Hospice Nursing
Hospice nursing entails working with terminally ill patients to provide them with the essential support and quality in their final days; rather than focusing on the healing process, these nurses focus on providing quality healthcare to patients who are already on their deathbeds. Hospice Nurses work at hospice facilities (a hospice facility is a place where patients come to live for their final days, such as Intensive Care Units) or in the patients' homes; most of these patients have a life expectancy of less than a year. The main aim of hospice Nursing is to enable those patients who no longer react to medical intervention to live their terminal days in comfort and equip both the patient and their relatives for death. Hospice Nurses are usually registered caregivers and work either individually or as a team to provide care, advise, monitor the patients' health conditions and administer medication to reduce pain. Therefore, this paper shall try to unveil the underlying importance of comfort while delivering hospice nursing patients.
According to a study conducted by Price & Knotts (2017) in America, it is estimated that every year 40,000 patients die in Intensive Care Units or at their home receiving hospice nursing. This means that an estimated 40,000 patients annually would die at the hands of their hospice Nurses. Therefore as a Hospice Nurse, it is important to acknowledge that even though, the patients will eventual die, he or she still need professional care and nothing much that a nurse can do to save the lives of such patients, apart from providing comfort during this time. Montgomery, Cheshire, Johnson & Beasley (2016) state that hospice nursing was developed in the 1960s mainly to assist patient with advanced cancer. With time it has grown to include all those patients that have chronic diseases that are undergoing through pain, emotional distress and exhibiting spiritual symptoms, which makes their life extremely intolerable. This type of care is administered to individuals who are considered to have no possibility of healing but should not be neglected because their death in imminent. However, they should be supervised to guarantee dignity in the process of death. Therefore, this responsibility, intended to bring about dignified death should be based upon the principle of comfort, solidarity, honesty, and respect for the patient. The primary goal is to prevent suffering, focusing on relieving the patient from the aggression of the symptoms, try and extend the life of the patient and address the psychological, spiritual and psychosocial needs. Comfort in this care needs to be managed to ease suffering; therefore, nurses should focus on the personality and not the sickness of their patients, valuing inter-multidisciplinary exchange and an automatic meeting between the patient and the nurse could be beneficial (Jordan, 2017).
Problem statement
Healthcare is the primary duty of nursing. Nurses always work in hospitals 24 hours in a day throughout the week next to inpatients, while other nurses' collaborate with those patients who need care practices. This gives the nurses the possibility to satisfy the existential sense of diseases, needs and desire to practice progression, assurance, and restoration of health needs of those patients in their end life term. From the pioneers of nursing such as Florence Nightingale, comfort has been a critical issue and principle to the practice of nursing and therefore any nurse ought to utilize it. It will make a lot of sense if nurses practice comfort to healing patients because such patients need their service the most and their recovery would motivate the nurses. It is a reverse situation when taking care of a patient that will die, despite the nurses working hard. This seems demoralizing for both the nurse and the family affected. Some have resorted to neglecting end-life patients or giving them poor quality services because at the end of the day they will die anyway.
The primary purpose of care in nursing for a dignified death from the viewpoint of ethical nursing is associated with promoting attention and comfort. This has been the central underlying principle of nursing, it is also the primary goal of nursing, and patients expect the same from nurses. Comfort is an optimistic, subjective and multi-faceted experience of individuals themselves with the diverse systems of health and rationality that hold institutional intentions (Bowers & Wetsel, 2014). This means that these social elements can cause comfort or discomfort, and as such, nurses should minimize any discomfort when people are in their end-life stage. The nurses can reduce pain through the terminal process while the family is engaged as subjects of the healthcare program that involves technical, scientific and humanistic competence. The overall interaction between the patient and the healthcare practice is expected to result in the well-being of the patient during any stage of illness. In the face of death, it is expected that enhancing well-being will remain the fundamental purpose of health care (Norlander, 2014).
Literature Analysis
Gage, Washington, Oliver, Kruse, Lewis, & Demiris (2016) suggest that it is possible for a nurse to plan a therapeutic intervention to patients in their end life by mitigating the current discomfort that the patient is undergoing and promoting comfort. Aksoy Derya & Pasinlioğlu (2015) add that nursing as practice focuses on the relief of discomfort and its elements such as pain, giving social and emotional support and making sure that the body probity can decrease fluctuations, distress, and challenges in environmental, subjective and social view encountered by the patient and their family, hence promoting comfort. The classification that denoted the definition of comfort for a noble death from the viewpoint of nursing manifested that the nurses reiterate the support as a multi-faceted area. This diversity is shown in the description of comfort given by Katherine Kolcaba as the gratification of basic requirements of relief, ease, and tranquility in socio-cultural, material, psycho-spiritual, and environmental settings. Another dimension of comfort is the relief of physical pain, which points the concerns of nurses to evade or eliminate any physical distress, acknowledging a dignified death, such as the one that a patient is independent of pain. Research conducted by Casimiro, Tiffany, France, Danielle, Livesay, & Rebecca (2016) revealed that pain management and physical comfort of dying patients were a primary interest for most nurses in the nursing practice. Buss, Rock, & McCarthy (2017) also corroborated with these resolutions by adding that one of the key factors of a dignified death is the deficiency of pain, empowering the individual to have both the physical and mental ability to attain their goals before the end. This means that comfort comes with self-assurance in the scientific excellence of care that gives reassurance that the end-life period can be undergone with less suffering. Kissvetrová, Vévodová, & Školoudík (2017) posit that to physical relief distress, promoting the state of comfort with promoting a dignified death. In regards to pain control, as much as the examined models of levels were not clarified, it is established that being a biased symptom, it is essential to its evaluation when feasible with the aid of the observed range, a system seen as an opening point for the management of the symptoms.
