Nursing Care Of Death And Dying Patients 6d3k6k
This document was ed by and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this report form. Report 445h4w
Overview 1s532p
& View Nursing Care Of Death And Dying Patients as PDF for free.
More details 6h715l
- Words: 1,888
- Pages: 71
NURSING CARE OF DYING AND DEATH PATIENTS
11/14/2012
NomiWG-ACI
1
OBJECTIVES • At the end of this lecture participants will be able to: 1. 2. 3. 4. 5. 6. 7. 11/14/2012
Knows concept of death in our daily life Define death Discuss responses of death and dying patient Enumerate stages of death Explain physical sign of death Illustrate changes in body after death Manage fear of death and death anxiety of patient NomiWG-ACI
2
OBJECTIVES 8. Define Hospice and Palliative care 9. Describe goal, purposes and principles of hospice and palliative care. 10. Demonstrate nursing care of death and dying patient. 11. Maintained ethical and legal issues related to death and dying. 12. Understand about concept of cryonics. 11/14/2012
NomiWG-ACI
3
سورة آل عمران
REALITY OF LIFE
ہر متنفس کو موت کا مزا چکھنا ہے اور تم کو قیامت کے دن تمہارے اعمال کا پورا پورا بدال دیا جائے گا۔ تو جو شخص آتش جہنم سے دور رکھا گیا اور بہشت میں داخل کیا گیا وہ مراد کو پہنچ گیا اور دنیا کی زندگی تو دھوکے کا سامان ہے 4
NomiWG-ACI
11/14/2012
Introduction • Birth and death are two aspects of life, which will happen to everyone.
11/14/2012
NomiWG-ACI
5
Introduction • Dying and death are painful and personal experiences for those that are dying and their loved ones caring for them.
11/14/2012
NomiWG-ACI
6
Introduction • Death affects each person involved in multiple ways, including physically, psychologically, emotionally, spiritually, and financially.
11/14/2012
NomiWG-ACI
7
Introduction • Whether the death is sudden and unexpected, or ongoing and expected, there is information and help available to address the impact of dying and death.
11/14/2012
NomiWG-ACI
8
Definition of death • "cessation of heart- lung function, or of whole brain function, or of higher brain function.
11/14/2012
NomiWG-ACI
9
Definition of death • "either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem”
11/14/2012
NomiWG-ACI
10
Responses to dying and death • Although each person reacts to the knowledge of approaching death or to loss in his or her own way, there are similarities in the psychosocial responses to the situation.
11/14/2012
NomiWG-ACI
11
Stages of Dying • According to Kubler- Ross, the five stages of dying are: 1. 2. 3. 4. 5.
11/14/2012
Denial Anger Bargaining Depression Acceptance
NomiWG-ACI
12
Denial • On being told that one is dying, there is an initial reaction of shock.
11/14/2012
NomiWG-ACI
13
Denial • The patient may appear confused at first and may then refuse to believe the diagnosis or deny that anything is wrong.
11/14/2012
NomiWG-ACI
14
Denial • Some patients never beyond this stage and may go from doctor to doctor until they find one who s their position.
11/14/2012
NomiWG-ACI
15
Anger • Patients become frustrated, irritable and angry that they are sick. • A common response is,” Why me? ”
11/14/2012
NomiWG-ACI
16
Anger • They may become angry at God, their fate, a friend, or a family member. • The anger may be displaced onto the hospital staff or the doctors who are blamed for the illness.
11/14/2012
NomiWG-ACI
17
Bargaining • The patient may attempt to negotiate with physicians, friends or even God, that in return for a cure, the person will fulfill one or many promises, such as giving to charity or repeat an earlier faith in God.
11/14/2012
NomiWG-ACI
18
Depression • The patient shows clinical signs of depressionwithdrawal, psychomotor retardation, sleep disturbances, hopelessness and possibly suicidal ideation.
11/14/2012
NomiWG-ACI
19
Depression • The depression may be a reaction to the effects of the illness on his or her life or it may be in anticipation of the approaching death.
11/14/2012
NomiWG-ACI
20
Acceptance • The patient realizes that death is usual and accepts the universality of the experience.
11/14/2012
NomiWG-ACI
21
Acceptance • People with strong religious beliefs and those who are convinced of a life after death can find comfort in these beliefs (Zisook & Downs, 1989).
11/14/2012
NomiWG-ACI
22
PHYSICAL SIGNS OF DYING.
