Challenges and Issues for Nurses While Caring for Patients - Assignment Example

? Challenges and Issues for Nurses While Caring for Patients at the End Of Life in Critical Care Setting Saad Bin Zafar College This essay explores the challenges and issues being faced by the nurses today in providing end-of –life care (EOLC). Various types of obstacle have arisen ranging from family issues to physician and hospital mismanagement. This essay underlines the significant role of a nurse in EOLC and tries to observe the different ways in which the nurse can better this. Furthermore the paper gives few examples in order to explain these obstacles and to design better interventions. Keywords: Nurses, End-of-life care, hospital mismanagement, obstacles Death is a grim reality, an undeniable fact, one which no one can escape. For decades nurses have been taking care of dying patients and their families, most of the time this happens in critical care setting. The role of nurses during the end of life period is a sacred one. It is the period in which it is expected that death is imminent and it cannot be avoided by using any intensive or life extending therapy (Kinoshita & Miyashita, 2011). The care provided during this period is known as end of life care, abbreviated as EOLC. The significance of EOLC is increasing and it is now becoming a subspecialty considering that 27% of deaths have occurred in ICU and of the deaths which occurred in hospital setting 42% of patients were in a specialty unit for the last three days (Bach, Ploeg & Black, 2009). For nurses a good death will be free of pain, will include comfort and respect for the patient and will allow the family to conduct their EOL rituals. In accordance with this the goal of EOLC is to offer support, consideration and attention to patients and their respective families during this period where one is in the last phase of his terminal illness (Doolen & York, 2007). Caring for dying patients is never easy which makes this job one of the most stressful ones. In addition to this nurses are facing a number of challenges and obstacles in providing the best possible care. There are a number of different barriers which are mentioned in various research articles. Crump, Schaffer & Schulte (2010) have identified lack of proper communication, insufficient staff and unfavorable treatment decision as obstacles (2010). However Doolen & York (2007) believe that cultural differences are the main issues which are causing problems in EOLC. This essay is written in order to identify and discuss these issues and challenges affecting the EOLC and see if they can be solved in order to help the nurses in their profession. It is very important to understand the role which culture plays in a health facility. Before this one must understand the concept of culture. Culture comprises of knowledge, ideals, beliefs, conscience, morals, habits, characteristics, perceptions and behavior of a particular society (Lewis, Heitkemper & Dirksen, 2004). Today many of the developed countries have cultural diversity. In accordance with this the nursing staff should also have had a similar diversity which unfortunately is not the case. According to Doolen & York (2007) cultural challenges have three significant elements which need to be considered. These elements include communication regarding the disease, family consultations and approaches regarding the different life extending therapies and advance directives. This can be seen in Korea where it is believed that one shouldn’t discuss death because talking openly about the death will not only bring sadness to the patient but will accelerate the dying process (Valente & Haley, 2007). In addition to this people belonging to the Filipino culture believe that if terms related to death are spoken loudly they will interfere with the natural process of healing and will result in death. On the other hand some cultures have beliefs which state that the decisions regarding EOLC are to be only shared with the family members and not with the patient itself in order to protect him from this burden while others have a belief that patient autonomy should not be there as it isolates a patient at a time when the need for the family is at its greatest (Kagawa-singer & Blackhall 2001). Keeping all these issues under consideration one can see how important of an obstacle cultural difference is. There is a need to recognize these differences and then incorporate culturally specific EOLC. Moving further the issues can be classified along family and hospital lines. This means that in some cases it is the family members of the patient who are causing problems while other times it is the hospital staff and management which should be held responsible. Hospital issues can be divided further, some of which involve the physicians, while the rest involve the hospital setting and services. Financial and legal reasons are behind most of the obstacles created due to hospital mismanagement. Hospital units are poorly designed which does not offer enough privacy to grieving families. Sometimes the hospital staff continues to provide advance treatments even to dying patients in order to avail the financial benefits. A few hospitals also have very restrictive visiting hours which also creates a barrier for good EOLC (Crump, Schafer & Schulte 2010). The physicians on the other hand see it as a black spot in their career if they are unable to treat the patients. They remain overly optimistic and do not allow the patient to die from the disease process by using life extending therapies even if the patient remains in pain. They also try to avoid confrontation with the family members and remain evasive. Also in few cases multiple physicians are involved with a single patient resulting in conflict of ideas and decisions. Also the physicians along with the hospital staff continue to keep a dying patient in critical care facility in fear of a future legal action. Above statements show that different types of obstacles are present at almost all levels of EOLC. Next we come to another important component of the challenges nurses are facing; family issues. Due to their lack of knowledge, obvious lack of patience, increase anger these issues form the bulk of the challenges nurses face today. The family members continually call the nurse for even the smallest update even though there is a designated family member who has the information. Family members do not understand what is meant by life saving measures which results in delays in EOLC. As a result of lack of knowledge they fail to accept the reality of what is happening to their patient. As mostly the patients are brought to ICU in sedated condition where they are unable to communicate this attitude of family members creates huge obstacles. Sometimes there is intrafamily fighting on whether to continue with the life support or not resulting in exacerbation of the challenges. Finally there are some obstacles which are created due to the nurses own fault. As mentioned earlier lack of knowledge regarding different cultures creates issue for nurses. Their own lack of knowledge also sometimes creates problems for them. Often there is a huge influx of patient in a critical care setting and the nurse is called away in order to admit another patient. This also reduces the efficacy of EOLC. Finally the nurse has to deal with the anger of family members while providing EOLC which also results in lower productivity. Any critical care nurse wants to aid the patients in dying with honour and tranquility. This is the greatest gift nurses can bestow to their patients. Critical care nurses can create an environment which is able to unite patients and their families for those final moments of life. For this it is necessary to fill the gaps in the healthcare system so that patients and families have realistic expectations and can make quick decisions about the type of treatment they want. Furthermore nurses will need to strengthen their role as advocators of patients and act as a messenger between patients and other health professionals for better EOLC. Different associations should try to find out the intensity and frequency of different issues and barriers so as to design meaningful actions to improve EOLC. References Bach, V., Ploeg, J. & Black, M. (2009). Nursing role in the end-of-life decision-making in critical care settings. Western Journal of Nursing Research,31, 496-512. Crunp, S. K., Schaffer, M. A. & Schulte, E. (2010). Critical care nurses’ perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimensions of Critical Care Nursing, 29(6), 297-306. Doolen, J. & York, N. L. (2007). Cultural differences with end-of-life care in the critical care unit. Dimensions of Critical Care Nursing, 26(5), 194-198. Kagawa-Singer, M. & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: “you got to go where he lives”. Journal of American Medical Association, 286, 2993-3001. Kinoshita, S. & Miyashita, M. (2011). Development of a scale for “difficulties felt by ICU nurses providing end-of-life care” (DFINE): A survey study, Intensive and Critical Care Nursing, 27, 202-210. Lewis, S. M., Heitkemper, M. M. & Dirksen, S. T. (2004). Medical Surgical Nursing: Assessment and Management of Clinical Problems, (6th Ed.). St. Louis, Mo: Mosby and Co. Valente, S. & Haley, B. (2007). Culturally diverse communities and end of life care. Retrieved from http://www.apa.org/pi/eol/factsheets.htm. Read More