Running head: END OF LIFE CARE

Family Preparedness and End-of-Life Support before the Death of a Nursing Home Resident
Maria Claudia Esquivel Vasquez
805 349 214
Humber College

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Introduction
The death of a loved one is always a stressful and depressing event. Fortunately, there are
multiple methods in which the family of a nursing home resident and front line staff can adhere to, for an
easier and more comfortable transition into the end-of-life (EOL) stage of a family member in a nursing
home. Three main points in the evidence-based practice guideline, (Family Preparedness and End of Life
Support before the Death of a Nursing Home Resident (Family Preparedness) (Davidson, 2009), to help
families and front line staff are a) the use of clinical indicators of mortality; by being able to recognize
certain progressive signs and symptoms the nurse will be the first to help with identifying the EOL
trajectory of nursing home residents, b) communication among decision makers; making it easier to
make important decisions and by being able and comfortable talking about death and ensuring the dying
residents care plan is updated to incorporate the personal, cultural and spiritual EOL values, beliefs and
practices that are important to the resident and family caregivers and c) family member recognition of
disease progression, dying trajectory, and the dying process; making sure that family members see what
the health care practitioners see and avoiding the use of nursing jargon and acronyms. By becoming
more informed of the situation, we are better able to deal with the number of unfortunate events that will
follow during as little time as days, weeks, months or even years with a disease such as Alzheimers like
my grandmother and family has been dealing with for the past five to six years. I picked this article
because not only does it give me advice as a future registered nurse, but it is also a guide that will benefit
my family and myself to cope with a dying family member.
Use of Clinical Indicators of Mortality
Knowing and being able to detect the clinical indicators of mortality is a skill that a nurse and the
rest of the medical staff come to learn and develop during the years. Being able to identify signs and
symptoms of a nursing home resident at the EOL will not only help staff determine what the best care
plan is but it will also allow medical staff to prepare and communicate with the family as to what is
happening and what some of the expectations are, that come with a sudden or gradual change in their

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loved ones health. Some of the clinical indicators of the trajectory of dying include weight loss and low
body mass index, increasing dependence with activities of daily living, and lower respiratory infection in
the past 90 days. (Davidson, 2011). When medical staff, specially nurses, are experienced in detecting
signs and symptoms of an elderly person approaching end-of-life, it improves nursing practice because
this means that the family might have a better opportunity in thinking about what the next course of
action in the care plan should be. It also improves nursing practice, because not always can a physician
find it easy to predict mortality in the absence of a clear terminal diagnosis (Davidson, 2011). The
nurses will in return, be trusted by families a lot more making the already established therapeutic
relationship stronger and taking some stress off the decision makers that may seem overwhelmed and
confused as to what could be an appropriate decision.
Communication among Decision Makers
Once family members have the opportunity to review the information the nurse has provided, on
their own, the next step is to learn how to communicate among each other; family members with other
family members or family members with patient, including the physician and other clinical staff. Being
able to do so will ensure the caregivers have a chance to discuss their points of view and agree on a
decision that will most importantly, benefit the individual that has had a change in health and is at EOL
palliative care. When my mother and two aunts had been told that my grandmothers health was getting
worse, already having Alzheimers, they had differences while discussing what they thought was best for
my grandmother; should she stay home with one of them? , a nursing home? , long term care facility?
These were all questions they could not answer without having full understanding of the new signs and
symptoms and without knowing what was required to make their mother feel comfortable at their home.
Communicating with the physician and nurses will ease the stressful feeling of not knowing what the best
decision should be as families are having a difficult time keeping hopes up. Families struggle to maintain
hope in the face of a grave situation while making decisions, which affect the whole family (Kirchhoff,

2007) Not only will caregivers benefit from communicating among each other, but they will also benefit

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by talking with the clinical staff about what the diagnosis means, and nurses can also have the opportunity
to discuss what plans should be made and how to implement treatment to meet goals of the care plan.
Nurses communicate with clients and members of the inter-professional team to guide informed
discussion about the goals of care and treatment (CNO, 2009)
Also, before any final care plan is implemented, the whole team of caregivers and clinical staff
have to make sure to include the patient along with their beliefs, religion, spiritual beliefs, etc., in every
decision if possible if they are able and understand. The RN must ensure the dying residents care plan is
updated to incorporate the personal, cultural, and spiritual EOL values, beliefs and practices that are
important to the resident and family caregivers (Kehl, 2006). Understanding one another is a big part of
being able to decide on what is best for the patient and by making sure to practice and implement
communication among decision makers improving competence in the nursing practice.
Family Member Recognition of Disease Progression, Dying Trajectory and Dying Process
As the family and clinical staff improve communication among themselves, it is also important that the
clinical staff teach caregivers the importance of what it is to be informed and understand the disease
progression, dying trajectory and dying process. Being able to have a better understanding of these stages
will immensely help the patients family deal with what is happening, ensuring that they do not feel guilty
about decisions they made, because sometimes no matter how good a care plan was, the disease just runs
its course and there is no delaying or even curing it. Nurses need to make sure that when they are
discussing with family members the indicators of the trajectory of dying, not to use nursing jargon and
acronyms. This encourages caregivers to continue being alert and to do their own research to better
understand and making them feel like they know what is going on and feel like they are on the same
page as the clinical staff. From experience, I know that my mother has done research on Alzheimers and
the various other complications my grandmother has been diagnosed with which has helped her
understand why certain measures were taken by the clinical staff to offer my grandmother a better and
comfortable stay where she currently resides. This can improve nursing practice because even though a

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family member is not a qualified nurse or physician, the family member could offer informed suggestions
that make it easier for the clinical staff to continue explaining and continue to build a therapeutic
relationship with communication. Also, at times there are nurses that might not regard a diagnosis
suggestion a family member made because there is no trust or that professional, medical respect, that the
caregiver will know exactly what is going on. Being able to trust and respect each other and each others
view, opinions and emotions will contribute to being able to make the best care plan for the patient.
Conclusion
It is essential to make sure families and clinical staff are taking these guidelines into
consideration because even though they may seem simple and easy, in reality it may take a while before
they are fully understood and mastered to be prepared before the death of a loved one as a resident of a
nursing home. The use of clinical indicators of mortality, communication among decision makers, and
family member recognition of disease progression, dying trajectory, and the dying process help the
nursing process because caregivers and the medical staff will become more aware of the situation
enabling everyone to be able to better deal with the number of unfortunate events that will follow during
the following days, weeks, months and even years. I enjoyed reading this article because it gave me the
opportunity to see how these rules help both the family and nurses how to communicate and learn from
each other creating a relationship that has strong principles such as trust and respect to be able to take care
and make a care plan that will ease the dying trajectory keeping in mind that Although the type and
content of communication that is acceptable to the person vary by culture, the nurse has a responsibility to
make sure that the dying person has an opportunity for the communication he or she desires (Touhy &
Jett, 2012)

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References
Davidson, K.M. (edited by D.P. Schoenfelder). (2011). Evidence-Based Practice Guideline:
Family preparedness and end-of-life support before the death of a nursing home resident. Journal of
Gerontological Nursing, 37(2), 11-16
Kehl, K.A. (2006). Moving toward peace: An analysis of the concept of a good death. American
Journal of Hospice & Palliative Medicine, 23, 277-286
Touhy, T. A. & Jett, K. F. (2010). Ebersole and Hess Gerontological Nursing and Healthy Aging
(1st ed). Toronto, Elsevier Canada, 463-464

College of Nurses of Ontario. (2009). Guiding decisions about end-of-life care. Retrieved
from http://www.cno.org/Global/docs/prac/43001_Resuscitation.pdf