Free Essay

End of Life

In: Social Issues

Submitted By youngswife21
Words 1707
Pages 7
End of Life Essay

It is very important for people to discuss and manage end of life issues. There are many issues that may need to have resolutions such as life support, curative vs symptom management, courses of treatment. Other issues such as burial plots and funeral arrangements. I have found that many people feel they have more time to discuss end of life issues. They feel that they have plenty of time to discuss their wants and wishes for the death and dying process with their loved ones. It is very important to discuss end of life issues with your significant others, spouses, children because one never knows when the end of life issues may come up. Maybe it is a young mother diagnoses with stage 4 ovarian cancer. Maybe it’s a 76 year old male patient that feels that while he has lived a good life, it is never enough time. Or it could be a 16 year old teenage girl that had a soft tissue sarcoma that wasn’t diagnosed until it had metastases all over her body. I have taken care of all of these patients. It is never too early to discuss end of life issues, but sometimes it can be too late. Death is very personalized such as life. It is important that the individual is allowed to pass in a manner that is important to them and to feel that they have taken care of issues that they may feel need to be resolved. We might think that we know what our loved ones want, but it could be very different from what they actually want. For example we may think that our loved one would want every medical treatment they could possibly have, but what they really want is to die at home. We may project what we think the patient should have done, when in all actuality it may not be what they had in mind. Caring for patients with a need to discuss end of life issues, it is important to look at the whole patient. It is good to use the assessment tools such as the HARP tool, and the Family preferences guidelines. It is good to assess what is important to the patient, whether it is spiritual issues, are they concerned with family needs, they may need community resources to help with care they need such as PT/OT, help to receive physician services, home health care, or possibly symptom management. It is important for the individual to say what they want with end of life decision making. For example, the patient may not want to have their life extended with heroic measures such as intubation or CPR. Nothing is more powerful than the patient’s own words even when the patient can no longer make decisions for themselves. This is where a complete advance directive comes into play. The patient may also have a MPOA, but this person does not make decisions until the patient becomes unable to make their own decisions. It is definitely a benefit for the person to also have an advanced directive because this can ease the decision making for the MPOA. The MPOA can know that they are doing what is best for the patient as well as what the patient wants. In reading the article Futility, Autonomy, and cost in End of life Care, the patient may decide to seek symptom management vs curative treatment. It is important to preserve patient Autonomy. The patient may have decided to terminate life support if they cannot be extubated. This is a quality of life issue and the patient has a right to make these decisions even though they may be incapacitated at that time. With an advance directive, they have already addressed the issues and have made it clear what they want. If patients have difficulty in deciding who should be their MPOA, you can assist the patient with the Consumer’s tool kit for health care advanced planning. When I think about my personal beliefs about death and dying, I know what I want. I worked as a hospice nurse and I know the importance of discussing end of life issues and making sure your wants and wishes are known. I know that I will go the curative route, and when the end of the illness was evitable, I would want comfort measures. Some patients seek curative treatment until the end of their illness. Other patients want to enjoy the rest of their life and to be able to have a high quality of life with their loved ones. I know that I would want my symptoms managed, such as pain, breathlessness, air hunger, etc., so I could enjoy my last days until I succumbed to my illness. I truly believe that this goes along with my belief in Christianity. I believe that we go to heaven when we die, for those who are saved. I imagine it would be different for the people who believe that dying is they end. They may seek to go to a curative route until the end. A key concept of EOL care is that an advanced directive protects the rights of the patients and takes the burden off of the family for the decisions made. Helping the patient to feel like an integral part of the decisions on how their care goes is important for their stages of acceptance in this process. Another key concept I have found with patients who feel that they are helpless in their illness, is to help with the grieving process. To assist with the 5 stages of grief it is important for them to be a part of the decision process if they can, because it can help them with acceptance of the disease process. So many things are taken away from a patient when they are diagnosed with a terminal illness. They are told from day one by the doctors and nurses what the course of their care is. The patients comply because they are seeking curative treatment, but when the patient decides they are finished with curative treatment, then they get to decide how their end of life should be if they have the time to do so. It is important for patients to be in the decision making process for all of their end of life issues if they want to. I worked with an ALS patient who decided what she was going to wear down to the jewelry after she passed. She also decided what everyone would eat and what music would be playing. Looking back on that experience and doing this assignment I can see that ALS took everything away from her and she needed to be in control of every aspect of her end of life arrangements. In the article strategies to help initiate and maintain end of life discussions. There are many aspects of different cultures that need to be respected and every person feels very strongly about what should happen, how it should happen and what should be done in the end of life. It is important that we honor what the patient and family want and that their wishes be respected. For example I worked with a patient where after the death of the patient we normally called the funeral home and the patient was prepared for death with embalming. This person’s religion was clear that she was not to be embalmed and she had to be buried the next day prior to a certain time. We made sure we managed the patient’s spiritual needs in a timely manner and the family had what they needed and what they knew the patient wanted. This was very important to them. The nurse’s role in end of life care is a teacher, to teach symptom management and comfort. The nurse is an advocate, to help the patient and assist in what she needs for end of life issues. For example with my work in hospice, I had a lymphoma patient that lived 22 years because of all the times she went in and out of remission and all she wanted to do was speak with her oncologist. We were able to get him on the phone and she talked with him and thanked him and said her goodbyes. It was something that was very important to her. I assisted with this, but in viewing all of the material for this class, I can see how important meeting end of life goals are for the patient. A role for nursing in end of life issues is also a collaborator. After we ask the patients what they need in place, such as advanced directives, MPOA, cultural preferences and basic wants and needs, it is imperative that we discuss issues with the care team to get the patient everything they need. This could include pastoral care for spiritual issues, care management so patient can have needs met at home. Hospice referral for at home medical equipment and symptom management, and any and all needs that are tailored to what the patient needs at that time. I remember I had a 34 year old single mother in hospice and I came to see her and she was on the floor crying surrounded by pictures. She had been there for hours and she was trying to get her photo albums and journals in place for her children before she died. It was very important to her that her children have a detailed photo book to look at to remember her by. My goal for her was to work on her journals and every visit we put her photos together and she did have that in place before she passed. Nursing can also aid family members with their acceptance of the disease process. Nurses can assist with the bereavement process and get the resources for the family that is needed. End of life care will have nurses utilizing all of their holistic skills. End of life care is different and personal for each individual patient. It is important to individualize our care and focus on what the patient needs, such as symptom management, and then what is important to the patient, such as familial or spiritual issues.

