The article that I selected from the Journal of Hospice & Palliative Nursing focuses on studying the implementation of statement cards to facilitate end-of-life discussion. The purpose of these discussions is to allow for a patient to discover and share what he or she finds important during the end of life. Healthcare practitioners, patients, and families often struggle with having open discourse on death and dying due to the pervasive sense of unease that surrounds this topic. Healthcare staff, to include nurses, are instrumental in assisting patients and families through the end of life process. The study found that patients felt more open to discussing difficult topics when introduced to these topics through the cards. This may prove to be an essential tool in evaluating not only palliative care patients but hospice patients as well.
fishbone_template_Melissa_Pelkey
Journal Club Critique Form Melissa Pelkey
Throughout the United State families are more open about using alternative methods to facilitate care during palliative or end of life care. Your research article shows how some patients use statement cards to verbalize their wishes during palliative care. To me, communication is the key during patient care. Some health care professionals do have a hard time verbalizing end of life care to their patients, so using other communication tools will help to decrease stress between both parties. As healthcare providers, we must consider what end of life care means to families and use that to come up with better methods of communication. I found an article that expresses how significant a dying person’s wishes and priorities are. The article also mentioned how end-of-life dreams and visions (ELDVs) are prevalent experiences that provide comfort and meaning to dying individuals and continue to say, “at the bedside, loved one’s regard ELDVs as fascinating, puzzling, but most importantly, a source of personal and spiritual solace.” Although the end of life dream/vision can be positive, negative or mixed, many believe it is positive. However, whether palliative or hospice care its important for health care providers to grant the patients their dying wish. It is also important for families to maintain dignity and spend their final moments in a peaceful environment. Good research.
References:
Grant, P. C., Grant, P. C., Depner, R. M., Levy, K., LaFever, S. M., Tenzek, K. E., … Holland JM. (2019, December 23). Family Caregiver Perspectives on End-of-Life Dreams and Visions during Bereavement: A Mixed Methods Approach. Retrieved from https://www.liebertpub.com/doi/full/10.1089/jpm.2019.0093
End of Life Dreams and Visions(ELDVs)are often one of the most difficult things for a patient’s family to handle. I am speaking purely from anecdotal experience here with several patients in mind. I belong to a professional discussion board, and we have had numerous conversations about the visions that people see and the various family reponses we have witnessed. There are times when even the nurse is affected by the patient’s visions and/or dreams. Common themes of ELDVs are visitations by the already deceased, interaction with the spiritual realm (seeing angels or demons), and preparing to complete unfinished business. One study discussed that “despite research and anecdotal evidence that ELDVs provide comfort, medical professionals who are not comfortable with or experienced in end-of-life care often have difficulty accepting them as inherent to the dying process (Nosek, C. et al, 2014).” Having families who are ill prepared to bear witness to their loved one’s dreams/visions creates difficulty for the patient, the family, and potentially the nurse.
Nosek, C., Kerr, C., Woodworth, J., Wright, S., Grant, P., Kuszczak, S., . . . Depner, R. (2015). End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients. American Journal of Hospice and Palliative Medicine®, 32(3), 269-274.
A nurse’s role at the end of life is crucial to a patient while maintaining professional boundaries they must promote comfort, relief and support families. During nursing school I remember having lectures on end of life, but no clinical experience in palliative care. Exposure to end of life care is often times limited, resulting in few opportunities to learn these skills. As suggested in your article, the addition of conversation starting cards as a tool would not only benefit the patient but family and nurses as well. In researching this further, I came across an interesting article that could increase nurse education and increase end of life communications. The article suggests, end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care. (Kunkel, Kopp, Hanson 2016) By using an assessment tool, researchers were able to explore nurse’s self efficacy level follow simulation. The simulation proved as an effective and sustainable teaching modality for enhancing ability to inform and provide high quality care during end of life.
Melissa,
Are you currently working in hospice? Do you feel you were adequately prepared upon entering the profession?
