END-OF-LIFE
CARE: -Part 2
ARE NURSES EDUCATIONALLY PREPARED?
There is little evidence of a coming together of providers from service delivery, education, and research.
Consequently, those concerned with ensuring an optimal quality of life for persons dying or living with a life
threatening illness are provided with little direction regarding their practice. There is an obligation to provide
comprehensive and compassionate EOL care which includes the promotion of comfort and the relief of pain, and at
times, foregoing life-sustaining treatments. Influence of managed care and lack of continuity of care were
described as most ranked barriers to end of life care (Ferrell, 2000). Providing excellent care for a dying patient
is something all patients deserve. It is important to remember that most patients want to prepare for death, if at
all possible. Everyone does this his or her own way, but oftentimes concern about pain and symptom management
interferes with this very involved and valuable process. Being prepared to treat these symptoms as well as
addressing your patients’ emotional needs is imperative. In the end, there is much that we have to offer a dying
patient. Efforts should not stop because the illness cannot be cured. So much can happen to someone in the window
of time between terminal diagnosis and death. Making this period one in which a person is as mentally clear,
physically comfortable, and symptom free for as long as possible is a goal that is worthy of our efforts.
The need for improvement in communication with patients and family, and the need of more education and support in
nursing are important issues in providing EOL care. Nursing practice, education, and research must embrace and
respond to these changing demographics, and nurses must focus on spiritual-psychosocial health as well as the
physical health of the population (Heller, 2001). Undergraduate education provides the foundation for nursing care,
including EOL care. Educational programs should focus on addressing the problem of stable misinformation. In
addition, education should offer didactic information and role modeling to skillfully incorporate EOL care planning
into clinical practice.
B. History of End-of-Life Care
Ancient hospices or hospitals (the two were one for a number of centuries) provided sanctuary for the poor
wayfarer, the sick and dying, and the woman in labor, the orphan, the needy, and the religious pilgrim. Medieval
hospices were generally run by religious orders, serving the Lord by serving His poor, His sick, and those in need
of shelter. The Knights Hospitallers of the Order of St. John of Jerusalem in the twelfth century C.E. offered aid
to pilgrims and the sick throughout Europe. If hospice workers were unkind to patients, or neglected them in any
way, the workers were whipped and condemned to eat bread and water for a week (Buckingham 1996). The records of the
Knights Hospitallers show their efforts to maintain their ideals and goals, despite increasing wealth and land
holdings. At their hospice, or hospital in Rhodes, the incurably ill were sheltered and cared for apart from those
with other illnesses, in a group of rooms reserved for travelers and pilgrims.
Dying was once viewed as a natural and expected part of life. Since, in the medieval worldview, life and death were
each considered part of the same mortal process, pilgrims and travelers were housed together with the dying. All
were on a journey, and therefore needed a place to stop for comfort. The news that the travelers brought them from
the outside world was of value. The dying was also valued as individuals and as beings that were on the road to a
higher plane of existence.
With the forced closure of monasteries in many countries during the Reformation, the concepts of hospice and
hospital gradually became distinct. Today, the responsibility of caring for the sick and dying, formerly a private
or religious one, has become a public or government function. The modern hospital increasingly has the look and
feel of a laboratory. The bureaucracy needed to support the hospital system places increasing demands on the time
and energy of medical and nursing staff as well as patients. The modern hospital, thought well equipped to aid in
an acute, life-threatening situation, is seldom in a position to offer comfort to a traveler who is nearing his or
her journey's end.
Now, after a lapse of several centuries, EOL care ideals are emerging again in the care for the dying and their
families, due in large part to the work of Elisabeth Kubler-Ross in the United States. Two fundamental difficulties
had to be faced: the American medical community's existing terminal care policy and the bureaucracy of contemporary
health care. Many in the medical establishment expressed doubts at first, thinking that EOL care would be
unacceptable in this country. Planners of EOL care were told that, "When Americans are sick, they want to be in an
acute care hospital with all the technological advances available. Nobody wants to die in this country; the society
isn't set up for it"(Buckingham, 1996). But, the response of patients and families has proven otherwise. A service
emphasizing care rather than technology can be accepted by both lay people and professionals. Evaluation studies
done between 1974 and 1976 show that EOL services measurably benefit patients and families.
Cont'd
Back to Top
| 
Digg
Facebook
Google Bookmarks
Stumbleupon
Livejournal
Twitter