Due to the rise in ageing population in Australia, the demand and burden of acute care hospital will increase to provide end-of-life care to people with critical illness. In this situation, the quality and safety of end-of-life care will have important implications not just for patients and their family members but also for the care providers working in acute hospitals. The focus of acute hospital is mostly on diagnosis and treatment of patients. They fail to identify that a patient may be approaching death and may be in need of end-of-life intervention. Due to lack of understanding regarding the care requirements for this patient, the provision of terminal care are often delayed (Bloomer 2015). The purpose of this essay is to analyze the care requirement that affect the dying patients in acute care hospitals and assess the challenges faced by nurses in palliative care setting that has an impact on best possible palliative for a hospitalized patient.
The care requirements of dying patients in acute care setting are often not met. Comfort care is a critical element of end-of-life care where dying patients requires soothing and comfortable environment in acute hospitals to relieve their suffering and improve the quality of life as far as possible. The care requirement of dying patients in acute hospitals mainly revolves around physical comfort, mental, spiritual and emotional needs and dignity in care (Providing Comfort at the End of Life, 2017). People at the end-of-life experience much physical discomfort such as pain, breathing problems, weakness and fatigue, digestive problem and temperature sensitivity. Their care process is also affected by the issues of acceptance of chronic illness and death, knowledge about disease and treatment, support from family members and level of comfort with health care providers. Hence, the primary care requirement for patient is symptoms relief and many specific treatment strategies are needed to manage symptoms of pain and other discomfort in patients (MacArtney et al., 2015).
Secondly, meeting emotional and mental needs of end-of-life care patient is important as they experience great emotional distress due to life threatening illness. A patient who is aware of the illness or the fact that they are approaching end-of-life experience suffers from depression and anxiety in acute care setting. The role of palliative care service is to treat emotional pain and suffering in end-of-life patients by encouraging them to speak about their feelings. Fear and concern about illness followed by emotional distress in family members deteriorate patient’s condition and reduces the effectiveness of interventions. Hence, health care team involved in caring for end-of-life patients need to be dedicated to improving emotional and spiritual care experience of dying patients by means of simple physical contact, setting a comfortable environment around the patients and engaging them in activities to improve their mood, promote relaxation and lessen pain (Kruizinga et al., 2016).
Other important needs of patient in end-of-life care include spiritual needs of patients such as finding meaning in one’s life despite illness. Some seek to find comfort through their spiritual beliefs related to religious practices of prayers and listening to religious music. Spiritual need is also related to relationship with family members and friends and providing comfort to end-of-life patients through sharing memories of good times with patients. The responsibility of health care staffs in this regard is to avoid interfering with spiritual needs of patients while providing intervention. However, barrier in spiritual care provision is seen due lack of adequate training in palliative care. Medical team spiritual support is critical to enhancing the quality of life of patients and enhances the effectiveness of palliative care (Balboni et al, 2014). Maintaining patient dignity is also an important aspect of end of life care and appropriate symptoms control and correct environment is needed to deliver dignified end-of life care. However, often dignity of patient is violated in acute care setting due to invasive medical procedure. It is the role of health professionals to effectively communicate about intervention, convey empathy and involve patients in decision making process to address dignity issues in palliative care (Kennedy, 2016).
Intensive care nurse mostly regard end-of-life care as a challenging process. They experience challenges in delivering care at the last stage of life when patients refuse treatment or withdraw from treatment. Although they tried their best to provide a comfortable and dignified death to patients, they lacked understanding about the process involved in treatment withdrawal. There is a need to reduce this ambiguity in end-of-life care by supporting the delivery of high-quality care in the final stage of their life (Efstathiou & Walker, 2014). Anxiety about death also influences nursing performance in palliative care. The nurse’s frequent exposure to dying patients and coming to close term with deaths make them aware of their own mortality and lead to anxiety and uneasiness among them. This strong anxiety affects their ability to provide nursing care to end-of-life patients. These challenges are mostly seen by younger nurse who are less likely to experience the atmosphere of ICU room. They need to be given death education and modify their death anxiety and attitudes towards care for dying people (Peters et al., 2013).