Kunkel C., Kopp W., Hanson M. (2016). “A Matter of life and Death: End of Life Simulation to Develop Confidence in Nursing Students. Nursing Education Perspectives. 2016; 37(5) : 285-286
To answer your questions, I recently resigned from my position as Administrator of a Home Health and Hospice so while I am not presently working in hospice, all of my most recent experience is in that area. I can say that I was ill-prepared to work in hospice or palliative care. I do remember learning some very basic information about death and dying (Elizabeth Kubler-Ross) but it does not seem to me that even in nursing school, we were hesitant to have an open discussion about the realities of death. In retrospect, I am not sure how one can adequately be prepared for some of the tasks that hospice nurses perform even if provided a clinical rotation. Every death I have witnessed or pronounced has been different in its own way. There are the biological aspects of death that are mildly predictable, but there is no reading assignment that can sufficiently prepare someone to deliver compassionate family-unit-based care. Now that I am no longer working in hospice, I am grateful for the experience, and I do feel as though it has helped me to be able to politely yet firmly introduce the discussion when appropriate. Death is inevitable and yet has so much stigma attached. Hospice works best when not introduced in the eleventh hour as it allows the nurse and patient and family to establish rapport and a comprehensive care plan that facilitates meeting the patient’s needs. Studies have shown that when end of life discussions begin earlier in a patient’s course of illness with expected terminality, it improves their quality of life without diminishing hope (Prone, C., 2013).
Prone, C. (2013). Towards a “good death”: Discussing transitions in care with patients facing advanced disease.(Eytan Szmuilowicz at the nursing symposium). Journal of Gynecologic Oncology Nursing, 23(1), 8.
End of life care is one of the most personal care a nurse can provide the patient and the patient’s family. In order to provide a holistic person-centered care its critical for the interdisciplinary team to really understand the patient and their family wishes and preference. Having an additional effective tool like the cards from the study to help facilitate the conversation is essential.
Study conducted by Periyakoil et al. (2015) revealed almost all the doctors in our study reported barriers to conducting effective end of life conversations with patients and 85.7% stated that conducting end of life discussions with patients was very challenging.
Periyakoil, V., Neri, E., & Kraemer, H. (2015). No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients. 10(4), E0122321.
The end of life can be a difficult situation for both staff and families. Getting more resources and education available for both staff and families would be very beneficial for everyone involved. Working in a rural hospital now, we do not have a palliative care team here; therefore, the rest of us staff have to be more knowledgeable in the end of life care, options, resources, etc. to be able to assist the pt and families the best we can. Scholars that have researched end of life have provided evidence that “communication is important for terminally ill individuals, family members, and healthcare/palliative care specialists. This research exploring communication at the end of life is especially relevant because every person experiences the death and loss of loved ones and ultimately faces the reality of their own death. When the terminally ill and their loved ones have the opportunity and the openness to freely talk about what is on their minds and hearts at the end of life, the end results is often the relief of stress, peaceful interactions, and greater readiness for the impending outcome. It is through communication where peoples’ true wishes are heard, understood, and followed that their loved ones are left without regret. True regret comes from what is not communicated at the end of life.” Great topic and good job.
Reference:
Keeley, M. 2017. Family Communication at the End of Life. Behavioral Sciences. 7(3):45. doi: 10.3390/bs7030045. Retrieved on February 29th from http://www.ncbi.nlm.nih.gov.
Statement cards sound like a great idea. The patient can pull out the cards that express ideas with which they identify. For some families, sharing the cards may be easier than simply saying, “let’s talk about this”. It makes such a difference if the family is on the same page and supportive of the choices and needs of the dying person. I am grateful for opportunities to provide end of life care. Helping someone to have the best death possible seems monumentally important and you only get one chance at it. Our skilled unit occasionally has a patient who has come to stay with us while they die. It is always much more difficult if the family didn’t discuss death and how they want their dying to be managed or are in disagreement about what the patient “would have wanted” after the patient can no longer communicate. These things are important to discuss before the patient can no longer speak. One website with helpful information for healthcare providers and family members is the The Conversation Project at https://theconversationproject.org/
Having the discussion is hard. No one wants to think of someone they love dying. For me, it was my Grandfather. I still remember him asking me if he could go meet the good Lord. How could I say yes, how could I say no. We selected hospice to help him through his final days. We selected hospice due to the fact that we were tired of seeing my grandfather in so much pain. Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease.
For grandpa, it was kidney disease.
Enrolling in hospice care early helps you live better and live longer. Hospice care decreases the burden on family, decreases the family’s likelihood of having a complicated grief and prepares family members for their loved one’s death. Hospice also allows a patient to be cared for at a facility for a period of time, not because the patient needs it, but because the family caregiver needs a break. This is known as respite care. For grandpa, we did not get him in early enough because his life was dependent on dialysis. Admitting him to hospice we had to take him off dialysis, so we knew it would only be days. It was a hard choice, but one I would always remake.
Hospice care: Comforting the terminally ill. (2019, January 30). Retrieved March 1, 2020, from https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050