EOL Care: Progress and Current Issues

End of life (EOL) care has all the time been a selected interest of mine. I do know the frustrations that usually arise when providing end of life care within the intensive care unit – for instance, when a patient isn’t any longer capable of make decisions for themselves, and their family is unsure of their wishes or when members of the family disagree with them. However, I also know the way rewarding it will possibly be when a patient’s death is a positive experience for all involved. Sometimes providing end of life care is as rewarding as watching a patient ‘get back on their feet’ and recuperate. I imagine that some nurses find end of life care much more rewarding.

When I read Ethics in Critical Care: Twenty Years Since Cruzan and the Patient Self-Determination Act: Opportunities for Improving Care on the End of Life in Critical Care Settings , I used to be reminded that although challenges still exist, we’ve got come a great distance by way of advance care planning (ACP) and EOL care. Resources similar to Careful Conversations Center for Practical Bioethics, Respecting your selectionsAND Five wishes have emerged to assist patients and families discuss their wishes. Other necessary events include the Joint Commission standards for palliative care, advance care planning, and pain management; National Health Decisions Day (April 16); palliative care consultation services in a lot of hospitals; and the increased variety of individuals with advance directives. I encourage you to read this text in its entirety to see the extensive list of examples provided by the authors.

What problems remain?

• Advance Care Planning – Increasing the Number of Patients with Advance Directives, Living Wills and Powers of Attorney
• Care for patients in a minimally conscious state versus a persistent vegetative state
• Provides hydration and nutrition
• Communicating a patient’s wishes or care plan when transferring from one care setting to a different (e.g. from a nursing home to a hospital)

Take a moment to read this text (it’s free to read online when it’s on our really helpful reading list!). On page 103 (page 5 of the PDF) you’ll find “Ten Things Critical Care Nurses Can Do to Improve Initial Care Planning.”

Reference:

Rushton, C., Kaylor, B., & Christopher, M. (2012). Ethics in critical care: twenty years since Cruzan and the patient self-determination act: opportunities for improving end-of-life care in critical care settings.