End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires. Support your response with evidence-based literature.
Many palliative care patients would prefer to receive care, and to die, at home. Despite of this, many die in institutions. The need for the healthcare provider to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. A significant proportion of patients experience an emergency admission from home, after ...view middle of the document...
For every one of these deaths, there is a patient and a family faced with difficult decisions about care at the last stage of life. It is important that a plan is in place, so that the family understands their final wishes.
Whether someone is facing an acute illness, a long-term chronic illness or a terminal illness, advance care planning can help alleviate unnecessary suffering, improve quality of life and provide better understanding of the decision-making challenges facing the person and their loved ones or caregivers. An advance care plan can be used at any stage of life and should be updated as circumstances change. Without a plan in place, Dr. Unroe states “the default in our medical system is aggressive care unless there is a clearly written, in-your-face, advance directive” (CDC, nd). Per the CDC, only 1/3 of the adults have an advance directive (CDC, nd).
As a healthcare provider, it is important to inform all our patients in regards to an advance directive, because you never know what can happen. It is also important for people to let their family and healthcare providers know that they have an advance directive. The SUPPORT study, sponsored by the Robert Wood Johnson Foundation, “found that nearly a third of terminally ill participants did not want cardiopulmonary resuscitation (CPR), but less than half of their physicians knew of their preference” (CDC, nd). It is our duty to respect the patients’ wishes and to ensure that the patient has the widest possible range of choices in how to finish their days.
Centers for Disease Control and Prevention. (No Date). Advance Care Planning: Ensuring Your Wishes Are Known and Honored If You Are Unable to Speak for Yourself. Retrieved from http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf
Wheatley, Victoria J. and Baker, J Idris. (2007) “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600129/