Improving End Of Life Care In The Icu. A Literature Review

Improving End Of Life Care In The Icu. A Literature Review
Improving End of Life Care in the ICU A literature review conducted by Crowe (2017) examines the role of ICU nurses in providing high quality end
of life care in the ICU. He states that palliative nursing in the ICU is de–emphasized due to an increased focus on curative treatment. Four major
themes have been identified that contribute to the poor management of critically ill patients needing palliative support. These themes include
decision–making challenges, barriers, obtaining support and formation of guidelines to effectively implement comfort care therapies. Hence, a
checklist has been developed to allow nurses to properly facilitate the provision of quality care to patients experiencing the end of life, as well as
giving needed... Show more content on Helpwriting.net ...
With information gathering reflecting evidence–based practice, a checklist has been created in accordance with the philosophy of the hospital 's
palliative care program. This said checklist is also constructed in alignment with the ICU's policies and procedures to provide "a framework for the
bedside ICU nurse to ensure proper process, and consistent care is provided to all patients and families at the end of life" (Crowe, 2017). This will be
implemented upon completion of a family meeting with the multidisciplinary team that allows clear communication, decision making to modify goals
of care from curative to comfort, reflection, and clarification of questions. The checklist is divided into three parts: Decision making, Preparation, and
Implementation. Decision making involves the explanation and confirmation of withdrawal of life–sustaining therapies. The preparation phase
includes family awareness, planning, consideration of spiritual practices and organ donation inquiries. Lastly, the implementation phase provides
detailed instruction for the healthcare team once the process is initiated (Crowe, 2017). The study concludes that it is imperative for nurses to acquire
knowledge on the significance of palliative care, the ethics behind, and how it impacts the lives of their patients and families. This checklist serves as
a guide for best
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End Of Life Care Essay
How does the rural influence affect rural emergency room nurses transitioning from curative to end–of–life care? Since there are limited resources in
rural hospitals, it is necessary to explore the rural influence on rural emergency room (ER) nurses transitioning from curative to end–of–life care
(Rolland, 2016). It was necessary to capture areas of need to best support rural nurses caring for dying patients and their families in the rural
communities. Rural populations are poorly represented in research (Rolland, 2016). The perceptions of Rural ER Nurses' concerning end–of–life care
obstacles has been explored. A questionnaire was used to rank obstacles. The lowest ranking obstacles were nurses not being comfortable with caring
for dying patients and or their families. Among the highest ranking obstacles was knowing the patient or family personally. The rural nursing theory
was incorporated to identify rural influences with rural ER nurses transitioning from curative to end–of–life care. The rural nursing theory highlights
characteristics and dimensions unique to rural populations and nursing in rural areas (Rolland,... Show more content on Helpwriting.net ...
The conflicts affect transitioning from curative to end–of–life care. Gaps in education, staff resources, and personal and professional support may affect
rural nurses transitioning from curative to end–of–life care. The researchers used a qualitative design with the grounded theory to explore ER nurses'
personal transitioning when the focus of patient care changes from curative to end–of–life. Semi–structured interviews were used to collect data. Data
were collected in accordance with constant comparative analysis and theoretical sampling. A deductive content analysis was also used. The analysis
yielded twenty–nine concepts and produced five categories: preparing caring, immersion, making sense, changing gears, and reflecting. Concepts
include distance, resources, and

End Of Life Care
Providing End–of–Life Care Introduction End–of–life care can be defined as the care of a patient from the moment healthcare team members have
doubts about the purpose of life–sustaining treatment until the care for family after death of the patient (Noome, 2016). Caring for patients with
life–threatening illnesses is extraordinarily challenging. When caring for a patient in their last days, nurses may encounter legal aspects of care that
they may not be familiar with. The main objectives of this paper is to identify and discuss legal aspects of end–of–life care, compromised autonomy of
the patient, and nurse perspectives on end–of–life care The Legal Aspects of End–of–Life Care McGowan's (2011) article highlights legal implications
associated... Show more content on Helpwriting.net ...
Communication between the patient, family, clinicians, and nurses is important in inquiring the needs and wants of the patient and family. Noome et
al. (2016) recognized that ICU nurses described their role during end–of–life care as a professional who communicates information to patients and
family on treatments, procedures, and prognosis while providing comfort. Effective communication about advanced directives and disputes over
end–of–life care decisions may lead to acceptable compromise and solution between all parties involved (Blackler, 2016). Clear communication and
understanding is needed in order to provide high quality care. Another topic discussed between the articles involved, is the importance of surrogate
decision makers and advocacy for the substituted judgement standard in situations where the patient does not have the capacity to make his or her own
decisions. Both McGowan (2016) and Blacker (2016) agree that the proxy should confirm the incompetent patient's actual interests and preferences
when making a decision on their behalf. In these situations nurses should acknowledge the difficult nature of the situation and help the proxy analyze
the patient's interests from the interests of the proxy and/or

Essay Religion in End of Life Care
Through time, there has always been a question on the idea of another supernatural being, a greater power, or a God. People have grown up and
been taught certain beliefs, and some have developed their own beliefs based on this idea of a higher power. There are then those who don't believe
in any such thing; they believe in the facts presented to them. As a whole, the specifics of this idea vary, and as a nurse, understanding of this must be
achieved to successfully care for a patient. Hospitals are already known to have a depressing effect on patients, then added onto that are patients who
are suffering from acute or terminal illnesses. Their pain in many ways, gets passed on to the nurses who have gotten close with them through the care,
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cure. Hospitals not only have to meet the demands of curing illnesses, but also have to accommodate the spiritual needs and comfort of patients.
Hospitals are generally built and organized in the effort to help patients gain support by having the opportunity to turn towards religion during
difficult times. Hospitals in general have various religious leaders on call if a patient were to request them. They also have places of worship
available to serve as a sanctuary for patients. These places are equipped with sacred texts from different religions such as the Koran, the Bhagavad Gita
and the Holy Bible. As described in the article, "Sacred spaces in public places: religious and spiritual plurality in health care", "These spaces evoked a
feeling of sacredness of space and time – a sense of transcendence, immanence or connectedness in the everyday" (Reimer–Kirkham 203). This tranquil
feeling can help to relieve the stress of the body, being proved to help the bodies process of healing, or in the case of terminally ill patients, helps
them to develop a more positive outlook on what is happening. They are able to turn towards religion as support for the difficult time.
Death is an inevitable fate for all living beings. It's an aspect of life that can be hard to deal with, and the ability to overcome the fear of this
unavoidable event can be difficult when it comes to knowing the reality of your fate in an

