End of Life Care

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It was recognised by Jevon (2009) that caring for the dying patient can be the most fulfilling whilst also most challenging times for nurses and healthcare professionals. This paper will introduce a case study based on personal experience within clinical placement, exploring and analysing the above statement. In accordance with the Nursing and Midwifery Council Guidelines (2008) names have been changed to protect patient confidentiality. The paper will seek to address issues relating to the case study examining relevant theory. Current policies and guidelines will be considered in relation to the patient. It will identify a framework involved looking at literature to assess the effectiveness against the case study. Finally, focusing on a specific area of care, which in this case will be communication, the paper will evaluate the care given within the case study before providing a conclusion. Mrs Jones, a 65 year old lady diagnosed with lung cancer in July 2010, lived with her husband of 29 years. They had two grown up daughters that lived close by their home. When Mrs Jones first received the diagnosis by her consultant her family were present. After discussions it was decided that the best care option for them was to care for Mrs Jones within their home. More investigative tests revealed that the cancer had spread; with this her condition seemed to deteriorate. Although appreciative of the support they were receiving within their home, Mr Jones and his daughters were finding it difficult to control Mrs Jones symptoms and pain management. Following a family discussion enquiries were made regarding the possibility of hospice care. Hospice care has been described as providing humane and compassionate care for people in the last phase of incurable disease (American Cancer Society, 2013). Within two weeks Mrs Jones was admitted into their local hospice. Symptom and pain management issues were addressed and Mrs Jones seemed relaxed and free from pain and discomfort. Mr Jones and her daughters visited frequently, towards her final days they decided to reside in the family room within the hospice. When it was no longer possible for Mrs Jones to consume food or liquids a decision was reached by the multi-disciplinary network within the hospice to commence the Liverpool Care Pathway. The hospice staff took the time to sit with the family and explain how the pathway works allowing time for any questions or objections. Within 48 hours Mrs Jones died surrounded by her family. ‘We cannot take away the whole hard thing that is happening, but we can help to bring the burden to manageable proportions’ (Cicely Saunders, as cited inEllershaw & Wilkinson, 2003) this was a comment made during a seminar in 1962 and is thought to be an early attempt at challenging the way in which health professionals approach end of life care. End of life care has been defined by the National Council for Palliative Care (2006) as helping ‘…all those with advanced, progressive or incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support.’ Dame Cicely Saunders, founder of St Christopher Hospice in 1967 paved the way and had a major impact on changing people’s attitude and thinking regarding end of life care. Primarily a small sample of only four patients was chosen to experiment with drug dosages. This was to assess the impact of regular and consistent administration of medications. The results of this study indicated an improvement in quality of life. Consequently, since the work of Dame Cicely, end of life care has advanced, further studies undertaken by Professor John Hinton established a link between physical and mental distress of patients at end of life care. Professor...
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