End of Life Care Shayna page

In an interview I had with my close friend, Emily, who is an RN, we discussed some of her methods of evidence based practice. When I had brought up a question about what she would personally like to explore more about, she brought up the topic of end of life care. This is what she had to say..

"With an unlimited amount of time I would research the correlation between patients who have family at the bedside during their death versus patients that die alone. In my experience the majority of patients that I have seen die have been alone. I would like to know why that is. Can patients still hear their families talking and do not want to disappoint them? Do the patients recognize voices when they are near death? Does music sooth and comfort dying patients? What are nursing tasks that would help both patients and their families during the end of life? How should nurses approach families when they are depressed and coping? Are Foley catheters a standard of care for the actively dying? Which medications are the best for a dying patient? Is seeing your loved one being suctioned more beneficial or harmful? Is treating a fever more benefiting for a dying patient?"

This really stuck out to me and made me want to research the topic into more detail. So for my research paper, I decided to figure out what methods are being used to better the care for terminally ill patients and what methods would make them the most comfortable as far as health-wise at the end of their life.

What does End of Life Care entail?

End of life care has a focus on the relief of suffering along with psychosocial support. This type of care helps patients to feel a sense of closure near the end of life. It is expected for experienced physicians to provide palliative care, however some still struggle when initiating these heavily-emotional and difficult discussions with seriously ill patients and their families. With findings from studies performed on terminally-ill and near-death patients, we can begin to get a sense of what steps can be taken by health care professionals to provide a more comfortable and easy death for patients. This can include the location of their death, the status of their loneliness via the company of family and friends that surround them and the matter of time in which palliative care is used.

Brief Summary of findings: Many studies that were performed on patients nearing the end of their lives showed that they would prefer to die at home over in a hospital. Many felt that they were leaving a burden on their families if they had them by their side while going through the end of their life. Research has shown that there are differing opinions on where near-death patients prefer to die. These range from at home or in a hospital or hospice setting. In a study conducted by Rubin, Evans, & Wilkinson (2016), terminally ill patients who were near death contributed to the determination of where they would like to die. The study aimed to report if subjects actually achieved their place of choice versus the actual location of where they died. A questionnaire was used to discover these results and was given to patients in their homes during two visits, 6-12 weeks apart. For those who completed the study (n = 43), more patients chose their home as the preferred place of death over the hospice (44% to 49% compared to 35%) and certainly over the hospital. An estimated 16% stated no preference for their place of death, for example one responding to the questionnaire: “I would like to die ‘when the sun is going down’. Don’t care when or where it happens” (Rubin et al., 2016). Commonly, participants in this study worried more about their families and how they would respond with their deaths, responding; “I would like to stay at home right to the end, but I only have my daughter… and she is busy” or, “If in a hospice my children would be spared from having to worry or physically care for me” (Rubin et al., 2016).

I also found that with such a demand in end-of-life care, clinicians who are responsible for the treatment of patients at the end of life ultimately lack the adequate training to foster the needs and help desired by these patients. There are overwhelming and substantial challenges that are faced by dying patients. These challenges include physical pain, depression, a variety of intense emotions, the loss of dignity, hopelessness, and the seemingly mundane tasks that need to be addressed at the end of life

How can this topic be used for clinicians?

This topic, by no means, is easy for health providers to discuss with dying patients, but it is a reality we all face. If I took anything from this paper, it is that clinicians must keep in mind that they have the power to use interviewing techniques to better their understanding of terminally-ill patients. This will help them build upon their patient’s responses while also addressing any physical, psychosocial, existential or spiritual suffering. Overall, these findings from studies conducted on EOL care could potentially open the door for further research on how we as healthcare professionals could give patients a good death versus a bad death.

Reference

Rubin, M., Evans, O., & Wilkinson, R. B. (2016). A longitudinal study of the relations among university students’ subjective social status, social contact with university friends, and mental health and well-being. Journal of Social and Clinical Psychology, 35, 722–737. http://dx.doi.org/10.1521/jscp.2016.35.9.722

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Created with images by 3dman_eu - "white male 3d model isolated"

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