... Abstract Acute hospitals play a significant role in end of life care, it is the place where most people die. Evidence suggests that end of life care in hospitals needs improvement. The purpose of this paper was to investigate patient and family experiences of hospital death, the weaknesses within the hospital setting and possible solutions to improve. A literature search identified common themes, these included: * Hospitals are seen as a place of treatment and cure; death may be viewed as a failure. * Good communication between physician and patient is vital for a patient to make an informed choice regarding their care. * Patients may not receive palliative care if end of life is diagnosed too late. * A lack of resources such as short staffing contributes to suboptimal end of life care. Dying in a Hospital Setting Most Americans die in hospitals; many suffer unnecessarily due to the lack of knowledge about end of life care. Some patients receive aggressive treatments up until the time of death. Patients often suffer in vain attempts to prolong life instead of receiving compassionate, comfort care. Death is part of life, sooner or later everyone will face death. It would be easier if one was prepared for it. Communication is important to prepare for death. There is often an expectation of a cure when a patient is hospitalized; people believe that death can be avoided or postponed....
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...7, 2014 A. Personal Perceptions Serving as a patient care advocate is the most important role a nurse serves as a health care provider. Nurses serve to support the patient, sometimes having to put their own personal beliefs and values to the side. Although this is ingrained in us as nurses, sometimes health care providers allow their emotions to alter their perspective when dealing with death and dying. For twenty-four years I have served as a critical care nurse, and as an ICU nurse, I have been trained to help patients and families through this time of illness to provide care to help them heal and get better. Despite all that we do to treat patients, sometimes their illnesses are such that they do not get better and a decision is made to pursue comfort care. Since we are trained to help patients and families heal, this can be difficult to handle. Regardless of my personal feelings or beliefs, I always encourage my patients and their families to make the decisions that are best for them with the information they have been given. Our job as patient care advocates is crucial, especially when dealing with end of life and quality of life issues. The National Institute of Health defines hospice as “end of life care provided by health professionals and volunteers.” This type of care gives attention to pain control while trying to keep the patient as alert as possible. A referral to hospice is placed when a patient has been given less than six months to live. The goal...
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...Begin by analyzing the sales approach of the organization that sells the product or service you have chosen. Describe the role of the sales professional and present your own personal selling philosophy. • Describe the personal selling role *comp 1 1 of 3 for this product (consultative, strategic, or partnership). What are the expectations of the personal selling role within the company? • There are three primary differentiators that mark a Consultative Salesperson: • - They ask more questions. • - They provide customized vs. vs. generic solutions. • - Their calls are more interactive. • - They provide insights to their prospects and customers http://www.richardson.com/Who-We-Are/Thought-Leadership/Defining-Consultative-Selling/ • Consultative Selling is all about the dialogue between the salesperson and the customer. The word dialogue comes from the Greek and means “to learn.” In Consultative Selling, the salesperson learns about customer needs before talking product. Product knowledge is transformed into a tailored solution when the solution is delivered and positioned based on the customer’s needs and language. http://www.richardson.com/Who-We-Are/Thought-Leadership/Defining-Consultative-Selling/ • With Consultative Selling, the customer’s needs come first. Needs are identified through a combination of preparation and effective probing and drilling-down into customer answers. Consultative Selling took the hard edge from product selling and...
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...assignment is to look at the issue of end of life care in dialysis satellite units, as these areas tend to be nurse led units. My interest in palliative and end of life care has arisen from the growing number of poorly patients we continue to dialyse, this has proved distressing especially for the patient, who often has unmanaged symptoms and for their families, it is also upsetting for the staff involved in their care, as it is felt nobody is acting as the patients’ advocate and helping the decision to facilitate the withdrawal of what is now an ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching the end of their lives...
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...Palliative and Supportive Care ~2006!, 4, 399–406. Printed in the USA. Copyright © 2006 Cambridge University Press 1478-9515006 $16.00 DOI: 10.10170S1478951506060494 Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options MARIJKE C. JANSEN-VAN DER WEIDE, M.SC., BREGJE D. ONWUTEAKA-PHILIPSEN, PH.D., AND GERRIT VAN DER WAL, PH.D., M.D. Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands ~RECEIVED June 5, 2006; ACCEPTED August 27, 2006! ABSTRACT Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide ~EAS!, the extent to which the options were applied, and changes in the patient’s wishes. Methods: In an observational study, 3614 general practitioners ~GPs! filled in a questionnaire and described their most recent request for EAS ~if any! ~n 1,681!. Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option ~67%!, and applied most frequently ~79%!, together with radiotherapy, most frequently resulted in patients withdrawing their request. Significance of results: GPs include the availability of palliative options in their decision making when...
