Quality of Life and Functioning
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The birth of a baby is often celebrated with excitement and joy as it is a truly wondrous and miraculous event. Life is wondrous and miraculous; as is death. I refer to death in the same manner as the birth of a child not because I am morbid or obsessed with death and dying, but rather because, in my opinion the end of life is as much a gift as the initiation of life. Witnessing the death of my father a few years ago helped me realize dying is beautiful and equally as miraculous and wonderful as life itself. As a nurse I view caring for a dying patient as a gift. It is an honor to aid a person and their loved ones through this journey and witness the amazing transition from the state of living to the state of death. Being able to support a patient and family from the initial realization that death is imminent to creating a personal plan of care and being there to ensure it is honored truly is at the heart of nursing.
It certainly is a personal struggle to see any person suffer the lingering effects of any illness, especially when there is no hope of relief, other than in death. Despite this fact it still brings me great satisfaction knowing that one’s wishes are being executed and that I can help them through their last months, weeks or days of life. Providing this intimate care gives me a great sense of purpose and makes my work completely worthwhile and satisfying. Strategies In the case of Mrs. Thomas many strategies could be instituted to improve the quality of life for both her and her husband. Utilizing advance care planning, offering respite care as well as grief counseling for the entire family are important and viable options.
Ensuring proper pain management and initiation of hospice are additional means of adding quality of life for this patient and her spouse. Advocating for these services is the community health nurses responsibility and can make the family’s experience one of beauty. Addressing Mrs. Thomas’ understanding of her illness, learning her wishes and discussing advanced care planning would aid in the completion of an advanced directive. This would foster the provision of holistic and respectful care to her throughout the dying process while supporting her family and loved ones. Tertiary prevention will focus on preventing complications from her illness with the provision of palliative care measures thus improving the quality of life for the entire family, including the patient (Clark, 2008, p. 534). Promoting family participation in the care of Mrs. Thomas will also aid in increased quality of life. Given she believes she is a burden and her sons report it is difficult to visit due to her illness, grief counseling for all members of this family is imperative.
Facing her illness and dealing with her impending death are obviously frightening and painful issues, but nonetheless real. Learning to cope with these issues and the anticipatory grief will enhance relationships, empower family members, boost her moral, and help the family maximize their remaining time together (Grief Counseling, n.d., para. 11). Managing Mr. Thomas’ chronic depression Provisions for respite care are essential for Mr. Thomas as the stress of caring for a loved one is profound. His personal struggle with depression, mounting financial burdens and work pressures make an already stressful situation even more difficult to manage. Openly and honestly discussing his history of depression and how this is currently affecting him is very important. Helping him to recognize signs and symptoms of distress and giving him resources to use in the event of an emotional crisis are essential. Encouraging him to work with his doctor for medical management of depression and a psychologist for therapy will help him work through the issues caregiving responsibilities, encouraging positive self-care measures and an overall healthier way to manage this difficult time in his life. By taking care of himself he will be better equipped to help his wife in the manner he truly wishes to.
Initiation of palliative care should be discussed with this patient and her family given the grave prognosis. Respecting her wishes, ensuring comfort, providing spiritual and emotional support and managing symptoms will aid in the quality of life this family experiences. Educating Mrs. Thomas on the use of pain medications is essential to ensure she is comfortable and her suffering reduced; the concern for addiction is of little significance at this late stage. Collaborating with hospice services could aid in providing this specialized care. Support of the family as well as the patient is crucial at this stage; hospice personnel have expert knowledge regarding death and dying and can assist the patient and family through this process. Holistic Nursing Action Plan Maintaining normal, routine life patterns as much as possible is important for a family who has a member facing a terminal illness; including the ill family member.
Mrs. Thomas’ abilities can be maximized with support from family and friends, community members like those from her church or former co-workers and from medical support programs like physical therapy. A dietician can guide her to make the most of her diet. Contacting her social supports could help with managing routine daily chores like cleaning and cooking meals. Having this interaction also increases contact with others letting her know she is valued and cared for, it may help her to increase her physical activity levels as well if she is encouraged to take walks with friends or sit outside and enjoy a warm day. Providing for her spiritual needs is equally important; having functioning, but her emotional and mental well-being also. Inevitably her ability to care for herself will decline and end of life care will need to be initiated. The patient’s comfort is of high priority. Nutritional and hydration needs can be met through the use of tube feedings or with IV fluids, but doing so would be determined by her advanced directive.
An indwelling catheter can be placed to reduce the discomforts of incontinence as well as the risk of skin breakdown. Routine bathing and cleaning needs would be maintained by the healthcare team. Aggressive symptom management is essential to alleviate patient distress; supplemental oxygen can be supplied for symptoms of shortness of breath or dyspnea, continuous attention for signs of pain or discomfort would be handled quickly (San Diego Hospice, n.d., para. 3). Open and continuous conversation with family members on the process of dying should be an option and an engaged member of the healthcare team present to assist in this process. Certainly a spiritual leader would be invited during this time if the patient or family desired. Offering prayers and spiritual assistance at the time of death is helpful for the dying patient as well as for the people who are grieving the death.
Life is beautiful, from the moment of conception to birth and all through the living years. Given appropriate medical support, patients who are facing death and those who love them can experience the process of dying in an equally beautiful manner. Nurses have the honor of caring for patients and their families facing this event during their careers and have the obligation to make the journey comfortable, peaceful and respectful for all involved.
Clark, M. (2008). Meeting the health needs of older clients. In Community Health Nursing: Advocacy for Population Health (5th ed., pp. 494-545). Retrieved from http://media.pearsoncmg.com/pcp/2008935461/ebook/ Othodox America: grief counseling . (n.d.). Retrieved from Orthodox America website: http://www.roca.org/OA/95/95n.htm San Diego Hospice. (n.d.). Hospice practice and patient care improvement [Educational sheet]. Retrieved from
Palliative medicine website: http://www.palliativemed.org/Center-forResearch