Providing End-of-Life Care to Terminally Ill Patients - Essay Example

Providing end-of-life care to terminally ill patients Name Institution Date The capacity to make decisions is often lost in a person experiencing a serious/terminal illness, or as he or she approaches death (Johnstone & Kanitsaki, 2009). A similar situation is presented in this paper where a terminally ill patient who has a lot of pain begs a nurse to end her life. This situation can be referred to as voluntary euthanasia since the nurse has informed consent from the patient to end her life with the intention to relief pain and suffering (Swerissen & Duckett, 2014). Voluntary euthanasia is a social issue that is very complex and is increasingly debated by the community. It is an issue because of the introduction of modern medical technology which has the capacity to artificially prolong life and the increasing population of elderly persons, as well as those with terminal illness. Additionally, existing laws such as the Rights of the Terminally Ill Act of 1996 in the Northern Territory which the Australian Government overturned makes voluntary euthanasia an issue (Australian Nursing Federation, 2012). The purpose of this essay is to discuss the respond of the Registered nurse when asked by a terminally ill patient to end her life and the applicability of the National Competency Standards for the Registered Nurse in the scenario. Registered nurses and other health professionals are obliged by their professional codes of practice and ethics and the law to practice within the law (Kerridge, Lowe & Stewart, 2013). Therefore, although the patient begs the nurse to end her life it would not be a right decision to proceed and take away the life of the patient. The decision not to end the life of the patient would also be influenced by the fact that euthanasia in an illegal act in Australia. As Johnstone & Kanitsaki (2009) argue, the main objective of medical care is to preserve life, but in situations where life cannot be preserved like this one, it is the responsibility of the nurse to offer dignity and comfort to the person who is dying and support others to ensure the person dies well. Therefore, the first thing to do would be to try and make the patient understand and appreciate the dying process and face death. This would particularly include helping the patient reflect on her live and to support her come to terms with pending death (Johnstone, Hutchinson & Redley, 2015). The nurse would also focus on managing the pain the patient is experiencing by use of medication in order to reduce suffering and anxiety. Besides giving medication, nurse’s presence and comfort will be very important as this will assure the patient that the nurse is very supportive to her (Daly, Speedy & Jackson, 2014). By listening to and comforting the patient, the nurse will show that she is concerned about her health and is ready to support her through the entire dying process. It is likely that the patient is worried, afraid and depressed because of her health condition and therefore does not see the need to continue living. As such, the nurse would use this opportunity to allow the patient share her fears and uncertainty to help relief the patient from distress (Johnstone et al., 2015). The nurse should make the patient feel loved and supported, enhance her dignity and give her a sense of control in life before embarking on any other thing. The patient is a state of desperation and by giving her hope in life and assuring her that people are there to take care of her would make her rethink about her life being terminated by the nurse (Daly et al., 2014). Generally, maintaining a strong therapeutic relationship with the patient is very important at this point. Spending some time with the patient, talking about the pains and pleasures she has had in life would bring her a sense of comfort. After comforting the patient and make her see the need to continue living, the nurse must conduct advance care planning where the patient should reconsider her end-of-life decision. The end-of-life care plan for the patient would involve a number of steps including assessment, disclosure, discussion and eventually, building consensus with the patient, her family and other health practitioners in the treatment team (NSW Department of Health, 2012). This process would not take long in order to ensure that the patient is provided with the care and support that she needs and to help reduce her fears and anxiety. According to Swerissen & Duckett (2014), uncertainty about prognosis, or a sudden deterioration in the health of a patient, normally requires the treatment team to stabalise the patient in order to perform a complete assessment and to establish the likelihood of reversing the condition. In this case the nurse and other members of the treatment team would assess the wishes of the patient and her clinical condition. After the assessment, the nurse may decide to subsequently withdraw the life-sustaining treatment which the patient was receiving if deemed appropriate (Brieva, Cooray & Rowley, 2009). In case the treatment team reasonably doubts the medical assessment undertaken, they should seek for advice from other senior clinicians who have experience in the condition of the patient. The opinions of other health practitioners must be documented by the nurse. Part of assessment should be the evidence if the preferences by the patient and since her preferences are likely to change, the nurse should review them regularly (Commonwealth of Australia, 2010). It is likely that the medical condition of the patient may fail to improve over an extended period, hence resulting to questions about treatment continuation. If this happens, a discussion on the same may be initiated by the treatment team, the patient herself, or the family. After assessing the views of the patient and the severity of her health condition, the nurse must provide the patient and her family honest information in a clear language in order to allow them to participate meaningfully in decisions concerning the patient’s end-of-life care (NSW Department of Health, 2012). As Broom, Kirby, Good, Wootton & Adams (2014) argue, the nurse should communicate possible response to treatment or indecision about prognosis to the patient and her family. It is likely that the patient and her family may be caught unaware about the possible treatment cessation and goals of care when they occur suddenly. For this reason, the nurse should engage them in open communication concerning possible outcomes in advance, especially