presented by Lu Krieger-Blake LCSW
When a patient is facing end of life (EOL), the family and caregivers are also profoundly affected by the changes experienced by the patient. This course will provide information for nurses, therapists, and social workers in a variety of settings so that they may be aware of issues facing the patient and family, promoting sensitivity to the family’s needs as they care for the patient. Advance care planning, role changes, anticipatory, and post-loss grief issues will be discussed.
Luana S. “Lu” Krieger-Blake LCSW, MSW, BA Lu Krieger-Blake has been a clinical practitioner for all 45 years of her Social Work career. In her 25 years as a hospice medical social worker, she lived out her “heart’s mission” by bringing her compassion and skill to help patients and families navigate their end-of-life process. A strong believer in the team concept of providing whole person medical care, she promoted clinical teamwork among co-workers in the hospice setting. She educated and inspired multiple teams to understand family dynamics and patient/family adjustments to end of life. During Lu’s hospice tenure, she obtained her MSW degree while working full-time. She was privileged to use her expertise by spreading the word about concepts of hospice care to the community, and to many university classes. Professors often scheduled her to introduce hospice as their new semester began, year after year! She became a sought-after mentor for many social work students from three different local universities who wished to explore the medical field by interning in hospice and later in gerontological care. Student reviews gave her high praise for the quality of her mentoring and their experiences under her direction. Upon retirement from hospice, Lu continued her heart’s mission by bringing her compassionate skills to a non-profit retirement community. She counseled residents and families going through end-of-life experiences that usually preceded the need for hospice care, but the issues of loss and physical decline remained similar and relevant. She continues speaking in the community and has continued to educate about hospice care and family adjustments at end of life by writing chapters in several editions of an award-winning gerontological nursing textbook and now through Medbridge courses.
Nurses are often the frontline personnel in working with patients with life-ending illness, and their families and/or caregivers. Social workers and therapists are also frequently involved with patients nearing the end of life as circumstances change for the patient and family. These disciplines need to be aware of options for the on-going care that is required when curative treatment is no longer effective, appropriate, or desired. Awareness of the hospice philosophy and advance care planning options are important in order to ease some of the patient's necessary transitions. This chapter will discuss legal options available for patients to designate the type and extent of care they wish to receive. These options often lead to hospice care which supports the patient as well as their family/caregivers.
Patients, families, and caregivers are often surprised by the changing roles they encounter as the patient’s disease progresses. Professional staff are often faced with recognition of these different “vibes,” and can be helpful in acknowledging these role changes and the accompanying emotions experienced by all parties.
As patients and their families progress through the disease process, they face many unknowns that may create adjustment issues for them in a variety of circumstances. This chapter will identify some of these issues, and propose possible adaptations to enhance patient and family coping and comfort.
Anticipatory grief begins with the patient’s diagnosis, as the possibility of a "future" is profoundly altered. The family “lives” with how the patient dies. The family continues to relive the memories of the death process long after the patient is gone. Grief can be complicated if the dying process was not perceived as peaceful and comfortable. Education for the family prior to the death is key for nurses as they accompany their patient and CGs on this journey. This chapter will discuss how, throughout the course of the illness, there are many changes in physical condition, which precipitate changes in emotional and spiritual adjustments to grief.