Dying in a Hospital Setting

For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.

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

The World Health Organisation (2010) defines palliative care as: An approach that improves the quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. It is also our duty to support John and his wife`s in their decision for John to die at home, Department of health (2008) patients should have a choice over the care they receive and where.

Key people could be family, doctors, carers, religious leaders etc. Each may own distinctive role to play in order for the choices and preferences of the individual to be respected and carried out. [ Every person’s end-of-life trajectory is different and needs differ in intensity and quality over time. End-of-life care must adapt to the varying and changing needs of the individual over time and that it cannot be limited to certain settings or services. The provision of good

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.

Essentially, Hospice and palliative care focus on managing symptoms when a patient is deemed to have 6 months or less to live and allows patients to live out their lives away from a hospital or nursing home setting. Partially the reason why most people, including me, haven’t heard that much about Hospice is most likely because it is intended for people at the very end of their lives. However, another major reason is addressed in Gawande’s book, and it revolves around the idea that doctors don’t inform their patients every time that Hospice is really an option. Gawande admits himself throughout his book that like most doctors, he is always over-optimistic and focus on the treatment of the disease, forgetting to focus on the idea of just managing the symptoms in cases where treatment would only prolong the inevitable or giving too many choices for families to make. Gawande explains “All-out treatment, we tell the incurably ill, is a train you can get off at any time- just say when”, however other options are often never talked about (2014, p. 187). One example from Being Mortal is the story of Sara Monopoli, who faced an incurable form of cancer at a rather young age. Sara, along with her family and husband, never focused on just symptom management, but rather what new and outrageous treatment can be done

Part One: In the documentary "Being Mortal" by Atul Gawande talks about the death of patients and how it 's a surprise to a large amount of the patients. He also explains the fear in the medical field, and as a doctor your suppose to help people and cure them, that you 're supposed to give them a better shot and if it later doesn 't go they way you expected,the doctors start to tell themselves what went wrong or what happen everything was going so well. Gawande talks about how he wants to learn more about how to communicate with patients and telling them that they have a certain weeks, days or months left. For example, He talks about one of his patients that he had, her name was Sarah and had stage 4 lung cancer was young and just had a

Comparatively, Bailey et al. (2014) studied the effects of implementing interventions to improve end of life care for inpatient veterans. The problem statement was determined to be that end of life care in the inpatient setting was lacking, which drove the aim of the study to improve EOLC and to minimize suffering of the patients (Bailey et al., 2014). The researchers theorized that this could be accomplished if recognition of end of life was increased and if home-based palliative interventions were implemented. Therefore, the team sought to study the effectiveness of implementing staff education of three items: evaluating patients who are actively dying, communicating end of life interventions with patients and families, and implementing home-based best practices for end of life care (Bailey et al., 2014). The purpose here was to improve inpatient end of life care.

Death is inevitable at some point everyone must face it. Whether it is the death of a family member, friend, or a family pet, people are forced to deal with the death. Nurses however have more frequent encounters with death than the average person does. When a patient dies in a healthcare setting his or her nurse is obligated to deal with that as well. They must find ways to cope with the increased amount of death that

“Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help” (Asnani, MR. 2009). Effective communication plays a big role in healthcare and contributes to the quality of patient care and teamwork.

(Schapira, 2010) It is important for patients to have all the facts in order to accept and prepare for death. Another area not always communicated well has to do with advance care planning. Many patients do not learn about options or talk about end of life issues until it is very late. Studies have shown that younger doctors are more likely to initiate conversations about end of life care options. (Pahwa, Babu & Bhatnagar, 2005)

The content of the Five Wishes document can be applied to practice by giving healthcare professionals words to use in the dialog that occurs when having a discussion related to end of life desires. Many times, during these challenging topics and moments staff, patients, and families do not know how to discuss dying or what to ask for during the days leading up to death. Additionally, this document can serve to offer an unbiased conversation. Lastly, Five Wishes can help to translate allowing natural death, end of life moments, comfort, and dying with dignity. Specialized areas of care such as intensive care settings can utilize this document to help patients and families make decisions and understand the kinds of care that will be given to their loved one.

I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of

Recent advancements in technologies have provided doctors the ability to keep a person alive, long after their organs have failed and their brain seizes to produce any activity. They can keep the heart beating. Regardless of the person’s life status, if a family refuses to allow their loved one to go, hospitals can keep them ‘alive.’ The living are often unable to make the final decision to let their loved one go even if they are beyond help. By keeping a person alive, it gives the family the false impression that their friend, brother, mother, or child, will come back. Doctors have the ability and technology available to keep a ‘dead’ person alive for the sake of the families, which cause greater turmoil on the living, as opposed to allowing nature to take its course, allowing loved ones to move on.

Today we are face with death in a different setting then our ancestors, instead of dying at a younger age and dying in our home with our families, people are now dying at a hospital or in a medical setting. We are living longer because of the advances in medicine, this is causing us to develop diseases that our ancestors never had to face. Our ancestors did not live long enough to develop some of the diseases we face today. As Jones (2011) provides, “we don’t just die of different diseases then our ancestors, we also die in different circumstances” (p. 302). The changes in circumstances have caused us to reevaluate what is believed to be ethical when faced with dying. There are many medical options a terminal ill or elderly patient that is dying can choose from, however there is great debate whether some of these options are ethical.