Before the 1950's many a lot of people died at home with the family around. They often died quickly of illnesses such as influenza, measles or scarlet fever. Today, as medical technology creates more and more tools and medicines to prolong lives, human beings are faced with the difficult process of living with chronic diseases. Currently, many patients and their families are questioning the belief that a longer life necessarily equates with to a higher quality of life. Instead of embracing medical technology that could forestall death, some patients have begun to change the focus onto the quality of their own deaths. Studies show that the majority of human beings will die from the degenerating consequences of chronic disease. This inevitable dying process, by virtue of significant advances in medical technology, can be prolonged for greater periods than in our recent human past. However, the quality of this final phase of life is now a widespread, publicly voiced concern. Planning for end-of-life care is an important social, legal, and ethical issue.
[...] (Waters 1999 107-17) In regard to end-of-life care and a patient wanting to take his/her own life, data shows that excruciating pain is not the first motive for patients who want assisted suicide. Reasons include many nonphysical symptoms such as “loss of person-hood, discomfort other than pain, loss of dignity, concern about loss of control, loss of meaning in life, being a burden, and dependency.” (Back, Wallace, Starks, & Pearlman, 1996; Canetto & Hollenshead, 1999; Chin, Hedberg, Higginson, & Fleming, 1999; Cohen, Fihn, Boyko, & Jonsen, 1994; Coombs Lee & Werth, in press; Ganzini et al., 2000; Sullivan et al., 2000a, Wilson, Viola, Scott, & Chater, 1998). [...]
[...] End-of-life care also demands a nurse's full attention for pain and symptom management, communication with the patient and family, fulfilling the patient's physical, spiritual, and psychosocial needs of the patient. (Pochard 2001 1893) Other means of improving end-of-life care include routine documentation of assessment, interventions, and outcomes, as well as improvement in communication between clinicians, patients, and families. Azoulay et al. found that more than 50% of ICU patient's families did not understand the diagnosis, prognosis, and/or treatment after a discussion with the physician. [...]
[...] Pochard (2001 1893) suggests that discussing death and dying in the same way that pregnancy and birth are discussed can lead to the development of a unit philosophy of end-of-life care within healthcare organizations. Pochard (2001 1893) also suggests that palliative care be used when dealing with critically ill patients. The World Health Organization states that palliative care, “Affirms life and regards dying as a normal process; neither hastens nor postpones death; provides relief from pain and other distressing symptoms; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement.” The precepts of palliative care include “Respecting the patients goals, preferences, and choices, providing comprehensive care, utilizing the strengths of the multidisciplinary team, acknowledging and addressing caregivers concerns, and building systems and mechanisms of support.” Recent palliative care studies show that patient end-of-life experiences can be bettered through creating a culture and environment that allows individuals to feel supported. [...]
[...] E., Meier, D. E., Block, S. D., Billings, J. A. (1998). The debate over physician-assisted suicide: Empirical data and convergent views. Annals of Internal Medicine 552-558. Rando, T. A. (Ed.) (2000). Clinical dimensions of anticipatory mourning: Theory and practice in working with the dying, their loved ones, and their caregivers. Champaign, IL: Research Press. Sullivan, A. D., Hedberg, K., & Fleming, D. W. (2000a). Oregon's Death with Dignity Act: The second year's experience. Portland, OR: Oregon Health Division. Sullivan, A. [...]
[...] Literature review The past decade has brought numerous studies focusing on end-of-life care. These studies have offered a plethora of functional recommendations primarily for physicians, nurses, and social workers, while many lack recommendations at the level of institutional leadership. Implicitly, this omission indicates a lack of executive support in the improvement of end-of- life care or, at best, one of indirect support. However, according to a series of recent studies in Georgia, a proactive presence of senior management is integral in implementing systematic change in hospital-based end-of-life care. [...]
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