Introduction
Evidence based practice is the basis for needed change in practice and function. It is a sound method for scientific, fact-based change. Changes which have no evidence to support them are fragile, unscientific, and subjective. These changes don’t effect real change over time, as they aren’t able to be proven to a more general population.
The change which is outlined in this paper relates to how early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management. PICO format question will be used , along with a supportive body of evidence regarding the fact that early onset into a hospice program is helpful with providing end of life pain control. Hospice programs available, and options associated with them will be discussed as well as common concerns associated with early admission to hospice. The methods used for payment of hospice, and how one qualifies for entrance into a hospice program will be explored. A literature search will be performed and its results detailed within the body of this paper. Recent publications on the subject matter and associated issues such as moral and ethical questions as well as the change question will be discussed. Planning, implementing and evaluation of the change proposed will be explored within this paper.
Identification of the Problem
End of life pain management is an important function of hospice organizations. Families and patients alike are comforted by the fact that, at the end, there are resources which allow for a comfortable death. Much of the quality of hospice care is determined by patient family members. In 2005, the Brown Medical school conducted research with regard to t...
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...nce that is necessary to provide primary care providers the tools necessary to provide care. Early hospice admission is statistically proven to be more effective in preventing pain at end of life. It is cost effective to do so and has been discussed within the confines of this project. A literature search using CINAHL proved that in different venues the fact that earlier admission does result in pain management was proven.
Support of our patients, our colleagues and of our own practice through evidence based practice techniques and scientific fact can be the most comforting evidence in this particular change proposal as it supports the PICO question, “In terminally ill patients, does early admission into a hospice program, versus those who are admitted later, result in more effective pain control at the end of life?” The answer, based in evidence is yes.
Pain is neither objective nor seen or felt by anybody other than the person that is experiencing it. Pain is subjective, therefore there is no way to distinguish whether or not someone is hurting and the only and best measurement of pain is that what the patient says it is. In settings such as end of life care, patients present with many different disease processes and ultimately are there because they have an average of six months to live. Along with this stage in their lives, palliative care patients can encounter a myriad of symptoms, which can result in these patients experiencing tremendous physical and psychological suffering (Creedon & O’Regan, 2010, p. [ 257]). For patients requiring palliative care, pain is the most incapacitating of symptoms and in return unrelieved pain is the primary symptom that is feared most by these patients. So why has pain management not become the top priority when it comes to end of life care, considering this area is growing at an extraordinary rate as a result of an increasingly ageing population?
Terminally ill patients deserve the right to have a dignified death. These patients should not be forced to suffer and be in agony their lasting days. The terminally ill should have this choice, because it is the only way to end their excruciating pain. These patients don’t have
Evidence Based Practice (EBP) is useful to practice because it aids practitioners development and widens their knowledge and insight, therefore enhancing the experience of the practitioner. This ensures that the best quality of care is given to the patient (Duncan, 2006).
It was produced specifically to improve localized quality in the delivery of healthcare. The document was chosen because I have a particular interest in palliative care and those suffering from chronic pain. Pain effects the quality of life effecting large numbers of the population, especially those near the end of life.
The first journal article is about advance care planning (ACP) in palliative care. This is of interest due to several clinical experiences and the realization that many families either ignore the patient’s request for end of life (EOL) care or who have no idea of how to plan for EOL care. By reading the research and understanding the methods used, this will allow for insight into how to implement palliative care into clinical practice across different sites. The authors of this original research are Jeanine Blackford PhD, RN, senior lecturer at La Trobe University in Australia, and Annette Street PhD, associate dean of research and professor of cancer and palliative care studies. According to Blackford & Street (2011), this research is important as there are many countries that “report a low percentage of people who have completed an advance care plan” (p. 2022), and ACP is needed upon admission to facilities that offer palliative care.
