon a patient.
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