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What is the Issues of Helthcare ?



Patients especially the elderly in Australia are subjected to end of life care. This enables them to be diagnosed, treated and released when they are cured, however, there are others who have terminal illnesses and can either be hospitalized or they are taken care of while at home. The acute end of life care is a complex care which requires knowledge in treatment, car, mediating patients with their families and the doctor (Boucher, 2016). These and other decision making roles are very crucial to the nurses and may affect their duties. Other decisions concerning end of life care are left to the family members unless the nurses are consulted for further steps. This paper, aims at outlining the details of the end of life care as well as the issues that the nurses face in taking care of these patients.

End of life care

This majorly involves the control of pain, as well as the onset of other disease symptoms, is the primary goal of the end of life care to the patients and their families as well (Oshima & Emanuel, 2013). The social, psychological and social problems which might affect the patients are also taken care of. The best opportunity becomes a point when a patient is not able to participate in care and hence the family members are asked to be closely involved. For instance, the decision to use methods such as endoscopy in the end of life patients are said to be only allowed by the family members at a point when the patient is dying and this becomes one of the remaining options.  According to Teno et al., 2013, it is important to note that making of decisions in the provision of end of life care involves several health care providers such as the social workers, physicians, and nurses who have specific roles to play in patient care.

During the end of life care, communication is prime because it enables the caregiver to offer services according to the needs of the patients. For instance, poor communication can make a nurse to give a life-sustaining care which could be subjecting a patient in a painful experience whereas the patient does not need such a care (Visser et al., 2014). On the other hand, the family members are required to be conversant with the health condition that the patient is battling with as well as the end of life care which is available. This, in turn, makes them be able to be prepared for the outcomes of the said care. In this case, the families should trust that when they ask questions concerning the patients, they are likely to get the actual information. In the end, meeting the needs of the family creates a feeling of satisfaction with the care being given to the patient.


Issues that nurses face

While taking care of the patients, the nurses are required to ensure that the patients are taken care of (Cherry & Jacob, 2016). In some cases, a patient might be required to undergo several treatments like radiotherapy and chemotherapy at the same time, or one after the other. It is upon the nurse to ensure that they follow the treatment plan of the patient every time. This indicates that the nurse serves as the mediator between the patients and the care giver. In other cases, the nurses may be required to give support services in form of education and emotional support. For instance, the nurses are tasked with helping the patients to stop some risky behaviors like smoking which can negatively affect their treatment outcomes.

Moreover, it is the duty of the nurses to bring to reality to the patients’ families that the patient is undergoing end of life care. Sometimes the nurses are torn in between in between giving the families hope and telling them that death is real. Such education enables the families to make decisions to either continue or withdraw the end of life care support. Hui  et al., (2014) states that sometimes the nurses become afraid that when they involve the families at the end of life care decision-making processes, the families might suffer guilt and have a feeling of being burdened. When there is a transition from curative to palliative care the nurses are able to manage the symptoms of the diseases as well as the resulting pain. However if there is no transition, the caregivers have no choice other than using the available options as the patient's journeys to death (Johnstone et al., 2016). It is also the nurse’s play a role in making the families understands that their loved ones are getting the best care. This, in turn, should be able to help the families to accept the truth and let go.

The decision making the role of caregivers have been found to accept the prognosis being given in health care and thus be prepared for the death of their kin. Some other times, the nurses are required to offer care which might be culture sensitive (Scott, 2015). For example, a lady nurse might be requiring providing care to a Muslim man. In the Islamic culture, the men and women are not required to mix freely unless for couples. In this case, the lady nurse might be so uncomfortable while the male patient might be too preserved and not interactive to the nurse. On most occasions, the nurses are at the bedside when the patient who has been receiving the end of care is dying. This experience haunts them very much and might lower their morale especially after struggling so much in caring for them. The nurses in provision of end of life care are actively involved in offering help to the family and the patients as they exchange shifts in which further improves their competencies (Mayland et al., 2014). Such experience makes the nurses be able to note when a patient is not responding to certain or all forms of treatments.

The nurses fear to give the family members the hopes of continued treatment to the patients, giving up or making other wrong decisions that appertain the patients early enough (Dening et al., 2013). It becomes even more difficult for the health caregivers and family members to decide on the withdrawal of curative health care. As such, the health caregivers feel as though they are not competent in initiating such discussions with families because they are not aware of the reception of such topics.


Proper communication between the caregivers and the families are very important to arrive at sound decisions concerning the patient on the end of life care in an acute environment. Discussions concerning death should also be done openly between the family and caregivers so that appropriate measures concerning the patient can be taken early enough. The role of caregivers in decision-making related to the patients is very important for the families of the patient too. This is because the family members on most occasions are faced with challenges of making proper decisions concerning their patients on their own in an acute care center.



Boucher, N. A. (2016). Direct Engagement With Communities and Interprofessional Learning to Factor Culture Into End-of-Life Health Care Delivery. American journal of public health, 106(6), 996-1001.

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

Dening, K. H., Jones, L., & Sampson, E. L. (2013). Preferences for end-of-life care: a nominal group study of people with dementia and their family carers. Palliative Medicine, 27(5), 409-417.

Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), 1743-1749.

Johnstone, M. J., Hutchinson, A. M., Redley, B., & Rawson, H. (2016). Nursing roles and strategies in end-of-life decision making concerning elderly immigrants admitted to acute care hospitals: an Australian study. Journal of Transcultural Nursing, 27(5), 471-479.

Mayland, C., Gent, M., & Raj, J. (2014). ‘Being with you’. Evaluation of a novel ‘volunteer companionship training programme’for supporting end-of-life care within an acute hospital setting. BMJ supportive & palliative care, 4(Suppl 1), A80-A80.

Oshima Lee, E., & Emanuel, E. J. (2013). Shared decision making to improve care and reduce costs. New England Journal of Medicine, 368(1), 6-8.

Scott, A. (2015). Difficult decisions: Achieving the Gold Standards Framework for end of life care requires a huge culture change, but the results are worth it, says Alison Scott. Nursing older people, 27(5), 11-11.

Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., & Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.

Visser, M., Deliens, L., & Houttekier, D. (2014). Physician-related barriers to communication and patient-and family-centred decision-making towards the end of life in intensive care: a systematic review. Critical Care, 18(6), 604.

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