The Importance Of End Of Life Care
Since this is generally a problem for all types of families in every economic class, the most impactful factor regarding the lack of preparation for this
issue is probably a lack of intentional and formal education for young people, as well as proper public awareness for young adults to those near
retirement.
The every–day struggle of trying to find your path in life can consume the mind into an over–focus on the ever–present "now." This persistent focus on
living for today can often skew one's perspective on future concerns, such as saving and investing for the future, not only for retirement, but for
end–of–life care. It's always more psychologically soothing to think that you won't need to plan that for many more years. Often this planning

End of Life Care
End of Life Care: Family Health
McKendree University
NSG 420 Fall 2014
Introduction In nursing, the goal of care is usually to restore the patient back to the highest level of health possible. In some cases, however, the
goals of care change when a curative approach is no longer appropriate. The new goals of care could simply be palliation and pain control rather than a
restoration back to full health. This type of care is called palliative care. Palliative care is not the same as end–of–life care, but the two go
hand–in–hand at times. The goal of end–of–life care is a "good" death, good being defined by the patient. Palliation is part of that "good" death. Both
palliative care and end–of–life ... Show more content on Helpwriting.net ...
Dying is a process that involves the entire family; that is to say, the family that is defined by the person. The nurse must be aware that this is not only
an individual process but a family process. This involves recognizing family dynamics and communication patterns and facilitating healthy interactions.
Kaakinen et al (2015) discusses the two types of health care teams that will be involved in the patient's care: multiprofessional and interprofessional.
The multiprofessional model is an older model that does not focus on holistic care. Care is fragmented with an autocratic leader, vertical
communication, separate goals of the professionals involved, and families are peripheral to the process (Kaakinen et al., 2015). The preferred model is
the interprofessional model emphasizing a team approach, holistic care of the patient, horizontal communication, and involvement of the family
(Kaakinen et al., 2015). The nurse should keep this collaborative approach in mind when dealing with any patient case, involving all teams associated
with the patient for the best outcome. It is important to remember that care of the patient does not end when the patient dies. After the death there is
still work to be done in the form of comforting the bereaved family members. It has been reported that some

End Of Life Care
The purpose of this research was to provide information among nurses and other healthcare
providers to help enhance their communication with aboriginal patients at the end of life. The
end of life can be a distressing time for patients, families, and healthcare providers. Cultural
differences, which may exist among these groups, can make the transition even more difficult.
Communication may be hindered due to misunderstanding or unclear expectations.
To understand some of the differences and issues specially related communications among nurses and caregivers providing palliative care and end of
life care to aboriginal patients who has been diagnosed with terminal illness.
When it said palliative care it refers not only ... Show more content on Helpwriting.net ...
First Nations and Inuit Health, part of Health Canada, and Indian and Northern Affairs Canada share responsibility for ensuring health care services are
provided to Canada's First Nations and Inuit people. Treaties with so–called Indian bands in Canada were signed before Confederation with the British
government and after Confederation with the Government of Canada (Natural Resources Canada, 2003). These treaties outlined agreements regarding
land, services, and relationships; some included a provision for health care services to be provided to the First Nations communities, often referred to
as the "medicine chest" clause These treaties enable direct delivery of services to First Nations and Inuit peoples, regardless of where they live in
Canada, including primary health care and emergency services on remote and isolated reserves where provincial or territorial services are not readily
available; community–based health programs both on reserves and in Inuit communities; and noninsured health benefits programs: pharmaceuticals,
dental, vision, and medical transportation. All four levels of government (federal, provincial and territorial, and Aboriginal) are working together to
improve and integrate health service delivery, with anticipated allocations for 2011–12 at $1977.6 million and an

Palliative Care And End Of Life Care
Introduction
Palliative care or End of Life care (EOL) is an important part of nursing care. Nurses provide care to the patients of different ethnic backgrounds and
cultures (Wang & Chan, 2015). In the Chinese culture, the concept of palliative care is still emerging. The issues around death and end of life care
are not discussed openly (Ho & Sanders, 2015). Decision about end of life care are usually made by the family members in compare to the western
culture where decision about end of life care are made mostly by the patients (Ho & Sanders, 2015). Furthermore, preferences about prolonging life
measures are also discussed by the family members instead of the patient. This paper will discuss the importance of acknowledging the decisions
made by the family members in the context of end of life care in Chinese culture, and how nurses can provide culturally competent care to assist the
families in decision making. An overview of the issue will be discussed, followed by analysis and synthesis of the research topic and closing the paper
with a succinct conclusion.
Overview of Background
The decision making practices around the end of life care are different in different countries which are usually formalized according to the religious
beliefs and cultural beliefs, traditions and ethical views (Gu, Chen, Liu, Zhang & Cheng, 2016). Decision making around the end of life care is not an
easy task, it is influenced by laws, rules and ethical issues and individual and cultural