Similar Documents

Free Essay

End of Life

...THE LAW ON ASSISTED SUICIDE On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington state that criminalized assisted suicide. These decisions overturned rulings in the 2nd and 9th Circuit Courts of Appeal which struck down state statutes banning physician-assisted suicide. Those courts had found that the statutes, which prohibited doctors from prescribing lethal medication to competent, terminally ill adults, violated the 14th Amendment. In striking the appellate decisions, the U.S. Supreme Court found that there was no constitutional "right to die," but left it to individual states to enact legislation permitting or prohibiting physician-assisted suicide. (The full text of these decisions, plus reports and commentary, can be found at the Washinton Post web site.) As of April 1999, physician-assisted suicide is illegal in all but a handful of states. Over thirty states have enacted statutes prohibiting assisted suicide, and of those that do not have statutes, a number of them arguably prohibit it through common law. In Michigan, Jack Kevorkian was initially charged with violating the state statute, in addition to first-degree murder and delivering a controlled substance without a license. The assisted suicide charge was dropped, however, and he was eventually convicted of second degree murder and delivering a controlled substance without a license. Only one state, Oregon, has legalized assisted suicide. The Oregon statute...

Words: 13101 - Pages: 53

Premium Essay

End of Life

...Being faced with our own mortality or that of a loved one, is a subject that’s very emotional, and some very difficult decisions will have to be made. But who should be making those decisions? The patient, families, the doctors? Should someone, who just received devastating news and is on an emotional roller coaster, make end of life decisions? How about the family members, who are so grief stricken and praying for a medical miracle, are wanting everything done no matter how bleak the outcome. What about the hospitals and doctors who know the cost associated with end of life care and realize that there is no real impact on curing or changing the outcome. They feel that resources should be spent on patients with better prognosis. In helping with some of these hard decisions the law makers in the state of Texas came up with the Texas Advance Directive Act. But the law has come under heavy criticism in recent years involving a few cases that received national attention. The Advance Directive Act passed into law in 1999 by then Gov. George W. Bush. With the passing of the act, Texas became the second state to pass regulation regarding end of life treatment.1 The law addresses and provides information on three different advance directives, the Directive to the Physician (living will), Medical Power of Attorney, and Out of Hospital DNR. A Directive to the Physician (living will), allows the patient to make their own wishes known about future medical treatments. ......

