With a senior population rising to unprecedented levels, there exists in nursing the challenge of adapting traditional policies of care to responsibly address the needs of those who are nearing the ends of their lives. The issue is in fact more problematic than it may appear, simply because so much of nursing is focused on returning patients to healthy, active living. With advanced age, and the presence of actual illness aside, the parameters and expectations are wholly different. As the following will address, the ethics of nursing must extend to humanely accommodate those who cannot reasonably anticipate an independent or active life, or one of any significant duration, and this must as well be in place irrespective of the difficulties inherent to the situations.
Strategies Pertinent to the Issue
The essential or foundational ethics of nursing go to the promotion of physical and mental well-being of the patient, and usually within the processes of treating illness and assisting in the patient’s recovery to an independent life. Gerontology, and particularly in regard to the elderly nearing or at end-of-life status, is a wholly different arena, and one which requires that nursing ethics expand to encompass its specific considerations. Clearly, leadership is pivotal here, and chiefly because the circumstances of the advanced elderly are so inherently complex. Cases vary enormously; some nursing is best practiced by determining when treatment interferes with a peaceful end, while in other instances more aggressive approaches to disease are warranted (Poor, Porrier, 2001, p. 76). Adding to this are family and financial concerns, as well as a Western ideology traditionally neglectful of senior needs, More to the point, there tends to be a social abhorrence of end-of-life scenarios which must influence how care is practiced. This being the prevalent reality, it falls upon the nursing leader to undertake responsibility for upholding in these cases the ethics intrinsic to all nursing; namely, the best interests of the patient, regardless of external factors or imminent death. In essence, the strategy required is that an insistence be maintained on the specific needs of the individual patient, which encompass the issues within that patient’s end-of-life situation.
Analysis of Evidence
Regrettably, the evidence overwhelmingly indicates that end-of-life care is at best a neglected arena within nursing. This exists, moreover, in all pertinent environments. Those of advanced age, for example, are less likely to be treated for severe pain, whether in hospital or nursing home settings. It is accepted that this is partially due to concerns of the adverse effects of medicines on the elderly, but it also appears that an element of disregard is in play; for example, studies reveal that no medication is administered in more than 25 percent of cancer patients of advanced ages (Bern-Kilug, 2013, p. 112). Other studies consistently find that elderly patients present challenges often frustrating or alien to trained nurses. They frequently respond to treatment with disruptive behavior, and this generates more aggressive medicating or neglect, rather than a focus as to underlying fears, confusion, or depression as creating the behaviors (Grace, 2009, p. 396). In plain terms, many nurses are not equipped to properly respond to these situations, which then translates to lapses in ethical approach.
Research also affirms that, in patients over the age of 80, there is a typical lessening of cognitive functioning, aside from development of dementia or other debilitating mental illness. In end-of-life contexts, then, this translates to a greater imperative on the part of nurses to engage in decision-making for the patient’s benefit (Pruchno, Smyer, 2007, p. 46). Any examination of the evidence supports an urgent need for end-of-life care to be reevaluated, if nursing is to be ethically responsible.
Importance to Nursing
The import of end-of-life care in nursing is by no means restricted to that field of practice. There can be no “partial” adherence to ethics within nursing, for a lack in any arena eviscerates the integrity of the whole. Then, nursing ethics may not be subject to distinctions based on age or circumstance; the profession demands a consistent regard for patient welfare no matter the case. In more pragmatic terms, such care requires a more intent commitment on the part of the nurse, simply because the circumstances are typically so extreme. The nurse here has an immense obligation, for attending to the patient’s welfare in end-of-life cases entails an understanding of any resuscitation protocols or life-sustaining measures as determined by the patient and physician (Roussel, 2011, p. 92). All nursing is intrinsically crucial, but end-of-life care, which brings into play issues not present in other care, places an expanded set of responsibilities, and of ethical and medical kinds.
The ethics of nursing are inevitably centered on the core obligation of the nurse to care for the patient’s well-being. Unfortunately, it seems that cultural viewpoints regarding advanced age, along with issues in actual procedure and variations in patient need, create challenges nurses must confront. End-of-life care is an increasingly prominent element in living today, yet the care attached to it is inconsistent at best, and this then translates to the need for a focus on the basics of nursing ethics. In end-of-life care, there must be nursing leadership equipped to comprehend and instruct in the many variables associated with this particular and crucial stage of life, and in ways promoting the same ethics that guide nurses in all practice.
Bern-Klug, M. (2013). ransforming Palliative Care in Nursing Homes: The Social Work Role. New York: Columbia University Press.
Grace, P. J. (2009). Nursing Ethics and Professional Responsibility in Advanced Practice. Sudbury: Jones and Bartlett Publishers.
Poor, B., & Porrier, G. P. (2001). End of Life Nursing Care. Sudbury: Jones and Bartlett Publishing.
Pruchno, R. A., & Smyer, M. A. (2007). Challenges of an Aging Society: Ethical Dilemmas, Political Issues. Baltimore: Johns Hopkins University Press.
Roussel, L. (2011). Management and Leadership for Nurse Administrators. Sudbury: Jones and Bartlett Publishing.