Personal and individual experience influences ones' ability to make decisions. As individuals we draw from those experiences and use them to learn and assist with future decision making. Those who have experienced death and dying are at a greater advantage to assist others through this process, however, how can we, as a profession, assist those who are not experienced to initiate end-of-life care discussions? This is a topic that needs continued attention for nurses to be better equipped to assist others and provide caring at end-of-life. The ultimate goal is for nurses to assist patients in a peaceful, caring death. society continues to make this difficult as a lack of care and additional treatments could be viewed as rationing healthcare. In our current healthcare system, a patient without an advance directive is left to rely on the wishes of their family. If the family insists on continuing care then we continue to provide care at any cost, whether futile or not. As healthcare providers, it is our responsibility to "pay more attention to the importance of developing skilled communication in end-of-life discussions and improve at moving patients and families into making end-of-life decisions that are more realistic in the face of futility" (Martinez, l., Pope, Tl, Day, L., & Sherman, D., 2009). Ultimately, "the patient has the right to be treated with respect and dignity and to determine what is to be done with his or her body" (Westrick & Dempski, 2009, p. 260). Additionally, we must be willing to accept other's viewpoints and decisions.
Florence Nightingale stated in her last letter addressed to her students in 1900: "Christ was the author of our profession. We honor Christ when we are good Nurses. We dishonor Him when we are bad or careless nurses. We dishonor Him when we do not do our best to relieve suffering - even in the meanest creature: (Phillips, 2006, p. 270). It is imperative that we, as nurses, involve our patients in their care as much as possible and acknowledge that they may not choose to follow all advice given for healthcare. The patient has the autonomy to decide what is their destiny as long as they have been provided with the benefits and risks associated with those decisions, and we must honor those decisions.
Upon completion of this course, I would like each of you to complete and advance directive for yourself to identify specifically what type of care and treatment you desire if faced with end-of-life care. The following is a website where you can obtain a free advance directive:
http://www.totallegal.com/livingwill2.asp
Finally, I would like each of you to answer the following two questions based on what you have learned and how you feel from the experiences in this class.
1. As a nurse, what would you consider to be a major challenge for you professionally when dealing with end-of-life care issues? How would you attempt to overcome these challenges?
2. Considering what you have learned about end-of-life issues surrounding adults, how would your view of end-of-life care differ if associated with a pediatric patient?
I hope that this class has provided some insight for each of you in the reconciliation of your feelings toward caring for end-of-life care patients. Best of luck to each of you. I anxiously await your responses to the above questions.
References
Martinez, L., Pope, T., Day, L., & Sherman, d. (2009), May). Controversies abound in end-of-life decisions... Medical futility, personal goods, and social responsibility. American Journal of Critical Care, 18(3), 279-282. American Journal of Critical Care. 18(5), 401-403. Retrieved from CINAHL Plus Full Text database.
Phillips, S. (2006). Ethical decision-making when caring for the noncompliant patient. Journal of Infusion Nursing 29(5), 266-271. Retrieved from CINAHL with Full Text.
Westrick, S.J., & Dempski, K. (2009). Essentials of Nursing Law and Ethics. Sudbury, Ma.: Jones and Bartlett Publishers.
Tuesday, July 3, 2012
Monday, July 2, 2012
Money? More or Less?
Think back to the initial Youtube Video published in the first blog. Although this was an exaggeration, those of us who have worked in a critical care setting know that some of what was depicted is not that far from the truth.
Today, while at work and caring for a very critically ill patient post open heart surgery, I found myself wondering what are the costs of the care we are providing and will this patient be able to survive this?
What is the cost of hope? Modern medicine has become so proficient at keeping the terminally ill alive that the inevitable process of dying is prolonged (cbsnews, 2010). It has been estimated that one third or out overall healthcare resources are spent in the last year of life (Harding, 2010). Medicare paid $55 billion dollars for the last two months of patient's lives. This accounts for more that the entire budget for Homeland Security. Furthermore 20-30% of these expenses have no meaningful impact (cbsnews, 2010).
Are we saving individuals with improved medical technology or are we preventing individual from dying a natural death?
Ask yourself, what is worse: having a loved one die or having a loved one die badly? It is well documented that most individuals would prefer to die at home. The reality is that 75% die in with hospitals or nursing homes (cbsnews, 2010). And remember back to our first video the Hospitalist vs the ICU end of Life Palliative Care: once a patient is admitted into the hospital, several consults and physicians order a multitude of tests in which many are not essential.
Communication and explanations are necessary to clearly identify a patient's wish for end of life care and potentially reduce the costs of dying or better termed the costs of hope.
Think of the savings, both money and quality associated with dying, that could be obtained if open conversations could take place to clearly identify individuals' wishes.
References
Harding, A., 2010. End-of-life care costs continue to climb upward. Retrieved from http://www.teuters.com/assets/print?aid=USTRE69C3KY20101014
The Cost of Dying: End-of-Life Care. 2010. Retrieved from http://www.cbsnews/2102-18560-6747002.html?tag=contentMain;contentBody
Today, while at work and caring for a very critically ill patient post open heart surgery, I found myself wondering what are the costs of the care we are providing and will this patient be able to survive this?
What is the cost of hope? Modern medicine has become so proficient at keeping the terminally ill alive that the inevitable process of dying is prolonged (cbsnews, 2010). It has been estimated that one third or out overall healthcare resources are spent in the last year of life (Harding, 2010). Medicare paid $55 billion dollars for the last two months of patient's lives. This accounts for more that the entire budget for Homeland Security. Furthermore 20-30% of these expenses have no meaningful impact (cbsnews, 2010).
Are we saving individuals with improved medical technology or are we preventing individual from dying a natural death?
Ask yourself, what is worse: having a loved one die or having a loved one die badly? It is well documented that most individuals would prefer to die at home. The reality is that 75% die in with hospitals or nursing homes (cbsnews, 2010). And remember back to our first video the Hospitalist vs the ICU end of Life Palliative Care: once a patient is admitted into the hospital, several consults and physicians order a multitude of tests in which many are not essential.
Communication and explanations are necessary to clearly identify a patient's wish for end of life care and potentially reduce the costs of dying or better termed the costs of hope.
Think of the savings, both money and quality associated with dying, that could be obtained if open conversations could take place to clearly identify individuals' wishes.
References
Harding, A., 2010. End-of-life care costs continue to climb upward. Retrieved from http://www.teuters.com/assets/print?aid=USTRE69C3KY20101014
The Cost of Dying: End-of-Life Care. 2010. Retrieved from http://www.cbsnews/2102-18560-6747002.html?tag=contentMain;contentBody
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