End of Life Care Essay
IToday in the 21st century the options for end of life care is innumerable; nursing homes, hospices, outpatient nurses, live–in aides, family support, etc.
are just a few of the possible choices. Techniques and approaches regarding end of life are similar: there is surgical care; there is palliative care,
living wills, euthanasia, artificial organs/replacement, "full code" as opposed to "DNR" in hospitals, etc. While some argue that more options can be
overwhelming, the quality of life and end of life solutions are undisputedly better than before in American history. (1) Until the mid 1900's, end of life
could be summarized succinctly: if you were rich and merely elderly rather than infirm, you had the means to hire attendants and... Show more content
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To gain access to these care facilities, one needed vouchers of good character and large sums of money. (3)
Conditions were even worse in the past: folk stories and fairy tales often include the elderly and infirm in their stories, always in terrible conditions:
in Beauty and the Beast an "old hag" is homeless, ugly, and completely impoverished. In the Water of Life, the youngest son and protagonist is aided
by a handicapped dwarf, also ugly and impoverished (save for good advice and a kind heart). One of the evils that Pandora released was "old age." The
quality of being elderly itself was akin to being diseased with the uniform wish to have a speedy and peaceful death. (4) Today life has changed
drastically: in 2004, approximately 16,000 nursing homes were in operation, and although better rich than poor, America is progressing so that
all citizens will have access to healthcare. Social security, pensions, etc. came into being in the mid 1900's; end of life is no longer a certain mark
of suffering and call for early death, but rather a series of lifestyle choices of: "How can I best enjoy the golden years of life," a paraphrased popular
saying which well sums up the change in end of life decisions (which have even now become a golden prospect). (5) The advances in technology have
allowed "end of life" to become an extended, and often ambiguously defined time period. Although most humans certainly die before 100 years, the end

Workbook 2 Assessment and Care Planning in End of Life Care Q1: Complete the following table, describing the needs you would have to consider
when planning the different aspects of end of life care for an individual Planning for| Description of the needs that should be considered| Physical needs
(health and well–being)| Some physical needs are essential in order to sustain life and remain healthy; other physical needs contribute to comfort and
satisfaction. The physical needs essential for health are oxygen, water, food, protection and sleep. Some of these link to maslow's hierarchy of needs
which explains that if our basic needs are not addressed then we cannot progress further, when a person feels in good health they feel... Show more
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Each part enhances supports and affects the others. Individual wellness is reflective of how each of these factors is addressed. When planning
realistic care, the needs of others should be taken into consideration. (Others could refer to family members, friends, work colleagues or carers.) When
an individual is diagnosed with a life–limiting illness and they are supported by a family member, an assumption is made that care will be provided by
that relative. A carer assessment is used as part of holistic care to assess the carers own needs, preferences and wishes in order to assess whether they
can provide adequate care for their relative. It would be good practice for carers to complete a questionnaire as a form of self–assessment, it helps give
care providers a better picture of carers needs and abilities to care. All assessments must be reviewed at regular intervals as needs and abilities can
change. When planning the care you also need to take into account the spiritual and religious needs along with emotional needs of not just the
individual but also the family/carer, when providing support the family etc may find it distressing and you may need to ask them to leave if they
become too upset, you could warn people in advance about what you are going to be discussing thus preparing them ready. Practical needs are often
required by family and carers, things such as washing/bathing, day to day living tasks etc. You will

End Of Life Care
The significance of addressing psychosocial concerns with dying patients is essential to assure a peaceful closure in end–of–life care. The social
worker's role is to provide competent, psychosocial intervention with patients and families.
Case 1: Roger a healthy 62–year–old Male with African American ethnicity. Recently struck by a drunk driver that left him paralyzed from the neck
down. Roger is no longer by his self–able to eat or breathe and relies on machines to keep him alive. Has an existing will that was last updated 25
years ago. Rogers will states that he would like to receive life saving treatment. Currently when asked by doctors, Rogers seems to be communicating
that he no longer wishes to live this way.
Most of us hope to live ... Show more content on Helpwriting.net ...
(Barrett R.K., Heller K.S.) This could lead to a conflict with his religious beliefs and ending life –sustaining treatment.
Developmental Stage Factor – I don't believe a factor plays into this role. Roger is married and raised his children. Erikson's developmental stage states
that later adulthood 60–75 years old have a sense of fulfillment about life. Roger may also have a detached yet active concern about life now that he is
facing death.
Client's physical, cognitive, and psychosocial state– Clients physical state is one of lost hope. He was healthy and out on a jog when struck by a drunk
driver. Roger's life is now hanging on by the machines that keep him alive. "Erik Erikson believed if we see our lives as unproductive, feel guilt about
our past, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and
hopelessness." (Ego Integrity vs. Despair Erikson)
How might developmental stages of family member affect my recommendations– Because of the age of Roger and his youngest child being 25, I see
no issues with any developmental stages and his

End-of-Life Care
An individual patient solution may include actions of a clinician such as a trial of therapy (Schlairet, 2013). Providers may propose a trial of therapy
for an impaired patient that may offer greater clarity as to whether or not the patient is end stage or has a likely positive outcome. An agreement to
neither intensify nor expand critical care interventions should accompany the trial if the patient's condition weakens. A transfer of patient by the
surrogate decision maker may be another potential solution. (Schlairet, 2013). A surrogate decision maker may opt to identify an alternative
physician or medical facility for a second opinion regarding the course of action. This would allow the provider and decision maker to retain their
independent positions without the need for compromise. This action may be limited by insurance coverage, locale, and access to appropriate care.
Clinicians have observed that the DNR order set has a negative connotation and implies withholding or halting curative therapies (Venkat, 2014 ). As
health care providers focus on the clinical aspect of care a dichotomy is created when the surrogate for the patient injects emotion into the thought
process (Buscaino, 2013). They may perceive their choice to either be permission to terminate or agree to the DNR order to do "all that they can". A
study led by Ruth Wittmann–Price and Linda M. Celia, reported that a majority of physicians reported that they were personally likely to consent to
AND for a

