Nursing Care Plan: Terminal Illness and End-of-Life

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

The first phase of the nursing process is the assessment of the current needs/problems presented upon Mr. Smith’s arrival to hospital. The initial assessment requires the nurse to gain consent in order to gather any information such as his contact details as well as the contact details of his next of kin who in this case his is wife Susan and also the details of his GP, any known allergies he may have and any medications he may currently be on, whether he has dentures as well as his weight and BMI. During this phase, communication with the patient and family is essential to ensure that correct information is obtained so that a proper informed decision concerning his care can be made. In this case there may be some barriers that may effect the assessment process and that is the speech of Mr. smith is sometimes slurred, therefore he may need his wife to answer some of the more complex questions that require more than a yes or no answer. Nurses need to choose their words carefully so that they match the patient’s ability to understand them avoiding the use of medical jargon (Kraszewski & McEwen 2010). The dignity of the patient must be maintained at all times through all phases of the nursing process and a comfortable environment is essential-preferably in a private room or if not ensuring that the curtain is drawn out of respect for the patient (Barnes

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.

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.

This process paper will evaluate the complex relationship between disease pathophysiology and how it has progressed to the patient’s current state of health. It will include a comprehensive discussion of chronic and acute problems leading to the patient’s hospital admission, a complete description of interrelationships and pathophysiology for all medical diagnoses, a comprehensive discussion of the client’s signs and symptoms and results of all diagnostic studies to the underlying pathophysiology, and a comprehensive listing of all medications ordered at the time of admission with explanations of why each was ordered and identification of the most common side effects which may

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

Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America, 2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization, 2012). Hospice care can be provided in many different settings, often the patient’s own home. Hospice care can also be provided in hospitals, nursing homes, long-term care facilities and free-standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

Quality of life is defined as a person’s wellbeing in terms of health and happiness. With a terminal illness, decline in mental and physical abilities is almost always prevalent. Physician assisted suicide would allow patients to end their life when the “patient’s own ‘value threshold’ for life has been crossed” (Breslow). PAS would allow patients to die while they still feel like their life has meaning and is a life worth living. The Journal of the American Medical Association conducted a study on PAS which concluded that “loss of autonomy and dignity, inability to enjoy life and regular activities and other types of mental distress were the dominant motivation” for seeking PAS (Esposito). If a person can no longer partake in anything that they find enjoyable they do not have a great quality of life. Many people “therefore view it as a means of self-preservation – the opposite of suicide” (Quill). One physician, with a mentally ill brother, stated that if his brother was “bed bound and unable to eat due to his dementia progressing, he would not have any reasonable quality of life, and I would not want to prolong his suffering” (Francis). Quality of life can diminish with illness, but through PAS, patients are able to preserve the quality of life that

In nursing, the goal of care is usually to restore the patient back to the highest level of health possible. In some cases, however, the goals of care change when a curative approach is no longer appropriate. The new goals of care could simply be palliation and pain control rather than a restoration back to full health. This type of care is called palliative care. Palliative care is not the same as end-of-life care, but the two go hand-in-hand at times. The goal of end-of-life care is a “good” death, good being defined by the patient. Palliation is part of that “good” death. Both palliative care and end-of-life

Nurses are the hospice team members who spend a lot of time with dying patients and their families. “The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraced a humanistic caring and holistic approach to patient care.” (Wu, Vilker, 2011).

Quality of Life and Functioning for End of Life Care. HAT2 Community Health Nursing. Western Governors University.

Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)