In the United States, many individuals who are nearing the end of their lives receive palliative care in acute care settings. Traditionally, acute care hospitals are designed to focus on the diagnosis, treatment, and eventual discharge of patients who are either cured or stabilized. However, when the disease reaches a stage beyond the scope of curative treatment, the needs of the patient shift from focusing on recovery to addressing comfort and quality of life.
This is where palliative care becomes critical. The purpose of this article is to examine the symptoms that affect individuals at the end of life and to highlight the challenges faced by nurses in delivering effective and compassionate care in acute care settings.
The Role of Palliative Care in Acute Settings
Palliative care is an approach to care that focuses on providing relief from the symptoms, pain, and stress associated with terminal illnesses. It seeks to achieve the highest quality of life for patients and their families, and it does so by addressing not only physical pain but also psychological, social, and spiritual needs.
Unlike curative treatments, which aim to cure or control disease, palliative care acknowledges the reality of death and works to make the process as comfortable and dignified as possible. The overarching goal of palliative care is not to hasten or postpone death but to support the individual through their final stages of life, ensuring they experience the best possible quality of living during their remaining time.
Palliative care begins as soon as a terminal diagnosis is made, continuing until the patient’s death. This approach includes managing physical pain, alleviating distressing symptoms, and offering emotional and spiritual support to both the patient and their family.
Nurses play a pivotal role in palliative care, acting as the primary caregivers in various acute care settings. Their responsibility is to provide comprehensive care that addresses not only the physical aspects of dying but also the emotional, social, and psychological needs of patients and their families.
Pain Management: A Core Component of Palliative Care
Pain management is one of the most important aspects of palliative care, particularly in acute settings. It is often the primary concern for patients who are nearing the end of life. While pain may not always be the most prevalent symptom during the final days of life, it is certainly the most distressing.
Uncontrolled pain can significantly affect the quality of life for both the patient and their loved ones, often causing emotional and psychological distress that compounds the physical suffering. Unfortunately, inadequate pain relief is a common issue in end-of-life care, and it can severely affect the emotional well-being of family members present at the bedside.
Effective pain management requires an accurate assessment of the patient’s pain, which can be challenging, especially when patients are unable to communicate clearly due to their condition. Nurses and medical teams must rely on the patient’s descriptions of pain (such as its location, onset, and intensity) as well as their behavioral cues to determine the best course of treatment. This process requires not only medical knowledge and expertise but also a high level of empathy and sensitivity.
The incorrect assessment or misdiagnosis of pain, such as misunderstanding its location or nature, can result in inadequate or improper treatment. This mismanagement can lead to unnecessary suffering and delays in providing appropriate relief, which is especially problematic for patients who are already in the final stages of life.
Additionally, the process of diagnosing and treating pain can be time-consuming, and for terminally ill patients, this can lead to a decrease in the quality of life in their final days.
Inadequate pain management remains a critical issue in the United States, with surveys of surviving family members indicating that more than 25% report their loved ones received insufficient pain relief during their final days. This highlights the need for specialized professionals trained to handle the complex issues associated with end-of-life care.
Nurses and physicians who are skilled in pain management, including understanding pain syndromes common at the end of life and who are familiar with pharmacological and non-pharmacological interventions are essential to improving the quality of care for terminally ill patients. Moreover, addressing the emotional and existential distress that often accompanies intractable pain is crucial for ensuring a holistic approach to palliative care.
Supporting Patient and Family Wishes
In addition to pain management, one of the primary roles of nurses in palliative care is to ensure that the wishes of the patient and their family are respected and supported. This is especially important when it comes to treatment decisions. If the patient’s desired treatment plan differs from the family’s understanding or wishes, nurses often serve as mediators to facilitate communication and ensure that the patient’s voice is heard.
Nurses also provide counseling and emotional support to both patients and families, helping them cope with the complex emotions that arise during this difficult time.
The process of supporting patients and their families involves not only respecting their treatment preferences but also providing information, guidance, and a sense of empowerment. Nurses must offer clear, honest communication about the patient’s condition, treatment options, and prognosis, allowing families to make informed decisions about the patient’s care.
At times, when the patient may not be able to make decisions due to their condition, the responsibility falls on the family to make these decisions on the patient’s behalf. It is essential that nurses ensure that these decisions are made with the best interests of the patient in mind, and that the family is fully involved in the care process.
Family Involvement in Care
Family members play a crucial role in supporting the patient during their final days. They are often the primary caregivers and are essential to ensuring the patient’s comfort and dignity.
However, for family members to provide effective care, they need support and guidance from healthcare professionals. Nurses can enhance family support by maintaining open lines of communication, providing regular updates on the patient’s condition, and offering practical advice on how to care for the patient at home or in the hospital.
It is important to recognize that family members come from diverse social, cultural, and psychological backgrounds, and these factors can influence how they approach caregiving. Nurses must be sensitive to these differences and tailor their communication and support to the specific needs of each family.
This may involve providing education about the patient’s condition, offering counseling services, or connecting family members with support groups to help them cope with the emotional and psychological burden of caring for a loved one at the end of life.
Conclusion
Palliative care in acute care settings plays a vital role in providing compassionate care for patients at the end of life. By addressing physical, emotional, psychological, and spiritual needs, palliative care ensures that patients experience a high quality of life in their final days. Nurses, as the primary caregivers in these settings, are essential to the success of palliative care programs, managing symptoms such as pain and providing emotional and informational support to patients and their families.
Despite the challenges faced in end-of-life care, with proper training, empathy, and effective communication, nurses can significantly improve the quality of care and support that patients and families receive in these critical moments of life. Ultimately, palliative care aims to ensure that the dying process is as comfortable, dignified, and peaceful as possible, and that the wishes of both patients and their families are respected throughout this journey.
About Complete Controller® – America’s Bookkeeping Experts Complete Controller is the Nation’s Leader in virtual bookkeeping, providing service to businesses and households alike. Utilizing Complete Controller’s technology, clients gain access to a cloud platform where their QuickBooks™️ file, critical financial documents, and back-office tools are hosted in an efficient SSO environment. Complete Controller’s team of certified US-based accounting professionals provide bookkeeping, record storage, performance reporting, and controller services including training, cash-flow management, budgeting and forecasting, process and controls advisement, and bill-pay. With flat-rate service plans, Complete Controller is the most cost-effective expert accounting solution for business, family-office, trusts, and households of any size or complexity.