11/14/2012
NomiWG-ACI
23
What are the physical sign of death? 1. 2. 3. 4. 5. 6. 7. 8. 11/14/2012
Confusion Loss of appetite Drowsiness Withdrawal and no socialization Bowel bladder control loss Cool skin Abnormal breathing Involuntary movement NomiWG-ACI
24
Confusion about… • Time, Place, Identity of loved ones and Visions of people and places that are not present.
11/14/2012
NomiWG-ACI
25
loss of appetite • A decreased need for food and drink, as well as loss of appetite
11/14/2012
NomiWG-ACI
26
Drowsiness • An increased need for sleep and unresponsiveness
11/14/2012
NomiWG-ACI
27
Withdrawal • Withdrawal and decreased socialization
11/14/2012
NomiWG-ACI
28
Loss of bowel or bladder control • Caused by relaxing muscles in the pelvic area
11/14/2012
NomiWG-ACI
29
Cool Skin • Skin becomes cool to the touch
11/14/2012
NomiWG-ACI
30
Abnormal Breathing • Rattling or gurgling sounds while breathing or breathing that is irregular and shallow, decreased number of breaths per minute, or breathing that switches between rapid and slow
11/14/2012
NomiWG-ACI
31
Involuntary movements • Involuntary movements (called myoclonus), changes in heart rate, and loss of reflexes in the legs and arms also mean that the end of life is near
11/14/2012
NomiWG-ACI
32
CHANGES IN BODY AFTER DEATH
11/14/2012
NomiWG-ACI
33
CHANGES IN BODY AFTER DEATH
1. Rigor Mortis 2. Algor Mortis 3. Livor Mortis
11/14/2012
NomiWG-ACI
34
Rigor Mortis • Body becomes stiff within 4 hours after death as a result of decreased ATP production. ATP keeps muscles soft and flexible.
11/14/2012
NomiWG-ACI
35
Algor Mortis • Temperature decreases by a few degrees each hour. The skin loses its elasticity and will tear easily.
11/14/2012
NomiWG-ACI
36
Livor Mortis • Dependant parts of body become discolored. The patient will likely be lying on their back, their backside being the 'dependant' body part. The discoloration is a result of blood pooling, as the hemoglobin breaks down. 11/14/2012
NomiWG-ACI
37
Hospice and palliative care
11/14/2012
NomiWG-ACI
38
Hospice Care • Specialized program that addresses the needs of the terribly ill and their loved ones.
11/14/2012
NomiWG-ACI
39
Team involve in hospice..? • • • • • • • •
Physicians Nurses Social workers Clergy (religious leaders) home health aids Volunteers Therapists family caregivers.
11/14/2012
NomiWG-ACI
40
Purpose of Hospice care • • • •
Help a dying person Manage pain Provide medical services Offer family
11/14/2012
NomiWG-ACI
41
What is palliative Care • Palliative care is the active total care of patients whose disease is not responsive to curative treatment (World Health Organization).
11/14/2012
NomiWG-ACI
42
Principle of Palliative care 1. Respects the goals, likes and choices of the dying person. 2. Looks after the medical emotional, social and spiritual needs of the dying person. 3. s the needs of the family . 4. Helps gain access to needed health care providers and appropriate care settings. 5. Builds ways to provide excellent care at the end of life (Foley and Carver, 2001) 11/14/2012
NomiWG-ACI
43
Goals of palliative care • The relief of suffering • Control of pain • Control of other symptoms • Control of psychological, social and spiritual problems 11/14/2012
NomiWG-ACI
44
MANAGING DEATH ANXIETY
11/14/2012
NomiWG-ACI
45
Spirituality
ہر متنفس کو موت کا مزا چکھنا ہے اور تم کو قیامت کے دن تمہارے اعمال کا پورا پورا بدال دیا جائے گا۔ تو جو شخص آتش جہنم سے دور رکھا گیا اور بہشت میں داخل کیا گیا وہ مراد کو پہنچ گیا اور دنیا کی زندگی تو دھوکے کا سامان ہے 46
NomiWG-ACI
11/14/2012
TECHNIQUES TO DEAL WITH DEATH ANXIETY. 1. 2. 3. 4. 5. 6. 7.
Concern Competence Communication Children Cohesion Cheerfulness Consistency
Seven C’s Cassen (1991)
11/14/2012
NomiWG-ACI
47
Concern Empathy, comion, and involvement are essential.
11/14/2012
NomiWG-ACI
48
Competence Skill and knowledge can be as reassuring as warmth and concern.
