End-of-life care becomes an issue at some point for elderly patients. Even with the emergence of palliative care programs and hospice programs, most 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 patients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.
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There are several reasons why elderly people may not be able to die in their own home, despite their preference. These reasons can include lack of family support, the complexity of medical needs, financial constraints, and limited access to appropriate resources. As a nurse, there are several actions you can take to support your patients regarding end-of-life care according to their wishes.
1. Assess and facilitate discussions: Initiate open and honest conversations with patients and their families early on about end-of-life care preferences and goals. Encourage advance care planning discussions and help patients express their wishes in legal documents like advance directives, living wills, or Medical Orders for Scope of Treatment (MOST) forms. Provide education and resources to help them understand the options available.
2. Advocate for home-based care: Work closely with interdisciplinary teams to develop and promote home-based palliative care programs. Advocate for the availability of home health services, telemedicine, and community-based resources to support patients who wish to receive end-of-life care in their own homes. Evidence shows that home-based palliative care can improve patient and family satisfaction, reduce hospitalizations, and increase the likelihood of dying at home (Reinke et al., 2017).
3. Provide education: Educate patients and their families about palliative care and hospice programs to ensure they understand the benefits and services offered. Address misconceptions or fears they may have and provide evidence-based information to empower them to make informed decisions. Research shows that education about end-of-life care options positively impacts patient-centered decision-making and satisfaction with care (Breen et al., 2020).
4. Support shared decision-making: Collaborate with patients, families, and the interdisciplinary team to facilitate shared decision-making. Use communication tools like "Ask-Tell-Ask" or "Shared Decision-Making Model" to ensure patients' values and preferences are respected (De Vleminck et al., 2020). Encourage open and regular communication to assess and address any concerns or changes in patients' wishes.
5. Provide emotional support: Recognize the emotional distress experienced by patients and families facing end-of-life care decisions. Offer compassionate and non-judgmental support, actively listen to their concerns, and provide reassurance. Engage in therapeutic communication techniques, such as empathy and reflective listening, to build trust and create an environment where patients feel comfortable expressing their wishes (Waldrop et al., 2017).
6. Facilitate interdisciplinary collaboration: Collaborate with the interdisciplinary team, including palliative care specialists, social workers, chaplains, and other healthcare professionals, to ensure holistic patient-centered care. Involve these professionals early and regularly to ensure coordinated and comprehensive end-of-life care. Research shows that interdisciplinary collaboration positively impacts patient and family satisfaction with end-of-life care (Wittenberg-Lyles et al., 2016).
In conclusion, the trend of elderly individuals not dying in their own homes, despite their preference, can be attributed to various factors. As a nurse, you can support your patients regarding end-of-life care by facilitating discussions, advocating for home-based care, providing education, supporting shared decision-making, offering emotional support, and facilitating interdisciplinary collaboration. By implementing these actions, you can help patients receive end-of-life care in alignment with their wishes.
References:
- Breen, L. J., Aoun, S. M., O'Connor, M., & Rumbold, B. (2020). Supporting family caregivers in palliative care: A systematic review of caregiver outcomes. Palliative Medicine, 34(8), 1038–1067.
- De Vleminck, A., Pardon, K., Beernaert, K., Deschepper, R., Houttekier, D., Van Audenhove, C., & Deliens, L. (2020). Barriers to advance care planning in cancer, heart failure, and dementia patients: A focus group study on general practitioners' views and experiences. Journal of Pain and Symptom Management, 60(4), 717-729.
- Reinke, L. F., Leff, B., & Sheehan, O. C. (2017). Home-based palliative care: A systematic review of the literature. Journal of the American Geriatrics Society, 65(10), 2321–2329.
- Waldrop, D. P., Meeker, M. A., & Kerr, C. (2017). Skilled communication in end-of-life cancer care: A systematic review and meta-analysis. Journal of Palliative Medicine, 20(11), 1216–1235.
- Wittenberg-Lyles, E., Goldsmith, J., & Ragan, S. L. (2016). Communicating at the end of life: The influence of interdisciplinary teams. Journal of Applied Gerontology, 35(5), 491–498.
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