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...NU 491: Concept of Palliative Care Physical & Sexual Concerns of Palliative Treatment Scholarly Paper Writing Rozina S. Rashid A diagnosis means twice a heartache, discomfort and worry for a human. When a loved one is stricken with the life threatening illness, every member of the family feels the pain. Life threatening illnesses are marked by fluctuations overtime and the individual suffering from it may experience pain and other symptoms that are not always adequately managed. The individual may have concerned and quarries but unable to ventilate it out. Their care givers often feel stress and burden as the illness progress but they have no support group to whom they share their feelings. In such circumstances, palliative care serves as an intervention to help those. World Health Organization (2012) defines palliative care as, “an intervention that improves the quality of life of patients and their families experiencing intermittent illness, with the ultimate goal being to offer pain and symptom relief, as well as spiritual and psychosocial support.” (Effiong, 2012, p. 01). In my clinical rotation at KIRAN hospital I came across a 20 years old female patient who came to the hospital for her 6th cycle of chemotherapy. 1.5 years back she was diagnosed with Ewing Sarcoma. This diagnosis has not come up in few visits, it took months because of which it was spread towards the chest-wall and the left lung thus she underwent the surgery for the removal of the tumor. Unfortunately...
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...Franciscan Hospice and Palliative Care Cindra Jones BSHS301 September 29, 2012 Christopher Bingham FRANCISCAN HOSPICE AND PALLIATIVE CARE I chose Franciscan Hospice and Palliative Care because I am interested in the valuable service they provide to the community. I wanted to know exactly what they do and how it is paid for so I made an appointment to talk to someone at the Franciscan Hospice and Palliative Care facility. Hospice is care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than a cure. The word “hospice” comes from the Latin “hospitum” meaning guesthouse. It was originally a place of shelter for sick and weary travelers. Palliative care is the treatment and relief of mental and physical pain for those with a life threatening illness. This treatment uses several types of therapy to make a person comfortable and free of pain. I was very fortunate to meet Pam Ketzner, the hospice educator and registered nurse at the Franciscan Hospice and Palliative Care facility located in University Place, Washington. Pam is in charge of educating the hospice nursing staff. With new equipment and medications always becoming available, she instructs the nurses on their proper use. She has been a nurse for 35 years. She was a visiting nurse to begin with and then became the head of education so she spends most of her time at the facility. She feels very privileged to be a part of...
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...difference between the act of killing a patient and allowing a patient to die via the act of foregoing treatment that is deemed not beneficial or that is excessively burdensome. The end result of both actions includes the patient’s death; however, the cause of that death and the intention behind the act resulting in that death are morally different. Consider, if one administers a lethal dose of medication to a patient, the lethal dose is the cause of death. The intention of the person administering the medication is to bring about this end. On the other hand, foregoing or ceasing medical treatment, when that treatment is of no benefit to the patient or the treatment imposes undue burdens, does not cause the patient’s death; the death is caused by the underlying medical condition. In contrast to the lethal overdose scenario, the intention in the second scenario is not necessarily to cause death, but to stop ineffective treatment. (Panicola, Belde, Slosar, &...
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...Running head: EUTHANASIA Euthanasia: A Silent Plea for Mercy Shannon Curry University of Southern New Hampshire Professor Henson Tuesday December 23, 2014 Euthanasia: A Silent Plea for Mercy All over the world there are amazing technological advances in medicine happening every day, despite that there are neonatal patients suffering from painful life limiting medical conditions that have no treatment or cure. “Advances in medical technology make it possible to extend life, at times, the focus on ‘cure at all costs’ overshadows the obligation to provide dignified, humane, and compassionate care” (Rushton, 2005). In an effort to provide legal, humane and compassionate end-of-life care to infants, the Dutch developed the Groningen Protocol in 2003. Developed in collaboration with the prosecutor’s office, the Groningen Protocol was designed to guide a transparent medical and legal decision making process for parents and their doctors considering neonatal euthanasia (Catlin, 2008; Petrou, 2005). Neonatal euthanasia is the practice of hastening the death of a terminal ill newborn in an effort to relive their suffering. Most countries current laws make it illegal for the neonatal population to benefit from euthanasia. Research is suggestive that albeit in secret neonatal euthanasia maybe disguised and illegally practiced around the world. Legalizing neonatal euthanasia would not only allow transparency...
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...End of life care: Overview of symptom control Authors Eduardo Bruera, MD Rony Dev, DO Section Editors Linda Emanuel, MD, PhD Ezekiel J Emanuel, MD, PhD Deputy Editor Diane MF Savarese, MD Disclosures All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Mar 2012. | This topic last updated: Apr 13, 2011. INTRODUCTION — Most patients in the terminal phase of a severe advanced illness such as cancer develop potentially devastating physical and psychosocial symptoms for weeks to months before death [1]. Patients admitted to tertiary palliative care units are likely to present with more frequent and severe symptoms compared with those admitted to community hospices or acute care hospital beds, although the frequency of symptoms is high in all groups (table 1). (See "Hospice: Philosophy of care and appropriate utilization".) Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination...
