Hospice is giving dignity, support and love to end of life patients. Hospice works with the patient’s pain to give the patient comfort, not to hurry death or hasten the dying process, but to relieve symptoms that are sometimes associated with grief and dying. In my experience, I have witness the positive effects associated with comfort care for both patients and love ones. Dying patients grieve for various reasons. Sometimes it is mentally, physically, emotional or psychological and it affects their love ones as well as their level of comfort. Our promise to every patient we take care of is “To provide exceptional care, to guide the patient and their family on their journey, and to respect their choices. Their comfort, needs and wishes come first. They can count on us when and where they need us” (Hospice and Palliative Care, 2013). …show more content…
I am a hospice nursing assistant and six years ago, I had to make an ethical decision at work.
In my field of work, I have to make ethical decisions on a regular basis under the supervision of nurses and doctors but this particular time it involved the stopping of liquids and food to the patient. The patient was still alert and able to sit, talk and even walk for brief periods. A swallowing test revealed that this patient was not able to safely ingest by mouth liquids or food so I was to do mouth care only with a fairly dry sponge swab. This was the patient’s only means of mouth stimulation. Some family members felt for whatever reason that this was wrong to do no matter what. How can we stave someone to death? That was a distorted view of hospice and defeated the whole purpose of our mission. Yet they were entitled to their
opinion. The family members had a very hard time understanding and accepting the doctor and nurse decision, therefore, as I was taking care of the patient, I was accused of starving the patient to death. I was looked at as refusing to give the patient food and drink. I found myself having to constantly reminding the family of the orders that were enforced, even though the patient was not affected by the outcome, in fact the patient was aware and agreed to the decision. The patient was aware that if he ate or drink anything, he was putting himself at risk of choking or collecting fluid in the lungs and aspirating. I had a duty and a right to the patient to assist in providing as much comfort as possible at this time in his life. It was my duty, my moral right to do my job in an ethical and professional manner. The patient died about two weeks later. While some of the family members came to understand the dying process and the reason to withhold food or drink, other family members did not, even up until the patient took his last breath. Was what I did ethical? Yes from a medical perspective, I did what was best for the patient. I did not hesitate or second guess any part of the decision. I experienced the horrible effects of a patient aspirating from food before and would not want that for any patient or family member to go through. Had the patient requested or a power attorney was requesting that we continue to give food and drink, then it would have been out of my scope of practice and geared to the doctor and nurse to evaluate. In this incident that did not occur, therefore I proceeded with the order. I also knew the consequences that would have resulted if I did not follow orders and the patient died from aspiration. That was the fact that outweighs the right to please the family. It was the right thing to do for the good of the patient, hospice, his family and everyone else that might have or would have been affected by opposition.
Final Gifts, written by hospice care workers, Maggie Callanan and Patricia Kelly, includes various stories detailing each of their life changing experiences that they encountered with their patients. Hospice care allows the patient to feel comfortable in their final days or months before they move on to their next life. This book contains the information considered necessary to understand and deal with the awareness, needs, and interactions of those who are dying. Not only are there stories told throughout the book, there are also tips for one to help cope with knowing someone is dying and how to make their death a peaceful experience for everyone involved. It is important that everyone involved is at as much peace as the person dying in the
God tells his children, “He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away” (Revelation). Death is one of the most frightening and confusing times a person can go through. Watching a loved one pass away is also one of the hardest trials a person can experience. Many people assume that death is a time of pain and the only thing that they can do is mourn and watch their loved one fade away from the earth. This is wrong. There are ways that people can turn a bad situation to good. Dying doesn’t have to be painful and full of suffering. The County Hospice staff makes sure of this. The Hospice staff not only takes care of passing patients physically, but they also take care of the patients emotionally and spiritually. Hospice staff also plays a key role in helping families during the grieving process.
Comfort care or palliative care is when a terminal patient is placed in a quiet room, where no medical interventions are done except morphine. The patients are not placed on any monitors, no vital signs or given prescription medications. Only the presence of families, periodic turning, swabs for dampening the lips, and perhaps restful music is around the patient. Comfort care is meant to allow a dying person a peaceful end, thus, morphine drip is added for pain relief. Stephens (2012), states that it’s the same medications used to control pain and discomfort, could be used to “help” the patient to stop breathing. The concept of terminal sedation assumes death as an outcome of the intervention.
