Betty R. Ferrell, PhD, RN


May 02, 2014

Discussion: Managing End of Life

In Ann's case, it would not be correct to provide deep sedation and minimize family visits. It is important to assess and treat each symptom and to also include the family in Ann's care in these final days of life. Although hospice care is the gold standard of care at the end of life, in some instances patients need to return to the acute care setting for optimal symptom management and support of the family. It is not necessary to transfer Ann to intensive care because her symptoms can be controlled on the oncology unit by the staff known to Ann and her family.

The final days of life are a sacred time, and it is important to remember that these days will be the family's memories forever. Nurses have the opportunity to direct care that will offer optimum symptom management, address psychosocial and spiritual concerns, and support family members to participate in the comfort of the patient.[1]

Palliative care research has documented that in the final days of life, symptoms often escalate and new symptoms may occur. Careful assessment is needed by nurses to proactively intervene in such symptoms as increasing pain, seizures, hallucinations, delirium, or dyspnea. Sedation may be indicated, but it is essential that each symptom be assessed and treated.[2]

Nurses will also play a vital role in the final days of life as family members face final decisions and honor advance directives, such as forgoing artificial hydration or nutrition and allowing natural death. Family members will need extensive support to understand the symptoms of approaching death.[2,3,4] Nurses are also critical in the interdisciplinary care team that includes physicians, nurses, chaplains, and social workers.

Palliative care is very intensive care, and this is even more evident in the final days of life. The many physiologic, psychosocial, and spiritual needs as death approaches will necessitate expert nursing care consistent with national guidelines.[3]


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