¶ … Life Care
End-of-life care may be one of the most difficult aspects of healthcare services. After all, the goal of most healthcare providers is to heal, and providing end-of-life requires a shift in perspective. One of the challenges in planning end-of-life care is that many healthcare providers are simply not comfortable discussing end-of-life (Detering et al. 2014). Fortunately, when providers take targeted classes with the goal of improving their ability to engage in end-of-life discussions, they self-report feeling more comfortable having these conversations (Detering et al. 2014). As a result, prior to ever working with a patient to help plan end of life care, any professional should make sure and take the classes necessary to help them with those decisions, including classes that are specific to racial, cultural, or social issues that might be linked to a specific group. This is important because different cultures approach death and dying in very different ways, which may necessitate a different approach based on the individual client.
Advanced Care Directives
Perhaps the most important thing to know when working with a patient at the end-of-life is whether or not the patient has prepared any advanced care directives aimed at transitioning from life to death. If the patient has provided a written documentation of the patient's wishes, then it is the duty of the healthcare provider to respect those wishes insofar as it is possible within the confines of the patient's physical circumstances as well as any legal or ethical rules that might prohibit carrying out any of the patient's wishes. If there is a conflict between what is possible and what the patient has requested in an advanced care directive, it is important to discuss that conflict with the patient, if possible, as close in time...
Moreover, if the patient has not prepared an advanced care directive, if the patient is still lucid, competent, and capable of decision-making, then the patient should be encouraged to prepare detailed instructions about end-of-life arrangements. This is true even if the patient and his or her family members have made assumptions that they know how they want to face the end-of-life challenges. Different diseases rob patients of different things at different rates. Therefore, it is critical to discuss specific end-of-life decisions with patients with reference to their condition. This is because, in many instances specific treatment decisions do not align with general treatment goals, particularly if the patient is facing a disease including a component of cognitive decline (Evans et al., 2014).
Physical
Perhaps the most basic goal of palliative end-of-life care is to eliminate or reduce pain for the patient. Furthermore, pain reduction goals are different with patients who are dying than with patients who are expected to recover, because the prescriber does not need to worry about addiction arising secondary to pain treatment. Physical care and comfort goes beyond medication. Patients may need to be moved at regular intervals to avoid the build-up of pressure sores. Moreover, many patients find that they are unable to provide basic self-care for hygiene, but may have concerns about cleanliness. The nurses need to work with patients to help them with waste elimination in a manner that helps preserve patient dignity, which can prevent physical challenges for the nursing staff.
Psychosocial
Most end-of-life patients will have family and friends present during the dying…
