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Question:

Discuss about  the End of Life Care ?
 
 

Answer :

Introducation:

Appropriate palliative care requires effective nursing skills and care management to relief the people from pain and provides the best quality of care in their end of life stage. It is a specialized type of medical care that is provided to the people suffering from serious illness. This kind of end of life care is focused to relief the person from the symptoms as well as from the prevailing stress. The main goal of end of life care is to improve the quality of life and care for the patients and their families (Buck et al., 2015). There are several care requirements needed for the people in palliation like management of pain, the spiritual needs, communication needs and advanced care directive. There is also requirement of skilled nursing care that helps to provide symptom management, spiritual support and psychosocial needs in collaboration with the palliative care team. However, the nurses encounter several issues while delivering the end of life care to the people like patient’s wishes, nurses’ grief, pain management and knowledge treatment. The following essay involves the care requirements during the end of life care and the nursing issues that arises during palliation.

In an acute setting, the end of life care for a dying patient requires specific care requirements. The pain management, the patient’s spiritual and communication needs of the patient and advanced care directives. Advanced care requirements are needed for the dying patients to improve their quality of life and relief pain. The man focus of care involves the relief of the patient from their symptoms and stress that arises due to the serious illness. Care requirements not only involves pain but also takes into account the depression, anxiety, difficulty in sleeping and other factors that causes distress in the dying patient (Lamba et al., 2014).

The pain management is an important need in the dying patients during the life of care. They suffer from severe illness that involves pain to a large extent. The patients often express their pain and it is the prime assessor of pain. It is greatly affected by emotional context as it is a complex subjective phenomenon (Kelley & Morrison, 2015). The management of pain is necessary as the patients want to live their last few days or months completely pain-free. The nurses have the duty to offer the best quality of care to the dying patients by managing their pain as they suffer from unanticipated illness.

As the patient is in their end stage, their spiritual and psychosocial needs should be addressed. Under The Nursing and Midwifery Board of Australia (NMBA), the competency standards states that the nurse should fulfill the spiritual needs of the patients that would help them to gather strength to life the rest of their last days as a normal person (Edmonds, Cashin & Heartfield, 2016). The patient’s religious beliefs, behavior and sentiments needs to be addressed by the nurses as their coping style, behavior and attitude has an association with the reactions during the stressful life events. It also helps to assess one’s inner being and meet the needs of the patient differently.

Communication needs are also important to address in a dying patient due the end of life care. It is often challenging for the nurses to communicate with the patients who are dying. The nurses need to understand the essential needs of the patients through effective communication. The nurses need to approach the patient with utmost care and sensitivity so that they feel motivated and encouraged to express their needs during the last days of their life (Jacob, McKenna & D’Amore, 2016). The understanding of the non-verbal communication is also important as a dying patient will not be able to express their needs verbally. The nurses need to understand the gestures and facial expression of the patient in assessing their pain and other essential requirements. It helps to establish the patient’s priorities and in making informed consents. Moreover, the communication needs are important for the assessment of anxiety or distress in the patients.

Advance care directives are also essential care requirements for the dying patients. It is a model that helps to understand the wishes and priorities of a dying patient in an acute setting. It is a legal document that encompasses the principle of autonomy during the palliative care (Best & Fredericks, 2014). This legal document is important as it expresses the desire of the patient in accordance to the medical treatments. This is important in instances when the patient is unable to take decisions of their own during palliation.  As it has great impact on the patients and their families, the advanced care directives are important care requirements for the dying patients.

The nurses play the most crucial role in delivering the end of life care to the dying patients. The end of life nursing care encompasses many important aspects like assisting patients, pain management and the patients’ families during the dying process, culture sensitive practices and in ethical decision making (Cherry & Jacob, 2016). In delivering the end of life care, the nurses face many issues like inability to recognize a dying patient, patient and family wishes being supported and information and support provided to patients and family. It also involves the nurses grief while taking care of the patients, knowledge of treatment, pain management and ethical decision making by the nurses.

 


The inability to recognize a dying patient is an issue faced by the nurses. At times, the nurses are not able to recognize the time of the dying patient as it is inevitable in nature. The nurses might not be able to understand the exact moment of death of the patients. As the patient in palliation is about to die, the nurses need to assess and know the patients’ wishes and priorities (Urden, Stacy & Lough, 2017). The nurses need to be careful in supporting the patient and their family wishes that might interfere with their professional code of conduct. Moreover, information and support should also be given to the patient and the family about the end of life care plan and treatment. As the nurses are dealing with dying patients, they are subjected to grief and distress. In the competency skills under the Nursing and Midwifery Board of Australia (NMBA), it is stated that the nurses have the duty to provide the best quality of care within their professional limits (Malloy et al., 2014). They need to control their emotions and perform their end of life care nursing. There are other issues like knowledge of treatment, pain management and in making ethical decisions for the patients. Ethical decision making is the most crucial issue for nurses in delivering end of life care. Nurses need to assess physical, spiritual and psychosocial needs of the patients and also working in accordance with the standards of care and ethical code of conduct. The nurses are restricted to their profession in making ethical decisions for the best of the patient’s needs and in inhibiting their own style of administration (Lazenby et al., 2016).  

Palliative care involves crucial end of life nursing in fulfilling the needs of the terminally patients. There many care requirements needed for the patients like pain management, fulfilling of the spiritual, physical and psychosocial needs, advanced directive care and communication needs that involve verbal and non-verbal communication. However, in delivering the best quality of care to improve their lives, the nurses face many issues. The nurses own grief, ethical decision making, inability to recognize a dying patient, proper support to the patients and their families, and knowledge of treatment are some of the issues faced by the nurses in providing the best quality of life to the dying patients. Therefore, delivery of palliative care is crucial for the nurses.

 

References

Best, O., & Fredericks, B. (2014). Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care. Cambridge University Press.

Buck, H. G., Mogle, J., Riegel, B., McMillan, S., & Bakitas, M. (2015). Exploring the relationship of patient and informal caregiver characteristics with heart failure self-care using the Actor-Partner Interdependence Model: Implications for outpatient palliative care. Journal of palliative medicine, 18(12), 1026-1032.

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Edmonds, L., Cashin, A., & Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards. International nursing review.

Jacob, E. R., McKenna, L., & D’Amore, A. (2016). Role expectations of different levels of nurse on graduation: A mixed methods approach. Collegian.

Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.

Lamba, S., DeSandre, P. L., Todd, K. H., Bryant, E. N., Chan, G. K., Grudzen, C. R., ... & Quest, T. E. (2014). Integration of palliative care into emergency medicine: the Improving Palliative Care in Emergency Medicine (IPAL-EM) collaboration. The Journal of emergency medicine, 46(2), 264-270.

Lazenby, M., Sebego, M., Swart, N. C., Lopez, L., & Peterson, K. (2016). Symptom burden and functional dependencies among cancer patients in Botswana suggest a need for palliative care nursing. Cancer nursing, 39(1), E29-E38.

Malloy, P., Paice, J., Coyle, N., Coyne, P., Smith, T., & Ferrell, B. (2014). Promoting palliative care worldwide through international nursing education. Journal of Transcultural Nursing, 25(4), 410-417.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical care nursing: diagnosis and management. Elsevier Health Sciences.

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