Improving Coordination Of Care Within The Hospice Setting Essay

This essay will discuss the importance of communication as an aspect of partnership within current nursing care. As stated by Brooks and Heath (1985, as cited in Bramhall, 2014), communication is “a process during which information is shared through the exchange of verbal or non-verbal messages” (p 53). Maintaining communication between the nurse and the patient regarding treatments and emotions contributes to improved patient-centred care. The communication between the nurse and their family is equally as important when the patient is unable to make medical decisions for themselves. With the implementation of family centred communication, a partnership can further be established. With reference to literature, the benefits of maintaining

Caring Hospice will be made up of an inter-disciplinary team that collaborate together to provide holistic, competent, and compassionate care for terminally ill patients and their families. The team will consist of the Medical Director, Patient Care Coordinator, Registered Nurse, Bereavement Coordinator, Social Worker, Chaplain, Certified Nurse Assistant, and Office Manager. Each team member will play a vital role in creating an effective care giving system.

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

Fields related to healthcare often utilize this model to address patient’s needs. St. Luke approach to team case management is effective in positive outcomes for their patients and families from a holistic point of view. In palliative care or nurse-led care, case managers with specific expertise to help individual care needs (Joo & Huber,20123). By regular case review, care plan meetings, evaluation of care, and constant direct contact with patient and families. Case management in hospice and palliative care agencies are very comprehensive in nature. Coordinating direct care services is the key component to positive outcomes (Spettell et al., 2009).

Communication is key to effective healthcare practices. According to American Journal Of Critical Care (2014), Patient-centered care starts with “effective communication, being empathetic and available, avoiding personal prejudges, and listening therapeutically are integral parts of patient-centered care” (Riley, White, Graham, Alexandrov, 2014, p. 320). This will improve communication; promote patient involvement in care, which creates a positive relationship with the healthcare provider and medical team. This results in improved adherence to treatment plan. Clinical practice guidelines need to be implemented for the patient and family members to be able to be involved in informed decision-making regarding healthcare needs. The fundamental core of nursing is to have a partnership with the patient and their family regarding the patient’s outcome.

My perception of palliative and Hospice care has changed slightly when it comes to communication with the family. I walked into the hospice unit mentally preparing myself to talk with patient families about their loved one and the dying process; this was certainly not the case. The family and the patient did not want to be bothered unless comfort interventions needed to be carried out and there was no conversation to be had about the patient and his situation. This shows that each family is different, each patient is different; and we need to respect and accommodate their unique

Long-term care is a result of people having terminal conditions, disabilities, illnesses, injuries, or being elderly. The purpose of long-term care is to provide services to people and to aid people at a time in their lives when they cannot depend on themselves to maintain daily activities. There are many variations of long-term care available – such as home care, adult day care, and independent and assisted living, personal care facilities, nursing homes, and hospice.

Volunteers played a large part in Pierre’s care, even staying with him overnight toward the end. How can the hospice’s management adequately supervise volunteer workers in such situations and ensure

Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, 2013). For most nurses, caring for a dying elder (individual aged 65 years and above) is a discrete, time-limited experience that begins with first contact, often in a hospital, emergency room, or long term care facility, and ends with the death itself (Phillips & Reed, 2008).

Kaakinen et al (2015) discusses the two types of health care teams that will be involved in the patient’s care: multiprofessional and interprofessional. The multiprofessional model is an older model that does not focus on holistic care. Care is fragmented with an autocratic leader, vertical communication, separate goals of the professionals involved, and families are peripheral to the process (Kaakinen et al., 2015). The preferred model is the interprofessional model emphasizing a team approach, holistic care of the patient, horizontal communication, and involvement of the family (Kaakinen et al., 2015). The nurse should keep this collaborative approach in mind when dealing with any patient case, involving all teams associated with the patient for the best outcome.

In the United States, our health care system is often characterized by communication failures. According to the American Nurses Association (2012), “Care coordination has been proposed as a solution to many of the seemingly intractable problems of American health care: high costs, uneven quality, and too frequent disappointing patient outcomes” (para. 14). Care coordination is a very important aspect in nursing roles and is extremely valuable because it can improve outcomes for everyone: patients, payers, and providers. Although it is obvious that the changes will improve patient care and general efficiency, applying changes in the general approach and everyday routines may be overwhelming. Luckily, there are resources available for those interested in taking a more coordinated approach to primary care practice (“Social Media’s leading Physician Voice,” 2012).

As I walk down the hallway, I hear the machines ubiquitously beeping a consistent hum. I see the glare of the fluorescent lighting reflecting off of the windows. I can smell the idiosyncratic smell of latex gloves and disinfectant. In this environment I have no worries, no responsibilities, and I am perfectly content.

According to the Agency for Healthcare Research and Quality (AHRQ) despite the evidence that consistently indicates that palliative care and provision of access to hospice is essential to end-of-life comfort and quality of life in the final stages of terminal illness, it is still not used effectively or sufficiently (2012). In fact, Ctarlson et al., (2010) determined that in spite of the fact that there has been a 41% increase in the total number of hospice service providers in the United States since 2000, that at least 60% of terminally ill Americans still die without the benefit of hospice services. This is because a variety of factors can create an availability gap, or make it increasingly difficult for individuals to access hospice care. These factors generally include: geography, race, age, and socioeconomic capital (Silveira 2011). Each of these factors can be individually examined, as they relate to care accessibility.

“Improved communication is noted as one of the most important factors in enhancing end-of-life care in a pediatric setting” (Hsiao et al., 2007). These factors are beneficial to maintaining the best care for the child. The relationship between hospital staff, the child, and the child’s family is crucial. “Parents have emphasized the importance of receiving honest and complete information from staff, having ready access to staff, and having continuous, caring relationships with compassionate staff “(Hsiao et al., 2007). Along with the parents’ communication with staff, parents feel it is important to have the child communicate directly with the physician when appropriate. They feel “gaining the child’s perspective is critical if there is to be a cohesive relationship among the child, parent, and health care provider” (Hsiao et al., 2007). Also, children who are able and comfortable enough to communicate with physicians benefit

I have been a registered nurse at UCLA for 18 months. One particular issue that has captured my attention is the utilization of palliative care in health care. Because nurses are generally at the bedside all the time, they have an important role to play in voicing the importance of its utilization and implementation in the patient’s care.