End-of-life Care: Patient’s Preference, Nurse’s Roles, Patient’s Wishes
End-of-life becomes an issue at some point for elderly clients. 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 clients regarding end-of-life care in accordance with their wishes. ***Support your response with evidence-based literature.
SAMPLE PAPER
End-of-life Care: Patient’s Preference, Nurse’s Roles, Patient’s Wishes
Introduction
Many palliative care patient prefer to die at home. In spite of this patient preference many die in institutional settings. Factors related to availability of healthcare programs and services, patient condition, patient preference and availability of caregiver determine the place where palliative patient will spend time in the last days (Sandsdalen et al. 2015). This paper examine the reasons behind this trend and what nurses can do to ensure patient preference is honored.
Reasons
Many palliative patients do not cope with or manage to stay at home and die there as they wish for various reasons. A good number of older adults experience emergency admissions from home and after that arranging home discharge becomes impossible. Although the patient’s condition may not necessarily require inpatient care, alternative arrangements may not be made quickly enough. Sometimes moving a patient is not possible because (s)he may be nearing death that the risk of dying en route is high (Danielsen et al 2018).
Dying at home may prove difficult for those palliative patients without primary caregivers and resources. Lack of resources at home such as medical supplies and lack of a primary caregiver can make it difficult for the patient to manage at home (Murray, Fiset, Young, & Kryworuchko, 2009). Relatives or family members may desire their loved ones to stay in the institutional setting. Additionally, the patient living alone makes it impractical to discharge home, especially when the patient is experiencing physical decline and terminal illness. This makes home environment to be deemed unsafe for the patient. These home barriers would necessitate the patient to remain hospitalized and die there. Family members may feel exhausted or feel uneasy with the idea of their patient dying at home.
It is important that healthcare professionals respect and honor patient’s wishes to die at home. Nurse’s role is to advocate for patient’s expressed wishes in the advance planning conversation or advanced directive. Nurses have an obligation as patient’s advocates to facilitate and honor the wishes of their patients regarding their preferences and goals. The end-of-life time is vulnerable and in such instances, the role of a nurse is to make sure the wishes and needs are honored. The principle of respect for autonomy requires the nurse to respect the patient’s right to self-determination (American Nurses Association, 2015). Autonomy is the capacity to express choices. Sometimes the patient may make decisions regarding their health that is not the best decision according to the nurse’ opinion. But nurses have an obligation to advocate and support for that patient’s right. Nurses have responsibilities to help patients and family in decision making processes by giving accurate information on patient’s rights, listening to their needs, addressing concerns about their care and attending to concerns about patients’ wishes and preferences.
Sometimes a home discharge and care pose a risk to those caring and providing care. Incompetent patient may not understand risks and be ready to accept them. Harm to self and others makes it practical to prevent such a discharge.
How Nurses can Support Palliative Patients’ Wishes
Nurses advocate for patients by informing healthcare professionals of patients’ expressed wishes. They also speak to family members and physicians about the ramifications of such decisions or wishes. It is important for the nurse to make the patient understand the risk of home discharge and the ramifications of this.
Healthcare providers make decisions in the best interest of the patient where the patient has mental capacity to express preference. Patients who express wishes and preferences after losing their mental capacity are not considered valid decisions. Such patients may be unaware of the risks of untimely discharge for the sake of being at home.
References
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.aspx
Danielsen, B. V. et al (2018).Experiences and challenges of home care nurses and general practitioners in home-based palliative care –a qualitative study. BMC Palliative Care, 17:95-103
Murray, M.A., Fiset V., Young, S., & Kryworuchko, J. (2009). Where the dying live: a systematic review of determinants of place of end-of-life Cancer care. Oncology Nursing Forum, 36(1):69
Sandsdalen, T., Hov, R., Hoye, S., Rystedt, I., &Wilde-Larsson, B. (2015). Patients’ preferences in palliative care: a systematic mixed studies review. Palliative Medicine, 29(5):399–419