Comfort in Hospice Nursing
The supervision for a dignified death is correlated with the physical enhancement of support using various medical interventions, especially those directed at relieving pain and respiratory discomfort. It is also important that the nurse should acknowledge that it does not call for the use of surgical procedures when they are unable to offer real-time comfort or the means to change the circumstances of the terminally sick. Invasive procedures do not help in this case; these systems only lead to the increased affliction of patients in the dying stages and their relatives.
The preservation of health and the body position exposed that nursing for a dignified death means to partake healthcare applications that are quality, meet the measures of hygiene, and treat the existing wounds. The term hygiene originated from the Greek word hugieinós, which implies administering sustenance to support health. Therefore, it merits practicing it, and it might assist in meeting the traditional socio-cultural conditions of the patient so that they can attain the anticipated level of satisfaction. When it gets to end-life care, the intervention associated with the hygiene in health is a dimension developing because of the lack of independence of the patient (Liu, Burns, Hilliard, Stump, & Unroe, 2015). Therefore, nurses should try to respect the patient and preserve their image. Taking care of injuries and eliminating odors are an effective way of taking care of pain, hence promoting comfort. This is fundamental to preserving the dignity of the patient in end-life. Both social and impassioned care subcategory highlights the interests of the nurses to increase support through presentations of comfort, recognition, and affection to the victim and the affected people. These types of attitudes show that support is related to a compassionate and sympathetic methodology towards patient care. Coelho, Parola, Escobar-Bravo, & Apóstolos (2016) point out that satisfaction can also be encouraged by the family interaction by the nurses not only in the medical perspective but also with the humanity of the nurses.
Emotion and social support is also another tool that used be used by the nurse to promote comfort among end-life patients. In this regard Unroe, Cagle, Dennis, Lane, Callahan, & Miller, (2014) argue that the activities that give pleasure, involve the plan to minimize the negative attitude of hospitalization in cases where the patient is in a hospital setting, keeping the patient engaged rather than idle and stimulated healthy relationships with their peers and other health professionals. The World Health Organization recognizes that social and emotional care are two fundamental aspects of a hospice nursing and should incorporate both the patient and the affected family to enhance the quality of life of the terminally sick people (Botti, 2017). Hansen, Higgins, Warner, & Mayo (2015), reason that this type of care would also help in reducing stress and anxiety of family members.
The basic definition of a dignified death rests in giving the practice of comfort in the cooperation with the healthcare systems that would enhance security, relief, transcendence, and tranquility to guarantee the preservation of human dignity. Inter-subjective collaborations among nurses and patients in their end-life phase can help in redeeming the virtue of humanity in the face of the mechanized nature of the hospital, enlisting different units that are brittle in the face of the persistent encounter of death (Varilla & Coll, 2016).
Nurses who have the understanding, abilities, and enthusiasm to provide welfare to their various patients have an opportunity to contribute to the realization of a noble level of comfort. To promote support for the patients in their end-life stage, nurses should not set their parameters or modus Operandi (mode of operation). Instead, they should respect the needs of the patients and what the patients think that is right for them, if the patient is unable to do this by themselves, then the nurses should listen to the family members (Cone & Giske, 2017). Nurses should always remember that people vary and have different needs and personalities, as much as the symptoms of the disease can be the same. Therefore, they should treat each patient different according to the patient's needs and not according to the disease. Care practices also ought to be developed to ensure the completeness of an individual and at the same time, respecting their individuality and the right to make their own decisions (Spicer, Heller, & Troth, 2015).
Further studies still need to be done in this area to determine what the meaning of a dignified death in the perspective is a patient who is terminally ill. Such studies can help health professionals to identify various practices that can promote more comfort and causes of discomfort among the terminally ill patients. Such studies could provoke reflection and qualifications of the process of care and support in hospice nursing.
Conclusion
The definition of hospice supervision for a dignified death articulated the primary division labeled improving comfort and its various elements such as reprieve of environmental discomforts, social and emotional comfort and maintaining hygiene and body position. Therefore it can be reasoned that care for a dignified death implies promoting comfort as a result of healthcare systems in nursing that regulate rationality and sensitivity assuring the honor of the victim and the affected people. This discipline of nursing is still relatively new and continuously developing, and so is the definition of comfort. Therefore, nurses should be updated on the modern trends of support to use in hospice nursing for a comprehensive nursing care.
References
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Varilla, V., & Coll, P. (2016). Comfort Always: Learnings from a Breakdown in Coordinated Care for a Patient with Parkinson's Disease on Hospice. Journal of the American Medical Directors Association, 17(3), B5.