Other challenges faced by nurses in practicing in acute care setting includes unrealistic expectation about treatment from patient’s family members, inappropriate ICU environment for care, lack of knowledge and experience in nurse, disagreement about treatment in team members and lack of engagement in care planning and taking end-of-life decision (Fridh, 2014). Moral and ethical distress is experienced by nurse when they are asked to act in a way that is in disagreement with their personal and professional values. They often struggle to follow physical order and their responsibility to provide a comfortable and dignified death to patients. Poor communication skills between team members also act as a barrier in care when nurse opinion or value is not sought in care process. Their inability to help terminally patient also lead to deep sense of sadness and low self-esteem among nurses (Morgan, 2009).
Apart from lack of support health care team in acute care setting, burnout is also a major issues affecting nurse performance in caring for end-of-life patients. High rate of burnout often contribute to low quality care. The level of self-management of burnout in relation to exhaustive nature of work affects patient’s outcome in palliative care (Sansó et al., 2015). Effective communication is also a requirement in palliative setting to promote well-being of patients, enhance psychological functioning, improve the quality of life and promote adherence to treatment regimen. However, nurses often report barrier in communicating empathetically with patients and family members due to the burden of carrying bad news, lack of skills in displaying empathy and due to resistive patient/family characteristics. It reflects the immediate need for health care institution to train nurse to effectively interact with end-of-life patients (Banerjee et al., 2016).
The essay on end-of-life care in acute care setting summarized the care requirement of dying patients in end-of-life care and gave indications about the different challenges faced by nurse in delivery high quality palliative care. The critical analysis of literature on barriers faced by nurses reveal that nurses experience challenges due to institutional, personal and emotional issues faced by them in ICU environment. It is suggested to improve delivery of end-of-life care by teaching them strategies to promote coping and resilience in palliative care. The job is emotionally draining for nurse, hence resilience along with appropriate communication skills and knowledge is needed to promote dignified death in end-of-life patients and provide all the comfort they need at the end stage of their life (Gillman et al., 2015).
References
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Banerjee, S. C., Manna, R., Coyle, N., Shen, M. J., Pehrson, C., Zaider, T., … & Bylund, C. L. (2016). Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse education in practice, 16(1), 193-201.
Bloomer, M. (2015). The challenges of end of life care in acute hospitals. Collegian, 22(3), 241-242
Efstathiou, N., & Walker, W. (2014). Intensive care nurses’ experiences of providing end?of?life care after treatment withdrawal: a qualitative study. Journal of clinical nursing, 23(21-22), 3188-3196.
Fridh, I. (2014). Caring for the dying patient in the ICU–the past, the present and the future. Intensive and Critical Care Nursing, 30(6), 306-311.
Gillman, L., Adams, J., Kovac, R., Kilcullen, A., House, A., & Doyle, C. (2015). Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review. JBI database of systematic reviews and implementation reports, 13(5), 131-204.
Kennedy, G. (2016). The Importance of Patient Dignity in Care at the End of Life. The Ulster medical journal, 85(1), 45.
Kruizinga, R., Hartog, I. D., Jacobs, M., Daams, J. G., Scherer?Rath, M., Schilderman, J. B., … & Van Laarhoven, H. W. (2016). The effect of spiritual interventions addressing existential themes using a narrative approach on quality of life of cancer patients: a systematic review and meta?analysis. Psycho?Oncology, 25(3), 253-265
MacArtney, J. I., Broom, A., Kirby, E., Good, P., Wootton, J., & Adams, J. (2015). Locating care at the end of life: burden, vulnerability, and the practical accomplishment of dying. Sociology of health & illness.
Morgan, D. (2009). Caring for dying children: assessing the needs of the pediatric palliative care nurse. Pediatric nursing, 35(2), 86.
Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., Hood, K., … & Shimoinaba, K. (2013). How death anxiety impacts nurses’ caring for patients at the end of life: a review of literature. The open nursing journal, 7(1).
Providing Comfort at the End of Life. (2017). National Institute on Aging. Retrieved 17 March 2017, from https://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/providing-comfort-end-life
Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative care professionals’ inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. Journal of pain and symptom management, 50(2), 200-207.
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