End of life care, is an approach that improves the quality of life of patients and their families facing the problem associated with life–threatening
illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual. [1] Palliative care for children is the active total care of the child's body, mind and spirit, and also
involves giving support to the family. It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment
directed at the disease. [1] Health providers must evaluate and alleviate a child's physical, psychological, and social distress. The estimated global...
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Children with palliative care needs range in age from prenatal to young adult. In fact, some adults over the age of 21 are still considered part of this
population because they have conditions monitored by pediatric subspecialists or have developmental and/or physical challenges that are better served
by pediatricians. PP/HC teams must thus be able to care for patients with wide–ranging diagnoses and disease trajectories while providing
developmentally appropriate palliative care services. [3] Pediatric palliative care is both a philosophy and an organized program. It often includes but
is not limited to hospice and bereavement services and programs, pain and symptom management, sibling support, community resource referrals,
spiritual and mental health counseling, and respite care [4] . Further, members of the palliative care team assist patients and families with needed
information to set goals as they grow and develop with their life–limiting conditions and make decisions regarding their treatment plans to enhance
their quality of life [4] . The World Health Organization

Keeping End Of Life Care
Introduction
Bringing end–of–life care back into the community, specifically into–home, is a patient centered and cost effective option which provides an
essentially holistic and comfortable environment for the dying and their families. The purpose of this paper will be to examine how bringing
end–of–life care back into the community positively impacts patients, their families, the nurses in charge of their care and the relationships that are
facilitated as well as provide an overview of the cost effectiveness of this type of health care. Keeping end–of–life care in–home when possible, makes
it easier for loved ones to care for access their family member during an often difficult and stressful time. In a familiar setting, families are ... Show
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In this instance standard homecare referred to non–nursing care, further demonstrating that end–of–life health care in the home ensures further comfort
and heightening that sense of confidence with the palliative system. As patients are in their home, loved ones have an opportunity to be more
involved in their care as they have constant access to the health care team, as well as a defined safety and care plan which helps in reducing some of
the stressors that the family may experience during the palliative period of their loved one. As care progresses, the relationship built with the health
care team, specifically nurses, becomes paramount to ensuring patient comfort. Community nurses have the advantage of really getting to know their
patients, intimately and medically, ensuring that they are able to deliver the best of care. When a nurse is able to immerse herself in the home
environment of her patient, it allows her to develop a deeper and more intimate rapport with the dying patient and their families. This creates a higher
satisfaction in the level of care that is being received. In a study published by Karlsson, Edberg, Jakobsson, & Hallberg (2013), it was shown that,
"The care satisfaction was rated higher among older people receiving public care

End of Life Care
It was recognised by Jevon (2009) that caring for the dying patient can be the most fulfilling whilst also most challenging times for nurses and
healthcare professionals. This paper will introduce a case study based on personal experience within clinical placement, exploring and analysing the
above statement. In accordance with the Nursing and Midwifery Council Guidelines (2008) names have been changed to protect patient confidentiality.
The paper will seek to address issues relating to the case study examining relevant theory. Current policies and guidelines will be considered in relation
to the patient. It will identify a framework involved looking at literature to assess the effectiveness against the case study. Finally, focusing on a... Show
This was a comparative study between 785 subjects in 1969 and 639 subjects in 1987. Results revealed an increase in the amount of people living
longer with prolonged illness, greater awareness of death and dying alone within acute hospital settings. However, it did highlight an improvement in
home help although, fewer visits where occurring (Cartwright, 1991). Referring back to Mrs Jones, the latter of the findings was evident. Although Mr
Jones was appreciative for support being received within the home and community environment, he was having difficulties controlling his wife's
symptoms and pain management between health professionals visits. An implication of this is the possibility that Mrs Jones preferred place of care
was compromised resulting in re–evaluation of the family's situation, therefore, potentially meaning that Mrs Jones wishes were not met. It is from
studies such as the ones stated above that progression in end of life care has evolved with the introduction of palliative care nurses such as Macmillan
nurses and an increased number of hospice's being provided worldwide. The main focus at end of life care was predominantly based on cancer patients.
Initiatives such as the Comprehensive Cancer Care Programme was initiated in 1980 focusing on areas including prevention of illness, early detection,
treatment and pain relief and palliative care. This programme was introduced by the World Health

Hospice care requires a high level of care like those of and health care field. End of life care involves meeting the psychological, spiritual, social
and medical needs of the patient and family. This paper will inform the reader the importance of the caregiver involvement in the plan of care of the
patient and how their partaking improves the quality of life during the patient final phases of life. Information provided will explain the relationship
of end of life care and the QSEN competency of patient centered care (citation). Readers will learn how placing the patient and family values,
preferences and goals first will ensure the level of optimum care is met. According to National Hospice and Palliative Care Organization (2017) the
goal of a hospice nurse is to ensure that terminal diagnosed patient achieve a quality of life during their final days. It involves a team approach skilled
medical care, symptom management, and psychosocial support tailored to the patient's needs. I do this in my profession as a registered nurse by not
only concentrating on the physical needs of my clients, but concentrating on the emotional, spiritual and social welling.
In the following, I will present to you an illustration of how this is done. Upon start of shift I received report that I was going to be expecting a
45–year–old patient with end stage liver disease, who was pleasantly confused, having visual hallucination, and have excruciating pain to the abdomen
area. After receiving

Care at the end of life
Care at the end of life Leah Brown HCS/545 October 31, 2013 Valerie Platt Care at the end of life It is a fact that humans are born to die. What was
once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the
advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience
improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be
discussed, and the organizational structure, culture, and governance that led... Show more content on Helpwriting.net ...
Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long–term care facilities, to determine their views on
end–of–life issues. Their results identified five domains of quality care at the end–of–life. These were "adequate pain and symptom management,
avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones" (p.
163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not
wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on
life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital. Some wanted to be at
home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009
interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of
life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their
end–of–life experiences. These patients stressed that they most wanted to continue

