Nursing care involves the support of general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible, a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers. These include pain and other symptom management; psychological, spiritual, and grief/bereavement support.
Recent studies have identified barriers to end-of-life care including patient or family member’s avoidance of death, influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.
The best opportunity for quality care occurs when patients facing death, and their family, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.
CARE SETTING
Much of the care of the dying is still provided by nurses in hospitals, primarily in oncology and critical care areas. However, other care settings are becoming more common, e.g., the home, assisted living/extended care setting, or hospice inpatient unit.
RELATED CONCERNS
Cancer
Extended care
Psychosocial aspects of care
Care Plan(s) reflecting underlying pathology of terminal condition
Patient Assessment Database
Data depend on underlying terminal condition and involvement of other body systems.
EGO INTEGRITY
May report: Stress related to recent changes in ability to care for self and decision to accept hospice services
Feelings of helplessness/hopelessness, sorrow, anger; choked feelings
Fear of the dying process, loss of physical and/or mental abilities
Concern about impact of death on SO/family
Inner conflict about beliefs, meaning of life/death
Financial concerns; lack of preparation (e.g., will, power of attorney, funeral)
May exhibit: Deep sadness, crying, anxiety, apathy
Altered communication patterns; social isolation; withdrawal
SOCIAL INTERACTION
May report: Apprehension about caregiver’s ability to provide care
Changes in family roles/usual patterns of responsibility
May exhibit: Difficulty adapting to changes imposed by condition/dying process
NURSING PRIORITIES
1. Control pain.
2. Prevent/manage complications.
3. Maintain quality of life as possible.
4. Plans in place to meet patient’s/family’s last wishes (e.g., care setting, Advance Directives, will, funeral).
Recent studies have identified barriers to end-of-life care including patient or family member’s avoidance of death, influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.
The best opportunity for quality care occurs when patients facing death, and their family, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.
CARE SETTING
Much of the care of the dying is still provided by nurses in hospitals, primarily in oncology and critical care areas. However, other care settings are becoming more common, e.g., the home, assisted living/extended care setting, or hospice inpatient unit.
RELATED CONCERNS
Cancer
Extended care
Psychosocial aspects of care
Care Plan(s) reflecting underlying pathology of terminal condition
Patient Assessment Database
Data depend on underlying terminal condition and involvement of other body systems.
EGO INTEGRITY
May report: Stress related to recent changes in ability to care for self and decision to accept hospice services
Feelings of helplessness/hopelessness, sorrow, anger; choked feelings
Fear of the dying process, loss of physical and/or mental abilities
Concern about impact of death on SO/family
Inner conflict about beliefs, meaning of life/death
Financial concerns; lack of preparation (e.g., will, power of attorney, funeral)
May exhibit: Deep sadness, crying, anxiety, apathy
Altered communication patterns; social isolation; withdrawal
SOCIAL INTERACTION
May report: Apprehension about caregiver’s ability to provide care
Changes in family roles/usual patterns of responsibility
May exhibit: Difficulty adapting to changes imposed by condition/dying process
NURSING PRIORITIES
1. Control pain.
2. Prevent/manage complications.
3. Maintain quality of life as possible.
4. Plans in place to meet patient’s/family’s last wishes (e.g., care setting, Advance Directives, will, funeral).
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