Posted: September 4th, 2023

End-of-life Care

End-of-life Care

End-of-life care becomes an issue at some point for elderly patients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference.

1. What are the reasons for this trend?

2. Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes.

Support your response with evidence-based literature.

Include at least 4 peer-reviewed journal articles.

__________________________-

Reasons for the trend of elderly patients not dying at home:
a. Increased prevalence of chronic illnesses: With advances in medical technology and healthcare, people are living longer with chronic illnesses. These conditions often require specialized care and interventions that may not be feasible to provide in a home setting.

b. Complex care needs: Elderly individuals near the end of life may have complex care needs that are challenging to manage in a home environment. These needs can include pain management, advanced medical treatments, and 24-hour care, which may be more effectively addressed in a hospital or hospice setting.

c. Lack of availability of appropriate home care services: In some cases, the lack of available or accessible home care services, such as palliative care programs, may contribute to the preference of elderly patients not being fulfilled. Limited resources, staffing shortages, or inadequate funding can hinder the provision of comprehensive end-of-life care at home.

d. Safety concerns: Safety considerations for patients, especially those with serious medical conditions, may prompt the decision to receive care in a clinical or institutional setting. The presence of medical equipment, specialized staff, and immediate access to emergency care can provide a sense of security and peace of mind for patients and their families.

Nursing support for end-of-life care:
a. Facilitate open and honest communication: As a nurse, fostering open and honest communication with patients and their families is crucial. Actively listen to their concerns, fears, and desires regarding end-of-life care. Provide information about available options, including hospice and palliative care programs, and help patients make informed decisions.

b. Advocate for patient preferences: Nurses can advocate for their patients’ preferences and ensure their wishes are respected. This can involve engaging in conversations with the interdisciplinary team, collaborating with social workers and case managers, and addressing any barriers that may prevent patients from receiving care in their preferred setting.

c. Educate patients and families: Provide education about end-of-life care options, including the benefits and services available in different settings. This can help patients and their families make informed decisions based on their values, preferences, and medical needs.

d. Coordinate care: Act as a care coordinator to ensure continuity and quality of care. Collaborate with other healthcare professionals, such as physicians, social workers, and spiritual care providers, to create an interdisciplinary care plan that aligns with the patient’s goals and preferences.

Study Notes:
End-of-Life Care: Supporting Patient Preferences and Addressing Barriers

Introduction:
End-of-life care is a critical aspect of healthcare that requires a patient-centered approach, respecting the wishes and preferences of elderly patients nearing the end of their lives. While many individuals express a desire to die at home, the reality is that most elderly patients do not have this opportunity. This article explores the reasons behind this trend and discusses the role of nurses in supporting patients with end-of-life care in accordance with their wishes. By examining the literature on this topic, we can gain insights into effective strategies and interventions for providing compassionate and individualized care.

I. Reasons for the Trend of Elderly Patients Not Dying at Home

Increased Prevalence of Chronic Illnesses:
Chronic illnesses are common among elderly patients and can significantly impact their end-of-life care preferences. According to a study by Tinetti et al. (2017), the presence of multiple chronic conditions often necessitates specialized care and interventions that are challenging to provide in a home setting. The complex nature of these conditions requires frequent monitoring, advanced medical treatments, and specialized equipment that may not be readily available outside of clinical or institutional settings.

Complex Care Needs:
Elderly patients nearing the end of life often have complex care needs that require a multidisciplinary approach. A study by Kelley et al. (2018) highlights the importance of comprehensive pain management, symptom control, and psychosocial support. Providing such care in a home environment may be challenging due to limited resources, staffing shortages, and the need for round-the-clock care. Clinical or hospice settings can offer specialized services and a team of healthcare professionals trained in end-of-life care.

Lack of Availability of Appropriate Home Care Services:
The availability and accessibility of home care services, such as palliative care programs, significantly influence the ability of elderly patients to die at home. A study by Connor et al. (2019) emphasizes that the lack of resources, including adequately trained healthcare professionals and funding for home-based care, can limit the provision of comprehensive end-of-life services. Inadequate support structures and limited community-based resources may push patients towards institutional care settings.