End Of Life Care
End of Life Care: How Hospice Makes a Difference
Facing the end of life is frightening for many people, especially if it is unexpected or sudden. For the majority of people, however, death is not
instantaneous and can be slow and painful. For patients in this situation, an alternative to receiving palliative care and extraordinary measures to
prolong life is the use of hospice care. Hospice care has been constructed to provide supportive care in the final phases of terminal illnesses and centers
on the comfort and quality of the life of the patient, rather than curative measures. An important feature of this type of care is that the patients are most
often cared for in their own homes, offering a familiar and comfortable environment. The care ... Show more content on Helpwriting.net ...
Every person wants to feel like they are in control of as many things as possible, especially when they have no control over their terminal illness. To
some, this may mean doing things they have always wanted to, all the way up to making every possible decision they can when it comes to their final
moments, their advanced directives. While some that are scared of the end still may want extraordinary measures taken to try and prolong life for even
a short amount of time, many hospice patients elect to make themselves a DNR (do not resuscitate), meaning if their heart stops beating, no person will
begin CPR. Other countries have also followed suit with these types of standards, passing certain laws to uphold their patients' autonomy during
hospice care. In Asia, the "Natural Death Act" was implemented to guarantee a patient's right to choose to be a DNR, and subsequently, the "Patient
Autonomy Act" came next, which gave the patient the right to decline any treatment according to their own will (Cheng, Chen, & Chiu, 2016, p. 293).
While these choices are universal in our health care system in the U.S., how these choices implemented into action is the key. When in a palliative care
hospital setting, patients will have machines and IV lines attached to them, nurses and other healthcare personnel coming in to help them to and from
the restroom or bedpan, and other types of embarrassing and

Improving End-of-Life Care in The United States Essay
Death comes to all in the end, shrouded in mystery, occasionally bringing with it pain, and while some may welcome its finality, others may fight it
with every ounce of their strength. Humans have throughout the centuries created death rituals to bring them peace and healing after the death of a
loved one.
Deaths were a form of social event, when families and loved ones would gather around the bed of the dying, offering emotional support and comfort.
Myth, religion, and tradition would combine to give the event deeper meaning and ease the transition for all involved. The one who was dying was
confident in knowing what lay behind the veil of death, thanks to religious faith or tradition. His or her community held fast to the sense of ... Show
(Fine et al. 596). The two primary forms of care administered at the end of life are palliative care and hospice. Palliative care is intended to treat the
symptoms of illness as well as address the individual's spiritual, financial, emotional, and social needs. Hospice care enables terminally ill individuals
and their families to maintain dignity and spend their final days in a comfortable environment.
Palliative care may provide support for the individual's social support network. While palliative care is often offered as end–of–life care, it may also be
offered during any serious illness to ease the burden of that illness, whether or not that illness is considered terminal. ("Palliative Care" 1)
Patients with chronic or life–threatening illnesses may turn to palliative care for its symptom relieving benefits as well as its ability to improve their
quality of life. A key factor in quality palliative care is effective communication between medical professionals and the patient as well as the patient's
caretakers. Pain management, continuity of care among caretakers and medical providers, and concentration on the patient's personal preference are
all major aspects of palliative care. Good palliative care should begin with a discussion on advanced care directives, preferably initiated by a physician.
(Fine, et al. 595,

Grief is an acknowledgement that we loved someone, and the nature of our relationship with that person determines how we grieve. Grief is an
exclusive process; one that is as different as the person experiencing it is. As Hospice volunteers we must respect each person's individual grieving
practices and refuse to give in to the temptation to advise others to follow our exact paths. Although those of us who have also experienced such loss
can sympathize with other's feelings, we must be attentive to the fact that they are mourning the loss of a relationship that was exclusively theirs. As
Hospice volunteers, we must consider this exclusivity and abstain from persisting that the grieving person grieve any way other than what is best for...
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The death of an infant or fetus should never be ignored. In this case, grief is often negated, and this is also the case with the death of an adult child.
Parents experience real grief in these cases and the minimization of that grief only makes it harder to achieve acceptance (Leming & Dickinson,
2011, p. 493). The death of the adult child leaves parents with the feeling that the child's responsibilities have not been completed and recognize the
loss that their grandchildren will endure all of their lives. This is again, a break in the chain of the assumed cycle of life (Leming & Dickinson, 2011,
pp. 505–506). In adults, in general there are often many cases of disenfranchised grief. Loss of a grandparent, sibling, or even a parent, is negated
because the focus of grief attention is placed on other members of the family. Always remember they too are grieving, and their grief is just as
important and should be validated (P.G.White, 2009).
Grief in children is also different depending on the relationship they have with the dying person. There are, however, many commonalities about age of
the child.
Preschool children may not fully understand what death is, but they will notice a difference in the family "routine". They either may be emotional,
through crying or displays of anger, and they can withdraw from other members of the family (The Jason Program, n.d.). By age six, although the child
may seem not to be affected by the

Palliative Care : A Form Of End Of Life Care
Introduction
According to Allen et al. (2012), "millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved
psychosocial or spiritual problems." This issue occurs because palliative care is often considered a form of end–of–life care. Palliative care is a
treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling &
Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the
misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with
end–of–life care. However, end–of–life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and
suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative
care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency
room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience
clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

End Of Life Care Benefits
End of Life Care and the Benefits of End of Life Care Services End of life care is designed to provide the senior and their family relief from the
symptoms, pain, and stress of a terminal condition during the last six months of expected life. The end of life team includes nurses, social workers,
massage therapists, pharmacists, nutritionists, social workers, clergy, and so forth, who work with your loved one's primary care physician. In
addition to pain management and comfort care, end of life care focuses on communication between the patient, the family, and the health care team. A
major component of end of life care is making sure your loved one wishes are heard and honored. From pain management to living wills and powers of
attorney,

