Palliative Care: Providing a Good Death in the ICU
Discussing end of life care with patients is important, as it makes certain the patient’s wishes and their control over their care decisions even when they may no longer be too ill to be involved with them. Sad to say, these decisions and the wishes of patients do not occur and when they do, they are not done effectively. Advanced care planning for end-of-life care is a process of communication among the patient, their family, and health care provider in regards to making decisions about the future medical care by clarifying treatment preferences for palliative care. Palliative care is the active total care of patients whose disease is not responding to therapeutic treatment. According to Huggins and Brooks (2007), discussing and planning for the end-of-life can be a challenge for both health care provider and patient. Hospice care are one of the few specialties who have focused their efforts on end-of-life, unfortunately for other specialties there are inadequacies and obstacles in facilitating end-of-life care. Some of the barriers challenging the communication between physician and patient into the discussion of end of life issues are that physicians find it uncomfortable to discuss death and dying and want to avoid their own emotions and the emotions it may bring up in the patient and their families. Also because of the limited training and communication skills dealing with this issue, physicians fail to probe patient’s values and belief systems. Thus when presenting this complex subject it creates misunderstanding and confuses patients with their unclear medical jargon in attempts to describe scenarios and outcomes. Generally patients want to discuss these issues with their doctors but wait for them to initiate the discussion. Some patients tend to procrastinate the issue especially if they are in good health, and others do not see the importance in advance directives because they expect their families to make decisions for them (Huggins and Brooks, 2007). The American Association of Critical Care Nurses sent out a survey to 1409 of its members on their perception of end-of-life care (Berkstrand, Callister, and Kerchhoff, 2006). 861 critical care nurses responded, 485 offered 530 suggestions for improving end-of-life care. In general the nurses desired they had more to say in the care of dying patients. They reported no consistency existed in the way patients were cared for. According to Besckstrand, Callister, and Kirchhoff (2006), patients are spared impending death only to experience a prolonged death due to advancements in diagnosis and treatments of today. The majority of critical care nurses believe that death is a fact of life in the ICU and it should be treated with the dignity and respect it deserves. They also desired for physicians to learn to know when enough is enough to continuous aggressive treatment when there is little hope of the patient surviving. Respondents identified several obstacles in providing a good death in ICUs. Included were staffing problems and lack of time spent with the patient and their families. Communication challenges such as physicians not being realistic about the patient’s condition and prognosis. Some respondents felt that physicians see death as a personal failure and not as a part of life, thus many patients suffer needlessly. Cassel and Foley (1996) mention that many medical societies agree that modern medicine has neglected its traditional role to end-of-life issues. In September 1996, Cassel and Foley called together representatives of medical specialty societies to propose an advance in clinical policy for care at the end-of-life. The Joint Commission on Accreditation of Health Organizations also participated in the development of the Core Principles. Together they offered a draft set of “Core Principles” for end-of-life care and distributed these principles to representatives of a number of medical specialty...
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