Evidence-Based Practice is a methodology, framework, gathering of ideas or concepts, adopted principles and strategies supported by research (Fixsen et al.,
Although euthanasia requests have begun to stabilize throughout the years while palliative care has improved, euthanasia will never completely disappear. This topic depends on the type of person someone is and what thethat person is enduring. Many people fear the process of dying and the dying itself. Even though there are treatments to relieve some pain throughin the process, a patient still knows death will eventually come. Some might believe it is better to end it now rather than prolonging it. Improving palliative care will not get rid of euthanasia requests, but instead, prolong the requests. A person’s suffering can only be temporarily managed. Even if a patient is on a pain relieving treatment, there might be other side effects that cause the patient to suffer, such as nausea and vomiting. Some may like the idea of temporarily removing the suffering, but others may not because of the realization of needing a treatment to temporarily make himself feel better. These treatments can be very costly and, over time, can add up to a great amount of money that a patient and his family does not have. Also, those who are on palliative care may decide later on that the wait or the side effects are not worth it anymore and eventually request euthanasia. The improvements of palliative care will only prolong the requests of
Instead of turning to death as an option, patients should realize that there are other ways to stop pain caused by illness or depression. For example, palliative care is available in today’s society. Palliative care is a medical specialty based solely on pain and is very advanced in today’s technology. If the patients that requested euthanasia were to undergo this treatment, they would not feel pain, or as much as they normally would, and the pain would be more tolerable (O’Steen). Also, in most situations, the longing for death or suicidal death, which was revealed to be clinical depression, can be treated by medicine and sympathetic counseling (Bonin).
The history and name hospice got its name from hospitality. In 1967, Dr. Cecily Saunders evented the first hospice was which was used for people who were terminally ill. However, the Hasting center Report, shows that in 1973, hospice emerges in the United State, and was used as a concept of care and not a place of care. Hospice upholds life and neither speeds nor postpones death. They offer palliative care to people with end of stage of life regardless of their age, gender, nationality, race, sexual orientation, etc. Hospice believes that proper care to the community will help patients and their families to be mentally and spiritually prepared for the death of their love ones. They provide 24/7 care in either home or facility base setting. The care of hospice is for patients who have chronic illness and have six month or less to live (NHPCO, 2012). Opiates mediation is used to treat pain. Hospice offer palliative care service to their patients to improve the quality of life. The primary goal is to control patient’s pain, symptoms management, and improve the quality of life (NHPCO, 2012). Hospice also provides bereavement services for families who have lost their love one. This is to help the family to cope with death. The bereavement services last for about a year or thirteen months after patients die. Families are offered individual counseling or support group (NHPCO, 2012).
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Evidence-based practice is important to consider when researching for interventions, further knowledge, or help to guide a new idea in the health professions. Evidence-based practice is comprised of three significant concepts: respect and awareness for the targeted population’s values, previous clinical practice or experience with that population, and systematic research to establish a better understanding of what is already known about the study’s focus. These concepts are all taken into consideration when designing and conducting a study because it provides a more valid and credible source for others.
Evidence Based Practice emerged in the late 20th century, becoming widespread in the 21st century. According to Research and Practice: The Role of Evidence-Based Program Practices in the Youth Mentoring Field ( 2009) “The concept of Evidence Based Practice (EBP) actually has its roots in the medical field, where the work of Archie Cochrane (1972) and others examined the key role that the substantial body of medical research and literature could play in how doctors make decisions in patient care” (para 6); Thus, a doctor’s decision would be an “educated” decision, based on evidence gathered (patient symptoms), history of cases they have overseen, or research of previous case diagnosed by another doctor, with a related case. Evidence Based Practices are defined as “ integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve” (“Evidence Based Practice (EBP),” 1997-2014); often described as the “Best Practices”. The evidence itself is not the basis of decisions made, but it does help support the process of care given to our clients.
What are the best ways of achieving this in the reality of the modern NHS? To conclude, Evidence Based Practice is a process of building up accurate information from medical research which has been correlated and assessed. From this, the nurse is capable of advising the best plan of care. For nursing standards to improve, it is vitally important that the nurse is given the time to research and the trust to start off the process of change for better care. References Cullum, N., Ciliska, D. and R. Haynes, Marks (2008).
One feature of evidence based practice is a problem-solving approach that draws on nurses’ experience to identify a problem or potential diagnosis. After a problem is identified, evidence based practice can be used to come up with interventions and possible risks involved with each intervention. Next, nurses will use the knowledge and theory to do clinical research and decide on the appropriate intervention. Lastly, evidence base practice allows the patients to have a voice in their own care. Each patient brings their own preferences and ideas on how their care should be handled and the expectations that they have (Fain, 2017, pg.
We as health care professionals need to work side by side with the families to provide the best care and decisions that are right by our patients. We have to be mindful of the cause and effect our course of treatment depicts for our patients. No individual wants to live in pain or misery, we all want to be healthy and happy and are willing to go great lengths to achieve this goal. Death is the final stage of life, but as we live and get older we start to prepare for death as to not fear death but accept it. Health care professionals may benefit from the opportunity to acknowledge, normalize and integrate death and dying into the continuum of life, both for themselves as well as their patients. (Sinclair, 2011) With advancements in technology and medicine we are living longer and fuller lives, and given time quality of life will only continue to improve.