Challenges Faced By Nurses in End-of-Life Care Provision and Their Effects on the Nurses’ Personal Life in Limbe and Buea Regional Hospitals
Department: Nursing
No of Pages: 55
Project Code: NS10
References: Yes
Cost: 5,000XAF
Cameroonian
: $15 for International students
ABSTRACT
End-of-life
care (or EOLC) also refers to health care for a person with a terminal
condition that has become advanced, progressive, and/or incurable. End-of-life
care requires a range of decisions, including questions of palliative care,
patients' right to self-determination, medical experimentation, the ethics and
efficacy of extraordinary or hazardous medical interventions, and the ethics
and efficacy even of continued routine medical interventions.
End
of life care presents many challenges especially in the management of pain and
suffering for nurses as well as for patients and their families. Moreover, the
care of the dying patient must be considered within the context of the
psychological, physical and social experience of the person.
This
was a cross-sectional hospital based study which involved 100 nurses from
different units in the Limbe and Buea
Regional Hospitals. The results of this
study reveal that 17 participants (17%) reported restlessness as the most
common physical symptom that is found in patients at the end of life.
As
for the challenges, majority of the participants reported workload, lack of
social services and non-cooperative family members and on the effects the
nurses who were psychologically unhappy, physically suffered from back pain and
socially there was financial burden as well as caregiver burden. In conclusion,
end of life care is a challenging and has far reaching detrimental effects on
the personal life of the nurse as well as the family.
CHAPTER ONE
INTRODUCTION
1.1 Background
End-of-life care encompasses the care for patients that are considered to be in the
last stage of their lives. It includes care provided to “all those with an
advanced, progressive, 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.
End-of-life
care (or EOLC) also refers to health care for a person with a terminal
condition that has become advanced, progressive, and/or incurable. End-of-life
care requires a range of decisions, including questions of palliative care,
patients' right to self-determination (of treatment, life), medical
experimentation, the ethics and efficacy of extraordinary or hazardous medical
interventions, and the ethics and efficacy even of continued routine medical
interventions.
In
addition, end-of-life often touches upon rationing and the allocation of
resources in hospitals and national medical systems. Such decisions are
informed both by technical, medical considerations, economic factors as well as
bioethics. In addition, end-of-life treatments are subject to considerations of
patient autonomy. (1-3) End of life care (EOL) is an essential element of care
provided in the health care institutions or the community.
Patients
with advanced and progressive diseases live with possible disruption of their
daily routine, experience undue pain of all natures, suffer from dead and
loneliness through the caring episode (1,2). End of life care has received an
increased recognition in recent years as a critical opportunity to improve
health care quality.
It has been defined as the active, total care of patients whose disease is not responsive to curative treatment (3). The provision of excellent end-of-life care requires, first and foremost, an excellent knowledge of the pathophysiology of terminal illness or injuries.
The most appropriate health care at the end of a person’s life is a worry whether it is ultimately likely to benefit the patient. Nurses are often challenged when confronted by the patients and families on decisions concerning the painful realities of whether the patient will make it at the end or will not make it at the end of life.
One
of the greatest challenges of end-of-life care in the twenty-first century is
not offering care that cannot benefit the patient, but it requires the
involvement and support of all levels in the health care system, from those who
directly provide patient care to the administrators and regulators who address
more system-based issues and also the nurses themselves (4-6).
Decisions
about care at the end of a person’s life often involve quality-of-life
considerations. Nurses are obligated to provide care that includes the
promotion of comfort, relief of pain and other symptoms, and support for
patients, families, and other closed relatives to the patient. They are also in
a very good position to make every effort to provide aggressive symptom
management at the end of life.
Since
decision-making for the end of a patient’s life should occur over years rather
than just in the minutes or days before a patient’s death, nurses can be a resource
and support for patients and families at the end of a patient’s life and in the
decision-making process that precedes it.
In
this light, nurses are often ideally positioned to contribute to conversations
about end-of-life care and decisions, including maintaining a focus on
patients’ preferences, and to establish mechanisms to respect the patient’s
autonomy (7-9). Excellent, skilled, precise communication is essential for the
physical and psycho-social care of the patients and their families. Nurses must
have the knowledge and communication skills to explain to patients why certain
activities need to be done (10).
Nurses
who work in such units as critical care units (CCUs), surgical units and the
maternity have traditionally received little education and training in care of
dying patients and the patients’ families, which ultimately affects the nursing
professional and their practice at the end of life care in these units (11).
Other
factors that may be as important for providing end of life care may include a
work environment with strong communication and collaboration between nurses and
physicians, availability of ethics consultations, and adequate support of
patients, patients’ families, and staff (12).
Globally,
the need for compassionate and effective end-of-life care (EOLC) grows more
critical as the number of people predicted to get ill is expected to increase
in every region of the world (13). In the case of cancer which happens to be
the second most common cause of death in the United States and around the
world, as opposed to heart disease so far nurses are providing end-of-life care
for these patients on a daily basis. (14)
The
World Health Organization (WHO) and Centre for Disease Control and Prevention
(CDC) conducted a global cancer research in 2012 and found that about 14.1
million new cancer cases were diagnosed with 8.2 million people dying from
cancer and this number is expected to rise to about 15 million by 2020.
In
sub- Saharan Africa about 551200 people are being affected with over 421000
deaths recorded per year (15). Although there is no reliable data on the
incidence and pattern of cancer, it is still recognized as a public health
problem in Cameroon as the incidence and mortality increases annually.
1.2 Statement of the
problem
End
of life care presents many challenges especially in the management of pain and
suffering for nurses as well as for patients and their families. Moreover, the
care of the dying patient must be considered within the context of the
psychological, physical and social experience of the person (Della Santina and
Bernstein, 2004). (13)
Foremost
among those who require end of life care are the elderly who are more prone to
loneliness and who frequently under report pain and who have a greater
sensitivity to drugs and drug interaction. (Lyness, 2004).
Unfortunately
nurses who are responsible for the treatment of patients at the end of life
commonly lack adequate training to help guide end of decisions and to deliver
bad news to patients and the families (Boyle, Miller & Forbes, 2005; Gorman
et al., 2005) (16).Nurses lack of knowledge on end of life care and its
importance to both the patient and health care provider.
Therefore,
it is imperative to identify the challenges faced by nurse in the end of life
care provision and their effects on the nurses’ personal life.
1.3 Goal of Study
- The goal of this research study is to identify the challenges of end of life care and its effects on the personal life of nurses working in Limbe and Buea Regional Hospitals.
1.4 Objectives of the
Study
1.4.1 General Objective
- To identify the challenges faced by nurses in end of life care provision and its effects on nurses personal life working in Limbe and Buea Regional Hospitals.
1.4.2 Specific Objectives of the Study
- To examine the care provided by nurses to patients who are at the end of life in Limbe and Buea Regional Hospitals
- To identify the challenges faced by nurses in providing care to patients who are at the end of life in Limbe and Buea Regional Hospitals
- To identify the effects of end of life care on the personal life of nurses working in the Limbe and Buea Regional Hospitals.
