...Service Hospitals. (Office for National Statistics, 2012). These figures indicate a substantial amount of individuals dying in a hospital setting each year, therefore a large proportion of patients will be receiving some form of care prior to and at death (Blackwell 2010 p.1). Numerous research studies have been carried out by theorists identifying the impact of bereavement on different individuals. The earliest thorough study of grief and loss developed from Freud with his classic paper ‘Mourning and Melancholia’ (Freud 1917 cited in Payne et al 1999). Freud believed that for the bereaved to detach from the deceased one must work through their grief by reviewing memories and thoughts of the deceased (Ellman 2010). Other theorists have recently identified death and the importance of understanding it. 'Death is a natural progression from life. Most nurses will be exposed to the physical and emotional effects of this experience as they care for a dying patient. The nurse is taught how to provide support for the patient and family as they proceed through the stages of grief. Often, however the nurse may not realise his or her own need to grieve'. (Brosche 2003 p. 173). Although nurses try to remain professional whilst at work, once they are home and the uniform is removed , emotions that were kept at bay may begin to surface. The main purpose of this literature review is to identify the effects of patient death on nurses within a hospital setting...
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...impacting this experience. (Siden, 2008) Home hospice helps the entire family and family members are encouraged to take an active role in providing supportive care to the patient. In doing so, the family experiences fewer feelings of helplessness and the patient is not relying solely on strangers for all of his/her care. The goal of hospice care is to achieve the best quality of life not only for patients, but also for their families. Enabling death at home, if this is the patient's choice, is often seen as part of ensuring the best possible quality of life. There are hospitals which have a hospice program to give terminally ill patients access to support services and other health care professionals. Many hospitals have a special hospice unit. These units provide intensive medical and psychological support to patients who need aggressive symptom management. Home hospice provides end-of-life care in a setting which is familiar to the patient and their family therefore making their final days more comfortable and beneficial to all. Excellent end-of-life support, in the location of choice, is in itself, an essential aim but my goal is to determine which choice provides the best care for the patient and the family. Palliative care It has been noted that the most common answer to the question "How would you like to die?" is "Asleep in my own bed." A home death is considered the ideal when defining a good death. Interest in the development of home-based palliative care and the concept...
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...Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked more often to provide care to patients on their deathbeds (Puntillo et al., 2001). Deciding which ICU patients are actually dying remains an extremely inexact science, and the transition to palliative care is not one easily made. ICU mortality rates are as high as 69% (Puntillo et al., 2001);...
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...Gerontology Kristin Bachman February 27, 2012 A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist. Stewart Alsop Death, dying and bereavement finds a way of impacting everyday living. Images of real or fictional death are often while watching television or movies. Death can impact people on a personal and a cultural level. This essay will entail how cultural attitudes toward dying, death, and bereavement have changed. While examining hospice, the care obtained, and its role in this shift. Cultural attitudes toward dying, death, and bereavement have changed. There are enormous variations across societies and over time in attitudes toward death. Some societies engage in death avoidance while others celebrate the communion between the living and the dead. In the United States there has been an immense change in the process of dying from past centuries to the present. “This change is partly due to a shift in the average age of death and the association of dying with old age” (Aubrey, 2007). It is also caused by a change in the causes of death. At one time most people died from critical illnesses that struck quickly. Now people are more likely to die from a chronic illness that leads to a slow death. The setting for death has also changed. Most deaths in the past occurred in the home. Now death typically takes place in a medical setting such as a hospital or nursing home. Certain people prepare for death...
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...studying three California hospitals by immersing herself in the hospital culture. She followed, observed, and interviewed nurses, physicians, therapists, patients, family members, social workers, and others while trying to understand the factors that led to the prevailing practices. She was particularly interested in how hospitals organized dying as a result of acculturated behavior that was regarded as normal and unproblematic by practitioners who did not understand the origins of the behavior. She discovered how hospitals shape medical practices, how shared medical rhetoric frames decision making about dying patients, and how cultural factors determine the way death occurs in the hospital and even which patients are considered to be dying by physicians and nurses. Kaufman was particularly intrigued by patterns of social behavior. She observed that today death usually is orchestrated by professionals in hospitals and no longer is waited for, a transition that has markedly shortened the “waiting time” for dying. She found that hospital procedures and bureaucracy produced the imperative to “move things along,” mandating that health care professionals expedite decision making and produce the conditions for death. She identified “pathways” for moving things along, such as heroic intervention, and discussed how and why patients may stop moving along a pathway. Her ethnographic study features the detailed case histories of 27 patients culled from more than 100 dying patients she observed...
