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Introduction :-         

This essay is based on news article, ‘How to better enable end-of-life care choices’ by author Rosie Bonnin, which is published on Australian Ageing Agenda on 24th May 2019. This essay will illustrate author’s argument and examine strengths of author’s claims against current aged care literature. Moreover, focus on how this information impacts on caring older people and provide possible solutions for future care. Also examine how this knowledge influences on nursing practice to care older people as a new graduate nurse.

Summary of media item :-

This news article, ‘How to better enable end-of-life care choices’ is very relevant in caring older people. It is specially focused on importance of end-of-life care and the importance of primary health care, community and aged care role in providing end-of-life care to individual as per their preferences. Rosie Bonnin, an author of the article, argue that, advance care and end-of-life planning should be included in new quality standards for aged care services as per individual consumer’s preferences. As ageing population increasing day by day and death per year will also increases, she believes that majority of people are not interested to discuss and plan about end-of-life care. Most of the older people prefer to die in their own home but in reality is most of people die in residential care or hospital. Author claims that end-of-life care at home requires range of community supports and services which should meet both personal and carers needs and it’s a multidisciplinary approach to support older people to live fully and actively, provide relief from medical symptoms to improvise quality of life.

A review of the aged care literature:-

Bonnin states that, ageing population is increasing day by day and the number of deaths predicted to increase by double in next 25 years. The number of death rates expected to rise by 17% by 2030 (Trueland 2014). As per Bonnin, many people are not interested to plan and discuss about death. Majority of people prefer to live and die well in their own home rather than in hospital or care facilities. In reality most of the older people die in hospital or facilities. According to Trueland (2014), most people do not want to die in care facilities or hospital, majority of people choose to die in their own home but most people dies in hospital. Home is very important for people who are receiving end of life care. Home is where people can meet their spiritual needs, psychosocial needs and comfort (Trueland 2014). Range of community support and services are needed which should meet their personal and carers needs and preferences to better enable end-of-life care at home (Bonnin 2019). Similarly, author argue that advance care and end of life care planning should be included in new quality standards as per consumer’s preferences in aged care services.  According to author, a range of multidisciplinary team including nurses, medical and allied health team can assist older people to have quality lives in their end stage of life. Nurses or carers delivers who provide palliative care or end of life care in home must be expertise. They should anticipate problems specially associated with EOL. They must prepare family member and carers and also need to make sure that medication might needs to order from community pharmacy (Kiyanda et al. 2015). Author believes that, needs of end-of-life care should be recognised well and addressed properly, comfort level should be maximized, and their dignity should be preserved. Each clinical care should be evidence-based practise to optimise health and well-being. Similarly, Mistry et al. (2015), states that end of life care is not just managing physical symptoms, but also includes patient’s addressing non-physiological needs such as supporting both family and patient spiritual and emotional journey, addressing psychosocial issues. Care providers need to understand that requirement of care change day by day and patient needs to feel their requirement are being meets (Mistry et al. 2015). Patient’s wishes and preferences should be honoured. Need to ensure that patient’s wishes are meet as per their needs. It’s important to provide what quality care they want rather than what providers think (Brinkman-stoppelenburg et al. 2014). Similarly, end-of-life care should always tailored patient’s and family’s needs and preferences (Stow et al. 2019). Author believes that end-of-life care needs to be proactive and evidence based. Likewise, study shows that implementation of proactive management of end of life care will helps meets legal, ethical and clinical challenges associated with caring older people with chronic condition. Framework of care supports communication between GPs and patient, carer or substitute decision maker. This enable development of informed management plans with patient’s personal choices (Reymond et al. 2016). Proper implementation of framework allows patient to receive right care in right pace and time (Reymond et al. 2016).

