Case Study on the End of Life Care

Case Study on the End of Life Care

Catherine, a 48-year old patient, is brought to the hospice awaiting a hospital bed. She has a medical diagnosis of Right Breast cancer but is not aware of her diagnosis. The affected breast has a huge wound that is foul smelling. On general examination, she is very thin, weak and is unwilling to talk. She is also single and lives with her mother. In this paper, I will discuss the end of life nursing care on the support of patients and their significant others during stressful situations such as breaking bad news and cases of unexpected death. I will further explore how a nurse can empathetically manage patient’s emotions, for instance, anger, anxiety and hopelessness. Lastly, I will discuss on Nursing care and support that can be provided to patients’ and their significant others during the stage of imminent death.

Supporting Patients and Significant Others during Critical Moments

Critical moments include diagnosis of a terminal illness, dying, death and bereavement. In such situations, a nurse has to break the bad news to the patients and their families, although the news will

Case Study on the End of Life Care

Case Study on the End of Life Care

extreme and negatively alter their view of the future. The bad news is determined by the gap between the patient’s expectation and the reality of the situation (Bousquet et al., 2015). Before breaking bad news, the nurse should prepare by having all the information about the patient’s diagnosis and history (Mishelmovich, Arber, & Odelius, 2016). The environment should also be conducive, and the patient should be relaxed and have a helper.

The client should be informed that it is not good news, and the information should be given in a simple language and should be honest and accurate. The nurse should also constantly check the client’s understanding during the conversation and should also assess the amount of information the client needs (Mishelmovich, Arber & Odelius, 2016). Additionally, the nurse should be willing to repeat from the start, offer extra information if requested, and also allow time for the client or family to take in the given information.

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 Before terminating the session, the nurse should inquire if there are any concerns at that specific time and offer

Case Study on the End of Life Care

Case Study on the End of Life Care

helpful information and the nurse should refrain from making false promises (Mishelmovich, Arber, & Odelius, 2016). In the case of Catherine, I will help her settle and enquire from her what she knows about her condition. I will then inform her and her mother of her actual diagnosis, explain the disease process in a layman’s language, possible interventions and the effect of the condition on her quality of life. Any concerns will also be addressed, and I will further inquire if they have any questions. Lastly, I will plan for a future session with them to offer emotional support.

Discussions on ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACR) with patients and families ought to be initiated by nurses. Patients with terminal illnesses are likely to have a DNACR order, as they understand the disease burden (Osinski, Vreugdenhil, Koning & Hoeven, 2017). As a result, the nurse should ensure that the patient’s order is documented and reviewed. Furthermore, nurses have a duty to support patients’ or their next of kin’s decisions on the choice of natural death as long as it holds the principle of non-maleficence.

Handling Patient’s Emotions with Empathy

Empathy is the ability to recognize another person’s emotional state, experiences and thoughts without them openly expressing their emotions (Ruiz-Junco & Morrison, 2019). Being empathetic involves trying to be in the type of world the client is and asking oneself “what if it was me?”  Patients handle difficult situations with different emotions such as being anxious, angered or losing hope. Besides, emotions come as a result of fear of death, excruciating pain, body alterations, financial costs and loss of dignity, control, and independence (Goldsmith & Ragan, 2017). Patients who are empathetically understood can trust and recognize themselves and make positive behavioural changes. Consequently, nurses should help patients and their families to accept the situation, experience pain, adjust and move on.

Moreover, patients should be allowed and given time to express their emotions in their unique ways. Positive body language, such as the use of hands and facial expressions, should be adopted to portray a positive attitude (Ruiz-Junco & Morrison, 2019). Positive body language gives hope and shows that you love, appreciate and concerned about the patient. Additionally, nurses should practise the art of attentive listening when communicating with patients and their families (Goldsmith & Ragan, 2017). Attentive listening helps in detecting a depressed or anxious client who needs counselling and encouragement.

Providing Nursing Care and Support at Stage of Imminent Death

Death is a normal stage of life, and every individual should be allowed to have a peaceful and dignified death. However, during the dying process, patients should be provided with interventions to relieve pain and control symptoms. The aim of palliate care is not to cure but to improve the quality of life and have a dignified death with minimal suffering (Bousquet et al., 2015). Consequently, palliative care should be offered in a manner that is sensitive to the patient’s culture.

The family members should receive explanations regarding some of the signs of imminent death as a preparation process (Holm et al., 2015). Besides, the family should be assured death is not always a painful process. Family members should be informed that their presence can be a source of comfort and hope to the patient (Holm et al., 2015). They should also be encouraged to talk to the patient even though he or she is too weak to respond. Lastly, the family should be encouraged to say goodbye at the bedside when the patient dies, and professional counselling should be offered to ease the grieving process.

Conclusion

In summary, a nurse should adequately prepare before breaking the bad news to patients and their families. This is by preparing a conducive environment and finding out any information that they have. The nurse should also allow the patient to express their emotions and should handle these emotions with empathy. Moreover, nurses should use positive body language and attentive listening skills when communicating with patients and families. Lastly, patients and family members should be offered end of life care and taken through the dying and grieving process. By doing these, the end-of-life care offered will ensure a less painful death to the family members and even the patient.

References

Bousquet, G., Orri, M., Winterman, S., Brugière, C., Verneuil, L., & Revah-Levy, A. (2015). Breaking bad news in oncology: a metasynthesis. Journal of Clinical Oncology33(22), 2437-2443.

Goldsmith, J., & Ragan, S. (2017). Palliative care and the family caregiver: trading mutual pretence (empathy) for a sustained gaze (compassion). Behavioral Sciences7(2), 19.

Holm, M., Henriksson, A., Carlander, I., Wengström, Y., & Öhlen, J. (2015). Preparing for family caregiving in specialized palliative home care: an ongoing process. Palliative & supportive care13(3), 767-775.

Mishelmovich, N., Arber, A., & Odelius, A. (2016). Breaking significant news: The experience of clinical nurse specialists in cancer and palliative care. European Journal of Oncology Nursing21, 153-159.

Osinski, A., Vreugdenhil, G., de Koning, J., & van der Hoeven, J. G. (2017). Do-not-resuscitate orders in cancer patients: a review of literature. Supportive Care in Cancer25(2), 677-685.

Ruiz-Junco, N., & Morrison, D. R. (2019). Empathy as Care: the Model of Palliative Medicine. Society, 1-8.