Nursing Roles in End of Life Care

Health care professionals, particularly nurses, are guided by a Code, which obliges them to show compassion, respect for human dignity and the rights of their clients or patients, especially those at the end of life. How they manage the inherent needs of elderly or end-of-life patients for that compassion and respect has significant impact on the outcome and quality of care nurses extend. There may be limitations of resources in the hospital or care setting, which incline nurses to certain un-appropriate behavior or remarks, but a patient's interests and rights are always of primacy over other considerations in the workplace. They also need to address the proper and prompt use of two legal documents, the Patient Self-Determination Act of 1991 and a Durable Power of Attorney for Medical Care, to prepare them for the difficult end-of-life event and its consequences. Surveys also showed that African-American elderly and others nearing the end of life are most in need of that compassion and respect as leaders of their community but which they feel is denied them in care settings because of racism and discrimination.

Literature Review

Arino-Blasco, Sergio. Dignity and Older People - the Voice of Professionals. Quality Ageing: Pavilion Publishing Ltd. (Brighton), 2005

The author writes about a study conducted on the views by 424 health and social care professionals in six European countries on the aspects of dignity and older people and how these professionals can provide better dignity-enhancing care for these clients. The surveyed professionals expressed their views on dignity, on older people, working with older people, dignified care, undignified care, the system, guidance and education for dignity. According to the participants, dignity is particularly important to older people on account of their vulnerability, so that patient-professional relationships, which focused on individual dignity, bore positive effects on the patient's care and cooperation. The participants in generally painted a gloomy picture of the frailest elderly and found that those who violated the dignity of the elderly created barriers to their dignified care. They said that a care sector with low value, a lack of respect and lack of funds would tend to turn into impoverished and unsuitable environments for these elderly patients. This condition, would in turn, reduce the workforce and increase its workload. The majority of the participants also said that personal skills and professional values, communication and behavior had impact on the dignified care of the elderly. While they acknowledged this, they also emphasized that the system and the scarcity of resources often pushed them to the edge and at time led some of them to become insensitive to the needs of elderly patients, whose dignity and self-respect could have been damaged by the situation. All of the participants said that they had little or no education on the provision of dignified care yet they were expected to automatically know how to provide it. At present, the aging population needing this type of care has been increasing and the expectation for the care has similarly been growing. Health professionals are challenged to seriously consider specific concepts, such as dignity, ageism, values, communication, holistic care and human rights, in their practice. but, as it was, they said that existing guidelines, rules and protocols touched on dignity only in relation to etiquette. In general, they pointed to the lack of resources, rather than the lack of education or other measures, as the greatest cause of stress among them, which tended to impact on the type of care they provided the elderly who were most sensitive to a sense of dignity as they felt near the end of life. These indignities associated with old age drew from ill health, dependency, vulnerability, frailty and loss of competence and their being left behind current technological advances and information technology. The surveyed professionals identified promotion of autonomy and independence, a person-centered and holistic approach, the maintenance of identity and encouragement of involvement, participation and empowerment, effective communication and respect as the essential factors to dignified care. Undignified care was associated with invisibility, de-personalization and regard as an object, humiliation, abuse, narrow and mechanical approaches to care

New Mexico Nurse. Code of Ethics for Nurses with Interpretive Statements. Part I Sections 1 to 2 of 9, 2005

This code establishes that the nurse, in all her professional relationships, is to show compassion and respect for the inherent dignity, worth and uniqueness of each person, particularly the patient or client, irrespective of social or economic status, personal attributes or the nature of the illness. She must show compassion and respect in her relationships with all patients, whatever the patients' human needs and values, lifestyle, value system and religious beliefs, whether she approves of these or the patients' individual choices. She must respect them as persons. The respect extends to supportive care needed by the elderly and the dying, Nursing care is particularly needed in the care of patients and their families at the end of life in preventing and reliving the symptoms and suffering associated or common at the end of life. She must actively participate in the assessment and assurance of the responsible and appropriate use of interventions to minimize unwarranted or unwanted treatment and patient suffering. She should provide interventions to relieve pain and other symptoms even if they would entail risks of hastening death. But she may not make choices to end a patient's life based on compassion, respect for his or her autonomy and quality of life concepts. She must recognize the patient. She must know the moral and legal rights of the patient to self-determination and must only assess the patient's understanding of the information and the implications of his or her decisions. The code establishes the primacy of the patient's interests over other interests and must collaborate and cooperate with other members of the team in a concerted effort to attain the shared goal of the patient's health needs and the needs of the public.

Johnson, Mary E. The Ultimate Advocacy Role. AAACN Viewpoint. American Academy of Ambulatory Care Nursing, 2003

Johnson writes that the end of life care by nurses involves more than providing compassion but involves two very important legal documents, namely the Patient Self-Determination Act of 1991 and a Durable Power of Attorney for Medical Care. The first poses a challenge to the nurse in her understanding and grasp of the end-of-life care of the patient. Most clinics today are fast-paced and with limited resources, decreasing the time needed for in-depth discussions. The ambulatory nurse may begin to inform or educate patients about end-of-life matters and issues by providing them with these two documents at the waiting area. When she, the patient and the patient's family become aware of the legal documents, they can look for an attorney for appropriate assistance.

Turner, William L. The Last Mile of the Way: Understanding Caregiving in African-American Families at the End of Life. Journal of Marital and Family Therapy: American Association for Marriage and Family Therapy, 2004

Using in-depth interviews and focus groups consisting of 88 African-American family caregivers, the author presents the findings that African-American family have some special end-of-life concerns and profiles of a different care-giving picture than that on which current care is based on. It points to persistent sources of mistrust in the healthcare system, which has cried out for attention and real action. It must incorporate values, which give importance to the African-American community. Family practitioners, especially marriage and family therapists, can play an important role in helping these families obtain the support they need and desire especially at the end of life. The status of African-Americans has also been often correlated with age, wherein the African-American elderly is viewed as the backbone of the family. As such, the elderly need to feel respected, highly valued, experienced extended…