Discuss about the End of Life Care in Acute Setting.
Human lives start with the aid of health care setting and end with it as well. In the last stages of life the elderly generally spend the more of their time in the hospital care facility than they spent in their own homes. By the law of nature the old age comes ridden with medical complexities and the older population depend completely upon the health care service provided by state or nation (Curtis et al., 2012). Studies suggest that most of the old-age population that spent the most of their time in the health care facility, the end to their existence mostly comes in the acute health care setting. This essay attempts to describe different aspects of the end of life care services in the acute health care services taking the example of Australian health care.
There was a time in the long lost past where the ageing population died in the confines of their houses without any clinical intervention to relieve the pain and provide any means of comfort. Health care has come a long way since then, with the new age technological advancements, hospitals now provide pone of a class end of life care to the ageing terminally ill population in the palliative care units (Hui et al., 2014). Taking the example of Australian citizens, 52 % of the ageing individuals die in the acute care settings. One might raise a question as to what is the need for the aged members of the society to spent the last years or months or days in the formal hospital settings rather than in the comfort of their homes surrounded by the loved ones, making the most of each passing moment. However, the advanced palliative care provided to the elderly in the very last stages of their lives can minimize if not eradicate the pain and suffering and decrease the grief of death that looms over the patient as well as the family (Jones et al., 2012).
There are a lot of dimensions to the end of life program, a lot of frameworks and legislations coming together to provide the optimal care to the patients that are very last of their days or months in the hospital setting. The program of recognising and responding to clinical deterioration policy has constructed the very basics of the end of life care program. The national consensus statement of the Australian government about the essential elements for safe and high-quality end of life care in the year of 2015 has clarified the part of physicians, nursing professionals and health care professionals in the end of life care setting with the common goal of delivering the best of care to the ageing members of the society (Katz & Johnson, 2013). The consensus statement serves as a guide for the horde of health care professional about the specific requirements of the ageing and terminally ill patients complete with all the safety procedures to comply with.
However, with all the progressive technologies and advanced health care services, there are a number of factors that drag down the successful operations in the end of life care setting. Health care is a people focussed field and undoubtedly there are going to be challenging external factors that will inevitably dag down the progress. Almost all regions of Australia has a different end of life care unit, be it New south Whales, Queensland, Northern territory or Victoria, the variables affecting the standards of palliative care are the same (McCourt, Power & Glackin, 2013).
The variable that demands prior recognition when discussing about palliative care is pain management and that too as the earliest. The terminally ill patients are mostly suffering with acute pain and trauma and mostly the health care professionals do not know which way to go with their complex and multiple medical complexities. There are poor skills at display that could refer the needy patients to palliative unit and diagnose the cause of pain and offer immediate relief, even if the patient is not dying (Murray et al., 2012). The most of the issue with pain management failures for the terminally ill or patients in acute care unit is the lack of skilled decision making force, the lack of judgment in the incompetent staff can lead to a loss of life even if that was meant to be lost soon anyway.
The next most influential variable in the acute end o life care setting will be keeping up with demands of the patients and their families. The fear and denial in the patients or their family members is mostly the most challenging hurdle for the health professionals to overcome. Mostly the professionals hesitate to face the family of the patient to deliver information about the tragic turn the health of their beloved has taken (Teno et al., 2013). And even if they do deliver the message the emotional attachment of the family members restricts them from coming to terms with the reality. the denial of the patients themselves often interfere with the care delivery as well. Another vital point in this scenario is the unrealistic and impractical demands that the patients and their families make that critically restrict the flow of care services. This conundrum can only be solved if there is effort from both sides, meeting each other halfway. The health care professionals need to overcome their apprehension of breaching the topic of impending death with the family members and the patients and family members need to embrace the reality so that the care is not withheld for their emotional outbursts (Thomas et al., 2013).
This issue undoubtedly is a major concern to the health care professional working in the palliative care unit. However, the root cause behind this issue lies in the lack of knowledge in the public about palliative care. In most cases the family of terminally ill patients are terrified of the impending death of their loved one and palliative care seems like uncharted territory for them about which they have no clear idea (Virdun et al., 2015). This lack of knowledge and terror and grief on the impending death of their own fuels their denial and unrealistic demands. Sometimes the health care professionals suffer from blame game as well, where they find the death or failure of the treatment top be due to their incompetency, they need to overcome this apprehension to communicate with the patient and their families better, explain the benefits of end of life care so that they are not terrified o this concept.
Another restriction to efficient and optimal care to the terminally ill is the sparse effort given to differentiate the patients. Often the health care professionals cannot recognize who is dying and why they are dying, is it due to an accident or an organ failure, a terminal disease, and without ample effort to recognize this differentiation it is impossible to deliver required care (Watts, 2012). Moreover, the palliative care units are majorly focussed around the terminal illnesses like cancer and lack the framework and infrastructure to deal with other trajectory of decline.
Above mentioned issues are just the surface of the iceberg in metaphorical sense, there are a lot more complex issues that are associated with the inadequacies in end of life care setting. However, newer and better policies and programs are being designed like the national palliative care program to improve this sector of health care and it can be hoped as the future comes so will come strategise to target these key areas that will change the face of end of life care.
References:
Curtis, J. R., Engelberg, R. A., Bensink, M. E., & Ramsey, S. D. (2012). End-of-life care in the intensive care unit: can we simultaneously increase quality and reduce costs?. American journal of respiratory and critical care medicine, 186(7), 587-592.
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), 1743-1749.
Jones, D. A., Bagshaw, S. M., Barrett, J., Bellomo, R., Bhatia, G., Bucknall, T. K., … & Hillman, K. M. (2012). The role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study. Critical care medicine, 40(1), 98-103.
Katz, R. S., & Johnson, T. G. (Eds.). (2013). When professionals weep: Emotional and countertransference responses in end-of-life care. Routledge.
McCourt, R., Power, J. J., & Glackin, M. (2013). General nurses’ experiences of end-of-life care in the acute hospital setting: a literature review. International journal of palliative nursing, 19(10).
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2012). Illness trajectories and palliative care. Int Perspect Public Health Palliat Care, 30, 2017-19.
Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., … & Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.
Thomas, M. J., Schultz, T. J., Hannaford, N., & Runciman, W. B. (2013). Failures in transition: learning from incidents relating to clinical handover in acute care. Journal for Healthcare Quality, 35(3), 49-56.
Virdun, C., Luckett, T., Davidson, P. M., & Phillips, J. (2015). Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliative medicine, 29(9), 774-796.
Watts, T. (2012). Initiating end?of?life care pathways: a discussion paper. Journal of advanced nursing, 68(10), 2359-2370.
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