11/14/2012
NomiWG-ACI
49
Communication Allow patients to speak their minds and get to know them.
11/14/2012
NomiWG-ACI
50
Children If children want to visit the dying, it is generally advisable; they bring comfort to dying patients.
11/14/2012
NomiWG-ACI
51
Cohesion Family cohesion reassures both the patient and family.
11/14/2012
NomiWG-ACI
52
Cheerfulness A gentle, appropriate sense of humor can be palliative; a somber (serious) or anxious demeanor(appearance) should be avoided.
11/14/2012
NomiWG-ACI
53
Consistency Continuing, persistent attention is highly valued by patients who often fear that they are a burden and will be abandoned (avoided); consistent physician involvement mitigates (lessen) these fears.
11/14/2012
NomiWG-ACI
54
Nursing care of a dying individual
11/14/2012
NomiWG-ACI
55
Nursing care of a dying individual 1. 2. 3. 4. 5. 6. 7.
Decrease fear of Death Listen more Self evaluation Self control Family Involvement Resource management Pain and communication (Schwartz and Karasu, 1997)
11/14/2012
NomiWG-ACI
56
Death fear Deal with mental anguish and fear of death,
11/14/2012
NomiWG-ACI
57
Listen more Try to respond appropriately to patient’s needs by listening carefully to the complaints
11/14/2012
NomiWG-ACI
58
Self evaluation • Be fully prepared to accept their own counter transferences, as doubts, guilt and damage to their selfimportance are encountered.
11/14/2012
NomiWG-ACI
59
Self evaluation • Management of the dying patient often elicits anxiety in nursing staff.
11/14/2012
NomiWG-ACI
60
Self evaluation • Education and role playing can improve perspective taking and empathetic skills, respect each other’s point of view as well as appreciate the situation of patient and their families. 11/14/2012
NomiWG-ACI
61
Self control
Developing a sense of control and efficacy.
11/14/2012
NomiWG-ACI
62
Family Involvement Encouraging peer groups for families coping with bereavement.
11/14/2012
NomiWG-ACI
63
Resource management Developing increased resourcefulness in dealing with death related situations.
11/14/2012
NomiWG-ACI
64
Pain and communication • Improving our understanding of pain and suffering will also improve communication and effective interactions.
11/14/2012
NomiWG-ACI
65
Ethical and Legal Issues • Patients have a right to refuse Life-sustaining treatment, even if they die as a consequence (Stanley, 1992).
11/14/2012
NomiWG-ACI
66
Ethical and Legal Issues • Informed consent and refusal to lifesustaining treatment has three elements: 1. adequate information must be conveyed to the patient, 2. the patient must be able to decide, and 3. the patient must have freedom from coercion (force).
11/14/2012
NomiWG-ACI
67
CRYONICS • Cryonics is the preservation of the dead body to be revived, till the time, medical technology advances to do so.
11/14/2012
NomiWG-ACI
68
Arguments against cryonics 1. There is no way to preserve bodies so that their organ will resume functioning when they are thaw (Darwin and Wowk, 1992). 2. Immortality does not yet fall within the province of technology (Shermer, 1992). • Currently, these efforts are simply wastage of resources. 11/14/2012
NomiWG-ACI
69
REFERENCES • Robbins J, Moscrop J. caring for the dying & family. 3rd ed. London: Chapman&Hall;1995 • Craven R F, Hirnle C J. Fundamentals of Nursing. 5th ed. Philadelphia: Lippincott Williams & Wilkins Publishers;2006 • Feinberg A. W. The care of dying patients. Annals of internal medicine. 2007 Jan 17; 126 (2): 164-65. • Meyers T. a turn towards dying: presence, signature, and the social course of chronic illness in urban America. Med Anthropol(PMID 17654261). 2007 JulySept;26(3):205-27. 11/14/2012
NomiWG-ACI
70
THANK YOU Nomi Waqas Gul Asst. Clinical Instructor Continuing Nursing education (CNE) Pakistan Institute of Medical Sciences, Islamabad, Pakistan
For More Information Email: [email protected]
Facebook: •add as friend (by email address) To free Notes Visit: www.idoub.com/nomiwg 11/14/2012
NomiWG-ACI
71
11/14/2012
NomiWG-ACI
1
OBJECTIVES • At the end of this lecture participants will be able to: 1. 2. 3. 4. 5. 6. 7. 11/14/2012
Knows concept of death in our daily life Define death Discuss responses of death and dying patient Enumerate stages of death Explain physical sign of death Illustrate changes in body after death Manage fear of death and death anxiety of patient NomiWG-ACI
2
OBJECTIVES 8. Define Hospice and Palliative care 9. Describe goal, purposes and principles of hospice and palliative care. 10. Demonstrate nursing care of death and dying patient. 11. Maintained ethical and legal issues related to death and dying. 12. Understand about concept of cryonics. 11/14/2012
NomiWG-ACI
3
سورة آل عمران
REALITY OF LIFE
ہر متنفس کو موت کا مزا چکھنا ہے اور تم کو قیامت کے دن تمہارے اعمال کا پورا پورا بدال دیا جائے گا۔ تو جو شخص آتش جہنم سے دور رکھا گیا اور بہشت میں داخل کیا گیا وہ مراد کو پہنچ گیا اور دنیا کی زندگی تو دھوکے کا سامان ہے 4
NomiWG-ACI
11/14/2012
Introduction • Birth and death are two aspects of life, which will happen to everyone.
