How May Nurses in Acute Settings Support Families in End of Life Care?
The purpose of this paper is to provide insight into how nurses may better support families during end of life care. Nurses are faced with multiple tasks and responsibilities within their careers; however, are nurses fully prepared for the immense amount of responsibility that it takes to care for patients and their families during end of life care? I will use Ruland & Moore’s (1998) Peaceful End of Life Theory to explore how this theory is relevant to my research topic of how nurses in acute settings may support families during end of life care. In the form of a literature review, I will outline common themes found throughout the literature and identify the most prominent barriers that nurses, patients and their families face during end of life care. I will depict the limitations and gaps within the literature, provide some recommendations for continuing research, discuss nursing implications, and lastly, the learning that occurred.
Nursing Theory
Ruland & Moore (1998) state that there is a need for clinical guidance in caring for patients and their families who are nearing the end of their lives. By providing nurses with clinical guidance, they can give patients and their families quality care. This theory focuses on dying in a peaceful and meaningful way with family members being present; however, there is great complexity in caring for patients who are nearing the end of their lives, and it is important for nurses to have an adequate level of knowledge about end of life care (Ruland & Moore, 1998). It is essential for nurses to help patients and their families during end of life care by providing them with peace, which involves feelings of calmness, harmon...
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...their families with peace, dignity, and respect. I have identified numerous themes throughout the literature such as the nurses role in end of life care, being present with patients and families, improving end of life care education, nurses attitudes about death, and lastly the importance of communication between nurses, patients, and their families. The nursing implications are to provide nurses with a greater awareness in end of life care, secondly, nurses must become more comfortable with death and dying. This paper has provided information on how nurses in acute settings may support families in end of life care; however, the question of how to provide support still persists. The focus of this paper requires larger sample sizes and experienced nurses to improve the overall statistics of this study; however, there is still much ambiguity on this particular topic.
God tells his children, “He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away” (Revelation). Death is one of the most frightening and confusing times a person can go through. Watching a loved one pass away is also one of the hardest trials a person can experience. Many people assume that death is a time of pain and the only thing that they can do is mourn and watch their loved one fade away from the earth. This is wrong. There are ways that people can turn a bad situation to good. Dying doesn’t have to be painful and full of suffering. The County Hospice staff makes sure of this. The Hospice staff not only takes care of passing patients physically, but they also take care of the patients emotionally and spiritually. Hospice staff also plays a key role in helping families during the grieving process.
Charalambous, A. (2010). Good communication in end of life care. Journal of Community Nursing, 24(6), 12-14. Retrieved from EBSCOhost.
Final Gifts, written by hospice care workers, Maggie Callanan and Patricia Kelly, includes various stories detailing each of their life changing experiences that they encountered with their patients. Hospice care allows the patient to feel comfortable in their final days or months before they move on to their next life. This book contains the information considered necessary to understand and deal with the awareness, needs, and interactions of those who are dying. Not only are there stories told throughout the book, there are also tips for one to help cope with knowing someone is dying and how to make their death a peaceful experience for everyone involved. It is important that everyone involved is at as much peace as the person dying in the
Nurses are both blessed and cursed to be with patients from the very first moments of life until their final breath. With those last breaths, each patient leaves someone behind. How do nurses handle the loss and grief that comes along with patients dying? How do they help the families and loved ones of deceased patients? Each person, no matter their background, must grieve the death of a loved one, but there is no right way to grieve and no two people will have the same reaction to death. It is the duty of nurses to respect the wishes and grieving process of each and every culture; of each and every individual (Verosky, 2006). This paper will address J. William Worden’s four tasks of mourning as well as the nursing implications involved – both when taking care of patients’ families and when coping with the loss of patients themselves.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
Nurses take an active role in advocacy and policy development regarding assisted death and other end of life choices. Through the help of advance care planning, nurses has helped patient think about what gives their life a meaning, learn about medical procedure offered at end-of-life care, help them communicate about their future health care wishes, choosing a person who would speak for them when they cannot speak for themselves and recording goals and wishes. The role of the nurse in end-of-life care is very crucial, they might be getting more queries on physician-assisted death. So, it is significant for nurses to understand the law and professional standard for better continuity of care and also to protect themselves against potential
The Code of Ethics for Nurses was created to be a guide for nurses to perform their duties in a way that is abiding with the ethical responsibilities of the nursing profession and quality in nursing care. The Code of Ethics has excellent guidelines for how nurses should behave, however; these parameters are not specific. They do not identify what is right and wrong, leaving nurses having to ultimately make that decision. Ethics in nursing involves individual interpretation based on personal morals and values. Nursing professionals have the ethical accountability to be altruistic, meaning a nurse who cares for patients without self-interest. This results in a nurse functioning as a patient advocate, making decisions that are in the best interest of the patient and practicing sound nursing ethics.
