Psychological Barriers of the Client and Family Members Facing Death and Dying Term Paper

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Palliative Care Nurse Minimizing Psychological Distress for Patient and Their Family


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There was little in earlier centuries that the health care professional could actually do to help patients during the end-of life period except to attempt to ease the pain and suffering experienced by the individual however, recent research has identified specific competencies and best practices for the individual who acts as a nurse to patients during this transition period. Since people live longer in today's world and the elderly population only continues to grow, there are more people with chronic illness in need of care. The work of Ferrell and Coyle (2002) relates that the way that individuals die in today's world has changed. As well: "Patterns of dying include the unexpected death; a steady decline with a short terminal phase; or a slower decline that often includes several crises before death occurs. In each case, patients at the end of life and their families will depend on expert nursing care to meet their needs." (Ferrell and Coyle, 2002) Presently, the world's population is comprised of more elderly individuals than every before in history and because of this fact, palliative care must focus upon not only end-of-life care for trauma victims and those with terminal disease if health care is to fulfill the very important task to ensuring the best quality of life for the patient. This can only be assured through addressing not only physical needs such as pain relief but also this requires that psychological factors be considered because frustration will only add to anxiety levels of both the patient and their family and is likely as well to create depression in a time already characterized by the grieving process. It is important to that the nurse prepare not only the nursing role but also the patient and their family in order to minimize psychological distress during the end-of-life period.


Term Paper on Psychological Barriers of the Client and Family Members Facing Death and Dying Assignment

Palliative care has room for improvement according to Ferrell and Coyle (2002) who state that the nurse spends more time with the patient and the family of the patient "than do any other health care professionals and are intimately involved in all aspects of end-of-life care." Thus, expert nursing care has the potential to greatly reduce the distress these patients and families feel." (2002) Ferrell and Coyle relate that there have been major deficiencies noted in recent research in the education of nurses pertaining to end-of-life care. The American Association of Colleges of Nursing has identified specific competencies necessary for nurses in providing high-quality care to patients and families of patients during the transition at the end-of-life stage of care. Those competencies are: (1) Recognize dynamic changes in population demographics, health care economics and service delivery that necessitate improved professional preparation for end-of-life care; (2) Promote the provision of comfort care to the dying as an active, desirable and important skill, and an integral component of nursing care; (3) Communicate effectively and compassionately with the patient, family, and health care team members about end-of-life issues; (4) Recognize one's own attitudes, feelings, values, and expectations about death and the individual, cultural, and spiritual diversity existing in these beliefs and customs; (5) Demonstrate respect for the patient's views and wishes during end-of-life care; (6) Collaborate with interdisciplinary team members while implementing the nursing role in end-of-life care; (7) Use scientifically-based standardized tools to assess symptoms (e.g., pain, dyspnea [breathlessness] constipation, anxiety, fatigue, nausea/vomiting, and altered cognition) experienced by patients at the end of life; (8) Use data from symptom assessment to plan and intervene in symptom management using state-of-the-art traditional and complementary approaches; (9) Evaluate the impact of traditional, complementary, and technological therapies on patient- centered outcomes; (10) Assess and treat multiple dimensions, including physical, psychological, social and spiritual needs, to improve quality at the end of life; (11) Assist the patient, family, colleagues, and one's self to cope with suffering, grief, loss, and bereavement in end-of-life care; (12) Apply legal and ethical principles in the analysis of complex issues in end-of-life care, recognizing the influence of personal values, professional codes, and patient preferences; (13) Identify barriers and facilitators to patients' and caregivers' effective use of resources; (14) Demonstrate skill at implementing a plan for improved end-of-life care within a dynamic and complex health care delivery system; and (15) Apply knowledge gained from palliative care research to end-of-life education and care. (1998)


The work of Kristjanson, Toye, and Dawson (2003) states that, in diseases such as Parkinson's disease: "...psychological and communication problems include depression, personality changes, sleep disturbances and dementia." In these types of diseases, cognitive impairment has followed a progressive course and patients with these types of diseases: "...must cope with significant feelings of loss and fear of removal of their dignity. As it is a genetic disease, family members have to cope not only with the cognitive and behavioral changes in their relative, but also with the distress of 'rehearsing' their own future illness if they are genetically at risk." (Kristjanson, Toye, and Dawson, 2003)

It is also related by Kristjanson, Toye and Dawson that neurodegenerative diseases:."..are also accompanied by mood disturbances." (2003). There are stated known correlations between disease activity and depression in the disease known as MS, or Multiple Sclerosis. In motor neuron disease correlations are noted between an increase in physical dependency and depression, and between speech impairment and anxiety. A very critical aspect of palliative care is support on the psychological level and making necessary preparations for the patient and family members of the diseases progression in terms of copying with these factors associated with impending death. (Kristjanson, Toye, and Dawson, 2003) Mood disturbances also are often associated with neurodegenerative diseases. Correlations between disease activity and depression are commonly reported in multiple sclerosis. In cases where the patient is not able to communicate effectively great frustration is experienced by the patient and their family members at a time when added stress should be eliminated by health care staff. Correlations are also stated to have been found between speech impairment and anxiety.

Huntington's and Parkinson's are both diseases identified as being those in which dementia is associated with intelligible speech and comprised communication. In turn, compromised is effective pain assessment and distress management. When individuals are in a state of agitation, many times due to frustration from communication breakdown due to symptoms in progressive diseases, interpretation is often difficult or impossible resulting in: "...over or under..." (Kristjanson, Toye, and Dawson, 2003) use. In this instance, it is common to call in palliative care specialists. Another disease that is inclusive of the need of anticipatory planning is that of Alzheimer's which is "the most common neurogenerative disease, responsible for 50% -70% of dementia cases of dementia." (Kristjanson, Toye, and Dawson, 2003) Comorbidities are stated to be the cause of extremely high symptom levels, which are incidentally "...very difficult to alleviate in the presence of dementia." (Kristjanson, Toye, and Dawson, 2003) Due to the common factor among those who are elderly having a "...often severe and long-term nature of functional incapacity" (Kristjanson, Toye, and Dawson, 2003) added to the fact that caregivers of the individual may be elderly as well the use of institutional care may be the only choice. A palliative care nurse is able to ensure that the patient's family and caregivers are well informed as to the management of "...the downward trajectories of final illnesses during aging." (Kristjanson, Toye, and Dawson, 2003)


In summary, this research notes that the nurse is rendered completely incapable of possessing any one of these competencies if preparation has not been made in an anticipatory nature for the progressive stages of the disease through… [END OF PREVIEW] . . . READ MORE

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