There is not a single specific point in an illness, when end-of-life care begins. It depends on an individual and progression of their illness. At stage of terminal illness, despite best care, attention and treatment. If your loved one comes to the end of their life, the focus would be to make them comfortable as possible. Depending on nature of disease, the final stage period may last weeks, months, or several years. This time palliative care help to control pain, other symptoms, shortness of breath, hospice care, support emotionally and spiritually to both patients and their families.
Dying at home a major challenge; a severe shortage of professional home care giver, the expense of hiring-quality help, the difficulties of pulling together a community of family and friend for 24-hour care, medical advances of recent decades. Depending on what is available near you, some hospice offering include in-home care, but Medicare has limited coverage. Families prefer alternatives that are expensive or require endless hours. The options come in mind is nursing homes, 5 thousands-10 thousands/month. Though, at home you have the smell of cooking, grand children coming, is more comfortable for elders. Some elders love their life at home but need more service at home. Dying at home is realistic? Sandi Hebley, an educator at faith presbyterian hospice in Dallas, shares her visit to japan and New Zealand, observed and found out that the resources at home are larger more extensive. In Great Britain, hospice movement started in 1960. Hospice advocate, Cicely Saunders placed teams that went to home with case manager several nurses. That setup made a huge difference there.
To support patient regarding end-of-life. I like the POLST paradigm, a framework to help and guide a conversation about what kind of care a patient wants when future health crisis occurs. Some changes in health care system can improve care of individual with progressive illness. For example, we should broaden end-of-life to mean the last years of life, by developing a health care pathway for chronically ill and declining people who are at their last years of life as described in “Medicaring” white paper by Dr. Jonne Lynn. The UK has developed a “Gold standard Framework” along similar lines. We can learn their work by studying their approach.
Furthermore nurse can support by communicating with members to manage family involvement t, by focusing on values by knowing wishes, help to seek financial and legal advice such as living will, attorney, address family conflicts by involving social worker or hospice specialist, preparing early by hospice and palliative care services.
Bill. W. (2018). How realistic is dying at home. The difference between where American would prefer to die and where they do?
Grand Canyon University (2018). Health assessment: foundation of effective practice.
Health assessment of aging adult. Retrieved from http// www.gcumedia.com.
Melissa. W. (2019). Late stage and end-of life care. Help guide.
Leslie. K. (2013). How we can get to better end-of life care. Practical information for aging health and family care giver
End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend?
“Dying at home is not favored in certain cultures (due to cultural taboos) and some patients may wish not to die at home, out of concern that they might be a burden on the family.” (Stanford School of Medicine, 2020) Being a burden on family or lack of family is a big concern for many patients. Another reason many patients are not dying at home is due to the multiple physical issues requiring nursing care occurring at the time of death. (Ward, 2018) Limited coverage by Medicare for in home care during the final days is another barrier. Cost for in home care can be very expensive and if a lack of finances occurs then it would be impossible to utilize those services.
Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.
Nursing plays an important role in end-of-life care. Not only do nurses assist the patients during this difficult time but they also support the family members. Ensuring patient’s wishes are met is something the nurse needs to strive to complete during the end of life timeframe. If the patient wishes to have spiritual support, the nurse will help coordinate that. (Pathways Home Health and Hospice, 2020) Create a plan with the patient, if able, to remove the gray areas on the patient’s wishes. Nurses will act as the mediator between the family and patient in order to support the patient’s wishes. (Pathways Home Health and Hospice, 2020) “Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.” (Rights, 2016) If nurses follow the code of ethics and patient’s wishes it will provide a positive experience in this difficult end-of-life care situation.
Pathways Home Health and Hospice. (2020). Retrieved from https://pathwayshealth.org/hospice-topics/the-critical-role-of-nurses-in-end-of-life-care/
Rights, A. C. (2016). ANA. Retrieved from American Nurses Association: https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf
Stanford School of Medicine. (2020). Retrieved from https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/
Ward, B. (2018, December 6). Next Avenue. Retrieved from https://www.nextavenue.org/how-realistic-is-dying-at-home/