After reading the different stories in the book “Final Gifts”, I believe I have a better understanding of the nurse’s role in caring for the needs of the dying patient and how their families need to be guided through this experience. The different stories in this book provide insight into the experiences of the dying as well as how their loved ones cope with their loss. The authors Maggie Callahan and Patrician Kelly, experienced hospice nurses who have extensive exposure to dying patients and their families, through their shared stories, paint a picture of what the dying want. To many, death is a difficult concept.
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
End of life pain management is an important function of hospice organizations. Families and patients alike are comforted by the fact that, at the end, there are resources which allow for a comfortable death. Much of the quality of hospice care is determined by patient family members. In 2005, the Brown Medical school conducted research with regard to t...
Palliative care is medical or comfort care that reduces the severity of a disease or slows its progress, but does not provide a cure (Dreeben, 2007). Different people have different needs when life is ending. Working with the incurable may sound depressing but death is a certainty and what we do each day for these patients as physical therapist assistants, matters. Providing care effectively and appropriately has a huge impact on the patient, therefore acquiring the ability to comfort and care for a patient at such a critical stage in life, is an amazin...
Being in hospice care is a better alternative than being stuck in the hospital to try to avoid the unavoidable. Common misconceptions about Hospice could include that hospice makes life more miserable; however, a physician expressed his findings in Hospice,“You can only fail a patient if you fail to understand and respond to their needs. We may not be able to cure all of our patients, but if we can make them comfortable in the last moments of their lives, we will not have failed them”..Hospice care gradually emerged in the 1970s, when groups like the National Hospice Organization were formed “in response to the unmet needs of dying patients and their families for whom traditional medical care was no longer effective.”Herbert Hendin, an executive director of the American Suicide Foundations illustrates a story of a young man diagnosed with acute myelocytic leukemia and was expected to have only a few months before he died. He persistently asked the doctor to assist him, but he eventually accepted the medical treatment. His doctor told him he can use his time wisely to become close to his family. Two days before he died, Tim talked about what he would have missed without the opportunity for a
The hospice aide’s job duties varies depending on the patient. If the hospice patient is in good condition, the job duties are very similar to that of the nursing home CNA. The hospice aide’s main goal is to maintain the patient’s dignity while providing the most comforting care possible. Many hospice patients are referring to as being on “comfort cares” – meaning if they don’t want to eat, they aren’t forced to. The hospice aide’s job is a hard one, as any CNA’s is, but perhaps more so, as they lose their patients at a higher
Hospice workers, likely more than any other group of care providers, deal with the desperation that many individuals feel when they accept the fact that their illness is likely to be the cause of their death. In that process, hospice staff deal not only with the physical pain of the illness, but also the emotional pain of facing leaving one's family, the social pain of enduring what may be considered indignities, and the spiritual pain associated with one's cultural and personal beliefs about life after death. Through an interdisciplinary approach that is unique to hospice care, patients who elect hospice receive treatment for all their concerns. Hospice caregivers have discovered three central reasons a terminally ill person may want to discuss suicide.
Hospice always patient and families the automaty to decide a choice of end of life care. It allows who prefer to end life in their homes, pain free, surrounded by family and loved ones: Hospice works to make this happen. The focus in on caring, not curing. Hospice utilizes an interdisciplinary team of healthcare professionals and trained volunteers that address symptom control, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Hospice is not “giving up,” nor is it a form of euthanasia or physician assisted
Vendlinski, S. & Kolcaba, K. (1997). Comfort care: A framework for hospice nursing. American Journal of Hospice and Palliative Care, 14(6), 271-6.
Some feel that a terminally ill patient should have a legal right to control the manner in which they die. Physicians and nurses have fought for the right to aid a patient in their death. Many families of the terminally ill have exhausted all of their funds caring for a dying patient and would prefer the option of assisted suicide to bankruptcy. While there are many strong opposing viewpoints, one of the strongest is that the terminally ill patient has the right to die in a humane, dignified manner. However, dignity in dying is not necessarily assured when a trusted doctor, whose professional ethics are to promote and maintain life, injects a terminally ill patient with a lethal dose of morphine.
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.
Palliative care involves the holistic care to maintain and improve the quality of life of the patient and family during hospitalisation until the terminal stage. Palliation of care refers to the multidisciplinary approach of providing comfort and support for the terminally ill patient and family, thus has an important role in maintaining and improving the quality of life of the whole family. Chronic illness such as cancer gives a physiologic and emotional burden for the patient and family. Education and counselling of the possible options as well as treatments for pain and other symptoms that could help alleviate anxiety, suffering and discomfort. Palliative care provides assistance for the family as a channel for communication between the