How can this healing impact become a more prominent part of healthcare? Who should be educated first on how to take care of this patient population? Nurses. “Studies indicate that nurses spend more time with patients at the end of life than any other health care discipline (K. M. Foley & Gelband, 2003). So it is imperative that nurses be educated so they can provide this high-quality end of life care (Wallace 2009). Both novice and experienced nurses often do not feel competent or confident in caring for dying patients. End of life care can be challenging in the best of circumstances, a nightmare in its worst. Nursing educators, in schools and in the field, have a responsibility to educate nurses about end of life care. Knowledge will give to nurses the ability to better understand this difficult part of nursing and hopefully the competence to maintain the continuum of care. Nurses can also extend this education to patient’s families and to other healthcare workers including physicians. Teaching is a vital and dynamic part of nursing, it can change and improve patient outcomes, even at the end of life. For the patient, a nurse who understands the process of dying, offers comfort and care that makes the time left easier. Small things, such as good oral care, smoothing out wrinkles in the sheets, or just quietly holding their hand are eloquent, gentle nursing care. The confidence that the nurse possesses can decrease the stress for the family. Nurses are the liaison between the staff, physician and family. “Research suggests that seriously ill, hospitalized patients and their families want alleviation of physical distress, some control over their health care decisions, prevention of death-prolonging procedures, improvement in familial relationships, and reduction in caregiver burden.” (Gelfman 2007) Again, the importance of the nurse’s interaction with patient and family is critical. Since the nurse spends more time with the patient, she can assess and utilize the resources offered by a palliative care team. “…palliative care programs reduce symptom distress, improve patient and family satisfaction, and reduce hospital length of stay, costs, and utilization.” (Gelfman 2007) Data from studies suggest “that people dying in institutions have unmet needs for symptom amelioration, physician communication, emotional support and treatment perceived as respectful.” (Gelfman 2007) Families who witness their loved ones in serious distress often suffer psychiatric illnesses and functional impairments. “Additionally, Azoulay et al. fount that post-traumatic stress reaction was common in family members of ICU patients.” (Gelfman 2007) If hospitals are to be a place of healing, then the quality of care cannot end when the patient becomes incurable and is dying. Nurses must be competent and comfortable performing quality end of life care, not just for the benefit of the patient and family, but for themselves.

“In approaching this paradox it is necessary to restate the most fundamental tenet of the hospice or palliative approach to care: Dying is a part of living. The period of time referred to as dying can, therefore, be considered as a stage in the life of the individual person and the family. Modern psychological theorists, among them Erik Erickson, Jean Piaget and Abraham Maslow, whose work collectively forms the basis of modern behavioral medicine, all asserted that human development is a life-long process.
  There is a tendency within contemporary culture and reflected in medical practice to assume that on receipt of a terminal diagnosis meaningful life has ended. Within this perspective the person is constrained to wait for death, being reduced to hope only for some measure of comfort and to avoid being a burden to others. This attitude is incongruous with the basic philosophy of modern palliative care for it inappropriately devalues and separates this last stage of living from the continuum of a person's life.
  It is useful to conceptualize dying as a stage of the human life-cycle, comparable to infancy, childhood, adolescent, adulthood and advanced age. While individuality, of course, extends through the very end of life, characteristic challenges, or developmental landmarks, can be discerned and representative task work toward achievement of these goals can be identified.” (Byrock 1996)

  Healing is defined as: to cause (an undesirable condition) to be overcome (Merriam-Webster online dictionary). Impact is defined as: a measure of the tangible and intangible effects (consequences) of one’s things or entity’s actions or influence on another (Business Dictionary.com). A healing impact on healthcare is the goal of palliative care. We are born, live and we die, this cycle will never change. Healthcare can no longer ignore and push aside the final chapter of human life, it must turn and face the challenge of responding to the needs of the population, especially the aging population. Leonard Di Vinci said, “As a well-spent day brings happy sleep, so a life well spent brings happy death.” As a society, as healthcare professionals, as sentient beings, we are obligated to meet the needs of those who are at the end of their life with the healing impact of palliative care.

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