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...The Liverpool Care Pathway: Does it improve the quality of dying? The Liverpool Care Pathway (LCP) is an integrated care pathway developed in the late 1990’s (Ellershaw et al, 1997) as a means of transferring best practice in care of the dying, from the hospice environment to other sectors starting in the acute setting. Currently the LCP is a recognised tool used by clinicians in the United Kingdom as well as over twenty countries, to give appropriate care to patients who have reached the last hours or days of their lives. Described to provide comfort to the dying and also address the needs of the carers (Chapman 2009). During this assignment the author will highlight and explain how a data search was conducted, and will analyse the data retrieved, explaining and evaluating the data to build a discussion based on the chosen topic of end of life care, with a focus on the Liverpool Care Pathway. The author will conclude by producing recommendations for practice. Although described above that the Liverpool Care Pathway is an appropriate tool for providing adequate care for patients, it can also be seen as a controversial pathway, being described as a ‘tick box’ approach rather than a humanistic approach (Chapman 2010). It has been referred to by the UK’s Daily Telegraph as ‘sentenced to death on the National Health Service’ (Devlin 2009). The author has a keen interest in palliative care, after researching is interested in enhancing knowledge surrounding the LCP as there are many...
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...been key motifs totally integrated into our traditional understanding of life (Tomomatsu 1939). However, the traditional perception of death as an acceptable process has been vanishing as the Japanese have applied modern biomedical technologies more frequently in well-equipped hospital settings. Although the involvement of family members in the process of dying and particularly in the death event continues in a variety of ways, the care of dying patients in Japan is becoming much more similar to that delivered in advanced hospital settings in many countries of the world, than it is different. Now, in Japan, a majority of people end their lives in the hospital, surrounded by high-technology machine. Yet, in a survey by the Yomiuri Shimbun of 15 June 1991, half of the respondents said they would prefer to die at home. In addition, there has been a tradition of not explaining to terminally ill people the true nature of their condition, on the ground that this is most appropriate way to proceed (Kashiwagi 1994, pp. 78-85). However, views on this matter are changing. There is a gradual move toward telling patients the truth, and the notion of informed consent has been widely publicized in the clinical setting (Leflar 1996, pp. 96-107). In the 1991 nationwide opinion poll by the Yomiuri...
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...and the only thing that they can do is mourn and watch their loved one fade away. But there are programs out there to help not just the dying person but also the families of the dying person. Palliative care and Hospice care are two of the programs in the U.S that are tailored to medical care, pain management, and emotional and spiritual support for the patient and family. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. Palliative care focuses on relieving symptoms that are related to chronic illnesses, such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s and other dementias, AIDS, Amyotrophic Lateral Sclerosis and other neurological diseases. World Health Organization defines Palliative care as “improving the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement” (“WHO”, 2013). Palliative care is accessed at any point during the course of a chronic illness regardless of life expectancy. It is typically provided through regular physician and nursing visits in an inpatient consultation service in a hospital setting. Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide...
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...they are better prepared to handle the death of loved ones. In our society, we tend to shy away from thinking about death. The terminally ill generally die in institutions (hospitals and nursing homes), away from their homes. Therefore, we are seldom exposed to people dying. Many people in our society seek to avoid thinking about death. They avoid going to funerals and avoid conversations about death. Many people live as if they believe they will live indefinitely. Fortunately, the hospice movement has been developing in recent years in an attempt to foster death with dignity. A hospice is a program that is designed to allow the terminally ill to die with dignity—to live their final weeks in a way they want. Hospices originated in the Middle Ages among European religious groups that welcomed travelers who were sick, tired, or hungry (Sullivan et al., 1980). Hospices serve patients in a variety of settings—in hospitals, in nursing homes, in assisted-living facilities, and in the dying person’s home. Hospices provide both medical and social services, Children should not be sheltered from death. Funerals help children learn that death is a natural process. Taboos against talking about death and dying need to be broken in our society. You may find that tactfully initiating discussions about death and dying with friends and relatives will be helpful to you, and to people close to...
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...been adopted around the world.Their broad aim is to optimise the quality of the dying process, enabling people to ‘die well’ across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory. Key words: End-of-life care l Care pathways l Terminal care l Health promotion Michael Allen is Staff Nurse, Chemotherapy Day Unit, Singleton Hospital, Abertawe Bro- Morgannwg University Hospital Board, Swansea, Wales; Tessa Watts is Senior Lecturer, Swansea University, Swansea, SA2 8PP, Wales Correspondence to: Tessa Watts t.watts@swansea.ac.uk End-of-life care (EoLC), a core component of palliative care, is concerned with pre- venting and easing suffering experienced by people facing death. As life draws to its close, the aim is to optimise the quality of living and dying and to facilitate effective family support and coping in bereavement. Thus, at...
