Australia is called to be a ‘death denying’ country. Lot of efforts have been put to improve over the available medical facilities and policies for the people of this country. Around 70% of the total diseases reported in Australian hospitals are chronic illness. People require medical care during protracted illness which makes the end of their life-journey more peaceful. Palliative care services are available to provide ‘comfort care’ to the terminally ill patients. In a task oriented environment of acute hospitals, the only goal is to cure the patients (ACSQHC, 2013) from the pain and suffering. Safety of end-of-life care in such settings is debatable as in many cases dying patients are found not being given required amount of attention. In most of the clinical practice settings, nurses are mainly accountable for safe end-of-life care. But due to some inherent issues like lack of effective communication with patients and their relatives, late detection of protracted illness, and improper pain management, the patients go through lot of suffering in their last days (Rosenstein, 2011).
Psycho-societal needs and holistic treatment for pain management of dying patients are not even considered. From available literature and surveys, it is clear that despite advancement in medical technologies and availability of all types of resources, flaws still persist. The objective here is to highlight the issues faced by nurses while delivering care for dying patients in acute hospitals. It will give us an insight on the real challenges and further measures that can be taken to alleviate them. It might also raise few questions on the existing care taking practices.
The first thing while providing proper care to a dying patient is to get totally familiar with the patient and his relatives. Even though nurses delivered individual care to the dying patients, much of it was directed toward meeting only the physical needs and emotional needs were ignored. Just after admission to the hospital, a patient might get scared due to the new hospital environment, chronic pain, loneliness, separation from spouse, and medication. Conversation with the patient and listening to his queries at such stage is utmost necessary. Patients and families might have particular queries and varying needs through the different stages of illness and such needs are to be addressed during the whole process of caretaking (Van der Steen et al., 2014). A situation might arise where a nurse really intends to take care for a dying patient but concurrently required beside another active patients. This condition is quite common in all acute care hospitals. Increased work load and time constraints also restrict nurses to cope up with the demand of the patients. Sometimes, negative reaction of medicine, mental condition or frustration also leads to non-cooperation from the patients; nurses have to deal with all such tough situations.
A well timed diagnosis of terminal illness gives more time to the doctor and nurse community to maneuver the illness in a better way. Though the patient dies eventually, early diagnosis and proper assessment reduce the amount of pain and sufferings that the patient undergoes in his last days. Medicines only cannot reduce suffering much. Sound analysis of pain-pattern of the patient and thorough assessment of his suffering by nurses under different conditions leads to better care (Dansie & Turk, 2013). Timely diagnosis helps doctors and other healthcare professionals to keep on trying various treatments without losing hope. It also reduces the possibility of over-treatment and prolonged medication which adds up to the pain, unnecessary harassment, fear and stress for the patient as well as his family members (Hickman & Douglas, 2010).
Chronic and persistent pain in dying patients must be managed with extreme care. It reduces mental stress in patients. The actual meaning of pain management is to provide maximum pain relief with marginal side effects. Pain is not entirely physical but also includes spiritual, emotional and psycho-societal dimensions (Wei et al., 2016). Knowledge of pain and pain assessment boosts the ability of nurse to assure effective pain management for the patient. Many nurses have shown interest to care for dying patient’s spiritual needs but it is not in further practice. Spiritual needs become more important toward the end of life (Garcia & KOENIG, 2013). A dying patient sometime may wish to make amends with others which bring spiritual comfort to him. At the same time, fulfilling some last wishes for the patients also bring them peace. A nurse can facilitate these things.
In case of incurable illness, families have to be mentally prepared for the future and what to expect after death of the patient. Another issue reported is nondisclosure of information about terminal illness (Bloomer et al., 2011). Majority of the terminal patients wish to die at home, surrounded by their family members or friends. But very few of them get their wish fulfilled (Fischer et al., 2013). Nurses need to take the patient in confidence to know such wishes. It reduces the trauma of death and also advocates for preferred environment of the patient for a peaceful and dignified death. A nurse even provides a considerate and therapeutic presence to family members, including support for grief and bereavement throughout the dying process.
Care plan, in an emergency, for a dying patient, need to be developed by the interdisciplinary team and the nurse in cooperation with the patient’s family. As nurses tend to have maximum communication with the patient and his family, they have to make sure that the care plan is most suitable and up to date. Nurses only are uniquely positioned to meet these challenges in a way that will improve outcome of terminally ill patient caring process by lowering cost, and by successfully navigating amendments in health care legislation which finally prepare the future of the healthcare industry (Berglund et al., 2012).
Health care staffs are trying to deliver their best at acute hospitals with the ever-present constraints of time limit and increased workload. However, environment at hospitals should be more salubrious to provide safe and effective care for dying patients. As death is inevitable for a terminal patient, a nurse must be knowledgeable enough to assuage him during the concluding part of his life-journey. Doctors, nurses and health care persons all together have to work in cooperation and coordination to build up a new standard role model for care of such patients. Quiet spaces, care planning and understanding of the patient’s mental condition at every deteriorating stage is very necessary for effective care. Throughout life, a nurse vows to work for the welfare, comfort and safety of the patient. End-of-life care will be more meaningful, if a nurse is more prudent about all these issues. Special trainings and education programs must be introduced for nurses, so as to provide ‘comfort care’ to the dying patients.
References:
Australian Commission on Safety and Quality in Health Care. (2013). Safety and Quality of End-of-life Care in Acute Hospitals: A Background Paper. Sydney: ACSQHC
Berglund, M., Westin, L., Svanström, R., & Sundler, A. J. (2012). Suffering caused by care—Patients’ experiences from hospital settings. International Journal of Qualitative Studies on Health and Well-Being, 7, 10.3402/qhw.v7i0.18688.
Bloomer, M., Moss, C., & Cross, W. (2011). End-of-life care in acute hospitals: An integrative literature review. Journal of Nursing and Healthcare of Chronic Illness, 3(3), 165-173.
Dansie, E. J., & Turk, D. C. (2013). Assessment of patients with chronic pain. BJA: British Journal of Anaesthesia, 111(1), 19–25.
Fischer, S., Min, S., Cervantes, L., & Kutner J. (2013). Where do you want to spend your last days of life? Low concordance between preferred and actual site of death among hospitalized patients. Journal of Hospital Medicine, 8(4),178-183.
Garcia, K., & KOENIG, H. G. (2013). Re-examining Definitions of Spirituality in Nursing Research. Journal of Advanced Nursing, 69(12), 2622–2634.
Hickman, R. L., & Douglas, S. L. (2010). Impact of Chronic Critical Illness on the Psychological Outcomes of Family Members. AACN Advanced Critical Care, 21(1), 80–91.
Rosenstein, D.L. (2011). Depression and end-of-life care for patients with cancer. Dialogues in Clinical Neuroscience, 13(1), 101–108.
Van der Steen, J.T., Radbruch, L., Hertogh, C.M.P.M., E de Boer, M., Hughes, J.C., Larkin, P., Francke, A.L., Junger, S., Gove, D., Firth, P., Koopmans, R.T.C.M., & Volicer, L. (2014). White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliative Medicine, 8(3), 197-209.
Wei, D., Liu, X.Y., Chen, Y.Y., Zhou, X., & Hu, H.P. (2016). Effectiveness of Physical, Psychological, Social, and Spiritual Intervention in Breast Cancer Survivors: An Integrative Review. Asia-Pacific Journal of Oncology Nursing, 3(3), 226–232
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