Everything with a beginning must have an end, and human beings are born to die. Most people use to consider death as a natural experience changes have taken place making the experience more painful for the patients, family, and caregivers due to the advancement in medical care. The current technology and the procedures have allowed the extension of life than ever before. The argument here concerning this is if the dying experience has improved due to the advancement in the medical care. This paper will review death and a sick patient taking into consideration the perspective of the patient and the caregiver. The article should also recommend the necessary changes to help prevent such cases from happening.
A death review is about a woman known as rose who had breast cancer that spread and affected her lungs and the liver. The woman lived with her two daughters in the hometown. Rose became very weak and debilitated due to lengthy chemotherapy and radiation treatment. Due to her weakness in the body, she developed respiratory arrest due to the pneumonia complication. The respiratory difficulty forced her to use the ventilators wherein two weeks, relocates into Intensive Care Unit (ICU). The family was there with her during all the visit hours, but she always complains that she wishes to die due to severe pain.
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The nurses had a lot of concern about the pain rose was going through, but they also had feared that medication could also cause another respiratory arrest. Rose stayed in the ICU for three months when she had another respiratory arrest and died without any of her family members at her side. Rose with her family decided not to be in the ventilator again, and the physician, therefore, had written a Do Not Resuscitate (DNR) order. There was a plan to move her from the Intensive Care Unit and place her on a regular floor, but they hesitated. The people who were in one way or another involved in the case believed that rose case was not well handled and there was a need to find a way of improving the care of the dying.
Many people believe that health-providing facilities need to improve their care upon the dying. Autonomy is among the principles of core bioethical that considers that rights of any individual to decide on their health. In most cases, the caregivers and the providers spend most of their time in giving patients the instructions and coaxing them to take control of their health. Nevertheless, sometimes the responses or actions of the patients surprise the caregivers and the providers when they show the desire to control the timing and circumstances that influence the experience of the end-of-life (Volker, 2004). The patients can also interfere with the ability of the caregivers to provide the maximum level of care that is in need. An example is how rose decided with her family that she would not be in the ventilator anymore leading to severe complication causing death. Patients should adhere to the facility terms and conditions because it is for their good.
The organizations are essential in the development of the policies that ensure that there is a provision of the support to the individuals when battling with such severe health complication. In many cases, health providers receive training that can make them perceive death as the enemy forcing them to forget that end of life is a natural experience that every human being must pass through. Some people have managed to express that they do not deal with the issues that revolve around death and dying well, for instance, the story in the health leaders (Cantlupe, 2013). Some publications conclude that there is a high number of patients dying in pain and many of them do not attend the hospice on time. This means that the improvement in health care do not have any positive impact in ensuring that the patients have excellent care at the end of life. The goodness is that studies are going on focusing on the perspectives of the patients on death and dying and the view of the physician and nurses on the same issue. The reviews are essential in helping people understand the experience and methods or approaches that will help in improving end-of-life care (Cantlupe, 2013).
Many people may consider the quality of end of life care as a strange thing, but the truth is that it is in recognition as one of the ethical obligations of health care providers and organizations. There is a study conducted by Singer and Kelner focusing on patients living with AIDS and residents of long-term care to find out the issues relating to the end of life. The outcomes of the study manage to identify five domains that are in connection to the quality of care at the end of life. The five domains include proper management of pain and symptoms, avoiding prolongation of dying, relieving the burden, achieving the sense of control, and building strong relationships with the loved ones (Singer, 1999). Most of the patients respond that there is no need of staying for a more extended period when life is no longer enjoyable. The patients are not also willing to go into the life support machines if they cannot improve to the normal state of living. Most of the patients consider being in life support machine is the same as being a guinea pig. Generally, factors like the individual approach life, illness and the quality of life is the critical determinant that shapes the end of life experiences. The understanding on the death and the process of dying is crucial in ensuring that people receive the quality health care during their last days on the earth.
As the health providers get to understand the gaps that exist between the training and the needs of the patients, new skills come in to play ensuring a better quality of end of life care. Nurses play an essential role when it comes to the end of life care provision. They always stay with the in-patients for 24 hours a day employing a patient-centered care approach that is efficient in providing care for the dying patients as well as their families. The involvement of the nurses in end of life care is essential when it comes to technical decisions in the care process as well as in understanding the patient's vulnerabilities because they have constant interactions with the patients. Furthermore, because of the patients' vulnerability nurses are ethically sensitive to the needs of both the patient and the family. The International Council of Nurses (ICN)have come up with the code of ethics that consider nurses as responsible for alleviating suffering as well as promoting health and preventing illness. Nursing becomes more involved in the provision of quality end of life especially when the end of life care is beyond the medical perspective. Some of the patients have complained that they are feeling abandoned by their primary care providers at the time of death. Many patients at home benefit significantly by primary care providers especially when the system in the hospital is under immense pressure due to financial constraint (Silveira, 2012).
Another important thing is improving the role of intensive care providers. It is very complicated to involve the families at the end of life decision because it demands excellent skills in communication and more time discussing and explaining the issues to ensure that the family members are satisfied. The use of alternative ways is essential in saving cost as well as bettering the care at the end of life. The programs of palliative care are significant in improving and extending the life of the patients, reducing cost as well as satisfying the needs of the patient and that of the family. During the chronic illness, there is a need to adopt the multidisciplinary team approach where nurses, physicians, spiritual counselors, psychologists join hands to help in relieving the pain, suffering, stress, and depression. The nutritionist and therapist are also exceptional people who can contribute to decision making when handling patients. The team is essential since it listens to the requests of the patients and that of the family, therefore, providing a suitable environment when providing the end of life care.
In conclusion, many people undergo pain and suffering as they end their life in homes and hospitals. The little understanding about the death and the process of dying among the patients and the caregivers make it even worse because the patients tend to die a painful death. There are studies in place that help the caregivers and patients better understanding of the care they should receive towards the end of their life. Proper decision-making between the patient, family and the care providers is essential in ensuring that there is quality care during end of life process. Nurses are among the crucial individuals in ensuring the better end of life care because they are the ones in close conduct with the patients enabling them to understand their vulnerabilities.
References
Cantlupe, J. (2013). Bundled payments come to cancer care. HealthLeaders Media, 11 .
Silveira, M. J. (2012). End-of-life care from the perspective of primary care providers. Journal of general internal medicine, 27(10) , 1287-1293.
Singer, P. A. (1999). Quality end-of-life care: patients' perspectives. Jama, 281(2) , 163-168.
Volker, D. L. (2004). Patient Control and End-of-Life Care Part II: The Patient Perspective. In Oncology nursing forum, 3(5) .