11/14/2012
NomiWG-ACI
5
Introduction • Dying and death are painful and personal experiences for those that are dying and their loved ones caring for them.
11/14/2012
NomiWG-ACI
6
Introduction • Death affects each person involved in multiple ways, including physically, psychologically, emotionally, spiritually, and financially.
11/14/2012
NomiWG-ACI
7
Introduction • Whether the death is sudden and unexpected, or ongoing and expected, there is information and help available to address the impact of dying and death.
11/14/2012
NomiWG-ACI
8
Definition of death • "cessation of heart- lung function, or of whole brain function, or of higher brain function.
11/14/2012
NomiWG-ACI
9
Definition of death • "either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem”
11/14/2012
NomiWG-ACI
10
Responses to dying and death • Although each person reacts to the knowledge of approaching death or to loss in his or her own way, there are similarities in the psychosocial responses to the situation.
11/14/2012
NomiWG-ACI
11
Stages of Dying • According to Kubler- Ross, the five stages of dying are: 1. 2. 3. 4. 5.
11/14/2012
Denial Anger Bargaining Depression Acceptance
NomiWG-ACI
12
Denial • On being told that one is dying, there is an initial reaction of shock.
11/14/2012
NomiWG-ACI
13
Denial • The patient may appear confused at first and may then refuse to believe the diagnosis or deny that anything is wrong.
11/14/2012
NomiWG-ACI
14
Denial • Some patients never beyond this stage and may go from doctor to doctor until they find one who s their position.
11/14/2012
NomiWG-ACI
15
Anger • Patients become frustrated, irritable and angry that they are sick. • A common response is,” Why me? ”
11/14/2012
NomiWG-ACI
16
Anger • They may become angry at God, their fate, a friend, or a family member. • The anger may be displaced onto the hospital staff or the doctors who are blamed for the illness.
11/14/2012
NomiWG-ACI
17
Bargaining • The patient may attempt to negotiate with physicians, friends or even God, that in return for a cure, the person will fulfill one or many promises, such as giving to charity or repeat an earlier faith in God.
11/14/2012
NomiWG-ACI
18
Depression • The patient shows clinical signs of depressionwithdrawal, psychomotor retardation, sleep disturbances, hopelessness and possibly suicidal ideation.
11/14/2012
NomiWG-ACI
19
Depression • The depression may be a reaction to the effects of the illness on his or her life or it may be in anticipation of the approaching death.
11/14/2012
NomiWG-ACI
20
Acceptance • The patient realizes that death is usual and accepts the universality of the experience.
11/14/2012
NomiWG-ACI
21
Acceptance • People with strong religious beliefs and those who are convinced of a life after death can find comfort in these beliefs (Zisook & Downs, 1989).
11/14/2012
NomiWG-ACI
22
PHYSICAL SIGNS OF DYING.
11/14/2012
NomiWG-ACI
23
What are the physical sign of death? 1. 2. 3. 4. 5. 6. 7. 8. 11/14/2012
Confusion Loss of appetite Drowsiness Withdrawal and no socialization Bowel bladder control loss Cool skin Abnormal breathing Involuntary movement NomiWG-ACI
24
Confusion about… • Time, Place, Identity of loved ones and Visions of people and places that are not present.