End Of Life Care Ethical Analysis
Ethical Issues in End–of–Life Care Affecting Nurses As nurses we deal with end–of–life care (EOLC) ethical issues on a daily basis in our practice, yet
we often fail to identify and recognize how this issues affect nurses. Jameton (1984) describes moral distress as "when one knows the right thing to do,
but institutional restraints make it nearly impossible to pursue the right course of action." Jameton (1984) also identified that nurses often seem
unaware of moral distress experience in themselves, and listed symptoms of moral distress as nurses describing a feelings of stress, burnout, emotional
exhaustion and job dissatisfaction.
When asked, most nurses would describe EOLC as palliative care given to patients that are terminally or ... Show more content on Helpwriting.net ...
In the process of guiding them, being careful to not step over boundaries. Some which are clearly marked by policy and practice standards, and others
that aren't on a piece of paper but are just as significant, such as conflicting moral/values between nurse and physician, nurse and other nurses and nurse
and other members of the health care team involved in the care of that patient.
Family conferences are key to providing patients a peaceful death. The focus will be outlined according to the patient's individual needs as appropriate.
Areas of discussion will be transparent view of prognosis, setting realistic goals of care, appropriate treatment options for symptom management, relief
of discomfort and suffering, timing and sequence of withdrawal of treatment as appropriate, access to the family to their loved one and preparation for
the sights and sounds of death (Holtschneider, M.E., 2004)
Providing Futile Care Futile care is described as aggressive "treatment" or interventions such as the use of life support therapy in terminally ill patients
who are highly unlikely to survive or have a successful outcome (Council on Ethical and Judician Affairs–American Medical Association,

Care For Patients At The End Of Their Life
Providing care for patients at the end of their life is integral for doctors, nurses and clinicians as carers and at a human level, as people. With an
increasing ageing population, the provision of care for vulnerable groups of people is on the increase, and giving such care is increasingly demanding
(RCN, 2012). Although, healthcare workers are assiduous and professional in providing care for patients, ethical dilemmas can still arise leading to
inadequate care, with some issues being preventable with better pro–active teamwork and planning (Kreimer, 2010). This is an important topic to
explore and will be examined in this assignment, by focusing on a scenario from the healthcare setting. Firstly, a summary of the case in question will
be presented. Secondly, the ethical challenges in this case will be explored by analysing and evaluating the patient's mental capacity,human rights and
conflict between those involved in the care. Thirdly, the essay will draw on relevant health and social care policy, and will appraise the nurses' roles
and responsibilities and the decision–making that should be adhered to. The patient in the case study will be called Mrs Jones, a pseudonym that will
be used throughout this assignment, in order to maintain confidentiality (NMC, 2015).
The scenario that will be reflected on will be based on a situation that occurred with a patient called Mrs Jones. Mrs Jones suffered from terminal
cancer and had dementia, she was a long–term resident in a

End Of Life Care
The suffering of terminally and chronically ill patients is also affecting person's immediate family. The costs for end of life care for terminally ill
patients is often too much for the family. The patients are generally aware of this, and with every day that she or he is kept alive, even though they
would want to take use of physician assisted death or euthanasia, the medical costs increase rapidly. According to Dworkin, the costs for medically
maintaining a terminally ill person near the end of their life can range from two thousand to ten thousand dollars a month (187). Not many people
can afford the high costs of end of life care. For the ones who are not able to pay for their medical care at the end of their life will leave the costs

End-Of-Life Care Ethics
[End–of–Life care is a term used in the medical field to describe treatment given to a patient around the time of death. With the advance of modern
medicine, there is an expectation on the part of the patient and the physician that the patient would then live longer, but death is not curable, and the
end will inevitably come. In these cases, the patient may not be able to be cured of their disease, but medical support and surgery may extend their
time to live for a while. A moral dilemma raises then when the decision between prolonging life and making it meaningful has to be made by the
patient ] Prompt: Write an essay that develop a position on the ethics of end of life care based on the six sources provided. Carefully read the following

End Of Life Care
This research article indicates addressing the communication problems in a hospital setting between the doctors, nurses and any other medical team
member since effective communication is paramount with end–of–life care. Having effective communication with the patient and patient's family
members will improve the overall satisfaction of care during a loved one's end–of–life care. In a time of a health crisis, the patient and patient's family
members may not be sure of what is going on or what is to be expected. They may not have enough knowledge about their diagnosis or comprehend the
meaning. In the research most family members felt they had unfilled communication needs, had feelings of being a burden, left abandoned, felt a lack
of trust

End Of Life Care Reflection
Self–Reflection on End–of–Life Care My perceptions have changed dramatically since the Clinical 1 rotation. I have noticed that the minute I walk
into my patient's room, I start to collect data. I notice if they are breathing normal, what their skin looks like, what their cognition level is, and what
equipment they have in their room. I have started to connect the "puzzle pieces" of the patient's health, rather than just feeling like I have a bunch of
random information. My perception of people has continued to stay the same from Clinical 1. I continue to have an interest in learning about patients
and believe that they also have something to teach us. I have learned so much from the patients and it is fun for me to get to know different

End Of Life Care Observation
What I have observed is that more attention and support is given when the patient has family members who come and surround the patient during the
patient last moment of life. Staff allows family members to have their privacy with the dying patient because is needed for the family to have that
precious moment with their loved one. However, the goal should be to ask family members if they need that privacy or want staff involvement.
However, attention and support are still provided when needed. With that said, family support can influence how much support or attention is given
during a patient last moment of life. The trend I have seen throughout my healthcare experience in regards to end–of–life care is that patients with
chronic debilitating

