ELNEC Core Module 8: Final Hours

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Section 2: Preparing for a Good Death

A Good Death

Witnessing A Good Death

Preparing for Death

The Nurse, Dying, and Death

Open, Honest Communication

Importance of Being Honest

Individualized, Personal Experience

Medically Administered Nutrition and Hydration

Resuscitation

Discontinuation of Cardiac Devices and Treatment

Discontinuation of Respiratory Ventilation

Discontinuation of Dialysis

Organ and Tissue Donation

Hastened Death Request

Spiritual and Cultural Considerations

Meet Graciela Martinez

Review

Summary

Section 3: Frequent Symptoms Associated with Imminent Death

Signs and Symptoms

Most Common Symptoms

Medication Management

Pain During the Final Hours

Myoclonus

Controlled Sedation or Sedation for Uncontrolled Symptoms

Symptoms of Imminent Death

Remember Graciela

The Death Vigil

Review

Summary

Section 4: Bereavement Care

Care Following Death

Care and Respect of the Body

Bereavement Support

Addressing Bereavement

Remember the Children

Graciela’s Death

Review

Summary

Section 5: Conclusion

Course Summary

Course Contributors

Resources

References

The content for this course was written by The ELNEC Project Team.
The ELNEC Project, which began in 2000, is a collaboration between City of Hope, Duarte, CA and the American Association of Colleges of Nursing (AACN), Washington, DC. For more information about ELNEC, go to www.aacnnursing.org/ELNEC

The content for this course was revised by:
Constance Dahlin, MSN, ANP-BC, ACHPN®, FPCN, FAAN has focused her career within hospice and palliative care. She has experience in administration of programs, program development, curricula development, education of the interprofessional team, and clinical practice in the home, clinic, long term care setting, rehabilitation setting and the acute care setting.. Currently, she is faculty here at University of Maryland Baltimore PhD, Master of Science and Graduate Certificate in Palliative Care, a consultant to the Center to Advance Palliative Care (CAPC) in community-based care and education, co-director of the Palliative APP Externship, with a clinical practice as a palliative nurse practitioner at Salem Hospital and. She serves as national faculty for the End-of-Life Nursing Education Consortium (ELNEC), the American Hospital Association Circle of Life Committee, the Massachusetts Serious Illness Coalition Nursing Taskforce, and the Massachusetts Comprehensive Cancer Steering Committee. 

Ms. Dahlin authored several editions of the Palliative Nursing: Scope and Standards and Competencies for the Palliative and Hospice RN, and APRN.  She wrote the Hospice and Palliative APRN Professional Practice Guide and A Primer of Reimbursement, Billing, and Coding: Essential Information for the Hospice and Palliative APRN. She is coeditor of the Oxford University Press Advanced Practice Palliative Nursing 1st and 2nd editions. She referenced the 2004 first education of the National Consensus Project’s Clinical Practice Guidelines for Palliative Care and edited the 2009 second and third 2013 editions. 

Ms. Dahlin served on the Measurement Applications Partnership PAC/LTC Workgroup, the Measurement Applications Partnership Clinician Workgroup within the National Quality Forum and co-chaired the Massachusetts Comprehensive Cancer Control and Prevention Network Palliative Care Workgroup. Ms. Dahlin is a Fellow of Hospice and Palliative Nursing, a Fellow of the American Academy of Nursing, a 2005 Certified ACHPN APRN of the year, a 2016 recipient of a Sojourns Cambia Health Foundation Sojourns Leadership Scholar Award, a 2018 American Academy of Hospice and Palliative Medicine Visionary in Hospice and Palliative Medicine, the 2020 HPNA Distinguished Practice Award and the 2021 University of Maryland Baltimore Master of Science and Graduate Certificates in Palliative Care Teacher of the Year.  She completed her MSN in oncology nursing and her post-masters in adult primary care at the MGH Institute of Health Professions. She has authored peer reviewed articles, chapters and curricula and presented nationally and internationally.

Judith Paice, PhD, RN is the Director of the Cancer Pain Program in the Division of Hematology-Oncology and a Research Professor of Medicine, Northwestern University, Feinberg School of Medicine. She is also a member of the Robert H. Lurie Comprehensive Cancer Center.  Dr. Paice is presently a member of the NIH HEAL Initiative Multidisciplinary Working Group and has served as President of the American Pain Society and Secretary of the International Association for the Study of Pain. Currently a panel member of the NCCN Adult Cancer Pain Clinical Practice Guideline, much of Dr Paice’s clinical work has been in the relief of pain associated with cancer. She has traveled widely within six continents to educate health care professionals regarding cancer pain relief and palliative care.  Dr. Paice serves on the editorial board of the Journal of Pain, Journal of Pain and Symptom Management and Journal of Clinical Oncology and is the author of more than 170 scientific manuscripts. She was one of the original consultants in the End-of-Life Nursing Education Consortium (ELNEC) and has continued serving as a faculty member in this program. In 2018, Dr. Paice was named one of the 30 Visionaries in the field by the Academy of Hospice and Palliative Care.

Disclosure: 2022 ELNEC Core has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.