Palliative care is a type of health care for patients and families facing life-threatening illness, and helps patients maintain their dignity and quality of life so close to the end. During my clinical at Rosthern Hospital, I had a few experiences with patients and their end of life care. In these situations the patients, their families, and the healthcare team have been confronted with many ethical dilemmas. At Rosthern, there were three different patients who had a difficult time during their end of life care. T. C. was in his early 80’s and he did not have do not resuscitate (DNR) order, so when he coded, he received CPR and was revived. Aftern his resuscitation he had crippling deficits in his memory and much of his motor function. M. T. was in her 70’s, and she was diagnosed with stage 4 lung cancer and deteriorated quite quickly. Finally, H. M. was in his 80’s and was expected to pass quickly, so he was moved to palliative care room before Christmas, but since then has lived longer than expected, and has received palliative care for quite some time. It is important to remember than in palliative care the patient is the priority, and according to Dr. Aveyard (2004), when a patient denies care, “care cannot be given. To do so would be infringing on patient autonomy and to contravene the principles of consent” (2004, p. 1). I analyzed my experience with these patients at Rosthern Hospital using the Carper’s Five Ways of Knowing (1978) and I will reflect upon palliative
The purpose of this paper is to examine communication strategies related to palliative and end-of-life care with a focus on Aboriginal clients. Firstly, I will explain the role of cultural competence in the nursing care of an Aboriginal client. Secondly, I will argue the cultural challenges a nurse may face when caring and communicating with Aboriginal clients receiving palliative end-of-life care. Thirdly, I will present solutions to the aforementioned communicative challenges. Lastly, I will discuss the impact I believe this experience may have on my future practice.
Over the past five weeks, I have learned what palliative care really is all about. I found that there were areas that really changed my perspective as well, about what palliative care is. Some of these include, but are not limited to, when palliative care is used, how difficult is can be to get patients the pain management they need, as well as how many different complimentary therapies are available to patients.
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
****In this article nurses had raised some extended questions, “what is the nursing role in treating patients than physician-assisted suicide?” First, we need to define physician-assisted suicide “the provision to a patient by a medical health professional of the means of ending his or her own life” (Dilemma,2010). As we all know that the patient has the right to deny any kind of treatment at the patient’s proposal so we cannot view it as physician-assisted suicide but other than a respectful manner to the patient’s nobility and one’s own choice. Nurses encounter problems when caring for their terminally ill patient who request for a physician-assisted suicide. The Code of Ethics for Nurses, is a standard principle for nurses to abide by. When the end-of-life questions arises for nurses, “The Code of Ethics for Nurses” is to guide their practice so no
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
An ethical dilemma is a difficult situation that usually involves a conflict between moral obligations, in which to obey one would result in disobeying another (Murphy, 1997). Sedation is an ethical dilemma in palliative care because on one side it helps to relieve suffering for patients who are terminally ill and almost at the end of their lives. However, at the same time, sedation is making the patient deprived of certain bioethical principles such as autonomy, the main issue with palliative sedation is that it prohibits the patient from changing his or her decision, once sedation is commenced and informed consent also becomes complex (Cooney, 2005). The writer is in the favour of palliative sedation because it is an effective symptom controlled strategy for the patients who are nearly at the end of their lives. Moreover, it is believed that by providing sedation to a patient induce unconsciousness, which makes the patient completely unaware of the external world and tend to reduce the suffering by considering ethical and moral principles. However, some people think palliative sedation as euthanasia, which cause death because of making the patient deprive of nutrition and hydration while giving sedation. Ethical principles are going to be discussed in this essay such as autonomy, beneficence, non- maleficence and justice. Moreover, this essay also going to put light on current research
Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).
You have made excellent points. I do not believe that health care professionals neglect to treat patients in palliative care in the correct settings. The care one receives is based on what type of locations they are in. Hospitals and hospice centers often have employees with higher education levels and an increased passion for their job. I believe that health care providers want to ensure that one is comfortable at the end of life. I have visited Alive Hospice here in Nashville and was able to see the the great amount of care they provided to their patients. I have attached a link to their website below. I am curious to know your opinion on why you think one would not receive adequate care at the end-of-life phase.
Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.
In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.
With major advancement in medical treatments, it is now possible to keep a patient alive, which would not have been possible in former times. This has made end of life issue one of the most controversial issues in healthcare. Medical improvements have set the stage for ethical and legal controversies about not only the patient’s rights but also the family’s rights and the medical profession’s proper role. It is critical that any decision made in such situation is ethical and legal to preserve the rights of the patient and also protect the healthcare institution involved. It is very important when making decisions to discontinue treatments to make sure all other alternatives have been explored.
Freedom, independence and self-autonomy are fundamental rights of a human, This directly pertains to the central notion of an individual's right to live and right to die. A terminally ill patient should not suffer through excruciating pain and discomfort but rather embrace a timely and dignified death, this is implicit in the concept of liberty and self-determination. Despite rapid advancement in medical technology and modern palliative care, some patients suffer from incurable terminal diseases which inflicts destructive pain upon the patient both physically and mentally. They are unable to seek the compassionate relief of pain and suffering that they wish to
The educational topic related to the nursing profession that I am interested in enhancing my nursing practice and knowledge in is palliative and end of life care. Specifically, furthering my education to encompasses more spiritual knowledge and strategies when encountering patient specific cases.
The senior population will always have a great abundance in society. They are highly aware that death would be right around the corner, especially if they are terminally ill or disabled. It is the time for them to have conversations with their doctors about the different options that will highly impact their remaining life. The high costs of the many services affect the patient’s decision on how they should be treated as to why Medicare and private insurance is an important factor and issue. Older patients want to live out their life, but they cannot do that if these services are limited. Seniors often take the surgical path in order for them to improve their state. They do not really consider the option of palliative care. It’s a great
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.