HSM 542 Course Project

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

Patients that qualify or use palliative care also have a terminal diagnosis but usually have a longer life expectancy than those with hospice. The definition for hospice and palliative care is something many nursing students learn during their program. Young-Ran, Min, and Kyoung-Soon (2015) found in a study that 70% of nurses in a general hospital setting that had cared for a terminal patient had no prior education or training for palliative care. Nursing education continues to evolve in attempts to better prepare nursing students for life after their program completion. Attempts to better familiarize students with end of life care some programs are using simulation. Simulation has been found to be an effective method of teaching when related to high stress and emotional situations (Moreland, Lemieux, and Myers, 2012). It is great that there have been attempts to increase the amount of education in this specialty area especially since 76% of dying patients are receiving nursing care at time of death (Moreland, Lemieux, and Myers, 2012). Now it will be important for current nurses and educators to continue to increase the amount of information provided in nursing programs and to novice nurses about hospice and palliative specialty

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

Comparatively, Bailey et al. (2014) studied the effects of implementing interventions to improve end of life care for inpatient veterans. The problem statement was determined to be that end of life care in the inpatient setting was lacking, which drove the aim of the study to improve EOLC and to minimize suffering of the patients (Bailey et al., 2014). The researchers theorized that this could be accomplished if recognition of end of life was increased and if home-based palliative interventions were implemented. Therefore, the team sought to study the effectiveness of implementing staff education of three items: evaluating patients who are actively dying, communicating end of life interventions with patients and families, and implementing home-based best practices for end of life care (Bailey et al., 2014). The purpose here was to improve inpatient end of life care.

Our end of life care is offered by a multi-discipline team that supports patients and manages illnesses. Throughout the process, our team provides the emotional, physical and spiritual support that patients need to feel comfortable. Our services include medical social services, supportive nursing care, bereavement support, volunteer support, medical equipment, pain management and respite care.

The American Board of Medical Specialties [ABMS] recognizes palliative care as a medical subspecialty classified under internal medicine (ABMS, 2015). Currently, there are only 5,000 board-certified palliative care specialists in the US (Quill & Abernethy, 2013). The demand for palliative care physicians outweighs the supply. This opens the door for other medical disciplines, such as intensive care unit (ICU) doctors or anesthesia personnel to step-in and assume some care of this unique patient population. Only 75-85% of hospitals with greater than 300 beds provide palliative care services and palliative care is available in only 20% of smaller hospitals (fewer than 50 beds)(Morrision, Augustin, Souvanna, & Meier, 2011; Goldsmith, Dietrich, Du, & Morrison, 2008).

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

Regardless of the benefits of palliative care, many problems remain in the execution of palliative care which is often referred late in the course of one’s illness. Despite the many barriers identified, education that is supported by evidence remains the key to rendering the effectiveness with better outcomes predicted for the patients, love one, and healthcare treatment

Throughout this course, I have learned new information and refreshed myself on old information. I was also able to connect old information with caring for individuals going through palliative or end of life care. Being a palliative care nurse can be a busy and stressful job. The nurse needs to be fully educated on many different areas to be able to provide the best possible care for the patients and their families. A few of the topics that we discussed were the role of the palliative care nurse, cultural competency, pain control of those in palliative care, communication strategies, and legal and ethical issues that may occur during the end of one’s life.

When it comes to end-of-life care, nurses working with terminally ill patients frequently lack confidence in tending to the emotional and existential needs of their patients. This is derived from a lack of knowledge surrounding end-of-life care and results in a decrease in nurses’ communication skills and job satisfaction (Abu-El-Nor, 2016). A study researching nurses’ perceptions of readiness and ability to care for dying patients found this to be true.  They discovered that 84% of critical care nurses felt as though they did not receive adequate end-of-life care content in school (Todaro-Franceschi, 2013). The articles discussed below address the relationship between end-of-life education and nursing care delivered to terminal

D-The patient arrived on time for her counseling session. The patient immediately requested to decrease her dose by 5mgs from her current dose as she wishes to be stabilized on a lower dose. This writer completed the HCRC form. This writer informed the patient that her reinstatement of her take home bottles were denied due to her AWOl on the 27th of January as the patient reports of not feeling well. In addition, this writer updated the patient about the clinic's new policy of take home bottles of which the patient will have to attend the take home bottle group. The patient then reported that she cannot attend the take home bottle group any time soon due to her work schedule, but will keep this writer posted about her availability to attend

The implications for future practice is a significant consideration. Creating quality end of life for patients is a concept that has deemed merit. This can be completed through the implementation of educational and enhanced palliative programs. Training programs on improving communication in relation to palliation and dying would allow for better outcomes. This would better communication and comprehension of the

5)The possibility of the natural death of the patient must be somewhat ascertainable. While also being made as to the specific length of time that the individual has to live.

Gunten et al. (2012) conducted a quantitative study of 593 third-year medical students from July 2002 to December 2007. A pre-and post-instruction performance on knowledge, confidence, and concerns, regarding end of life care and palliative care measures was evaluated. The intervention required a 32 hour didactic and experiential curriculum. The results showed a “23% improvement in knowledge (F1,486 = 881, p < 0.001), 56% improvement in self-reported competence (F1,486 = 2,804, p < 0.001), and 29% decrease in self-reported concern (F1,486 = 208, p < 0.001)” (p. 1198).