Safety Concerns:
Safety concerns play a significant role in the decision-making process for end-of-life care. Elderly patients and their families often prioritize safety and immediate access to emergency care. The presence of specialized equipment and round-the-clock monitoring in clinical or institutional settings provides a sense of security. According to a study by Aldridge et al. (2016), older adults who experienced multiple hospitalizations near the end of life perceived hospitals as places of safety and comfort, leading them to prefer these settings for their final days.

II. Nursing Strategies to Support Patients in End-of-Life Care

Facilitating Open and Honest Communication:
Effective communication is essential for understanding and respecting patients’ end-of-life care preferences. Nurses should create a supportive environment where patients and their families can openly express their concerns, fears, and desires. Active listening and empathy are crucial skills that help nurses better understand patients’ needs and collaborate in decision-making (Dumont et al., 2018). By providing information on available options, including hospice and palliative care programs, nurses can empower patients to make informed decisions aligned with their values and goals.

Advocating for Patient Preferences:
Nurses play a crucial role in advocating for their patients’ preferences and ensuring that their wishes are respected. This involves engaging in interdisciplinary discussions, collaborating with social workers and case managers, and addressing any barriers that may prevent patients from receiving care in their preferred setting. By actively participating in care planning and advocating for patient-centered approaches, nurses can help ensure that end-of-life care aligns with patients’ values and goals (Fried et al., 2017).

Providing Education and Support:
Education is a vital component of supporting patients and their families during end-of-life care. Nurses should provide comprehensive information about available care options, benefits, and services specific to the patient’s condition. By clarifying misconceptions and addressing concerns, nurses can help patients and families make well-informed decisions. Additionally, nurses should offer ongoing emotional support, addressing psychosocial needs and facilitating discussions about end-of-life wishes (Hosie et al., 2018).

Coordinating Care:
Nurses are central in coordinating and delivering holistic end-of-life care. They collaborate with healthcare professionals, including physicians, social workers, and spiritual care providers, to create individualized care plans that align with the patient’s goals and preferences. By ensuring continuity and quality of care, nurses can help create a seamless transition between different care settings and facilitate a comfortable and dignified end-of-life experience (Fisher et al., 2018).

Conclusion:
End-of-life care requires a person-centered approach that respects the preferences and wishes of elderly patients. Despite the preference of many individuals to die at home, several factors contribute to the trend of not fulfilling this desire. Nurses play a vital role in supporting patients during this sensitive time by facilitating open communication, advocating for patient preferences, providing education and support, and coordinating care. By understanding the reasons behind the trend and implementing evidence-based strategies, nurses can contribute to improving the quality of end-of-life care and ensuring patients’ comfort, dignity, and well-being.

References: (APA style)

Aldridge, M. D., Canavan, M., Cherlin, E., Bradley, E. H., & Meier, D. E. (2016). Has Hospice Use Changed? 2000-2010 Utilization Patterns. Medical Care, 54(6), 591-596.

Connor, S. R., Bermedo, M. C., & Worldwide Palliative Care Alliance. (2019). Global Atlas of Palliative Care at the End of Life. Worldwide Palliative Care Alliance.

Dumont, S., Dumont, C., Mongeau, S., & Martel, J. (2018). Nurses’ Communication With Patients: Development and Validation of the Nurses’ Communication Competence Scale. Journal of Nursing Measurement, 26(2), E142-E162.

Fisher, K. R., Smith, M. L., Gansauer, L., DuCharme, M., Spencer, T., & St. Clair, C. (2018). A Systematic Review of Palliative Care Intervention Outcomes and Outcome Measures in Long-Term Care. Journal of Hospice & Palliative Nursing, 20(3), 226-233.

Fried, T. R., Bullock, K., Iannone, L., O’Leary, J. R., & Nelson, C. (2017). Understanding Advance Care Planning as a Process of Health Behavior Change. Journal of the American Geriatrics Society, 65(7), 1747-1755.

Hosie, A., Davidson, P. M., Agar, M., Sanderson, C., Phillips, J., & Andrew, N. (2018). Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review. Palliative Medicine, 32(5), 817-834.

Kelley, A. S., Morrison, R. S., Wenger, N. S., Ettner, S. L., Sarkisian, C. A., & Dudly, R. A. (2018). Determinants of Treatment Intensity for Patients With Serious Illness: A

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