Patients who require end-of-life care due to terminal illness require specialized and compassionate nursing care which is designed to improve pain management, provide support to families during this difficult period, and to make ethically responsible decisions (Hebert, Moore, & Rooney, 2011). From this perspective, it is necessary for nurses to provide their patients with care and treatment that will facilitate improved quality of life and support impactful decision-making at this level. Nurses are responsible for offering a listening ear to patients and their families and demonstrating behaviors that support advocacy and strength during this difficult period. It is necessary for organizations to evaluate their decision-making in regards to patient care and to be mindful of patient and family members’ needs above all else. Since patients are highly vulnerable during this period, it is necessary to accomplish the intended objectives through discussion and collaboration to ease some of the pain associated with helplessness and loss of control that emerges during the end-of-life (Hebert et al., 2011).
From a legislative perspective, there have been efforts across many states and at the federal level to provide advance directives for patients to support and strengthen hospice care and other palliative care measures that will positively impact quality of life for patients (Muchmore, 2016). In this capacity, it is also important to consider some of the laws that exist regarding euthanasia that may have ethical implications but which are legal options for some individuals. These directives are of critical importance in addressing some of the challenges associated with end-of-life care and how to best address issues that impact patients and families who must make difficult decisions regarding this period. In addition, advanced planning is essential to address some of the difficulties of managing individuals who have terminal illnesses or who may not have the capacity to make independent decisions due to the devastation of disease (Muchmore, 2016).
Advanced care planning has been established to demonstrate the importance of addressing critical issues that impact end-of-life care before patients reach this stage, and this information is essential to the identification of individual patient needs and preferences (Lund, Richardson, & May, 2015). From this perspective, it is necessary to evaluate specific conditions under which patients and family members should be involved in advanced care planning and how to best accomplish these directives in an effective manner that will strengthen outcomes. These plans should express the challenges of managing patients’ loss of self and cognition at the end of life; recognize that death is a reality that will occur sometime in the future; identify patient-based preferences in regards to clinical decision-making; designate individuals to manage the legal affairs of patients at the end of life; and identify needs and preferences regarding the disposal of property during this stage (Lund et al., 2015). From this perspective, recognizing that “loss of capacity” is perhaps the most critical marker of legal influence and interpretation is necessary to ensure that patients and family members are aware of the magnitude of decisions that must be made and that they should be made early before it is too late (Lund et al., 2015).
The ability to provide high quality care and treatment at the end-of-life is contingent upon nurses’ ability to discuss issues of critical importance without taking away the hope that patients and family members have regarding their health status (Adams, Bailey, Anderson, & Docherty, 2011). In this capacity, it is important for nurses to express their full support for patients and to provide information that is necessary and appropriate in making decisions that impact end-of-life care (Adams et al., 2011). In this capacity, nurses must also provide realistic options to patients and demonstrate compassion as they struggle with difficult decisions, such as DNR orders and the withdrawal of care under specific circumstances (Adams et al., 2011). These efforts are instrumental in shaping an environment in which patient care will continue at a high level and will not be compromised by poor decision-making, conflicts, or other measures that could negatively impact end-of-life care. It is imperative that nurses work with patients and family members and empower them to make decisions that are in their best interests and which convey the need for greater respect during the end of life. Furthermore, any efforts made by nurses should also demonstrate the importance of providing patients with greater satisfaction and strength during end-of-life care through activities that may include specific therapies to increase contentment and satisfaction during this difficult stage (Nakano, Sato, Katayama, & Miyashita, 2013). From this perspective, it is necessary for nurses to use their knowledge wisely and to offer positive approaches to end-of-life care that will engage patients and family members and provide greater autonomy and strength during this stage.
End-of-life care poses many challenges for patients and family members due to the highly sensitive nature and difficulty of these situations; therefore, it is necessary to evaluate nurses’ roles and responsibilities in this process. These efforts require nurses to be mindful of the decisions that must be made and the level of compassion that is required during this period. It is necessary for nurses to utilize existing frameworks regarding end-of-life care effectively and to monitor patients on a routine basis to identify areas where decision-making may be impacted by changes in a patient’s health status or in other areas which influence the ability to make effective decisions that will positively impact patients and their families during this stage. These efforts are critical to empower patients and family members at the end of life and to provide them with some sense of comfort during this stage.