CONCLUSION
The ranks of older adults continue to swell in the United States. Many of them have one or more chronic diseases. Thus, the need for high-quality end-of-life care will only increase. The number of children needing end-of-life have also swollen, causing overtaxed parent-caregivers to seek support in the form of bereavement care, respite care, and spiritual guidance.
Americans are beginning to accept that death is inevitable and that planning for end-of-life care is essential to ensuring that our preferences are respected when we can no longer care for ourselves. More people are drawing up advance directives, appointing a healthcare proxy/agent, choosing hospice and palliative care over aggressive treatments, or considering “assisted death.” This growing awareness around end-of-life issues would not have come about without the educational and outreach efforts of nurses, other health professionals, public health agencies, and private foundations.
Increasing numbers of dying patients have opted to select palliative care or hospice as an alternative to more aggressive medical care performed in acute care hospitals, often in ICUs. Communication with patients and families is essential to stress that these are a means to make the patient more comfortable rather than “giving up.” Palliative care is mostly noninvasive and focuses on the patient’s comfort. Hospice care is ordered when a physician determines that the patient may have less than six months to live and may be renewed after six months with another physical examination.
Since pain, dehydration, excess secretions, and other symptoms at the end of life may cause discomfort, pharmacologic and nonpharmacologic measures are necessary as a part of care, particularly in the last hours of life, when the patient is considered to be actively dying. After death, specific legal considerations and tasks are performed by physicians, nurses, and nursing assistants as part of postmortem care.
All healthcare professionals have a role in helping their patients and families understand the range of options available and the benefits of planning for end-of-life care before it is needed.
RESOURCES
American Academy of Hospice and Palliative Medicine
Center to Advance Palliative Care
Children’s Hospice International
Hospice & Palliative Nurses Association
MOLST (Medical orders for life-sustaining treatment)
National Association for Home Care and Hospice
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