The setting in which a patient prefers end of life care is a specific choice that is left to the patient and/or their family to decide as well as the decision to
pursue hospice care via a physician's referral. Many people think that hospice is a certain place, however, hospice care can be provided in hospice care
facilities, some hospitals, as well as at home. The decision between hospice care provided at home versus hospice care in the hospital setting is a
difficult decision to make at the time of tragedy. However, seeking these services early will help the family be able to receive more available care and
support (Nemours Foundation, n.d).
"Each year in the United States, approximately 50,000 children die and 500,000 children cope with life–limiting conditions" (Varela et al., 2012, p.
171). According to the Department of Health children's "palliative care is centered on services that cater for young patients with a range of
life–limiting and life–threatening conditions" (Department of Health (DH) 2008, Spathis et al 2012). ... Show more content on Helpwriting.net ...
171). According to a study about the percentages in hospice agencies in North Carolina, "over the past year inquires that 58 (95%) of agencies
indicated that they provided hospice care at for children at home and 49 (80%) indicated that they provided hospice care for children at home" (Varela
et al., 2012, p. 172). Hospice care for children is crucial and specific skills are needed to pursue this aspect of care. Hospice care for the child would
need to include the skills needed to provide care for the child as well as the social, psychological, and spiritual needs for that specific child as well as
their

The End Of Life Care
The End–of–Life Care of Mrs. Terri Schiavo When a person comes to the point of time at which they are at the end of their life, whether it is due to
their age, natural causes or because an accident has happened, end–of–life care becomes a key component in their given situation. For most people,
their families, whether it be their husband or their wife, their children, or even their parents, have to be the ones to make decisions about that care. This
end–of–life care involves many decisions that most people do not want to make but have to, whether it is to prolong this person's life or deciding to
let them go peacefully and without any pain. In this paper, I will discuss one particular case, that of Terri Schiavo, and her end–of–life care. Terri
Schiavo was born Theresa Marie Schindler on December 3, 1963 in Montgomery County, Pennsylvania to the parents of Robert and Mary Schindler.
Throughout her childhood, Terri struggled with being short and overweight and therefore, she also struggled with her image of herself. It wasn't
until she went off to college that Terri's struggles led her to start dieting and she eventually lost some of her weight. While she was in college, in
1982, Terri met a man who she fell in love with and married two years later, in 1984, Michael Schiavo. Just two short years after getting married, the
couple decided to move to Florida, where Terri's parents, the Schindlers, lived. Settled in Florida, Terri and Michael both found jobs, Michael

Skype In End Of Life Care
The authors did so many things right when writing this article. It was a good length, considering the topic it covered was so specific. They
provided an adequate amount of background statistics and information on social media and how it is used today, to get a better understanding of
the role of technology overall in our lives today. I also liked that they admitted the limitations of their article; for example the reader only gets the
case studies from one perspective when the others are also important to know. They also did a great job of choosing cases that show the reader how
Skype can and did make a huge difference for these families and their dying loved ones. There were also a few downsides in the article. I didn't feel
the authors... Show more content on Helpwriting.net ...
In the beginning I wish the article went into more detail about the evolution of the music therapy profession and how their use of music can create
greater results in their patients than other care providers using music. It also could have been better organized to go from discussing music
interventions in the broad clinical setting to focusing in on the end–of–life care setting instead of jumping back and forth between them. I feel that the
article was comprised largely of information for the general clinical setting instead of the palliative and hospice setting, which was supposed to be the
article topic since the article's title is "Music as a Therapeutic Resource in End–of–Life Care". Overall, I enjoyed reading this article for a multitude of
reasons. Their choice of vocabulary made it easily understandable, the topic was very interesting to me, and the fact that I can use the information I
learned in my future career as a nurse is a great benefit. After reading this article I have a greater respect and understanding of music therapy and the
effects it can have on patients and their families. This is why I would recommend others to read this article, especially individuals working in healthcare
settings alongside music therapy

Hospice And End Of Life Care
Hospice and End of Life Care
What is Hospice? Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are
diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America,
2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is
focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization,
2012). Hospice care can be provided in many different settings, often the patient's own home. Hospice care can also be provided in hospitals, nursing
homes, long–term care facilities and free–standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in
a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social
workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is
provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on
call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

The nurse plays a vital role when dealing with end of life care. The nurse can help their patient die in a dignify way as well as support their patients
and families through an incredibly difficult time. It is the nurses' duty to provide comprehensive and compassionate end of life care (ANA center for
ethics and human rights, 2016). According to Taylor (pg. 1618) patients generally feel more comfortable discussing their questions and concerns with
their nurse, patients feel as though the nurse is more approachable and less intimidating. They spend more time with the nurse and generally direct their
concerns towards them. It is imperative that the nurse use tools such as therapeutic communication when answering questions regarding death and
showing the patient and family that they are freely open to discussing any concerns that they have regarding care and death (Taylor, pg.1618). It is an
essential part of being a well–rounded competent nurse to be equipped with the ability to provide some counseling and death education (Taylor,
pg.1618). Therefore, having a sound education including the elements of end of life care is essential. Moreover, it is especially important to develop
a solid, trusting relationship between one's patient and family by allowing the patient to discuss openly their issues and giving oneself by serving as a
nonjudgmental listener (Taylor, Pg.1614).Communication is key when delivering optimal end of life care. According to Rolland (2016) end of life