11/14/2012
NomiWG-ACI
25
loss of appetite • A decreased need for food and drink, as well as loss of appetite
11/14/2012
NomiWG-ACI
26
Drowsiness • An increased need for sleep and unresponsiveness
11/14/2012
NomiWG-ACI
27
Withdrawal • Withdrawal and decreased socialization
11/14/2012
NomiWG-ACI
28
Loss of bowel or bladder control • Caused by relaxing muscles in the pelvic area
11/14/2012
NomiWG-ACI
29
Cool Skin • Skin becomes cool to the touch
11/14/2012
NomiWG-ACI
30
Abnormal Breathing • Rattling or gurgling sounds while breathing or breathing that is irregular and shallow, decreased number of breaths per minute, or breathing that switches between rapid and slow
11/14/2012
NomiWG-ACI
31
Involuntary movements • Involuntary movements (called myoclonus), changes in heart rate, and loss of reflexes in the legs and arms also mean that the end of life is near
11/14/2012
NomiWG-ACI
32
CHANGES IN BODY AFTER DEATH
11/14/2012
NomiWG-ACI
33
CHANGES IN BODY AFTER DEATH
1. Rigor Mortis 2. Algor Mortis 3. Livor Mortis
11/14/2012
NomiWG-ACI
34
Rigor Mortis • Body becomes stiff within 4 hours after death as a result of decreased ATP production. ATP keeps muscles soft and flexible.
11/14/2012
NomiWG-ACI
35
Algor Mortis • Temperature decreases by a few degrees each hour. The skin loses its elasticity and will tear easily.
11/14/2012
NomiWG-ACI
36
Livor Mortis • Dependant parts of body become discolored. The patient will likely be lying on their back, their backside being the 'dependant' body part. The discoloration is a result of blood pooling, as the hemoglobin breaks down. 11/14/2012
NomiWG-ACI
37
Hospice and palliative care
11/14/2012
NomiWG-ACI
38
Hospice Care • Specialized program that addresses the needs of the terribly ill and their loved ones.
11/14/2012
NomiWG-ACI
39
Team involve in hospice..? • • • • • • • •
Physicians Nurses Social workers Clergy (religious leaders) home health aids Volunteers Therapists family caregivers.
11/14/2012
NomiWG-ACI
40
Purpose of Hospice care • • • •
Help a dying person Manage pain Provide medical services Offer family
11/14/2012
NomiWG-ACI
41
What is palliative Care • Palliative care is the active total care of patients whose disease is not responsive to curative treatment (World Health Organization).
11/14/2012
NomiWG-ACI
42
Principle of Palliative care 1. Respects the goals, likes and choices of the dying person. 2. Looks after the medical emotional, social and spiritual needs of the dying person. 3. s the needs of the family . 4. Helps gain access to needed health care providers and appropriate care settings. 5. Builds ways to provide excellent care at the end of life (Foley and Carver, 2001) 11/14/2012
NomiWG-ACI
43
Goals of palliative care • The relief of suffering • Control of pain • Control of other symptoms • Control of psychological, social and spiritual problems 11/14/2012
NomiWG-ACI
44
MANAGING DEATH ANXIETY
11/14/2012
NomiWG-ACI
45
Spirituality
ہر متنفس کو موت کا مزا چکھنا ہے اور تم کو قیامت کے دن تمہارے اعمال کا پورا پورا بدال دیا جائے گا۔ تو جو شخص آتش جہنم سے دور رکھا گیا اور بہشت میں داخل کیا گیا وہ مراد کو پہنچ گیا اور دنیا کی زندگی تو دھوکے کا سامان ہے 46
NomiWG-ACI
11/14/2012
TECHNIQUES TO DEAL WITH DEATH ANXIETY. 1. 2. 3. 4. 5. 6. 7.
Concern Competence Communication Children Cohesion Cheerfulness Consistency
Seven C’s Cassen (1991)
11/14/2012
NomiWG-ACI
47
Concern Empathy, comion, and involvement are essential.
11/14/2012
NomiWG-ACI
48
Competence Skill and knowledge can be as reassuring as warmth and concern.
11/14/2012
NomiWG-ACI
49
Communication Allow patients to speak their minds and get to know them.
11/14/2012
NomiWG-ACI
50
Children If children want to visit the dying, it is generally advisable; they bring comfort to dying patients.
11/14/2012
NomiWG-ACI
51
Cohesion Family cohesion reassures both the patient and family.
11/14/2012
NomiWG-ACI
52
Cheerfulness A gentle, appropriate sense of humor can be palliative; a somber (serious) or anxious demeanor(appearance) should be avoided.
11/14/2012
NomiWG-ACI
53
Consistency Continuing, persistent attention is highly valued by patients who often fear that they are a burden and will be abandoned (avoided); consistent physician involvement mitigates (lessen) these fears.
