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Nursing and End-of-Life Patient Issues

Manage the Fear and the Pain
 
The National Gerontological Nursing Association (NGNA) has come out with some holistic care tactics for working with dying patients. After establishing that death is possible within the coming year, nurses are in the ideal position to initiate the conversation about end-of-life care. The NGNA recommends that a good place to start is by asking the patient, "Given your medical situation, is there anything we can do to help you live well?- After focusing on the patient"s answers, explore alternatives that may be of value, beyond prescriptions. Some people experience pain reduction via music therapy, while others respond positively to therapeutic massage. Spiritual counseling, especially by finding the right spiritual guide for the particular patient, lessens emotional fears. Some of the worst fears center on worries about dying in torturous pain and agony. This is where it is helpful to remind them that in most cases, pain can be completely diminished or markedly decreased. Keep in mind that patients may recollect an older relative dying in unbearable pain in the days before effective pain management, and they worry that they could face a similar end. A nurse can go a long way in correcting the myths about end-of-life suffering.
 
Some Nuggets of Wisdom
 
At the risk of sounding simplistic, end-of-life discussions can be driven purely by your ability to listen. Patients may seemingly answer a question, but if you allow for quiet pause, they may fill the conversational void with the more crucial and deeper answer. You cannot learn anything about the person if you are doing all of the talking. Send the message that what they have to say is important.
 
In the past, the medical establishment was guilty of not believing a patient"s assessment of pain. Today we know this to be a major mistake, as the likelihood of exaggeration is minimal. The mantra is now to accept the patient"s opinion as truth; it is unfair for an outsider to inject judgment about the matter. Based on the EPEC Project by the American Medical Association, "patient self-report is the gold standard for [pain] assessment. There is no reliable way to assess what the patient is experiencing other than by asking the patient.- One of the most reliable and valuable tools for understanding the level of pain is to ask the patient to use a numerical scale (0-10) to express the severity.
 
Finally, you can guide patients into living their final days to the fullest with exploratory questions. Often they have one conflict they would deeply like to resolve or a task they wish to finish. The AMA cites this question as a smart one to ask: "Is there something that you would like to do before you get too sick?- This is your chance to steer a life toward a meaningful close and play an invaluable role in end-of-life care.

By Adam Herschkowitz
Get Nursing Jobs, Contributing Editor

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