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Barriers Faced by Nurses Caring for End-of-life Patients

Updated January 11, 2022
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Barriers Faced by Nurses Caring for End-of-life Patients essay

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Florence Nightingale believed that nursing care transcended beyond the simple duties of keeping the patients dressed, cleaned, and feed. The mother of modern nursing warrant that a nurse was capable of managing the overall health, recuperation, and survival of his/her patients (Selanders, 2019). For this reason, she established standards of care, that would guide nurses to provide the best patient care and handle every complex case to the best of his/her abilities (Selanders, 2019).

She also acknowledged the importance of caring for patients holistically by not only taking into consideration their physical health but also their mental and spiritual needs. Involvement from the patient’s family or loved ones also makes a significant impact on the fast recovery of the patient (Selanders, 2019). Unfortunately, not all patients who get admitted to a hospital or healthcare facility have a positive outcome at the end. It is in the nurse’s power to make a  patient’s final days as comfortable, painless, and supportive as possible.

Carol Potera states that the duty of nursing care transcends medical diagnosis and because of this “a nurse is in charge of caring for her patients – even when there is no possibility of healing” (Potera, 2010). However, even when the nurse makes every effort to offer the best care to his/her patients there are still some barriers that restrict him/her from doing so, especially in end-of-life care. Nurses commonly describe that not having established protocols to provide comfort care to a dying patient due to the hospital’s policies and procedure that restricts them this autonomy makes their job purpose useless (Wallils, 2013).

Research

In the article, Code Comfort: Prompt symptoms relief in end-of-life Care (2015), Beth Fahlberg, talks about how until recently for some hospitals offering rapid symptoms relief care to a dying patient had been a challenge. Yet, many hospitals continue to face this challenge. The problem is not that nurses are not able to recognize and intervene in a medical emergency or a condition that threatens their patient’s life, but “when caring for a dying patient where comfort, not rescue, is the goal, nurses are often less prepared to intervene” (Fahlberg, 2015).

On the other hand, other nurse feels restricted and are not able to provide rapid comfort care due to their institution’s policies and procedures that mandate for them to follow a protocol before they can intervene (Fahlberg, 2015). Consequently, the people affected by this are the patients that have to wait to get the care that they need for their symptoms and their families who panic watching their loved ones in distress and not being able to help.

Bethe Fahlberg also mentions in her article, that many hospitals have become aware of this problem and with the intention of providing rapid symptom relief for dying patients they have implemented into their policies, Code Comfort. This code was specifically designed for patients who are terminally ill and have chosen not to be resuscitated.

A multidisciplinary team that consists of physicians, nurses,  respiratory therapist, counselors, and chaplains that specialize in palliative care is put together to attend to “code comfort” and help assist with patients who are experiencing symptomatic distress. They also provide comfort to their families who are likely to be in distress by the situation. The focus of this team is to “manage acute signs and symptoms such as pain, dyspnea, anxiety, and agitation” following standard orders, authorized intervention algorithms that are part of the “code comfort” policy (Fahlberg, 2015).

Significance

A team that attends specifically to the medical needs of patients who are terminally ill and in distress would be ideal to have in every hospital. Nevertheless, Bethe Fahlberg argues that nurses who work in a facility that does not have a specific team or a policy in place that attends to the needs of distraught patients, he or she can initiate other interventions that can help either “prevent or relieve the distress of breathlessness for dying patients and support those who love them” (Fahlberg, 2015).

First, nurses should “enlist the patient’s family in their assessment” that will help him/her get as much patient information and history, as well as identify interventions and/or treatment approaches that have helped the patient in the past (Fahlberg, 2015). Also, having the family involved provides comfort and support to the patient and can potentially reduce his/her anxiety and prevent further symptom exacerbation. In the article: Communicating with Family Caregivers (2011), Mary Walton, stresses how important it is for the nurse to collaborate and partner up with the patient and their families in order to “achieve something that would be impossible to do on your own and its characterized by working towards a common goal.”

Second, nurses should continuously endure that quality of care is being maintained or surpassed by “streamlining the system” or collecting and reporting quality indicators and variance data what will identify areas of improvement (Fahlberg, 2015). In a hospital that requires nurses to follow protocol and wait for another disciplinary team member to do what he/she is capable of doing or could have done an hour ago is unacceptable, and constant proof of such can implement change (Wallils, 2013).

Third, anticipating the patients’ needs and auditing the amount of time it takes for patients to get treatment can eliminate episodes of symptom distress (Fahlberg, 2015). The best care that a nurse can offer to a patient is one that is planned and individualized to fit the needs of the patient, and this takes “really getting to know your patient” (Dee, 2018).

