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
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.
Patients have the right to self-determination and individuals should have control over their own lives. With respect for human autonomy comes respect for patient rights. Apart of the nurses job is to promote, advocate and protect the rights, health, and safety of our patients. Patients have the right to determine their health needs, make informed decisions, and the right to information regarding their treatment and also the refusal of treatment. Nurses are obligated to know the rights of a patient and to make sure the patient understands their treatment plan. Supporting patient autonomy includes making decisions in the best interest of the patient, considering their values and recognizing differences between cultures. In the treatment
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.
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
The NMC (2015) are the providers of the Nursing Code of Conduct. The code contains the professional standards to which all nurses must uphold, allowing for accountability of patients that come into their care. As well as the code of conduct, all nursing professionals have a responsibility to develop their knowledge in relation to law within clinical practice, and furthermore, ethical frameworks that are linked to judgment and decision making when providing care (Savage & Moore, 2006). In light of this, the overall aim of this essay is to elaborate on issues surrounding law and ethics in nursing. To do so, a case study has been chosen from a previous clinical experience. The focus of the case study will be on the decision of withdrawal from life sustaining treatment. Emphasis will be largely on the law and ethics concerning the issue of withdrawal from treatment. Moreover, the ethics and law involved in the palliative/advanced end of life care planning and decision making. In order to protect the identity and uphold the confidentiality of the case study, a pseudonym will be used throughout. Hendrick (2005) portrays confidentiality as being ‘one of the most important and well established moral obligations of health-care ethics’.
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
End of Life Care Planning is a controversial topic that is huge dilemma in healthcare. The average Medicare expenditures per person over the last two years of life was $102, 939.00 (Harter, 2015). One quarter of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life (The Henry J. Kaiser Family Foundation, 2016). Nurses deal with ethical dilemmas when caring for patients at the end of life. Nurses are responsible in minimizing unwanted treatment and patient suffering, which can sometimes be interfered by what family members want and the patient wishes (American Nurses Association [ANA], 2012). This paper will go over why end of life care planning should and should be covered as a covered expense.
This is recognized to be an issue, and throughout the article the authors provided an understanding of how palliative care and end-of-life care are provided too late for a patient and should be provided at an earlier time in order to bring more comfort to the patients. The authors suggest that when and how end-of-life care is provided should be altered, with nursing ethics in mind, so that patients and nurses may feel better about the care they receive. This source will help my research by providing information on how changing the policies of end-of-life care and palliative care can result in the patient feeling a relief from their suffering and ultimately feeling more comfortable. This will also help my argument in how altering the current policies and focusing on providing better end-of-life care can lead to the diminishment of physician-assisted
Dr. Ira Byock’s latest book, The Best Care Possible: A Physician’s Quest to transform Care Through the End of Life, is a remarkable book written from a personal perspective as one of the foremost palliative-care physicians in the country. Dr. Byock shares stories of his experience with patients in his clinical experience to illustrate how end-of-life care affects each person. He explains what palliative care really is and how to make humane choices in a world obsessed with conquering death. Byock presents an agenda for end-of-life care that stresses compassion, dignity, and each patient being viewed as a unique case with the opportunity to partake in shared decisions amongst a team of professionals and family members. Dr. Byock is an advocate of dying well in a society marked by a fear of death; his highly personal account provides thought-provoking vignettes of how people struggle to make the right decisions in the winter of their lives. Byock urges society to embrace the reality of death and transform the medical community into an environment that will allow patients to live the last of their days in comfort with dignity and peace. This book is a vitally important piece of literature for everyone to devour with fervor. Everyone needs to understand the inevitability of death and the environment end-of-life care can present in what will be the final moments of life.
There are occasions when medicine is not your friend and the effects of the treatment will only prolong the suffering of the patient. Healthcare professionals must be objective and ask will the end result be changed. We must know when it is appropriate to discuss end of life options and when it is not. According to Adams (2015), most desire to die at home, but less than half are allowed to do so (p. 13). Our responsibility is to allow the client to make an educated decision about all the available service and treatments.
With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient
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.
Nurses are expected to provide physicians with quality assessments and needs of their patients to ensure when a change from curative care to palliative care is needed and to ensure good death. Death has always caused an ethical