It is found that nurses report that their most uncomfortable situations come with prolonging the dying process and some struggle with ethical issues by doing so (Seal, 2007). Studies have shown that implementation of the RPC program and educating nurses have increased the nurses’ confidence in discussing end-of-life plans (Austin, 2006). With confidence, the nurse is able to ask the right questions of the patient and make sure that the patient’s wishes are upheld in the manner that they had wanted, such as to not resuscitate or to make sure their spiritual leader is present when passing (Austin,
To “live as fully and comfortably as possible” is a key phrase in the care and treatment of a patient under hospice care. Hospice care focuses on the comfort and quality of life for a person with a terminal illness. The focus is not on a cure. A hospice care provider wants to help the patient be as pain free and comfortable as they can be, so that they can live the rest of their life as fully as possible. Unfortunately, more often than not, patients with terminal illnesses are viewed to be too frail to participate in occupations (Russell, M., & Bauh-Lampe, A., 20016). It is also true that people facing the end of their life feel helpless or depressed, lose their ability to participate in a lot of the daily activities they once enjoyed, and experience a loss of dignity. (Badger, S., Macleod, R., & Honey, A. 2016). However, with hospice care, many patients are able to find some degree of comfort, safety and control over their lives during their final days.
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...
The nurse becomes the confidant, the guide through the darkness, a source of comfort for those experiencing the trauma of losing a child. To successfully fulfill these nursing roles, in addition to roles that must be fulfilled to meet other patient’s needs, one must acknowledge their own definition of death and educate themselves on cultural and societal norms associated with death and dying. It is important to identify one’s own definition of death and dying but also understand that one’s preference does not define the death experience for others. The individuality and uniqueness of each death experience means that one definition of death may be hard for one to accomplish. It is important to maintain an open mind, nonjudgmental spirit, and impartiality for the cultures and practices of others surrounding death and dying. A culturally competent nurse is not only responsible for acknowledging the cultural norms of others but also respecting and educating themselves about the death rituals of their patient’s culture and providing the family with as many resources to safely and effectively fulfill their cultural practices. Education is empowering for the nurse who is navigating the death and dying process. Education often supplements ones credibility with the dying patient and their family which can ease overall anxiety and further promote ones role as a patient advocate and provider of
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The subject of death and dying is a common occurrence in the health care field. There are many factors involved in the care of a dying patient and various phases the patient, loved ones and even the healthcare professional may go through. There are many controversies in health care related to death, however much of it roots from peoples’ attitudes towards it. Everyone handles death differently; each person has a right to their own opinions and coping mechanisms. Health care professionals are very important during death related situations; as they are a great source of support for a patient and their loved ones. It is essential that health care professionals give ethical, legal and honest care to their patients, regardless of the situation.
Study Purpose The purpose of this research study was to develop a communication strategy for family members of patients dying in the ICU by evaluating a format consisting of a proactive end-of-life conference and brochure to see whether the intervention could minimize the effects of bereavement for the families left behind. This research provided the family members with more opportunities to discuss the patient wishes, to express emotions, to alleviate feelings of guilt, and to understand the goals of care. Research Hypothesis and Research Questions Here researchers evaluate the effect of a proactive communication strategy that consisted of an end-of life family conference conducted according to specific guidelines and that concluded with the provision of a brochure on bereavement....