when the patient becomes critically ill. This would help avoid unrealistic expectations about what treatment can achieve (Broom et al., 2014). When the nurse conducts early and honest communication on a regular basis, he would help create trust which is essential in supporting decision-making by the patient and diffusion of tension. The nurse should try to discuss with the patient and her family the limitation of treatment in a series of stages over some time. This should happen after disclosure to the patient and family. The discussions must be supported by effective communication between the family of the patient and the treating team (Broom et al., 2014). It is appropriate that the nurse takes the responsibility of communicating with the patient on behalf of the treating team in order to maintain consistency in information sharing. According to NSW Department of Health (2012), small differences in explaining the condition or progress of the patient is likely to appear as major disagreements to a patient and family, or even in the treating team. During the discussions, the nurse must avoid unproductive phrases, such as we will do nothing, or we shall do everything. Such phrases according to Johnstone & Kanitsaki (2009) are barriers to informed discussion about the burdens or benefits of particular courses of action. Importantly, the nurse must emphasize ongoing care purposely to provide comfort to the patient as the treating team plans for life-sustaining treatment. The discussion should be followed by documentation of the agreed management plan of the patient’s end-of-life care and any decisions concerning the use of life-sustaining treatment. All members of the treating team should be given document plan (Commonwealth of Australia, 2010). The nurse should summarise the discussions in the patient notes which must clearly indicate health practitioners involved in the discussion, medical facts that led to the decision, goals of treatment, statement of the wishes of the patient and details about medical treatment (NSW Department of Health, 2012). The nurse would also continue to document any form of care that will be provided to the patient, such as measures of comfort. The purpose of documenting the decisions made as indicated by Kerridge et al (2013) would be to promote transparency and accountability in the care provided to the patient and ensuring that the nurse and other health practitioners meet not only their professional obligations, but also legal obligations. The National competency standards for the registered nurse are highly applicable to this scenario. In particular, three domains which include professional practice, provision and coordination of care, and collaborative and therapeutic practice are highly relevant (Nursing and Midwifery Board of Australia, 2006). These sections are applicable due to a number of reasons. First, the situation requires the nurse to consider the legislation that affects nursing practice and health care and not to go against the codes of ethics and conduct of the nursing profession. For example, ending the life of the patient would be against the law and the nursing profession’s codes of ethics and conduct (Kerridge et al., 2013). Secondly, the nurse has to provide coordinated care that includes assessing the patient, developing end-of-life care plan and implanting to ensure that the patient experiences a comfortable dying process. Lastly, the success of the patient’s end-of-life care depends on the nurse working in collaboration with and maintaining therapeutic relationship with the patient and her family through open and clear communication (Johnstone et al., 2015). Therefore, it implies that it would not only be illegal for the nurse to end the life of the patient, but it would also be unethical for the nurse to terminate her life. Although providing end-of-life care to patients may be discomforting and make nurses feel powerless, they should always know that their capacity to comfort is not limited. They need to understand their role as comforters to help them comfort patients who are suffering from terminal illness. Conclusively, the case involves voluntary euthanasia which is currently not legal in Australia although it was briefly legal in the Northern Territory. In regard to this, the nurse would not end the life of the patient as desired. Additionally, the nurse would go against the nursing profession’s code of ethics and conduct when she decided to end the life of the patient. Instead, the nurse should spend some time with the patient to talk about her pains while comforting her not to think of ending her life, but to come to terms with the pending death. Besides comforting the patient, the nurse needs to develop advance care planning to provide the right end-of-life care and life-sustaining treatment to the patient. The end-of-life care should be guided by the legislation affecting nursing health care and practice and the codes of ethics and conduct. References Australian Nursing Federation (2012). Voluntary euthanasia/ assisted suicide: ANF position statement. Brieva, J. L., Cooray, P., & Rowley, M. (2009) 'Withholding and Withdrawal of Life-sustaining Therapies in Intensive Care: An Australian Experience [online]', Critical Care and Resuscitation, 11(4), 1441-2772. Broom, A., Kirby, E., Good, P., Wootton, J., & Adams, J. (2014) 'The troubles of telling: managing communication at the end of life', Qualitative Health Research, 24(2), 151-162. Commonwealth of Australia (2010). National Palliative Care Strategy 2010: Supporting Australians to Live Well at the End of Life, Daly, J., Speedy, S., & Jackson, D. (Eds). (2014). Contexts of nursing. (4th ed), Elsevier Australia, Chatswood, NSW. Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions (4th ed). The Federation Press, Leichhardt, NSW. Johnstone, M. J., & Kanitsaki, O. (2009). Ethics and advance care planning in a culturally diverse society. Journal of transcultural nursing, 20(4), 405-416. Johnstone, M. J., Hutchinson, A. M., Redley, B., & Rawson, H. (2015). Nursing Roles and Strategies in End-of-Life Decision Making Concerning Elderly Immigrants Admitted to Acute Care Hospitals An Australian Study. Journal of Transcultural Nursing, 1043659615582088. NSW Department of Health (2012). End-of-life care and decision-making: Guidelines, Ministry of Health, NSW. Nursing and Midwifery Board of Australia (NMBA) (2006). National competency standards for the registered nurse, Melbourne: Australia. Swerissen, H., & Duckett, S. (2014). Dying well. Melbourne: The Gratten Institute. Read More