Article Critique: Quality of Dying of Patients
Jessica Jorge
West Coast University
Abstract
The current article critique dissects a research undertaken by Goodridge, Duggleby, Gjevre, and Rennie (2009) and published in the Journal of Nursing in Critical Care. Their research was a mixed method approach centered on exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit. Keywords: nursing, critical care, COPD, ICU, quality of dying
Research Problem/Purpose
The article by Goodridge et al., (2009) sought to address the problem of inadequate research on the quality of end-of-life care for patients with advanced chronic obstructive pulmonary disease (COPD), who are frequently admitted and die in critical care units. The title of the article is clear and appropriate within the context of critical nursing care. In addition, the research problem has been clearly identified and the abstract precise, representative of the research topic, and in the correct form. The purpose of the article is clear both in the Abstract and Introduction sections, where the authors point out that their intentions were two-fold. One, to ascertain the perspectives of critical care providers in the quality of dying patients admitted for COPD, and two, to compare how nurses rate the quality of death and dying between patients from other critical care units and those in the COPD unit. Notably, the investigators
This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role
Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely
Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the
Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.
Although nurses have their experience to guide their practice, as the health professional most involved with the client at the end of life, there is a need for review of current assessment tools and management strategies to ensure the care given is evidence based and best practice.
Nurses: Assist the patients and families to cope with the end-of-life process such as assessing and
According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues
Briefly describe the patient and his/her situation, diagnosis and prognosis, brief history of the disease, and how/why the patient entered palliative-focused care.
This might be one reason why some patients choose conventional treatment instead of choosing a hospice program, there is many other factors that may contribute to this decision such as; financial status. This research will help give nurses a stronger knowledge base of characteristics and advantage of hospice care. In addition, nurses will be able to explain the advantages of Hospice programs to more of their patients, thus, they will be able to educate and encourage more families to choose hospice care. Not only will it help the patient live out a comfortable life it will also help the caregivers with
Despite significant advances in the multidisciplinary approach of palliative care and the growing body of evidence-based practice, a multitude of variables continue to interfere with excellence in end-of-life care for everyone (Anonymous, 2007). Because of this the primary nurse must be diligent in administering the proper medications to allow the patient to have minimal pain or suffering and provide emotional support and reassurance to family members, and possibly fellow staff members
Nurses are prone to deal with death, whether they would prefer it or not. Although, there is an increase of medical advances to slow the progression of death, it is inevitable that patients will die. When a patient dies, nurses must deal with the grief and emotions that encompasses death. Due to the nature of how often nurses deal with death, it leads to an increase awareness of how they will someday face their own death. The increase in emotions and grief leads to an overwhelming increase in stress for nurses. Continuous increase in stress can lead to burn out in nurses. Therefore, nurses must learn effective coping methods of death to reduce any devastating emotions and maintain professionalism.
Acute hospitals play a significant role in end of life care, it is the place where most people die. Evidence suggests that end of life care in hospitals needs improvement. The purpose of this paper was to investigate patient and family experiences of hospital death, the weaknesses within the hospital setting and possible solutions to improve. A literature search identified common themes, these included:
For these people, a reliable quality care serves as vital component. But, available studies mention that end of life care has become a poor quality for nursing home residents. There are reports on improper management of shortness of breath, increased prevalence of unrelieved pain, and poor satisfaction among family members about care and communication. Such defects have an association with financing arrangements for long-term and end-of-life care services which are under the control of acceptability, fees, and regulatory mechanisms (Huskamp et al.,
They provide the opinions of nurses nationwide and analyze suggestions from a large number of nurses to improve the care provided to patients at the end of their life. Since there are many suggestions as to how end-of-life care can be improved from not only a specific area of the United States but from nurses representing the nation as a whole, this proves that the care provided to these patients had become an issue. The authors have expertise in the nursing profession and have all acquired their PhD, proving that this is a reliable source. I will use this in my research paper to explore different ways of improving end-of-life care to help patients feel comfortable and how improving the system can cause physician-assisted suicide to no longer be
Many nurses are regularly confronted with the hopelessness and exhaustion of patients and their families making it difficult for them to find balance between the preservation of life and the enablement of a dignified death. Nurses must acknowledge their own feelings of sorrow, fear, dismay and helplessness and recognize the impact of these emotions in clinical decision making. These distressing pressures may cause a nurse to contemplate intentionally assist in ending a patient's life as a humane and compassionate answer, however; the conventional goals and standards of the nursing profession mitigate against it.