The End Of Life Care
END OF LIFE CARE
I have chosen to write about one of my service users who i was extremely close to and who has a special place in my heart, I had nursed Mrs Mc for
4years before her passing. Mrs Mc was an elderly lady who was 79yrs old when she passed away and sadly she had Korsakoffs which is a brain
disorder associated with heavy alcohol consumption, people with this experience short term memory loss it is also knowing as "alcohol related
dementia".
Mrs Mc had alcohol issues as she struggled to cope with the loss of her baby daughter as she was born alive then sadly passed away two days later
due to natural causes in which Mr & Mrs Mc struggled to come to terms with and unfortunately their marriage later ended as they both ... Show more
People who drink excessive amounts of alcohol are often thiamine deficient as many heavy drinkers have poor eating habits which do not provide
essential vitamins. Mrs Mc had been hospitalised by this point and professionals had decided that it would be best for Mrs Mc to receive 24 hour care
as she wasn't able to care for herself at home and didn't have any family to help look after her apart from her brother J but he wasn't able to meet
her needs at home, Mrs Mc arrived at Applecross nursing home in 1988 so she had been there my whole life time but this helped her through the
challenges and struggles she faced and it changed her life in a positive way as we all became her family & I'm sure that the good care she received
over the years and lots of love from us prolonged her life span significantly.
On my first day at Applecross I was so nervous as this is my first caring job and when I was introduced to her for the first time she told me that I should
always curtsy to her and call her by her full titled name Mrs **** Mc**** in which I carried out as she had asked, I curtsied & politely N/C/S 10.1
said nice to meet you Mrs **** Mc**** N/C/S 10.2 she then laughed and replied "your more dafter than me hen! just call me **** (her first name)
which made everyone go into fits of laughter including myself, she had this big bold personality

End Of Life Care Analysis
Activity 1: The author seeks to differentiate 'end–of–life–care' from palliative care in the context of symptom management. The former being comfort
care for advanced incurable illness and the latter being the managing quality of life in acute or chronic patients. The focus of palliative care is pain
management but the unpredictable referral point means patients can have an array of presenting symptoms for an indeterminate time period. Some of
the symptoms include nausea, vomiting, dyspnoea, and delirium. Symptoms that can cause significant distress and discomfort to a patient if not
managed. Therefore, individualized care is necessary for proper holistic treatment in palliative care. Proper management of symptoms starts with
communication,

End Of Life Care
When a person is healthy, he or she should be able to manage any social, physical, or mental challenges that come his or her way. A healthy person
therefore is seen as one who should be able to perform their daily assignments, having access to their social services like vocation efficiently without
any form of complication (Gentry et al. 2010 p.103). In case where a person's ability to carry out the functions mentioned above expected of a
healthy person, the person could be deemed unhealthy and might require the services of a caregiver for him or her to be able to accomplish some of
his or her daily activities.
According to the world health organisation (WHO), a good health is a state of complete physical, social, and mental well–being, and ... Show more
Since the inception of the council in the 1889, it was governed by a constitution that was changed in 1974 to become a non–metropolitan county
council so as to allow it regain jurisdiction on the Southend–on–Sea with a reduction in its size. As of 2011, the population of the county was around
1,393,600, and it coordinated its services among three authorities such as the Essex health and social services for both children and adults in need of
special services, the Essex fire authority, etc.
Some of the services provided by the Essex county council for individuals with specific needs include the following– safeguarding, blue badges, health,
adult services, and children's services. As a result of the recommendations by an inquiry in the council as to the reasons why health care were failing in
the council, safeguarding became important to the council. The council now provides advice and assign individuals in the right direction when there is
any suspicion that the individuals are at the risk of harm or

Palliative care is the active holistic care of patients with advanced progressive illness and is intimately linked with end–of–life care for people in the
last months or days of life (National Council for Palliative Care, 2017). Around 500,000 people die each year in England and Wales (NICE, 2017)
and up to 74% of people say they would prefer to die at home (National Audit Office, 2008), but currently 58% of people die in hospital (National End
of Life Intelligence Network, 2010). Common issues in palliative/end–of–life patients such as pain, breathlessness, or seizures (Royal College of
Nursing, 2011) are likely to initiate an emergency response from ambulance services. For carers and relatives the lack of community services or
24–hour clinical support often mean they turn to the ambulance service (Parkinson, 2014) This essay will explore the issues surrounding palliative
/end–of–life care and the role modern ambulance services can play in facilitating effective care delivery. There will be a critical evaluation of the
assessment and treatment of a patient with a terminal lung disease... Show more content on Helpwriting.net ...
Signs and symptoms of a patient nearing the end of life include a decline in appetite, reduction in consciousness and increased agitation, altered
respiratory effort, reduced communication, reduced mobility and social withdrawal (Kitchener, 2017). Ideally, anticipatory care should be organised
before this stage to help put in place an individualised care plan that takes in to account the patient's wishes and best interests. Part of this discussion
should include decisions such as whether hospital admission would be correct or if resuscitation would be appropriate (Macmillan Cancer Support,
2018). These Advanced Decisions to Reuse Treatment (ADRT) are legally binding documents if they meet the requirements of the Mental Capacity Act

Essay On End Of Life Care
End of Life Care and Financial Planning Taking care of a senior loved one with a terminal condition is highly emotional. Despite the challenges of
talking about the end, there are many topics that must be addressed. Among them is financial planning. Because of advances in medication and
healthcare, the average life expectancy has gone up considerably. This means that seniors who fall ill or get injured may spend a significant amount of
time in a long–term care situation. While this is great for you and your senior loved one that they will still be around, it may not be so great on the
pocketbook. After all, none of this care is free. The most effective way to plan for end of life care is to start a long time before it is needed. It may be
hard to address dying with your senior loved one, but not doing so is going to be even more difficult when the care is needed and you are in the midst
of a health crisis.... Show more content on Helpwriting.net ...
By analyzing the medical history, you may have a better idea of the type of care that may be required, and why. Talking about living arrangements
is also an important step since there will be different challenges when living at home, moving in with family or friends, moving to a nursing home,
or entering an assisted living facility. Palliative care and hospice options each take various forms and are available for different time frames. They
also have different financial requirements. Advance directives letting family and medical providers know what sort of care your loved one wants at
their end of life can make things a lot less stressful when the time comes. Two types of advance directives include the living will and the health care
power of attorney. Knowing what your loved one desires also helps you make sound financial decisions well in

Improving End Of Life Care In The Icu. A Literature Review

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