Words: 1717 - Pages: 7

Free Essay

End of Life

...End of Life Nursing Donnie Barnes Oklahoma Wesleyan University End of Life Nursing Every life will end in death. It can happen anywhere or anytime along the human lifespan, but it will definitely happen. Death is never an event in life that is encouraged or hope for, however when faced with impending end of life circumstances, it can be faced with dignity and decency. Many people associate end-of-life care with treating physical pain and discomfort. While that is an important part, complete end-of-life (EOL) care also includes helping the dying person manage mental and emotional distress. An elder who is nearing the end of life who is alert might understandably feel depressed or anxious. Encourage conversations, so the elder has an opportunity to talk about their feelings. You might want to contact a counselor, possibly one familiar with end-of-life issues. If the depression or anxiety is severe, medicine might provide relief. A dying person might also have some specific fears and concerns. He or she may fear the unknown or worry about those left behind. Some people are afraid of being alone at the very end. This feeling can be made worse by the understandable reactions of family, friends, and even the medical team. For example, when family and friends do not know how to help or what to say, sometimes they stop visiting. Or, someone who is already beginning to grieve may withdraw. Doctors may become discouraged because they can't cure their patient and feel helpless...

Words: 1308 - Pages: 6

Premium Essay

End of Life

...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 which it may not be possible to arrange discharge. Reasons for admission often reflect a change in the patient's condition, which may not necessitate inpatient care, but for which alternative arrangements cannot be made rapidly enough (Wheatley, et al, 2007). There are nearly 40 million senior citizens in the United States. But in the next 30 years, that number is expected to double to 80 million as Baby Boomers and their parents reach age 65 (CDC,nd). And each year, one-third of the people who die suffer from a chronic illness. For every one of these deaths, there is a patient and a family faced with difficult decisions about care...

Words: 581 - Pages: 3

Free Essay

End of Life

...THE CLINICAL, LEGAL, AND ETHICAL CONTEXT CHAPTER 4 DECISIONS AT LIFE'S END: EXISTING LAW page 49 New York law distinguishes between four types of practices that can arise at the end of a person's life: the withdrawal and withholding of life-sustaining treatment, whether based on the consent of patients or others close to them; suicide; assistance to commit suicide; and active euthanasia. The laws governing each of these practices reflect a judgment about the appropriate balance between individual autonomy and society's interest in preventing harm. At one end of the spectrum, the law covering treatment decisions embraces individual autonomy as its central concern, granting competent individuals a broad right to refuse medical treatment necessary to sustain their lives. Decisions about suicide and euthanasia fall at the other end of the continuum, where the law constrains individuals' actions for their own benefit and for the sake of the common good. Societal limits on suicide are reflected in laws that prohibit assisted suicide and euthanasia, regardless of the individual's consent. Likewise, while it is no longer illegal in New York State to commit suicide, there is no "right" to commit suicide as a matter of constitutional or common law. The Right to Decide About Treatment Under New York law, competent......

Words: 1367 - Pages: 6

Free Essay

End of Life

...As people approach end of life care, they and their families are faced with difficult choices. During this time it is important to have a support system. In the case study Janelle decided against medical treatment and relied on her religious belief. Therefore it is necessary to use her personal strengths in interventions and to empower her when intervening. Her self-determination towards treatment should be respected, According to (NASW 2008), Social workers respect and promote the right of clients to self- determination and assist clients in their efforts to identify and clarify their goals. As social workers we will advocate Janelle’s position not to seek treatment to the other members of the interdisciplinary team; in doing so we will explore ways to decrease the tension between her and the other members. Janelle has a strong religious belief that she will be healed. As members of her interdisplinary team we will education her family on the pros and cons of relying on spirituality only for healing. We will communicate with Janelle by being open and honest in planning and assessing care for her and her family. Woodhouse (2011) suggested that effective communication has the potential to engender a therapeutic environment and relationship. Good communication skills are vital for spiritual carers in supporting patients, families, and the multidisciplinary team in dealing with issues such as denial and confusion. According to Amoah (2011), Spirituality is central to......

