Nursing Concept of

Terminal CaseMutia Rahmah, S.Kep., NsSchool of Nursing, Medical FacultyLambung Mangkurat University2015

Tujuan Umum

Mahasiswa mampu mendefinisikan istilah terminal, kondisi terminal, penyakit terminal

Mahasiswa mampu memahami kriteria penyakit terminal Mahasiswa mampu memahami jenis penyakit terminal Mahasiswa mampu memahami implikasi penyakit terminal Mahasiswa mampu memahami hubungan penyakit terminal dan kematian Mahasiswa mampu memahami tahapan berduka Mahasiswa mampu memahami dimensi respon berduka Mahasiswa mampu memahami faktor yang mempengaruhi berduka

Tujuan Khusus

Mahasiswa mampu memahami konsep keperawatan pada kasus terminal

Palliative care

Terminal careTerminal illness

Terminal condition

Patient who diagnosed with

“Breast cancer”vs

“Abrasion skin”

Do you know???....

Definition• The term ‘terminal phase’ or

‘mode’ refers to the hours or days immediately preceding death.

• Terminal care is active care with a focus on symptom management and dignity (Departement of Health and Human Services. 2009).

• Terminal condition is a progressive process that lead to death through stages of process decrease in physiological, psychosocial & spiritual (Kubler-Ross, 1969; Carpenito, 2007)

Cont...

• Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families (Higginson, 2009).

Criteria of Terminal Illness

• Can’t be cured or untreated• Lead to death• Clear diagnosed• There are no medicines to cure• Bad prognosis• Progressive illness

Types of Terminal Illness• Cancer, main categories are of:a) Lung, trachea, bronchusb) Ear, nose and throatc) Female breastd) Lymphatice) Digestive tractf) Genitourinaryg) Leukaemiah) Haemopoietic.• Progressive non-malignant diseases, which can have a palliative period. These include:a) Diseases of the circulatory system e.g. cardiovascular, cerebro-vascular diseasesb) Diseases of the respiratory systemc) Diseases of the nervous system and sense organs e.g. motor neurone disease, multiple

sclerosis, dementiad) AIDS/HIV.• Children’s terminal illnesses and hereditary diseases, including:a) Hereditary degenerative disorder e.g. muscular dystrophyb) Cystic fibrosis.

Implication of Terminal Illness

• To manage terminal illness more than manage medical issues

• The condition can occur along phase of the disease

• To keep client’s condition to be controlled requires adherence to the regimens of therapy

• Cronic illness will influence to families• Client with terminal illness & families

must accept responsibility in daily care

• Provider of terminal illness is a process of colaboration

• Terminal condition cause ethical dilemma for client/families, health provider and community

• Living with terminal illness means living with “uncertainty”

Relationship between Terminal Illness and Death• Generally, death is a part of life• Death will give rise to a feeling of pain & fear• Not only patient, but also families or caregivers.

7 problems that will be faced by client/families1)Managing cries2)Managing regimens3)Controlling symptoms4)Dealing with the lack of money to pay for treatments5)Managing the trajectory6)Managing social isolation7)Normalizing

How about your feeling if

something which you need

(handphone) was lost...........??

Stages of Grieving

Catatan :Tidak semua orang dapat melampaui ke 5 tahap tersebut dengan baik, dapat saja terjadi ketidakmampuan menggunakan adaptasi dan timbul bentuk-bentuk reaksi lain.Jangka waktu periode tahap tersebut juga sangat individual.

Dimensions (Respons) & Symptoms of Grieving

Cont...

Factors That Affect Grieving

• Personality• Social role• Perception about death• Culture, Spiritual/beliefs • Sex• Social economic

Overview of complicated grief. (Adapted from Groot, Keijser, & Neeleman, 2006; Zhang, El-Jawahri, & Prigerson, 2006; Zisook & Zisook, 2005.)

Terminal care is an important part of palliative care and usually

refers to the management of patients during their last few days

or weeks or even months of life from a point at which it becomes

clear that the patient is in a progressive state of decline.

References• Sheila L.V. 2005. Psychiatric-Mental Health Nursing , 5th

Edition. Lippincott Williams &Wilkins• Departement of Health and Human Services. 2009. Care

Management Guidelines Terminal Care. Tasmania.• Cemy Nur Fitria. Palliative Care pada Penderita Penyakit

Terminal. Gaster, Vol.7 No.1, 2010.• Higginson. 2009. Palliative and Terminal Care. p.183-259• Murtiwi, Elly Nurachmah, Tuti Nuraini. Kualitas Hidup Klien

Kanker Yang Menerima Pelayanan Hospis Atau Homecare: Suatu Analisis Kuantitatif. JIK; Vol.9 No.1, 2005.

Thank You