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...Main Characters Mia Hall: 17 years old, cello player, has an easy life, quiet individual who prefers to keep to herself. Adam Wilde: 18 years old, lead singer and guitarist in local band “Shooting Star”, Mia is his girlfriend despite their different personalities. Kim Schein: She’s friendly to people that she knows especially Mia. She puts the people who are important to her before anything. Kim likes to keep things balanced. Setting: The main setting was in the hospital in Portland, Oregon. The book started first introduced that they were in the small town in Oregon then they were going to visit their cousin and grandparent. After the accident happened they airlift Mia into an unnamed hospital putting her into ICU. There are a lot of mini-setting...
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...ETHICS, PUBLIC POLICY, AND MEDICAL ECONOMICS A Systematic Review of Satisfaction with Care at the End of Life Sydney Morss Dy, MD, MSc,Ã wz Lisa R. Shugarman, PhD,§ Karl A. Lorenz, MD, MSHS,§ k Richard A. Mularski, MD, MSHS,# and Joanne Lynn, MD, MA, MS,§ for the RANDFSouthern California Evidence-Based Practice Center (See editorial comments by Dr. Jean S. Kutner, pp 160–162) The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six...
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...INTRODUCTION Although effects are extended in controlling the progress of a disease and restoring the well-being of patients, there are diseases which pass beyond the stage of being curable. Death is a natural occurrence in the health care setting and since nurses play a vital role in providing direct patient care, a patient’s death may bring a sense of loss and grief which could eventually affect the way health care services are appropriately and adequately provided to other patients. However, the degree of nurses’ grief as a reaction to patient death may vary in intensity. This variation may be influenced by several factors present in both the nurse and the nurse-patient relationship. This research study investigates the degree of correlation between these variables and the level of nurses’ grief, it will also look into the factors that may affect the level of grief that nurses experience upon the death of their patient. PROBLEM STATEMENT Grief is an inevitable phenomenon that every human being will eventually experience Cowles and Rodgers (1991). Base of the fact that nurses are in close contact with dying patients, they are vulnerable to the experience of grief. However, the emotional aspect of nurses’ responses to the death of their patients has barely been explored. It is opinionated that the nurse’s own emotional needs are unaddressed due to the fact that most of the studies related to patient’s death focus on the patient’s relatives and significant others. Other...
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...place in the first part of the second book of the novel ‘’The Heart of the Matter’’ by Graham Greene. It is set at a temporary hospital in Pende, the location in which a torpedoed ship had settled in. the characters involved in this particular scene are the main character of the novel, Scobie, who is the Commissioner of Sierra Leone, together with a young girl who is dying as a result of the traumatic experience she has just gone through. The initial couple of sentences of the extract also feature Mrs. Bowles, the missionary’s wife who is taking care of the injured and/or dying victims of this unfortunate incident. This scene follows the arrival of the surviving individuals of the torpedoed ship at Pende. Scobie is taken aback when he witnesses the arrival of a young girl and boy and a young female adult ‘’clasping a stamp-album’’ on a stretcher who are suffering terrible physical consequences. He questions for himself why the human person is allowed to suffer instead of simply passing on. Later on, Mrs. Bowles requests for Scobie to keep an eye out for the dying young girl. The scenario of the girl suffering in the process of death causes him to recollect his own daughter’s passing. He turns to God to pray for the young child, and selflessly asks Him to take away his own peace forever, ‘’but grant her peace.’’ Towards the end of this extract, the dying victim believes Scobie is her father. He hushes her down, resting her mind that he was by her side, and asks her to sleep. The...
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...new/old way of medicine is at an increase and is predicted to become the future of medicine. Allopathic and Osteopathic medicine are those medical practices on the rise. The future of medicine depends on the demand of practice. Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, stated, “We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner, and this does not include some 10,000 non–U.S.-citizen international medical graduates and about 3700 U.S.-citizen international medical graduates who seek GME posts in U.S. teaching hospitals.” Support toward Medicaid GME programs is on a significant decrease. Roles of physicians are sought to be taken on by Physician Assistants (PA) and Nurse Practitioners, allowing them all the “power” that a doctor, including but not limited to diagnoses, treatment, and procedures....
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