THE CHALLENGES FOR NURSES WHO PROVIDE PALLIATIVE CARE TO DAYING PATIENTS - Essay Example

CHALLENGES FOR NURSES WHO PROVIDE PALLIATIVE CARE TO DYING PATIENTS Introduction Several studies have shown that the health care delivery system have tremendously improved in recent years. Progress from health care facilities to the general health and well-being of the clients are undeniably remarkable. However, despite these positive changes, several issues are still confronting the health care industry, which elevates tension in the workplace particularly among nurses who directly provide care for patients. This paper intended to highlight some issues confronting nurses as they deliver palliative care to dying patients. It aimed to gather valuable practices of health institutions in providing palliative care. The paper also focused on some experiences, emotions and significant roles of nurses as they deliver care to patients and how they dealt with the family. Distinct viewpoints of authors were compared, with emphasis on the palliative care models. Relevant insights on the challenges faced by Nurses were considered, as far as quality of patient care is concerned. Palliative Care For Dying Patients The World Health Organization's (Sepulvida, et.al., 2002) defined palliative care as the approach which improves the patients' quality of life and their families who are facing the problem associated with such life-threatening illness, by means of early identification and assessment as well as treatment of pain and the rest of the problems. It applies interdisciplinary team approach in all parts of the continuum of illness, emphasizing critical importance of respectful and trusting relationships. Moreover, International Council for Nurses (ICN, 2006) added that, palliative care is also a holistic care of patients who have advanced progressive illness and are not responsive to the given treatment. Palliative care improves the quality of life of patients and their families in dealing with the problems associated with life threatening illness, prevention and relief of suffering is made possible by early assessment, identification and management of pain and other physical, psychosocial and spiritual problems. Pain management, symptom management, social, emotional, psychological and spiritual support and caregiver support are the basic components of palliative care. This holistic care services may be carried out in most clinical setting, including patient's home. Role of Nurses in Palliative Care Issues of death and caring for dying patients are certainly emotional human experiences that demands for a compassionate care. ICN reiterates that nurses should reduce suffering and help improve the quality of a dying patient's life, so with the family members. Nurses are expected create and maintain a relationship with the client who is therapeutic; working with them in a peaceful environment conducive for mitigating pain. As health care providers, they must be effective as clinical managers, supervisors, coordinating services, able to set priorities, monitor care outcomes, conducting health teachings to patient and the families, managing resources and efficient in providing nursing leadership in caring for dying patients. Issues and Challenges in Nursing Palliative Care In line with their work, several nurses experienced moral and ethical dilemmas. In January 2004 issue of Journal of the American Medical Association (2004, 11), authors who conducted survey about the end-of-life experiences of people who passed away shared that, majority of people preferred to die at home. Regardless of the setting, respondents shared that, the care given by the staff were inadequate: dyspnea (22%), pain (24%), and emotional needs (50%). There was higher patients' satisfaction with hospice care than the care provided by nursing homes, hospitals, and home care providers. Undoubtedly, the goals of care and care itself are interdisciplinary. On the contrary, The Institute of Medicine (IOM) elaborated that, in nursing homes, there is insufficient knowledge regarding the experience of dying, which makes majority of the health care personnel question like, whether older people and their families receive enough information on diagnosis, prognosis, and other treatment options Which assessment tools and protocols were used to guide care How is the evaluation and improvement of the quality of care implemented (Field & Cassell, 1997). In addition, a study from Journal of Gerontologic Nursing cited Forbes (2001; 37-45) who provided a basis that, licensed nurses supervising patients in some nursing home, are often inadequate of essential training and communication skills, which prevent them from addressing the needs of their patients. After investigating one nursing home, Forbes marked significantly that, although "resident clients expressed readiness to die," staff nurses were hesitant to discuss about death. Poor communication isn't the only problem to a peaceful death. There were some patients who experienced over-treated, receiving aggressive care up to their last breath, while others were under-treated and reached their last moments steeped in physical pain. Others were known to have received conflicting advice from nurses and doctors regarding the most appropriate action, providing and leaving them confused as well as unprepared for death. The quality of nursing home care is affected by staff nurses' inadequate training in end-of-life care. Certified nursing assistants mostly provide direct care, and they often feel frustrated with inadequate staffing, and they also feel inadequately prepared to report the grief and bereavement which follows a resident's death (Kayser-Jones, 2002; 11-9). On the other side, Meier (JAMA, 2001) reported that, awareness of nurses on