Satisfaction with Care at the End of Life - Literature review Example

END OF LIFE CARE Prof For most of human history, human beings have died at home usually ministered by family members. Hospitals were notespecially places of death: they were meant mostly for travellers and poor people and were usually charitable operations run by religious orders (Howarth, 116). But with the growth and evolution of medicine and medical research and the increasing violence of wars, hospitals began to take on a new role: ministering to the dead. This process was also sped up by the urbanization and industrialization of the world that occurred in the 19th century. Things began to rapidly change. Doctors and professionals were centered in cities in large institutions. These institutions got more and more power over peoples’ lives because this was seen to be the most efficient way the state could care for individuals. Death came out of the bedroom and into the harsh light of the clinic where it could be picked apart and examined without the interference of old superstitions and ways of thinking. How professionals minister to people at the end of their lives is very important. Many patients and family members often complain that their needs are unmet (Dy, et al). This paper will closely examine the situation. In a situation where a patient with heart failure is in intensive care, nurses and doctors have a number of ways of dealing with the patient and his or her family. They can be detached and completely professional and tell the patient: “There is a 90 per cent chance you will die.” Or they can be more sympathetic and human and try to work through the problem. Or they can completely ignore reality and make no mention of the fact that death is on the table. These are all options. There is a significant history behind all of these choices. Furthermore, as the population ages these kinds of problems will become much more frequent (Nguyen, 1) It is fair to say that there have been critics of the institutionalization of medicine and of death itself. They think that something was lost in the process. In the words of Howarth: According to the medicalization thesis, medicine, with its emphasis on the biometrical model, has become a dominant discourse in our understanding of social life and is, therefore, able to define health and illness. The biomedical model relies on the idea of the body as a source knowledge; the greater the knowledge of the body, the greater the power over individuals . . . The greater the claims of the medical profession to the ‘truth’ about illness, and the more societies came to rely on their expert knowledge, the more power they had to define the nature of social reality (Howarth 119). This strain of thinking believes that “the doctor has replaced the role of the priest at the deathbed.” Now instead of extreme unction, we have probability statistics and morphine. The world has changed dramatically. There are those who are somewhat suspicious of power in any form, but that mode of thinking is not important for the purposes of this essay. What is important to emphasize is that with the significant power professionals possess comes a great deal of responsibility to use it wisely. What is the subject of great debate is: to what purpose should this power be used in the course of the relationships between a professional and a terminally ill patient (and their family). Should nurses be unmoved by the plight of patients. Should they avoid any emotional engagement with terminally patient? Can they apply life and professional experience in such a way as to make the terminal patient more comfortable? Or is it better, as Freud once suggested, to keep one’s hands completely clean of the messy business of human emotions. One thing we know for sure is that the death of a family member has a major impact on the family (McClement et al, 1076). That is important to consider as we examine these difficult questions. It can be useful to look at the way thinking about death has changed. Different perspectives provide different answers to the above questions. It is therefore to engage with the different theoreticians who have come up with different perspectives on dying. For some it is a question of stages. Kubler-Ross, for many years, had much of the field of thanatology to herself. She believed there were five stages of dying: Denial, Anger, Bargain, Depression, and Acceptance. This concept helped to focus people’s minds on the idea that dying was not a constant process—but like all theories its popularity led to a uniformness of approach which eventually became stale. Some felt the focus on the idea of “Acceptance” was teleological and untrue. Critics wondered if anyone ever really accepts their death—and might practitioners end up forcing square pegs into round holes with this approach. Other theories came out in the 1990s that helped correct what were seen to be flaw in the Kubler-Ross model. For example Buckman in 1993 argued that when individuals are confronted with impending death they ‘react in a way that is consistent with their character and the way they have coped with difficulties in the past.’ It is vital that nurses therefore know something about the people they are caring for in order to help improve their experience. There are other sociological studies relating to terminal patients that are useful for our purposes one. A fascinating and especially useful model was developed in the 1960s by Glasser and Strauss. In it they describe the phenomenon of “suspicion awareness.” This occurs when doctors and nurses seek to avoid telling the patient of their imminent demise, withholding the information either because they are too anxious to or have decided the stress of the knowledge would be detrimental to the patients’ health. This, the authors believe, is high detrimental to everyone, creating a ‘fantastic psychological strain.’ The patient might conclude from the strange behaviour of the professionals that he is dying and play along with the silence on the subject or he may feel conspired against. In any event, such a course of action is fairly common, Glasser and Strauss, believe, and should be addressed via open channels of communication with both the patient and also with the patients family who can also get caught up in this drama. There are many different contemporary models of how to deliver care to the terminally ill. Some are products of a new wave of academic thinking on the issue. Others are the product of the growing respectability attached to practitioners voices when discussing such difficult issues—in other words, practical, experience-based models that may do more good than ones cooked up in a classroom. To ask of any human being that they be constantly attuned to the feelings of others is quite a bit—to ask that they interrogate their every reaction to those around them can be breed a sense of extreme self-consciousness, so much so that the notion might be completely counter productive and not of any value to practitioners. Nevertheless, there is something to be said for an approach that asks people to be more sensitive and to move away from rigorously delineating professionals’ roles. Indeed, this basic assertion is almost certainly key to developing a more caring dialogue between professionals and patients engaged in the long, sad battle against terminal illness and eventual death. Work consulted Dy, S.M., et al. (2008). “A Systematic Review of Satisfaction with Care at the End of Life.” The American Geriatrics Society. 56:124–129. Glaser, Barney G., and Anselm L. Strauss. (2005). Awareness of Dying. New York:  Aldine Transaction. Howarth, Glennys. (2007). Death and Dying. London: Polity. Kubler-Ross, Elizabeth. (1975). Death: The Final Stage of Growth. Englewood: Prentice-Hall. Nguyen, Mai. (2009). “Nurse’s Assessment of Caregiver Burden.” MEDSURG Nursing—May/June, Vol. 18/No. 3 McClement, S., et al. (2007). Dignity Therapy: Family Member Perspectives.” Journal of Palliative Care. Volume 10, Number 5. Read More