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END-OF-LIFE CARE: ARE NURSES EDUCATIONALLY
PREPARED?
Lisa Marie Chiplaskey, MSN, Ed., BSN
This study identifies that nurses are educationally unprepared
to offer quality end-of-life care to patients and families.
Exploration into end-of-life care issues is examined utilizing
a historical context. Focus areas for improvement in today's
education of nurses have been identified as
spiritual-psychosocial health areas and physical health areas.
The recommendations for improved end-of-life nursing care
outcomes are identified as: an increase in end-of-life issues
in curricular content, continuing education, and revision of
texts to more current competency standards. The potential for
"good death” by being cared for by competent nurses is
recognized by being educationally prepared to perform adequate
end-of-life nursing care.
[Key words: end-of-life care, spiritual-psychosocial health,
physical health]
Why were they bothering him?
Why couldn't they go pick on some other dead man?
Future corpses shouldn't be forced to answer questions.
Death was man's ancient privilege, his immemorial pact with
life,
Granted to the slave, as well as the noble.
But perhaps they had revoked that right; and now,
You couldn't evade your responsibilities,
Simply by becoming dead.
Robert Sheckly
Immortality Inc.
INTRODUCTION
A. Overview
End-of-life (EOL) care is defined as an active, compassionate
approach that treats, comforts, and supports persons who are
living with, or dying from progressive or chronic life
threatening conditions (Ross, 2000). We should not fear death,
nor should we ignore it. Unfortunately, the issue of death has
been denied, hidden, and thus feared by our current society.
Nurses look at death as failure and therefore shy away from
those dying patients whom they believe they have "failed."
Death, the ultimate outcome of life, is at once a fact and a
profound mystery. Two of the two and a half million persons who
die annually in the United States are elderly many of which die
in hospitals (Kirchhoff, 2000). Care of the dying is emerging
as a major concern in the United States. Almost 80% of all
American deaths now occur in healthcare institutions, and most
deaths are the result of degenerative diseases, characterized
by slow onset, extended decline, and multiple infirmities
(Schwarz, 1999). Recent attempts have brought this important
issue of death into people's consciousness and more efforts
must be made to educate the healthcare community as well as the
public about the importance of EOL care. This allows one to
live the last stages of life with dignity.
Recent studies have shown that three out of every four patients
dying from cancer experience significant periods of pain
(Kirchhoff, 2000). Providing comprehensive care to the dying
patient also means that nurses should be familiar with methods
of treating distressing symptoms other than pain. These
symptoms: dyspnea, anxiety, depression, gastrointestinal
symptoms, anorexia/cachexia, delirium, and asthenia are common
to the dying experience and are too often inadequately or
poorly managed (Tomko, 2001). Improvement in positive
communication techniques with the patient and family is another
area that needs to be addressed. Nurses who care for seriously
ill or dying patients face complex clinical situations that
inevitably include profound human suffering. It could be a
soul-wrenching experience for nurses to watch a patient day
after day trying to cope with terrible pain or suffering.
Researchers have indicated that nurses often lack the requisite
knowledge and skill to effectively manage pain, despite their
ethical obligation to do so. Nurses report that fear of
hastening a death is secondary in their actions of
administering care. Their primary motivation is to achieve
adequate symptom control (Schwarz, 1999). Despite the
increasing need for the provision of skilled EOL care; nurses
are often unprepared to assume this important
role.
Cont'd
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