NRS 434 Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes

NRS 434 Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes

NRS 434 Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes

There are several reasons elderly patients may not die in their own homes, despite it being their preference. Inadequate support from family members makes it challenging to care for elderly patients. The lack of resources also makes caring for them at home tough. In certain cases, elderly patients have complex medical requirements that pose problems when managing them effectively within their homes (González-González et al., 2020). Such individuals may rely on services more conveniently accessible in hospital or hospice facilities, such as specific equipment, routine medical interventions, or constant monitoring.

Other factors such as financial status, geographical location, and inadequate specialized care services also limit their access to palliative care programs, thus restricting their options for end-of-life care (González-González et al., 2020). In such cases, the patients receive services in alternative places they would not have preferred. Sometimes, patients may need to be in a controlled environment, such as a hospital or facility with competent staff who can effectively manage their symptoms and guarantee their overall health.

Nurses play a vital role in supporting patients regarding end-of-life care per their wishes. As a nurse, I would ensure open and honest communication, educate and empower, coordinate care, facilitate home-based care when possible, and provide emotional support (Hagan et al., 2018). Trust is established by actively listening to their wishes and respecting their preferences. Additionally, I would provide patients and their families with all information concerning the diverse possibilities of end-of-life care, which includes educating them on palliative care programs and hospices while elucidating the advantages, restrictions, and potential results associated with each choice (Hagan et al., 2018). When a patient strongly prefers spending their last days at home, it is vital to explore various alternatives that can support them in receiving care within the confines of their residence (Hagan et al., 2018). In such cases, I would coordinate closely with community resources, including home health agencies or palliative care teams, to ensure that all necessary aid and services are available comfortably at the patient’s home. By proactively involving my patients in decision-making processes advocating for their expressed desires, and providing comprehensive assistance when needed, I can facilitate the provision of end-of-life care that best adheres to their wishes.

References

González-González, A. I., Schmucker, C., Nothacker, J., Nury, E., Dinh, T. S., Brueckle, M.-S., Blom, J. W., van den Akker, M., Röttger, K., Wegwarth, O., Hoffmann, T., Gerlach, F. M., Straus, S. E., Meerpohl, J. J., & Muth, C. (2020). End-of-Life care preferences of older patients with multimorbidity: A mixed methods systematic review. Journal of Clinical Medicine, 10(1), 91. https://doi.org/10.3390/jcm10010091

Hagan, T. L., Xu, J., Lopez, R. P., & Bressler, T. (2018). Nursing’s role in leading palliative care: A call to action. Nurse Education Today, 61(1), 216–219. https://doi.org/10.1016/j.nedt.2017.11.037

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Home may be the most private setting for someone nearing the end of their life. The dying person may feel comforted by having the freedom to come and go with family and friends. It is possible to arrange for the home-based delivery of services, such as visiting nurses, or special equipment, such as a hospital bed. The people providing care for people at the end of their lives can face many physical, emotional, and financial challenges. Caregiving or home service providers can provide extra support, called respite care. Some hospital discharge planners, often social workers, can assist with the logistical details if the dying person returns home. 

Different Care Settings at the End of Life. (n.d.). National Institute on Aging. https://www.nia.nih.gov/health/different-care-settings-end-life

 support your point of view, as we aged there ia a lot of things that can make an older adult to not die at home as they wish it.

A loss of independence is a natural part of aging, coping with it does not often come easily.  Studies have shown that many older adults fear losing independence more than they fear death.  But it’s worth noting that becoming more dependent on others is a fact of aging and not a mark of failure or even an indicator of impending mortality.  There are several ways to cope with losing independence, whether you’re beginning to experience it yourself or want to help a loved one transition through the process.

A loss of independence can be due to physical or mental changes in an individual.  To understand what an older adult feels as they experience less independence, it’s important to consider what changes are occurring and what they are losing.  As we age, mobility decreases, making everyday activities like driving or walking more challenging.  It can be alarming when one’s body no longer works like it used to. The aging process may bring a loss of sight or hearing, difficulty walking, difficulty completing daily chores, loss of flexibility, or a general decrease in energy.  These physical changes can affect a person’s  confidence and self-worth.  Their social life can also be impacted as they find it more challenging to go see friends or take part in recreational activities. These changes can often result in sadness or depression.

References

https://www.nextavenue.org. How realistic is dying at home.

End-of-life care may also entail assisting the dying individual with coping with mental and emotional anguish. Someone nearing the end of their life may understandably feel unhappy or anxious. It is critical to address emotional anguish and suffering. To facilitate dialogues about feelings, you might wish to contact a counselor, preferably one who is knowledgeable with end-of-life concerns. If the sadness or anxiety is severe, medication may be prescribed (National Institute on Aging, n.d.).

Reference:

National Institute on Aging. (n.d.). Providing care and comfort at the end of life. National Institute on Aging. https://www.nia.nih.gov/health/providing-comfort-end-life#spiritual 

During end of life care the patient may have a better satisfaction when dying at home for they are in their home, familiar surroundings and with family. They do not need to worry about meeting new staff members day in and day out. I appreciate you mentioning that when providing care to a dying patient you would do your best to facilitate and coordinate care in addition to providing education and empowerment for their ending days. Patients have rights we must respect it however, if the patient does not have the resources due to insurance, caregivers or family to care for them this can make the last days difficult to fulfill.

It is important that we explore options in regards to end of life care for our patients. Everyone deserves to die in a dignified and respectful way of their choice. If their choice is home and it is not feasible, it is important that the patient and family understand their options available to them. We as nurses, need to advocate for what is best for the patient.

Despite the fact that there are many hospice and palliative care programs, many elderly patients don’t have the opportunity to pass in the comfort of their home. Studies show that the majority of people over 50 want to stay in their home as long as possible (Rowland, 2022). There are many reasons as to why elderly people pass outside of their home, such as them not having loved ones to care for them, not having enough space in their home for medical equipment, or their loved ones not wanting to or being able to care for them. Another reason is that by the time they get hospice or palliative referrals, it is too late with “fewer than 50% of the patients referred within the final 2 weeks of life and more than 35% within less than a week of dying” (Green, 2022). At my job, it is a process to get someone on hospice. We talk it over with the family and patient, then we ask for the doctor to order a hospice referral. The doctor has to come in and do an exam before giving their referral. After the referral is given, we wait for hospice to contact us back and set up an appointment with the patient to do an exam and admit to them to hospice care. When someone is dying, things can change drastically in such a small amount of time. Death is something that is part of the job for nurses, so it is something we know how to deal with. However, most family members are unable to see their loved one dying or care for them at home. This is another reason why many pass in nursing homes or at the hospital. It is very important to talk with your loved ones about your wishes and to create an advanced directive or choose a trusted person to become power of attorney if a situation occurs where you are incapacitated. Talking with and including family members “about the best evidence allows for autonomous, informed decision making over treatment options, including benefits, risks, and cessation of treatment (Green, 2022).

Green, S. (2022). Health Assessment of the Aging Adult. Grand Canyon University. Retrieved July 8, 2023 from https://bibliu.com/app/#/view/books/1000000000584/epub/Imprint.html#page_3

Rowland, C. (2022). Seniors Are Stuck Home Alone as Health Aides Flee for Higher-paying Jobs. Washington Post. Retrieved July 8, 2023 from https://www.washingtonpost.com/business/2022/09/25/seniors-home-health-care/

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