End-of-Life Care Essay: Challenges In Acute Settings

Write an essay to explain the care requirements that effect the end of life care of people in an acute care setting and their family. Outline the issus that are faced by nurses who are responsible for delivering this care.

Care Requirements for End-of-Life Patients

End-of-life (EOL) care involves giving acute care to patients suffering from serious diseases such as terminal cancer, respiratory failure, hepatic failure, heart failure, AIDS among others. EOL should be given to patients who are in their last months of life. This care helps them live a good life until they die to give them the opportunity to die with dignity. Most of the illnesses require this type of care called palliative care which does not necessary aim at curing the disease but works towards preventing or relieving the suffering of the dying patients and improve their quality of life. Healthcare professionals give EOL as part of their work. In this case, acute care could be provided at home or in an acute hospital. EOL begins when individuals request for it and can last for days, months, or even years. Other patients are given the care while they are expected to die in a few hours while others receive it over a long period of time. In this case, people are provided end of life care when they are expected to die within a year, although this is hard to predict. The paper will focus on the care requirements that these patients together with their families need and the challenges that nurses encounter while providing this care in the acute setting (Sykes, 2016).

To begin with, a terminal patient wishing to spend their final days at home requires social support from a caregiver who will always be available for them. Such could be a close person such as a family member, a spouse or a team of individuals who are always there to meet the physical and emotional needs of the patient. A terminal patient is most likely to be too weak to do anything for themselves such as feeding, bathing or even using the bathroom by themselves. The community could also come together and provide coordinated care with the help of a nurse or any other professional from social services and a religious minister to provide moral and spiritual support to both the patient and their family (Christakis et al. 2012).

Further, a terminal patient requires a relief of suffering from the pain and distress they experience in order to achieve a quality life. This suffering could comprise of physical and psychological pain and empathetic suffering from other people. Any kind of pain and suffering should be managed and although it could be impossible to eliminate all kinds of pain, the patient’s suffering should be alleviated by giving particular attention to physical pain, spiritual and social concerns (Casey et al. 2004).

Challenges Faced by Nurses Providing End-of-Life Care

In addition, the terminal patient has psychological requirements that ought to be met. They probably go through the five basic stages of grief upon receiving the news of their acute illness which are denial, anger, bargaining, depression and finally acceptance of the situation. Giving a dying patient the chance to express their emotions is paramount and it’s a positive and helpful technique. The health care providers need to be on the lookout for feelings such as guilt, low self-esteem and the lack of pleasure in such patients. They should also know when to best treat depression using antidepressants (Sykes, 2016).  An assessment and intervention approach should be used to meet the psychological needs of terminal patients in a professional manner. Additionally, the terminal patients require having their dignity respected and the health care providers ought to be sensitive and respectful of the patients’ wishes (McCaughan & Thompson, 2015).

Moreover, the families who are the most concerned with the terminal patient have their own needs. The clinicians should ensure that they supply them with relevant information, financial pieces of advice and care for the bereavement period. The caregivers and relatives should be kept informed upon the consent of the patient because they can be important stakeholders in the giving of the end-of-life care especially in making crucial decisions for a patient who is not able do so. They also require emotional and psychological support (Heyland et al. 2013).

The nurses who provide the end-of-life care face various challenges among them being ethical challenges. Sometimes a nurse can be uncertain about the best action to take when a patient is too ill to make decisions yet their preferences and wishes had not been previously enquired about. Such critical junctures could pose complex ethical questions about the patient’s deteriorating state and what exactly the nurse should do about it. Sometimes, even when a patient is capable of making decisions for themselves, the acute setting ethos may dictate otherwise and a nurse is left in a dilemma of whether to respect the patient’s wishes or overlook them and stick to the principles of the acute setting (Sorlie,Kihlgren, & Kihlgren, 2014).

Furthermore, the nurses are affected psychologically and emotionally by the traumatic experiences surrounding an acute setting which eventually ends up in death. They are also human and breaking the bad news to a terminal patient about the acute condition and to their families about the death of their loved ones is not an easy task. This could be because the nurses are afraid of causing anxiety and depression to the victims. Also, when the focus changes from curing to giving acute care as the patient waits for death, it could be traumatic for the nurses due to the change in patient goals and having to face the possibility of death (Kawano, 2013).

Ethical Challenges

Moreover, cultural factors and beliefs could act as barriers to the nurses’ provision of acute care to patients. For instance, some cultural beliefs could influence a terminal patient to reject the end-of-life care being given to them by the nurses with the claim that their time to die has come and no measures should be taken to prevent that from happening. Nurses encounter challenge of having to refrain from providing the required treatment to a suffering patient yet it is their obligation to improve the quality of life by respecting the patient’s needs and wishes. Additional issues that the nurses encounter in the acute setting include communication barriers, lack of sufficient time with the patients, and lack of proper training and knowledge on how to handle the patients.

In conclusion, people who are approaching their death need high-quality care. Patients have the right to express their wishes and desires on the nature of care they need and the place they want to die. In this case, different social and health care providers are involved in the provision of end of life care. However, the provision is not an easy task for nurses and care givers but it gives positive outcome to dying patients. Further, it allows for professional pain and suffering management and also assists patients with crucial decision-making and establishing the appropriate end-of-life care goals and plans. Therefore, regardless of the ethical challenges, traumatic experiences, cultural factors and personal problems, nurses need to overcome these issues and provide the necessary care and comfort for the terminal patients.  

References

Cioffi, R. J. (2013). Communicating with culturally and linguistically diverse patients in an acute care setting: nurses’ experiences. International journal of Nursing studies, 40(3), 299-306.

Heyland, D. K., Dodek, P., Rocker, G., Groll, D., Gafni, A., Pichora, D., & Lam, M. (2013). What matters most in end-of-life care: perceptions of seriously ill patients and their family members? Canadian Medical Association Journal, 174(5), 627-633.

Kawano, Y. (2013). Association of job-related stress factors with psychological and somatic symptoms among Japanese hospital nurses: Effect of departmental environment in acute care hospitals. Journal of occupational health, 50(1), 79-85.

McCaughan, D., Thompson, C., Cullum, N., Sheldon, T. A., & Thompson, D. R. (2015). Acute care nurses' perceptions of barriers to using research information in clinical decision?making. Journal of Advanced Nursing, 39(1), 46-60.

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Sulmasy, D. P., & Lynn, J. (2012). Quality end-of-life care: Patient’s perspectives. Jama, 277(23), 1854-1855.

Taylor-Brown, S., &Sormanti, M. (2014). End of life care: Health & social work, 29(1), 3-5.

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