11/14/2012
NomiWG-ACI
54
Nursing care of a dying individual
11/14/2012
NomiWG-ACI
55
Nursing care of a dying individual 1. 2. 3. 4. 5. 6. 7.
Decrease fear of Death Listen more Self evaluation Self control Family Involvement Resource management Pain and communication (Schwartz and Karasu, 1997)
11/14/2012
NomiWG-ACI
56
Death fear Deal with mental anguish and fear of death,
11/14/2012
NomiWG-ACI
57
Listen more Try to respond appropriately to patient’s needs by listening carefully to the complaints
11/14/2012
NomiWG-ACI
58
Self evaluation • Be fully prepared to accept their own counter transferences, as doubts, guilt and damage to their selfimportance are encountered.
11/14/2012
NomiWG-ACI
59
Self evaluation • Management of the dying patient often elicits anxiety in nursing staff.
11/14/2012
NomiWG-ACI
60
Self evaluation • Education and role playing can improve perspective taking and empathetic skills, respect each other’s point of view as well as appreciate the situation of patient and their families. 11/14/2012
NomiWG-ACI
61
Self control
Developing a sense of control and efficacy.
11/14/2012
NomiWG-ACI
62
Family Involvement Encouraging peer groups for families coping with bereavement.
11/14/2012
NomiWG-ACI
63
Resource management Developing increased resourcefulness in dealing with death related situations.
11/14/2012
NomiWG-ACI
64
Pain and communication • Improving our understanding of pain and suffering will also improve communication and effective interactions.
11/14/2012
NomiWG-ACI
65
Ethical and Legal Issues • Patients have a right to refuse Life-sustaining treatment, even if they die as a consequence (Stanley, 1992).
11/14/2012
NomiWG-ACI
66
Ethical and Legal Issues • Informed consent and refusal to lifesustaining treatment has three elements: 1. adequate information must be conveyed to the patient, 2. the patient must be able to decide, and 3. the patient must have freedom from coercion (force).
11/14/2012
NomiWG-ACI
67
CRYONICS • Cryonics is the preservation of the dead body to be revived, till the time, medical technology advances to do so.
11/14/2012
NomiWG-ACI
68
Arguments against cryonics 1. There is no way to preserve bodies so that their organ will resume functioning when they are thaw (Darwin and Wowk, 1992). 2. Immortality does not yet fall within the province of technology (Shermer, 1992). • Currently, these efforts are simply wastage of resources. 11/14/2012
NomiWG-ACI
69
REFERENCES • Robbins J, Moscrop J. caring for the dying & family. 3rd ed. London: Chapman&Hall;1995 • Craven R F, Hirnle C J. Fundamentals of Nursing. 5th ed. Philadelphia: Lippincott Williams & Wilkins Publishers;2006 • Feinberg A. W. The care of dying patients. Annals of internal medicine. 2007 Jan 17; 126 (2): 164-65. • Meyers T. a turn towards dying: presence, signature, and the social course of chronic illness in urban America. Med Anthropol(PMID 17654261). 2007 JulySept;26(3):205-27. 11/14/2012
NomiWG-ACI
70
THANK YOU Nomi Waqas Gul Asst. Clinical Instructor Continuing Nursing education (CNE) Pakistan Institute of Medical Sciences, Islamabad, Pakistan
For More Information Email: [email protected]
Facebook: •add as friend (by email address) To free Notes Visit: www.idoub.com/nomiwg 11/14/2012
NomiWG-ACI
71
Related Documents 2w1qw
Nursing Care Of Death And Dying Patients 6d3k6k
April 2022 0
Nursing Care Of Patients Undergoing Orthopedic Surgery 5q3k5e
October 2019 32
Nursing Care Of Patients Receiving Chemotherapy 2nz4y
November 2021 0
Nursing Care Of Patients With Diabetes Mellitus 3eu3v
November 2019 137
Nursing Care Of Patients Undergoing Orthopedic Surgery 5q3k5e
March 2021 0
Improving Nursing Home Care Of The Dying 4p1th
October 2021 0More Documents from "Nomi Waqas Gul" 2e411e
Nursing Care Of Death And Dying Patients 6d3k6k
April 2022 0
Social Evils Report 4m3v5o
November 2021 0
504uu
December 2019 34
Los Grandes Temas De Michael Sodaro 1p1l5j
July 2021 0
What Is The Difference Between A Weldolet And A Sockolet 6p385j
October 2019 99