Knowledge gaps identified from literature reviewed:-

Although Rosie argue that end of life care need to be available on home for every people who wise receiving end of life care at home, but its not always possible to receive end of life care on their own home as per their wishes. Multidisciplinary teams are not always available to care patient and family face to face in home setting 24 hours a day. Most of the time, a person who is responsible to providing end of life care will be nurses. Physician normally available once or twice a week and nurses have to communicate with physician for any medication orders, treatment plan and in emergency situation (Kiyanda et al. 2015). So, without multidisciplinary approach, sometimes it’s hard to provides health care as per patient’s needs and desires. Similarly, Bonnin has not mentioned about advance care planning in news article. To better enable end of life care, advance care planning plays a crucial role. Advance care planning is a process where patients makes decision as per their preferences which guide their future health care (Brinkman-stoppelenburg et al. 2014). Its’ based-on patient’s autonomy. Advance care planning need patients to understand medical condition they are having, benefits and burden of treatment as well as patient’s values and concerns. It is important in guiding decision-making when patient is not well to decide their preferences or not able to speak up (American Nurses Association 2016). Advance care directives honoured patient’s preferences on their health care which improves quality of lives in end of life.

Implications for the older person:-

End of life care is provided by wide range of expertise including doctors, nurses, social worker, occupational therapist etc (Mistry et al. 2015). For health professional, it is very important to know about end of life care and its importance in delivering quality care. This news article helps health professionals to understand how important it is to receive end of life care in their own home. Knowledge on end-of-life care helps to provide symptoms management and emotional support to the person who suffered from chronic illness or cancer. It helps to meet their cultural and spiritual needs as much as possible. Also helps health professionals to understand that, end of life care is not just about pain management but also includes addressing non-physical needs such as emotional, psychosocial, spiritual and cultural needs. This article helps to clarify that end of life care should includes active approach to symptoms management, patient-centred and holistic care (Bronnin 2019).

Importance to new graduate nurses:-

As a nurse it is very important to understand end of life care in hospital, community setting or even in patient’s own home. Nurses roles in end of life care is to provide guidance for both family members and patient who are tackling with those tough decision and help them to adapt sad realities (American nurses association 2016). Nurses considered as sole source of support during that time. Family and care givers are often scared, confused and distress. They expect nurses to give some emotional support. Primary responsibility of nurses on end of life care is to make sure patient’s wishes are honoured (ANA 2016). As a new graduate nurse, this knowledge about EOL care will help me to demonstrate emotional support for family and patient. Through this articles review, I understand that communication is very important in end of life, they want to speak more and want to be heard. It is very important to listen what they are saying rather than giving our opinion. Moreover, I will always respect and preserved patient’s dignity. I get to know what is important in end of life for patient and families, which includes place of death, forgiveness, autonomy, quality of life, pain control, comfort, assistance to achieve goals and emotional supports.

Conclusion:-

In conclusion, ageing population is increasing every year and death rates predicted to be double in next 25 years. Majority of people want to receive end of life care and want to die on their own home. End of life care should include symptom management, patient-centred and holistic approach. Similarly, advance care planning should be reviewed and update as per patient’s needs and desires. Patient’s comfort, autonomy and dignity should be respected and preserved. Moreover, the new quality standards required advance care and end of life care to includes in aged care services as per individual consumers preference.                                 

References:-

American Nurses Association 2016, Nurses’ roles and responsibilities in providing care and support at the end of life, ANA boards of directive, PP. 1-10.

Bonnin, R. 2019, How to better enable end-of-life care choices, Australian Ageing Agenda, viewed 24th May 2019, <https://www.australianageingagenda.com.au/2019/05/24/how-to-better-enable-end-of-life-care-choices/>

Brinkman-stoppelenburg, A., AC Reitjens, J. & Heide, A. 2014, ‘The effect of advance care planning on end-of-life care: A systematic review’, Review article, vol. 28, no. 8, pp. 1000-1025.

Carers Australia 2014, Dying at home: preferences and role of unpaid carers, Australia.

Kiyanda, B., Dechene, G. & Marchand, R. 2015, ‘Dying at home, experience of the verdun local community service centre’, Can Fam Physician, vol. 16, no. 4, pp. 215-218.

Mistry, B., Bainbridge, D., Bryant, D., Toyofuku. T, S. & Seow, H. 2015, ‘What matter most for end-of-life care?’, BMJ open, vol. 5, no.1, pp. 1-8.

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