Words: 356 - Pages: 2

Premium Essay

End of Life Decisions

...End of Life Decisions Brandon Irving Grand Canyon University HLT322 10/25/09 Abstract With anything that is done in the medical field there will be ethical issues that surround it. Since we are only on this earth for so long then death becomes one of those issues that we must face. With the new advancements in technology death can become complicated. Also since we have other issues such as euthanasia involved things will only get even more complicated. Euthanasia, definition of death, living will decisions, and ethical issues surrounding these subjects will be discussed. End of Life Decisions No one living on this earth will live forever. It comes a point in time when we all must go. Our bodies are not made that way and they start to break down. Once deterioration happens or if a person comes into physical contact that causes the body too much trauma then death occurs. In the past twenty years four concepts of death have emerged, traditional, whole-brain, higher-brain, and personhood. Each one of these versions of death has ethical issues surrounding them and complicate important end of life decisions. Ethical issues surrounding when a person is dying is euthanasia and end of life decisions such has a person being on life support or having a feeding tube. Euthanasia is define as “The act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of......

Words: 717 - Pages: 3

Premium Essay

End of Life Framework

...End of Life Population Health Framework University of Massachusetts Medical School Fall, 2011 Articles 1. http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care 2. http://www.loisgreenlearningcommunity.org/ < Compare and Contrast: The National Cancer Institute’s End of Life Care Questions and Answers on their website are written more the for caregiver or patient and describe what end of life care refers to. It’s formally written and describes each step or phase of care from initial diagnoses of end of life approaching or withdrawal of life saving measures such as chemotherapy to knowing when the patient has passed. It describes ways to take care of a patient at the end of life and when to call for professional help. It’s mainly geared toward the caregiver and really addresses all issues in providing care no matter how minor. The priority here is the well being and education of the non-professional care taker and the patient. The Lois Green Learning Community is an online resource for health professionals and a community to share experiences and also take care of yourself by doing so. It’s a place to blog or unwind about an experience, there are many resources listed for certification for palliative care and how to treat patients. It’s written with a very open and warm way and it’s a safe place to share your experiences, not formal and official like the NCI website. Communities like this are very important for health professionals to have a place...

Words: 2572 - Pages: 11

Premium Essay

End of Life Care

...End of Life Care Student’s Name Institution End of Life Care The cause for the trend of majority of elderly people not dying in their own homes as their preference is NHS failings, incorporating a scarcity of health visitors, which ensues in the desires of the elderly persons being ignored or not adhered to. Owing to poor co-ordination of social and health care services for the dying, the preferences of the individuals nearing death frequently go unidentified, and in instances where the preference to die at home is clearly stated, it frequently cannot be met (Rensbergen, Nawrot, Hecke, & Nemery, 2006). The social and healthcare providers conventionally offer low priority to end-of-life care as is evident in the lack of adequate training among significant staff. Another reason encompasses social-contextual elements. Gender, living status, and age are predictors of the location of death; however, the implant of a nursing home in a domestic community is the fundamental factor (Rensbergen, Nawrot, Hecke, & Nemery, 2006). As a nurse, to support clients in end-of-life care, and in reinforcing their preferences, one can come up with creative partnerships with healthcare professionals, patients, policy developers, and others to ascertain that care of the dying is prioritized. Moreover, one can record the comprehensive requirements of dying patients and families and taking note of individual, organizational, professional, and societal hindrances to quality end-of-life......

Words: 408 - Pages: 2

Free Essay

End-of-Life Care

...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 Medicare beneficiaries age 65 or older: • Blacks (18 percent)......

Words: 643 - Pages: 3

Premium Essay

Peaceful End of Life

...Peaceful End of Life Theory of C. Ruland and S. Moore I. Introduction a. Entire lives and careers are dedicated to postponing or avoiding death while caring for the living. Yet each day that passes, death is one day closer, unwavering. It is inevitable and unavoidable. Leaving loved ones behind creates sadness and shakes even the most stoic. Possibilities of pain evoke fear. Questioning faith, even the most devote become anxious when considering what has never been felt or seen. Ruland and Moore theorize that by easing the fears and anxieties, both real and/or perceived for the patient and family, nurses can create a more peaceful end of life, rather than simply complete the tasks at hand in the day to day when caring for the dying. II. Theory Perspective b. Defining “Peaceful” c. Dying is a personal experience and should never be alone. d. Five Outcome Indicators e. 16 Outcome Criteria III. Relationship to Nursing Practice f. Relevancy to Nursing i. Educate ii. Influence iii. Research g. Observe. Look, listen and feel h. Understand and Interpret i. Intervene with dignity, respect and empathy IV. Case Scenario V. Conclusion References Bjarnason, D. (2000, May). End-of-life care: Understanding and enhancing the nurse-patient dialogue. Retrieved May 3, 2011, from Proquest:......

