Nursing Care for the Dying Older Adults - Essay Example

Nursing Care for the Dying Older Adults [Name of the Student] [Name of the University] Nursing Care for the Dying Older Adults Introduction Nurses must have compassion for the older patients, who are on their deathbed. They must possess the required qualities to deal with older patients. Certain factors promote these qualities among nurses. These factors include clinical supervision, group support, mentoring, and clinical leadership. Nurses must enhance their capabilities to cope with the complex feelings they develop while providing treatment or nursing care to older patients. Moreover, qualities like attentive presence and respectful listening promote confidence among the older dying patients (Graham, 2005, p. 284). In addition, this will enable these patients to experience the true presence of nurses. Palliative end-of-life care combines a physical, mental, and social approach. This intervention is adopted when all other forms of treatment fail to cure illness. It is aimed at alleviating the symptoms of the illness and significantly improving the quality of life of the patient. It also entails support for the relatives of the patient, during and after the illness (Wallerstedt & Andershed, 2007, p. 32). Palliative care ensures dignity of death for the terminally ill. A nurse’s view regarding care to the elderly and dying people In general, the majority of nurses are of the opinion that they should first acquire the required knowledge and capabilities to provide nursing care to elderly and dying people. This would be the best policy as far as dying patients are concerned (Graham, 2005, p. 284). Most of the nurses are devoted to acquiring knowledge about the significance of sympathy, in providing better nursing care. Research studies suggest that nurses should increase their knowledge by using the Parse method. It is also beneficial for them to understand the suffering of such patients. It is also important to acquire information about the emotional turmoil being experience by the carers of such patients and the children of older adult dying patients. Nurses develop complex feelings when providing care for the dying patients. These feelings are generated due to their knowledge that the patients they are caring for do not have long to live (Graham, 2005, p. 284). This knowledge influences their emotions and makes it more difficult to deal with. In a study involving a number of nurses, who had experience of providing care for the dying patients, the respondents opined that the nursing schools should provide trainee nurses with hospital training on an on-going basis (Weigel, Parker, Fanning, Reyna, & Brewer, 2007, p. 90). Such training would help them throughout their professional career. These features of continuous training and participation in research, improves the ability of nurses in providing palliative care to dying patients. They are also beneficial to the patients who receive care. The training has to include the PEAS programme at the beginning and end of the training (Weigel, Parker, Fanning, Reyna, & Brewer, 2007, p. 90). This training decreases the fear and anxiety of nurses to deal with dying patients. Demands and impacts to a Nurse, while providing nursing care to the dying In the UK, the Code of Professional Conduct for nurses requires them to exhibit concern during the delivery of care. Patients have the right to choose or reject treatment. Accordingly, they are to be included in the decision – making process with regard to their treatment. There are a number of entities that have an influence on the treatment and the delivery of care provided to patients (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). The Code of Ethics for Nurses imposes several responsibilities on nurses. It states that nurses should provide care to the individual who requires such care. They should have concern towards the individual. Such concern takes precedence over the service or resources they employ to deliver care (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). As such, it is concern for the patient that plays a significant role in the delivery of care. The policies of local governments and the national government have considerable influence on the delivery of care. The policies of the government, lead to changes in health and social care. These changes, at times, have a profound influence on the delivery of health care to individuals (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). In some instances, these reforms may prove to be disadvantageous to certain groups of people. Sometimes, these polices attempt to establish a particular system of care, and in other cases, these policies are aimed at establishing systems based on past experience (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). Health policies are the outcome of political agendas. They are considered to be effective only when they involve social acceptability. This is determined by subjecting a policy to ethical analysis. Theorists apply the utilitarian and deontological philosophies to determine the effectiveness of ethical analysis (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). This involves the application of the principles of biomedical ethics. Reforms generate new results and effects to the existing practices of delivery of care. The results and impact of reforms have to be carefully analysed to determine the effectiveness of the reforms. Health policy evaluation and ethical analysis are widely used tools for determining the effects of reforms(Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). In combination these tools are capable of providing a solution to the problems posed by these reforms. The UK established the NHS policy, which is seized with the provision of palliative care, in the homes of patients. It requires the Primary Care Trusts (PCTs) to utilise their resources for the purpose of care in the patient’s home. If the hospital recommends that the patient requires specialist care, then the hospital has to engage a physician in the relevant field of speciality (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). In Sweden, the government decided to implement a nationwide policy of end-of-life care for all the people living in Sweden. As part of this programme, it proposes to introduce quality end of life care for all the people, without any reservations (Wallerstedt & Andershed, 2007, p. 32). Implications to the nurse Nurses play an important role in providing care to their patients. In the course of such practice, they are required to promote the cause of their patient. As such advocates they are required to deal with challenging decision – making processes, regarding the dying patients (McSteen & Peden-McAlpine, 2006, p. 259). This provides an excellent opportunity for nurses to obtain invaluable experience in addressing such challenging circumstances, involving the dying and death. The ability of the nurses in discharging their duty as the champions of the dying has a major bearing on the condition of the dying patients (McSteen & Peden-McAlpine, 2006, p. 259). The nursing profession involves encounters with suffering that have a strong influence on the emotions. The family members of the patient are not spared such suffering and emotional turmoil. In addition, these individuals are subjected to feelings of inadequacy and indecision. It is the task of the nurse to maintain a fair balance between the burden imposed and the capacity of the carers (Wallerstedt & Andershed, 2007, p. 33). Moreover, these people have to strike a reasonable and equitable balance, betwixt their feelings and expectations. A number of research studies have shown that the family members of a dying patient enact an important role in the dispensation of care. It goes without saying that a nurse should possess sufficient theoretical knowledge, practical skill, emotional sensitivity and an ethical approach (Wallerstedt & Andershed, 2007, p. 33). Implications to the patient The physical, social, spiritual and emotional characteristics of a patient are influenced by the provision of care that is patient centric. These features are interlinked and have a profound effect on the quality of life of the patient (Puchalski, 2007 – 2008, p. 39). Partnership in decision making between health care professionals and patients should be noteworthy. The patient’s assumption of respect for autonomy leads to the expectation that there will be a meaningful partnership in decision making. A major requirement for satisfying this anticipation is the capacity of health care professionals to ask patients for their opinion, to seek their acquiescence and formulate care plans (Cooke & Hurley, 2008, p. 1377). The patient’s participation in this process is indispensable, if such expectation is to be satisfied. Many dying patients had undergone negative experiences in the care provided to them. Some of their needs had been ignored and this had served to generate anger over the deficient services provided (Thompson, Menec, Chochinov, & McClement, 2008, p. 43). The experiences of patients have considerable impact on their feelings towards the care provided to them. Implications to the family The provision of quality care requires substantial inputs from nurses. This knowledge is of great importance for nurses who are working with family caregivers. Moreover, such collaborative provision of care is a challenging task for nurses. They have to concentrate on the family of the dying patient, the role of the associated caregivers, and the support that will be required by that family. A person at the end of the tether attaches the utmost importance to dying at home. Such thoughts are also shared by the friends and family of the dying person (Burgeois & Johnson, 2006, p.12). The outstanding feature of care at home is that it unites the family members of the dying patient. This promotes positive feelings and creates a congenial atmosphere for the dying patient. This sharing and cooperation amongst the family members and friends of the person at the end of life, generates a sense of community. The provision of care to the dying is an active process, and it involves all the capabilities of the caregiver. As such, nurses are required to employ their capabilities to the utmost, as healthcare professionals (Burgeois & Johnson, 2006, p.12). The family members of dying patients take decisions regarding the care being provided to the patient. Nurses also participate in this process. However, in several cases, nurses were hesitant to interfere with such decisions about the patient. Nurses, as such, were prone to feel extremely distressed, while dealing with the suffering of the dying patients (Lopez, 2007, p. 145). A number of nurses were of the opinion that they lacked the ability to deal with conflicts in the family of the dying person. Consequently, most of the nurses evaded confrontation with the family members of the dying patient. Under these circumstances, nurses were likely to employ palliative or curative treatment, as per the wishes of the family members of the dying patient (Lopez, 2007, p. 145). The family members of a dying patient constitute very important caregivers. They also take decisions, with respect to the dying person, in the context of end-of-life care. As such, family members act as either the formal or informal proxy decision makers for dying patients (Thompson, Menec, Chochinov, & McClement, 2008, p. 38). Moreover, family members provide valuable information about the dying patient’s psychosomatic condition. This is especially useful when the patients are unable to provide information about their condition, on account of their deteriorating physical and mental health (Thompson, Menec, Chochinov, & McClement, 2008, p. 38). Such response serves to enhance the quality of the care and is useful in assessing the care provided by the nurses. Implications to the health care team The provision of end of life care assumes different forms. One of such form is the provision of care in the patient’s home. This is a new development in the area of care for the terminally ill. Such patients are also provided with care in community care facilities. These novel interventions, in the provision of care to dying patients, impose new demands on hospitals, medical staff, and relatives (Wallerstedt & Andershed, 2007, p. 32). Consequently, health care professionals should be provided with the necessary resources to improve their knowledge. Moreover, nurses have to be employed in sufficient numbers, if satisfactory care is to be provided to all the patients. The scourge of a heavy workload makes it very difficult for nurses to perform at their optimum level. The problem is compounded by work related stress, which seriously impairs their capacity to provide care (Wallerstedt & Andershed, 2007, p. 38). There are several research studies, which have established that work related stress decreases the enthusiasm and interest of nurses in participating to the best of their ability, in end-of-life care. It is inherent in the very nature of nursing, to provide high quality care to patients. (Wallerstedt & Andershed, 2007, p. 38). This constraint imposes considerable tension and anxiety upon nurses. If the patient suddenly develops new symptoms and the GP is unavailable, then the hospital has to make a referral to acute services for a diagnosis. This rule applies where the patient requires differential diagnosis, due to the development of new symptoms (Cooke & Hurley, A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient, 2008, p. 1372). Resources and supports available to the nurse Intrinsic There are several intrinsic factors that enable the nursing staff to discharge their onerous duties, in a much better fashion. Some of these, as highlighted by Rasmussen and other researchers, are confidence in and support to the nursing staff, and acceptance of the advice and care provided by the nurse, during the course of the illness. The provision of professional support enables the nursing staff to analyse and combine experiences to death. A major reliever of stress, was found to be the use of humour, this was also seen to be a good intervention for bringing the nursing team together (Wallerstedt & Andershed, 2007, p. 33). Despite the advances in medical technology, cancer remains a dread disease. Nurses dealing with patients suffering from cancer, face a great deal of stress. End of life care, in respect of cancer patients, is therefore a harrowing experience for any nurse. In order to alleviate the difficulties associated with this demanding task, it has been recommended that a careful study should be conducted, in order to determine the various issues that hinder the provision of optimal end of life care (Beckstrand, Moore, Callister, & Bond, 2009, p. 447). Such studies will enable nursing educators and managers to provide better support and knowledge to these nurses. Furthermore, this will enable the nurse to collaborate, in a more meaningful manner with the other members of the healthcare interdisciplinary team, to modify and better end of life care for the dying patients and their families (Beckstrand, Moore, Callister, & Bond, 2009, p. 447). Extrinsic Palliative care is provided not only in the home but also in the nursing homes. Hence, there it is certain to prove beneficial to impart training in palliative care to nurses who work in nursing homes. To this end, a number of programmes were acquired by the health care authorities. Some of these are, the End of life Nursing Education Consortium, which is a compendium of nine end of life care training programmes (Lopez, 2007, p. 148). These are multi-faceted programmes, and one of these is devoted to the development of adequate communication skills. Obviously, communication plays a major role in understanding and empathising with patients who are at the end of their sojourn on earth (Lopez, 2007, p. 148). The Palliative Care Educational Resource Team programme is seized with the provision of end of life care in nursing homes. One of its components is to establish objectives relating to care. In addition, this programme entails a self – care workshop that considers the difficulties envisaged by nurses in nursing homes (Lopez, 2007, p. 148). The Toolkit for Nurturing Excellence at End of Life Transition is an educational programme that extends support to nurses involved in end of life care. This programme makes extensive use of the computer environment, including multimedia to impart knowledge about the latest trends in palliative care, to nurses. By accessing these programmes and completing them, the efficiency and capacity to bear the stress inherent in providing care to the dying, is vastly improved (Lopez, 2007, p. 148). All the same, further research on the influence of these programmes on nursing practice is required. Conclusion The effectiveness of end of life care for dying adults necessitates greater commitment on the part of the health care professionals. Such commitment is required in the area of training and empowering nurses, in providing care to them. Dissatisfaction in life arises, due to inadequate resources, dearth of cooperation, time, and other such drawbacks, in the daily routine. Addressing these factors adequately, improves the quality of life for patients. Health care professionals play a significant role in eliminating these factors; and they obtain job satisfaction, by succouring the dying patients. References Beckstrand, R. L., Moore , J., Callister, L., & Bond, A. E. (2009). Oncology Nurses’ Perceptions of Obstacles and Supportive Behaviors at the End of Life. Oncology Nursing Forum, 36(4):446 – 453. Burgeois, S., & Johnson, A. (2006). Caring for someone dying at home. Kai Tiaki Nursing New Zealand, 12(4): 12 – 15. Cooke, M., & Hurley, C. (2008). A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient. Journal of Clinical Nursing, 17(10): 1371 – 1379. Graham, I. W. (2005). Mutual suffering: A nurse’s story of caring for the living as they are dying. International Journal of Nursing Practice, 11 : 277–285. Lopez, R. P. (2007). Suffering and Dying Nursing Home Residents Nurses' Perceptions of the Role of Family Members. Journal of Hospice and Palliative Nursing, 9(3):141 – 149. McSteen, K., & Peden-McAlpine, C. (2006). The Role of the Nurse as Advocate in Ethically Difficult Care Situations with Dying Patients. Journal Of Hospice And Palliative Nursing, 8(5):259 – 269. Puchalski, C. M. (2007 – 2008). Spirituality and the care of Patients at the End of Life: An Essential Component of Care. OMEGA, 56(1): 33 – 46. Thompson, G. N., Menec, V. H., Chochinov, H. M., & McClement, S. E. (2008). Family Satisfaction with Care of a Dying Loved One in Nursing Homes What Makes the Difference? Journal of Gerontological Nursing, 34(12): 37 – 44. Wallerstedt, B., & Andershed, B. (2007). Caring for dying patients outside special palliative care settings: experiences from a nursing perspective. Scandinavian Journal of Caring Sciences, 21(1): 32 – 40. Weigel, C., Parker, G., Fanning, L., Reyna, K., & Brewer, D. (2007). Apprehension Among Hospital Nurses Providing End-of-Life Care. Journal of Hospice and Palliative Nursing, 9(2): 86 – 91. Read More