...Dying in a Hospital Setting Elizabeth Allegro Aspen University 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;...
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...Community Health Nursing SZT Task 2 February 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...
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...Come Join the Hospice and Palliative Nurses’ Association Houston chapter! Why Join HPNA Houston Chapter? • Free monthly subscription to CHPNA TODAY, a nursing journal with up-to-date articles and the most cutting edge research in hospice and palliative nursing • Speakers teach us how to apply research findings in clinical practice! • Bi-annual workshops and CEU’s • Fellowship with like minded professionals and networking opportunities • Houston chapter sponsors a bi-monthly newsletter for all things local in Hospice and Palliative Care! • Free study materials for CHPN certification! • Free Tote bag, T-shit and professional pin! Requirements for Membership: • Must be RN or LVN practicing in Hospice and/or Palliative Care setting for 18 months+ (special circumstances considered) • $120 yearly member ship fee, waived for members 55 years and up! American Cancer Society says, “HPNA is leading the charge for evidence based practice in a bourgeoning specialty.” Ruth M RN says, “ I have been a hospice nurse for 10 years, and yet I learn something new about this field and how to deliver care nearly every week!” Come see for yourself! This Monday November 15th HPNA Houston chapter is hosting an Ice Cream Social with keynote guest speaker Dr. John Wessley. Topic: “Caregiver Fatigue: Caring for yourself and Others, an RN’s perspective” Monthly meetings held the third Friday of the month 7:00p-8:30p In the M.D. Anderson...
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...The primary aim of my 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...
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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...
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...Nursing Nurses face various ethical and legal issues in the medical setting. As professionals, nurses must be aware of these legal and ethical issues when they occur. Nurses have a legal and ethical obligation to respond to these issues. Being a professional nurse requires a nurse to assess the pros and cons of different situations, but also to withhold their personal beliefs and listen and respect the beliefs and traditions of others. Legally Nursing implications require nurses to maintain licensure, obey state and federal laws and to remain within their scope of practice. Within these legal and ethical issues the American Association Code of Nursing ethics, personal and societal values, legal aspects and legal responsibilities all affect decisions. Two different cases will be discussed and explored; an advance directive case involving a woman by the name of Marianne, and a malpractice case involving a nurse and the involved healthcare organization. The American Nurses Association Code of Nursing Ethics can influence the final decision made in the case study involving Marianne’s family by designating a surrogate. According to "American Nurses Association" (2011), “The nurse supports patients self-determination by participating in discussions with surrogates, providing guidance, referral to other resources as necessary, and identifying and addressing problems in the decision-making process” (1.4). In the case study involving malpractice, the nurse being called upon...
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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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...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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...Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal 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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...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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...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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...ethical principle of non-malefiecense is the duty to do no harm. This is promoted by doing three interventions. First intervention is avoiding deliberate harm, risk of harm that occurs during the performance of nursing actions. The second intervention is considering the degree of risk permissible. The third intervention is determining whether the use of technological advances provides benefits that outweigh the risks. The ethical principle of beneficence is the doing or active promotion of good. This is done by providing health benefits to the patients, balancing the benefits and risks of harm, and considering how a patient can be best helped. The ethical principle of Justice is the promotion of equity or fairness in every situation a nurse encounters. The two nursing implications that promote justice are ensuring fair allocation of resources, and determining the order in which clients should be treated. ("Ethical Principles," January 2011, p. screen) There are several nursing ethical arguments on Euthanasia. Those that are against mercy killing have the ethical arguments that euthanasia might not be promoting the patient’s best interest, accepting that it means acknowledging that some people are more important than others, weakening the society’s respect for the holiness of life, and arguing that if voluntary euthanasia were to become legal nationwide, then most probably involuntary euthanasia will be committed at a higher level. The ethical arguments for those in favor...
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...The Effects of Palliative Care on Other Family Members Tonya Kerney McKendree University The Effects of Palliative Care on Other Family Members Family members of patients who are in palliative care experience emotions including hopelessness, guilt, and sadness. They are often physically exhausted and may become ill themselves. Many experience depression. Family Caregiver Alliance (as cited in McMillan et al., 2006) has estimated that over fifty million Americans assist a family member with a disability or illness on a regular basis. Of these ill patients, many require extensive care from family members. Caregivers of cancer patients especially experience very high stress levels. They are often burdened with physical exhaustion, emotional distress, and financial worries from loss of time at work to care for their loved one (Emanuel & Emanuel, as cited in McMillan et al., 2006). The purpose of the study I reviewed was “to determine whether hospice plus a coping skill training intervention improved family caregivers’ quality of life, burden, coping, and mastery, compared with hospice plus emotional support and usual hospice care (McMillan et al., 2006, p. 214)”. To participate in the study, caregivers had to be caring for adult cancer patients, both had to give consent, both had to be able to read and comprehend English, both had to have achieved at least a sixth grade education, and both had to achieve a minimun score of seven on the Short Portable Mental Status Questionnaire...
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...Evidence Based Practice: “Stress nurses face caring for palliative care patients?” Regina Nelson Governors State University Abstract Palliative Care Nurses are at risk of experiencing stressful situations related to symptom management and death. The aim of this paper is to critically examine the current stress nurses face caring for Palliative Care patients. Four Nursing Journals and one Psycho-Oncology were reviewed. There was strong evidence to support that nurse’s experience stress caring for Palliative care patients. Common concerns in the first study were caring for a dying patient; personal level, comfort of the patient, and mediating between patient and family. The second study reported physical and emotional health consequences for nurses who provide hospice and palliative care over extended periods of time. The third study of nursesreported job satisfaction, stressors, coping strategies, and support. The fourth study nurses had 10 themes that conceptualize their work that may enable palliative care workers to remain resilient and effectively buffer or moderate stressful effects. The fifth study reported routinization of care, lack of nursing staff’s availability for emotional engagement, frequent interruptions, quiet afternoons, upbeat and positive culture, and a matter of fact attitude surrounding death and dying ,were all the behaviors that “being with” could not create. Although the report showed nurses able to cope by not “being with” the overall impact...
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...Creation of Hospice Hospice care is 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 cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. The term “hospice” ( from the same linguistic root as “hospitality”) can be traced back to medieval times when it referred to a place of shelter and rest for the weary or terminally ill on a long journey in 1948 (History of Hospice Care, 2012). The name of the physician was Dame Cicely Saunders who treated the terminally ill and eventually went on to create the first modern hospice, named St Christopher’s Hospice, in a residential suburb of London. (History of Hospice Care, 2012). Ms. Saunders introduced the idea of specialized care for the dying to the United States of America during a 1963 visit with Yale University. Her lecture, given to medical students, nurses, social workers, and chaplains, about the concept of holistic hospital care, included photos of terminally ill patients and their families, showing the dramatic differences before and after the symptom control care (History of Hospice Care, 2012). Ownership In 2010, there were over 5000 hospice programs nationwide (Facts and Figures: Hospice Care in America, 2012). The majority of these facilities are freestanding agencies constituting 58 percent of all hospice centers (Facts and Figures: Hospice Care in America, 2012). They are...
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