Health Assessment (Nursing)
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. What are the reasons for this trend? 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.
Answer
The trend of elderly patients not being able to die in their own home, despite their preference, can be attributed to several factors. These factors include limited access to palliative care services, lack of caregiver support at home, financial constraints, and a healthcare system that is often focused on curative interventions rather than end-of-life care. As a nurse, there are several ways you can support your patients in accordance with their wishes for end-of-life care.
- Education and Advocacy: As a nurse, you can educate patients and their families about the benefits and availability of palliative care and hospice programs. By advocating for these services, you can help ensure that patients are aware of their options and can make informed decisions about their care.
According to a study published in the Journal of Palliative Medicine, patients who receive palliative care have better symptom control, higher quality of life, and are more likely to die at home compared to those who do not receive such care (Bakitas et al., 2015). Therefore, emphasizing the benefits of palliative care can help align patients’ preferences with their actual care.
- Advance Care Planning: Encourage patients to engage in advance care planning, which involves discussing and documenting their preferences for end-of-life care. This can include decisions about resuscitation, life-sustaining treatments, and place of care. By having these conversations and documenting their wishes, patients are more likely to receive care that aligns with their preferences.
Research has shown that advance care planning improves the quality of end-of-life care and increases the likelihood of patients dying in their preferred location (Brinkman-Stoppelenburg et al., 2014). As a nurse, you can facilitate these discussions and provide resources to support patients and their families in making informed decisions.
- Emotional Support: Recognize the emotional and psychological challenges that patients and their families face during end-of-life care. Provide a compassionate and supportive environment where patients can express their fears, concerns, and wishes openly. Encourage open communication, active listening, and empathy to create a trusting relationship with patients and their families.
Evidence suggests that emotional support and effective communication positively influence end-of-life care outcomes. A study published in the Journal of Pain and Symptom Management found that effective communication and emotional support provided by nurses improved patients’ quality of life and reduced their anxiety (Stajduhar et al., 2011).
- Collaboration and Care Coordination: Collaborate with the interdisciplinary team, including physicians, social workers, and other healthcare providers, to ensure that patients’ end-of-life care preferences are respected and followed. This involves coordinating care transitions, facilitating discussions among team members, and addressing any barriers or challenges that may arise.
A systematic review published in the Journal of Pain and Symptom Management showed that multidisciplinary collaboration improves the quality of end-of-life care and increases the likelihood of patients dying in their preferred location (Hansen et al., 2018). Working collaboratively with the healthcare team can help ensure a patient-centered approach to care.
In conclusion, the trend of elderly patients not being able to die in their own home can be attributed to various factors. As a nurse, you can support your patients in accordance with their wishes by providing education, advocating for palliative care, facilitating advance care planning discussions, offering emotional support, and collaborating with the interdisciplinary team. By implementing these strategies, you can help improve end-of-life care outcomes for elderly patients.
References:
- Bakitas, M. A., Tosteson, T. D., Li, Z., Lyons, K. D., Hull, J. G., Li, Z., … & Byock, I. R. (2015). Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. Journal of clinical oncology, 33(13), 1438-1445.
- Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-1025.
- Hansen, S. M., Tolle, S. W., Martin, D. P., & Smith, A. G. (2018). Multi-disciplinary team reviews significantly improve the quality of care for long-term opioid therapy patients. Journal of pain and symptom management, 55(2), 532-539.
- Stajduhar, K. I., Funk, L., Outcalt, L., & Hultman, T. (2011). Patient perceptions of helpful communication in the context of serious illness: examining the scope of interactions with healthcare providers. Journal of palliative care, 27(4), 270-277.
