End of Life, Coursework Example

Introduction

This paper considers the impact of end of life care for the elderly.  This often has a profound  impact for medical professionals, particularly those nurses that are new to this form of patient care. Nurses are often at the sharp end when it comes to preparing a patient for death and dying. Equally they are often the first contact with the bereaved persons who are grieving over the loss of a loved one.  With the patient it is the comfort of not feeling alone or abandoned and that someone is there to help and comfort them through this passage with the minimum of discomfort and pain. With the bereaved family it is the ability to come to terms with the loss. Death is not something that they will recover from but something that has to be accepted as part of life and the ability to come to terms with this.  Those that are unable to make this adjustment can equally put their own health and wellbeing at risk.

The nurses and Doctors have to carry out this facilitation function whilst conditioning them to remain relatively detached from the mental anguish involved.  This period can create many mixed and varied emotions including distress, anger, sadness, separation, aspects of denial and loss of interest in social functions and potential isolation.  In order to advise the bereaved the nurses require a background of each families personal circumstances as advice can vary differently for each person.  Very often, after preliminary advice is given, this needs passing over to a specialist grief councillor

Spiritual Counseling

Depending upon religious persuasion spiritual guidance can be provided and most hospitals have a chapel and a Priest that will be prepared to assist in this process.  Equally the nurses can gain spiritual guidance and support from the priest in the best determination of how to deal with specific situations.

Training needs to be provided in order to help nurses assist in solving the problems caused by emotional responses and the families of terminal ill patients.  There are certain consistent stages that each patient and family passes through. It is important to both recognise and have an understanding of these stages in order to be able to deal with them.  Only in this manner can you progress through this in a logical manner .  This provides a learning experience and a degree of competency over the process.

Legal Considerations

As Doctors are faced with the concept of mortality on a regular basis they become somewhat hardened to the condition. Very often this takes on a clinical perspective and somewhat cold perspective on the harsh realities of life.  The interface with the patients often occurs with life threatening conditions like Cancer.  Most patients want to know their chances of survival and possibility of a cure.  Doctors on the whole tend to be pessimistic and deal with trends or statistics.  The real patient care being passed on to the Nurses who are at the sharp end of dealing with patient care and often the transition of dying patients providing them with the help and dignity of coming to terms with death.  The nurses are greatly undervalued in Society for the significant role that they play here.

Both Nurses and Doctors have to take care in order to avoid potential legal problems when dealing with elderly dying patients.  Nurses have to be careful in administering the correct doses of medications and avoid potential overdoses that may result in death. Such occurrences may result in legal malpractice lawsuits being raised.  The need to be careful of allergies and medical treatment is another consideration. Informed consent is another important factor in terms of making the patient and family aware of any medical treatment that is to take place. This is by the signing of an informed consent form. This usually has to be witnessed by an independent person.  Negligence can also be raised where a Doctor has prescribed a particular prescription and the nurse fails to administer it.

Family Care Provisions

Training needs to be provided in order to help nurses assist in solving the problems caused by emotional responses and the families of terminal ill patients.  There are certain consistent stages that each patient and family passes through. It is important to both recognise and have an understanding of these stages in order to be able to deal with them.  Only in this manner can you progress through this in a logical manner .  This provides a learning experience and a degree of competency over the process.  There have been many psychological models that have been produced that nurses can become familiar with. These include such theoretical models from the likes of Kubler-Ross, Pattison, Cor, Buckman and Copp etc.  Each offer different psychological perspectives on death and dying. Whilst useful background reading these can be somewhat restrictive when facilitating someone’s transition from life to death.

Nursing Diagnosis and Interventions

Most hospitals have a chapel and a priest that can assist with spiritual guidance for the dying elderly.  Nurses can arrange suitable introductions in line with family requests.  This can equally help the family in coming to terms with the situation and provide some comfort and peace to the elderly patient.  (Reed, P.G. 1991).  Certain patients who are facing death may elect to have a period of home nursing care in order to allow the patient to pass away in the peace and serenity of their own home.  “nurses responded to complex problems and used a variety of interventions to assist patients and families in management of the illness experience..”  (Hughes, et al., 2002). Other interventions in terminally ill cancer patients help them to develop a coping strategy that embraces the family and patient in helping to come to terms and deal with the predicament. (PASACRETA & MCCORKLE, 2000)

Nursing Considerations

As Doctors are faced with the concept of mortality on a regular basis they become somewhat hardened to the condition. Very often this takes on a clinical perspective and somewhat cold perspective on the harsh realities of life.  The interface with the patients often occurs with life threatening conditions like Cancer.  Most patients want to know their chances of survival and possibility of a cure.  Doctors on the whole tend to be pessimistic and deal with trends or statistics.  The real patient care being passed on to the Nurses who are at the sharp end of dealing with patient care and often the transition of dying patients providing them with the help and dignity of coming to terms with death.  The nurses are greatly undervalued in Society for the significant role that they play here.   Studies of patients with small cell lung cancer often showed the patients to be more optimistic about their potential for recovery than the Doctors who were treating them.  In Hong Kong the Doctors and Nurses are receiving more advanced training programs to learn how to approach and deal with terminally ill patients.  (Wong, Lee, & Mok, 2001)

Conclusions

Most nurses in hospitals recognise the important need for training in this area.  Doctors can be somewhat more detached in the final analysis but the nurses are at the sharp end.  Whilst to an extent a lot of experience is gained over time by exposure to different practical experiences, nevertheless, training helps in putting together a suitable framework that will help all nurses engaged with having to deal with transition experiences.  This will help the nurses to gain confidence in their approach and help to reduce some of the levels of personal stress in the provision and facilitation of these services.

Works Cited

Hughes, L. C., Robinson, L. A., Cooley, M. E., Nuamah, I., Grobe, S. J., & McCorkle, R. (2002). Describing an Episode of Home Nursing Care for Elderly Postsurgical Cancer Patients. Nursing Research Vol 51 (2), 110-118.

PASACRETA, J. V., & MCCORKLE, R. (2000). Cancer Care: Impact of Interventions on Caregiver Outcomes. Annual Review of Nursing Research Vol 18(1), 127-148.

Reed, P. G. (1991). Preferences for spiritually related nursinginterventions among terminally ill and nonterminally ill hospitalized adults and well adults. Applied Nursing Research, Vol 4 (3), 122-128.

Wong, F. K., Lee, W. M., & Mok, E. P. (2001). Educating Nurses to Care for the Dying in Hong Kong: A Problem-Based Learning Approach. Cancer Nursing, Vol 24(2), 112-121.