Finally, interventions that do not require a doctor’s order can be implemented by the nurse, such as “having a person stay with the patient at all times, ongoing monitoring, and emotional support can prevent the feeling of abandonment,” as well as repositioning and distraction can reduce anxiety and distress (Fahlberg, 2015). Dianne Puzycki says in her article: There from the start, A Hospice Nurse Looks Back (2017), mentions that what she valued more as a hospice nurse is the opportunity to be present and firmly believes that “sometimes is not always about medicine – sometimes it is just being there, meeting their needs.”

It is essential for nurses to take evidenced-base nursing interventions and incorporate them into their daily practice. For instance, if during a patient assessment a nurse can get more information regarding the patient’s health history and previous treatments that have worked for him/her by merely getting the family involved, one should make it an automatic process. Next, improvement in the workforce and finding strategies and protocols that will improve patient care should always be a nurse’s concern.

Over the years, nursing care has revolutionized and has changed for the better as a cause of nurses who took it upon themselves to research and develop better strategies of delivering quality care to their patients. Nurses should continue improving their field by continuing to collect data, refining previous research, and improving strategies for patient care. A nurse cannot deliver safe and proper care if he/she does not know his/her patients. Positive patient outcomes and full recovery can only be reached with an individualized plan of care that identifies the patient’s conditions, abilities, needs, routines, and goals.

Also, a  plan of care creates a clear idea of the interventions that a nurse must perform or implement to help his/her patients reach their goals. Furthermore, A nurse must get creative when it comes to patient care and not wait for doctors’ orders to help a patient in distress. One must take into consideration that simple things such as constant monitoring, therapeutic talk, and attending to the patients’ needs can make a complete difference in their recovery.

A nurse can only know if the interventions and strategies that he/she incorporated into his/her patient care worked or not is through evaluation. For example, one can evaluate whether enlisting the family during their assessment and planning care for the patient makes a difference; one could do so by comparing the outcomes of those who did and those who did not. In terms of enhancing nursing care by developing strategies and protocols that will improve patient care, one can do so by collecting data, measuring, and analyzing the outcomes.

When a nurse uses his/her creativity to provide comfort care to a patient in distress using interventions that do not require a doctor’s orders, one can automatically see if such made a positive difference by looking and assessing their patient. The nurse can then continue using the same interventions on other patients with similar distress.

Conclusion

In summary, comfort care for end of life patients continues to be a problem. Many hospitals have implemented “code comfort” that is run by a specialized palliative care group that can provide fast symptom relief to dying patients and comfort to their families who might also be in distress. Nevertheless, not all hospital have a specialized team that focuses on providing care to terminally ill patients or a policy in place that allows nurses to provide rapid intervention. Nurses can still implement other interventions such as enlisting the family into the patient’s care, identifying areas of improvement on patient care, anticipating the patients’ needs to avoid symptomatic distress, and implement care that does not require a doctor’s order.

References

  1. Dee, V. (2018, June). Caring with Intention: Hospice Care and the Human Family. American Journal of Nursing, 118(6), 63-64. http://dx.doi.org/10.1097/01.NAJ.0000534855.50632.6f
  2. Fahlberg, B. . (2015, December ). Code Comfort: Prompt symptom relief in end-of-life care. Nursing 2015, 15, 19-20. http://dx.doi.org/10.1097/01.NURSE.0000473401.74424.92
  3. Potera, C. (2010, April ). End-of-Life Care Still Falls Short. American Journal of Nursing, 110, 14. http://dx.doi.org/10.1097/01.NAJ.0000370142.41739.ba
  4. Puzycki, D. (2017, July). There from the Start: A Hospice Nurse Looks Back. American Journal of Nursing, 117, 56-57. http://dx.doi.org/10.1097/01.NAJ.0000520949.62094.e0
  5. Selanders, L. (2019). Florence Nightingale British nurse, statistician, and social reformer. Retrieved February 21, 2019, from https://www.britannica.com/biography/Florence-Nightingale
  6. Wallils, L. (2013, September). Improvements in End-of-Life Care Promising but Not Uniform. American Journal of Nursing, 113, 16. http://dx.doi.org/10.1097/01.NAJ.0000434161.15633.c8
  7. Walton, M. (2011, December). Communicating with Family Caregivers. American Journal of Nursing , 111(12), 47-53. Retrieved from https://www.nursingcenter.com/cearticle?an=00000446-201112000-00027&Journal_ID=54030&Issue_ID=1264639
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