Important Aspects of Communicating with End-of Life Patients and How Nurses Can Facilitate the Process
End of life decision-making is often a very difficult process and one that every person will eventually have to go through at some point in their lives. Although communicating about the advance directives is the typical route most health professionals use, it is not adequate in aiding families in the process of end of life decision-making. While nurses are in an ideal position to help patients and their families through this process, it is often over looked because most people are uncomfortable with communicating about death and dying. These choices are a quality of life issue and it is not a subject that should be taken lightly. End-of-life discussions should be addressed with compassion and empathy. Nurses can facilitate and ease this process by being clear, avoiding euphemisms, spelling out goals and expectations of the patients treatment, being comfortable about talking through end of life decision-making and helping patients and their families to maintain hope and optimism. Clarity One obstacle nurses face when communicating with end-of-life patient’s is clarity. Nurses need to be clearer and more specific with patients so there is not any confusion. According to Hancock, Butow, Walder and Tattersall’s article on facilitating end of life decision making, it say’s that the providers that are unwilling to use words such as death and dying send mixed messages to
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
It is important to educate patients and families about their terminal illness and end of life care. Knowledge of what to expect can decrease anxiety related to the patients expected decline and empower the patient and family to direct care to meet their needs. Knowledge also brings about understanding and acceptance of the death and dying process. Alleviating anxiety allows for a higher quality of life for the patient and higher satisfaction of care provided.
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
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
As people approach the end of their lives, they with their families and their caregivers, face many tasks and decisions. They may be psychological, spiritual, or medical in nature, but all end-of-life choices and medical decisions have complex psychological components, ramifications, and consequences that have a significant impact on the suffering patients and their caregivers.
I t is important that end of life care is delivered in respect of patients Autonomy, Beneficence, and in a Truthful way. In what follows I argue that we as nurses need to fulfill obligation to support and assist the dying patient and his family’s right to self-determination as it relates to end of life care. I believe that we have made headway but still have much to achieve. Education and research in these areas by and for health care workers and the general population would do much to improve the quality of end of life care.
The article points out how the American Nurses Association (ANA), the Hospice and Palliative Nurse Association (HPNA), and Oncology Nursing Society (ONS) do not support the use of assisted dying. However, due to recent law changes, the organizations are reevaluating their position on dying with dignity. The article talks about the countries and states that have legalized assisted dying and who can qualify to obtain the prescription. It also points out that nurses who live in these countries and states are more likely to be uncomfortable to talk about this subject with their patients. Either way, patients need to be educated and advocated for while following the code of ethics when dealing with the subject of assisted dying. The article also points out how a nurse needs to be a tentative listener to further assess why the option of assisted dying is being considered. A brief case study demonstrates how a good nurse can reveal the true motives behind choosing the assisted dying as an option. Finally, the article talks about different communication techniques and approaches a nurse can use when discussing the subject of
Many patients and families in this situation have understood that all treatment options have been exhausted, and the focus then shifts to a peaceful, respectable, and comfortable dying process for the patient. The healthcare team desires what is best for the patient. As members of the health care team, nurses may often find themselves in situations where establishing patient wishes and preparing for end-of-life care decisions falls on them. According to evidence-based guidelines for initiating end-of-life care planning “discussions should be driven by the philosophy of hope for the best, prepare for the worst.”
1.1 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.
Thirdly, during the difficult time, a compassionate care is necessary for a nurse to reach the family in making the decision. At this stage, Clabots (2012) implored nurses to be strong advocates for the patient and family by offering available treatment options, such as palliative and hospice care. Additionally, Clabots (2012) suggested that nurses accommodate their patient and family to ensure questions are answered, concerns are addressed, and patient’s privacy and dignity are maintained.
At times the dying patient’s loved ones become the nurse’s patients. As stated in End-of-Life Care: Caring for the Dying Patient and Family of the Dying Patient, “End-of-life (EOL) care of the dying patient and the patient’s family encompasses a variety of interventions that meet the physical needs of the patient and the emotional/psychosocial needs of the patient and the family. The rationale for EOL care is to provide physical comfort for the patient by managing pain and reducing emotional stress, and to promote effective coping and spiritual comfort for the patient and family” (Woten and Schub, 2016). As future nurses, it is critical that we acknowledge the potential we hold, we treasure the gift we have been given and we take our responsibilities
Helping adolescent and young adult palliative care patients communicate their end of life requests is a significant aspect of hospice nursing, yet the conversations can be difficult (Wiener, et al., 2008). The use of age appropriate advance care planning documents is one way to facilitate the death and dying discussion (Wiener, et al., 2008).
Communication between the patient, family, clinicians, and nurses is important in inquiring the needs and wants of the patient and family. Noome et al. (2016) recognized that ICU nurses described their role during end-of-life care as a professional who communicates information to patients and family on treatments, procedures, and prognosis while providing comfort. Effective communication about advanced directives and disputes over end-of-life care decisions may lead to acceptable compromise and solution between all parties involved (Blackler, 2016). Clear communication and understanding is needed in order to provide high quality 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
Our society finds it difficult to talk about dying and euphemisms are the norm. It is typical for both doctors and patients to be hesitant to initiate a discussion on dying. Focus instead is often more often placed on interventions and actions for managing symptoms. This avoidance can leave patients and their families unprepared for the inevitable death. (Schapira, 2010) It also often results in requests for therapies which may be excessive, costly and even painful in the hopes for a cure. One study demonstrates that when patients are aware that they are terminally ill, the majority are able to reach a state of peacefulness and also exhibit lower levels of distress. (Ray, Block, Friedlander, Zhang, Maciejewski & Prigerson, 2006) It is also important that family members are willing to discuss end-of-life options with their loved ones. According to elderly patients, they are most often the ones who initiate these conversations with their