Words: 277 - Pages: 2

Free Essay

End of Life Paper

...Holland and participate in its physician- assisted suicide program. As your primary care doctor and oncologist for the past fifteen years I am very empathetic and very concerned not only with your physical health but your emotional health and experiences as well. Even though we have exhausted all therapeutic treatment options; I would really like for you consider hospice care here in the United States. Because I truly believe that hospice care can provide comfort and support to you, family, and friends. Hospice care is designed for those who are nearing the end of life. All care services are provided by a team of health care professionals who maximize comfort for a terminally ill patients by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support. You are considering traveling to another country to end your life but if decide to stay here hospice gives you the option to receive this care in your home. In addition to hospice care for your consideration; the Federal Drug Administration has recently approved a new pain medication that wasn’t available before. This medication is was formulated and strictly marketed to treat pain associated with an illness' such as yours and of magnitude. The drug will be available in two weeks and it will be readily available. I have also investigated the probability of your insurance...

Words: 773 - Pages: 4

Premium Essay

Current Business Research

...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 cancer, and studies on cancer in which pain resulted (Kumar,......

Words: 442 - Pages: 2

Premium Essay

End of Life Care

...Examples of Reflective Writing Example 1 I arrived on the ward at 7:30 ready to begin a 12-hour shift. After receiving handover, my mentor assigned me the job of bathing Mr B with the help of a healthcare assistant. Mr B has Creutzfeldt-Jakob disease (CJD), a progressive disease of the nervous system with rapid deterioration due to spongiform encephalopathy. He is not expected to live to Christmas, even though he is only 19 years old. He is mentally aware of what is going on but is physically unable to demonstrate activities of daily living, including eating and drinking, has limited communication skills and is doubly incontinent. He is unsafe on his feet so mobilises with a wheelchair. I approached Mr B’s bed and asked his consent to take him for a bath. While the bath was running we began helping him to undress. He looked rather nervous. At the thought of myself being in his position, being the same age as him, I began to feel embarrassed too. I thought that I could not possibly be a professional individual if I let my embarrassment and sympathy get in the way of my nursing care. We assisted Mr B into the bath and started his wash. I knew he was uncomfortable and wanted to be able to wash himself, but was unable to do so. I was finding it difficult to look him in the eye, especially when it came to washing his genitalia. I tried to ease this by making conversation, but in a way this made matters worse. After the bath we dried Mr B, dressed him and returned......

Words: 1844 - Pages: 8

Premium Essay

Peaceful End of Life

...Justin Sicheri 3/18/12 1 LOTF Poetry Project Poem excerpt | Insight | LOTF Excerpt | “The single clenched fist lifted and ready. Or the open asking hand out and waiting.Choose:For we meet by one or the other.” –“choose” by Carl Sandburg | In the same way that the poem “choose” is saying that the person must choose to be with or against but either way they will meet, So Jack on the island makes the boys choose between joining a tribe that is only concerned about being rescued and a fire or choose the tribe that is concerned about staying alive and hunting and protection. | “I’m going off by myself. He can catch his own pigs. Anyone who wants to hunt when I do can come too.” He blundered out of the triangle toward the drop to the white sand.” (127) | Poem excerpt | Insight | LOTF Excerpt | “From the thunder, and the storm- And the cloud that took the form(When the rest of heaven was blue) Of a demon in my view-“ “alone” Edgar Allan Poe | In the same way the poem says that when the rest of the heaven was blue, there was a demon in their view, so its saying that when everything else is okay there is danger right in front of you. In LOTF it shows the confrontation of the beast and the boys, so its saying that when they are stuck on the island with the beast everybody else around the world is doesn’t even know it’s happening. | “In front of them, only three or four yards away, was a rock-like hump where no rock should be. Ralph could hear a tiny chattering noise coming...

Words: 628 - Pages: 3