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 deathâ 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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