their own vulnerabilities and losses can increase due to their care of patients and their families with experiences of progressive illness, death, as well as bereavement. These can also heighten nurses' fear of death which consequently increase their level of stress and anxiety that may further lead to guilt, anger, frustrations, irritability, inadequacy, sleeplessness, feelings of helplessness and depression. On the other hand, in nursing homes, many efforts have been done to improve end-of-life care, but there have been lagged behind such efforts in hospitals (JAMA, 1995). In reviewing the manifestations of stress and stressors in oncology as well as palliative care settings, it was discovered that, lack of support and collaboration in the workplace can diminish nurses' self-esteem and can decrease professional effectiveness (Vachon, 1998). Redefining the Quality of Palliative Care The best palliative care given to patients would not entirely come from nurses. All the more, a peaceful death is not solely dependent on one person. How a patient's final days spent will depend on the patient and the family, nurses, physicians, and if the patient is not at home, the policies of the hospice or hospital, the insurance providers and at a distant but equally important level include the state and federal laws. These factors work together and contribute to the patient's most intimate, remaining period of life (Institute of Medicine, 1997). Nurses may have the most sincere intentions to ensure the peaceful death of their patients, yet alone, this may not be possible. Therefore, care must be improved at all levels, from individual, institutional to governmental level. Concrete examples of the aforementioned include: The state can set out and provide care guidelines which will be used for skilled nursing facilities, or may provide advance care planning tools, available in different language. The government can also sponsor effective palliative care management training programs for health care givers. Staff must be continually educated (Lynn, et.al., 1997), regardless of the clinical setting, most providers' desire families to be assured that a loved one did not die isolated and suffered. Norton and Talerico (2000) described communication strategies for the use of health care providers which could help terminally ill elderly patients and also their families to make decisions. In the course of communication with their patients, it must be clear, avoiding ambiguous language and euphemisms, specific about expectations and treatment goals. Careful in the use of words like "hope", the meaning may change with time (the term "hope" may initially refer to cure then later to a peaceful death). The Association of American Critical-Care Nurses, American Pain Society, American Cancer Society, and Oncology Nursing Society have formulated care principles applicable for all age groups and recommended stakeholders to help in the physical and emotional symptoms alleviation. There should be support of function and autonomy to maintain the patient's dignity. The health care team with the family must do advance planning so that, during the course of decision making, patient's preferences are ensured. The patient needs to be guarded against any aggressive and inappropriate care near death. The team also has to make the time spent by the dying and the family precious. Despite declining physical health, the patient's quality of life must be ensured. The financial burden of the family must be minimized; patient and the family should be educated in terms of insurance which cover treatment of the illness and help the family with bereavement should be given (Virani & Sofer, 2003). All these are important and health care providers should be educated of the said principles. Conclusions The roles and responsibilities of nurses are never easy. It is highly regarded, fulfilling, yet, it involve risks and stress. Nurses are always at the frontline, expected to deliver quality care at all times. Despite barriers in providing quality palliative care to patients who are dying, nurses should continue to set goals, achieve the said goals and demonstrate nursing care procedures effectively-Promote harmonious relationship with the clients, collaborate with other health care professionals, alleviate pain and patients' suffering, carry out effective therapeutic communication, be positive health-outcome centered, and several others. Good health is a responsibility of everyone. The overall health outcomes of a patient greatly depends on the collaborative efforts of the patient and family, health care providers and institution, insurance companies, and all the more, the government. When health care costs are rising, insurers must see to it that they address properly the patient's needs. The public and policy making bodies must adopt the prolonging-life-at-any-cost approach in order to upgrade the existing quality health care system. Nurses should not only predict the moment of patient's death but should anticipate the risks and difficulties patient experience, rather discuss dying, support patient and family by informing them about appropriate treatment decisions. REFERENCES Field, M. & Cassell, C. (1997) Approaching death: improving care at the end of life. Report of the Institute of Medicine Task Force. National Academy Press, Washington, DC. Forbes S. (2001) This is heaven's waiting room: end of life in one nursing home. Journal of Gerontologic Nursing, 27, 11: 37-45. International Council of Nurses. (2006) Code of ethics for nurses. Retrieved December 28, 2008 from http://www.who.int/hiv/topics/palliative/care/en/ International Council of Nurses. (2006) Position statement on care of dying patients and their families. 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