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...Running head: Research Critique, Part 1 Research Critique, Part 1 Grand Canyon University: NRS-433V Introduction to Nursing Research May 20, 2012 Research Critique, Part 1 Advanced Care Planning (ACP) is a huge part of healthcare. Dying is a part of life, but that doesn’t make the subject any less scary. Just because healthcare professionals handle end of life issues on a regular basis, doesn’t mean that they are immune to the sensitivities of the topic. End-of-life decision making is the process that healthcare providers, patients, and patients’ families go through when considering what treatments will or will not be used to treat a life-threatening illness. (Thelen, 2005) Many nurses who deal with death and decision making burn out. Hospice staff, because of their work with the terminally ill, are considered a high-risk group for burnout. Often, the reason behind the decision to leave or take a sabbatical from hospice work is that the staff member reached the limits of his or her capacity to care and “couldn’t take it anymore.” (Keidel, 2002) A qualitative study done, on anticipating emotion, related to ACP, was chosen to be critiqued, due to this highly sensitive topic in the healthcare industry. The subject this study was critiqued on, were, the problem statement, purpose and research question, literature review, and conceptual/theoretical framework. The clinical problem, addressed, is that end of life discussions between healthcare professionals and clients...
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... 6 References Beckstead, J.P., Conley, C.E., Kruse, B.G. (2005). Psychometric Properties of the Serenity Scale: Journal of Hospice and Palliative Nursing, November/December Volume 7, 337-344. Chinn, P.L., Kramer, M.K., (2004). Empiric Knowledge Development: Explaining and Structuring. Yvonne Alexopoulos. Melissa Boyle , Kristin Hebberd (6th Edition), Integrated Knowledge Development in Nursing (pp.54-90). St. Louis, Missouri. Dictionary.com, (2010). An Ask.com Service. Retrieved on January 25th, 2010 from http://dictionary.reference.com Get Palliative Care, (2010). What is Palliative Care. Retrieved on January 25th, 2010 from http://www.getpalliativecare.org/home/ . THE CONCEPT OF SERENITY 2 Incorporating the concept of serenity within nursing practice has been proven to be very beneficial when applied to patient care. The concept of serenity can have different meanings to different people. How one goes about obtaining serenity may vary greatly with each individual. The idea of serenity, of inner peace is desired by many. Nurses can assist patients with obtaining and maintaining this important concept. This paper will identify the concept of serenity and its relationship to nursing practice. The idea of serenity will be examined from a nursing and non-nursing perspective...
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...EVALUATION Current Business Research Project Reporting Characteristics of Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals by Senthil P. Kumar used descriptive methods of research to discover the number of research journals of the pain experienced in cancer patients toward the end of life. The research delved into the end-of-life care journals published from 19 facilities from 2009 – 2010 (Kumar, 2011). The study involved finding the percentage of research journals for end-of- life cancer patients’ pain in comparison to actual number of research findings. The data collection methods involved a search of Journals that had terms such as hospice, end-of-life, supportive, and palliative in the titles (Kumar, 2011). A total of 19 journals included in the study, which had a total of 2600 articles researched in the study. The studies uncovered articles concerning cancer pain, of which most were categorized into ‘original articles’ and ‘review articles’. Original articles were separated to studies of quality and also of quantity. Quantitative studies were grouped according to the study designs. Once the findings of the number of articles study designs were computed, the total number of journals pertaining to end-of-life pain of cancer patients was determined. Later categorization of articles were sort into groups such as those related mostly to cancer pain, articles with studies related to pain that mentioned...
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...Palliative care has a board definition that includes caring for patients with life-threatening illnesses by relieving pain and other distressing symptoms that focuses on using an interdisciplinary approach that also addresses psychosocial and spiritual guidance. Most importantly it promotes a team involvement in caring for a person with chronic health illnesses. It is important to stress that palliative care is not intended to hasten or postpone death (WHO, 2017). As the disease process progresses, hospice care becomes an easier option for patients and family members to accept. Hospice care includes palliative care because it is focused on keeping the patient’s life as comfortable as possible. It is designed to provide care for the last six...
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...According to the Centers for Disease Control and Prevention, most people say they would prefer to die at home, yet only about one-third of adults have an advance directive expressing their wishes for end-of-life care. Among those 60 and older, that number rises to about half of older adults completing a directive. The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. Barriers to advance care planning include, • Lack of awareness: While advance directives are supported by state laws, there is still no clear process to allow an individual’s wishes to be known and ensure that care is tied to those documents. • Denial: A key part of the problem is our society’s denial of death and dying, and of being in a circumstance in which we are unable to make our own decisions and speak for ourselves • Confusion: Concern that emphasizing palliative and end-of-life care options could interfere with doing whatever it takes to help patients extend their lives as long as possible. • Cultural Differences: The majority of Medicare beneficiaries of all racial and ethnic groups say that in the event of a terminal illness with less than a year to live, they would want to die at home and would not want to receive life-prolonging drugs with uncomfortable side effects or mechanical ventilation to extend their life for a week or a month Among community-dwelling...
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