Educational Needs in Acute Care Nursing in Dealing with End of Life Care

Educational Needs in Acute Care Nursing in Dealing with End of Life Care

Salina Thapa

Daemen College

Abstract

Nurses play a crucial role in many aspects of health care, especially at the delivery end of it. [Acute care] Nurses should challenge end of life (EOL) care practices in place and rally for more education and training on this topic. In doing so, we can begin to fix the apprehensions and stresses that the idea of death and dying may be causing on the patients, families and nurses. This could greatly improve the patient-caregiver relationship, as well as help families cope more effectively. The aim of this literature review is to explore and identify factors that if changed or embraced could better facilitate the nurses' ability to provide quality EOL care.

Introduction

The topic of death and when the "end of life" begins is a subject that many people have difficulty both understanding and experiencing. The ambiguity of the time when death approaches and the subsequent effects that it has on both the one experiencing it and those that experience it around the dying makes it all the more difficult. Death is inevitable and the question of "how" and "when" due to medical advances and evolving technology is ever-changing (Al-Qurainy, Collis & Feuer, 2009). Intensive care units (ICUs) by design are made specifically for patients with acute illness/injury that require highly advanced nursing care and skillset in order to achieve the best health outcome. Once the patients' care needs change from curative to palliative, it is expected that the patient would no longer need the services of an intensive care unit, and be moved to a more suitable care environment focused on end of life (EOL) care. It is becoming increasingly difficult to differentiate the shift from curative to palliative care with the advancements of medicine and technology along with the high volume of patients that are chronically critically ill (Al-Qurainy, Collis & Feuer, 2009).

In the intensive care unit, death is a frequent occurrence experienced by the patients, families, and those that care for them (Thompson, Austin & Profetto-McGrath, 2010). Literature on end of life (EOL) care is focused most on the patient, families and the outcomes associated with how well the EOL care was delivered. There is an abundance of literature in the field related to improving EOL care for the family and patient. There is however, a lack in research related to the nurse. In an effort to significantly improve EOL care in patients and help families grieve and cope in a healthy manner, I believe that research should focus on incorporating the nurses' perspectives, views and [educational] needs. By concentrating on research from the nursing point of view, it may better facilitate the needs of nurses that are to deliver the best standard of EOL care.

Theoretical Framework

The theoretical framework for the topic is based on Imogene King's theory of goal attainment. Imogene King introduced the idea that the interaction between nurses and patients was an open system that interacted within the environment. The interaction between these three elements were classified into three systems that included a personal, interpersonal and social aspect (Hanucharurnkul, 1989). Within King's concept of nursing, it is important to recognize that interplay between the above concepts should employ a goal oriented strategy where the people involved within the same social system act together to attain the goals given by the patient, after the goals have been defined once the nurse-patient relationship is achieved. The course of "goal attainment" is a series of actions, reactions, interactions, and transactions (King, 1981).

Perception is believed to be the first and important step towards achieving goals. Changes in perception can have a profound effect on judgment, action, reaction, and