Running head: END OF LIFE CARE

End of Life Care

Harpreet Kaur
California State University, Stanislaus

END OF LIFE CARE

2
End of Life Care

Through advocacy, counseling, teaching, managing, and researching, nurses hold a

significant spot in many patients and their families lives. These aspects are not only visible in
medical surgical floors, but also in end-of-life care. However, with the lack of information on
palliative and hospice care, many individuals do not approach these programs and further have
misconceptions about the available services. To shine a light on these programs and clear some
misunderstandings, this paper will compare and contrast hospice and palliative care; explore
physical, psychological, social, and spiritual well-being of EG and her family; and discuss the
role of nurse in providing end-of-life care.
Hospice versus Palliative Care
The health care team in hospice and palliative care focus on managing the symptoms of a
chronic disease and helping and supporting with decision-making (Bonebrake, Culver, Call,
&Ward-Smith, 2010). This team is composed of chaplains, social workers, nurses, and
physicians. Hospice provides care to the patients who have life expectancy of six months or less.
It supports the individuals at the end stage of life when the assertive and remedial care is no
longer effective; thus, the emphasis swings to the physiological and psychological aspects of life.
Upon receiving a referral from the physician, hospice may be delivered in different settings such
as inpatient, extended-care facility, and hospice facility. On the other hand, palliative care can be
approached earlier in the disease course along with the treatments and therapies. In addition, the
care may be implemented in combination with aggressive measures (Bonebrake et al., 2010)
Physical Well-being
As mentioned by the nurse, EG had a heart disease that lead to fluid secreting from the
skins pores and mouth. The death rattle or the saliva accumulated in the mouth seemed to be

END OF LIFE CARE

bothering the family, consisting of EGs two daughters and a sister, as they were unsure about
clearing the secretions and providing comfort to EG. Moreover, EG was unresponsive to voice
and touch; however, she occasionally opened and closed her eyes. However, EGs younger
daughter mentioned that she once responded to her sisters touch when she initially visited her.
As far as the familys physical well-being is concerned, they seemed to be in no distress.
Psychological Well-being
Because EG was unresponsive, her psychological well-being could not be assessed.
However, the family demonstrated different stages of dealing with grief when they were told that
EG has only few days to live. EGs younger daughter and sister were more accepting of this fact
compared to the elder daughter. The older daughter was in slight denial. She stated that she was
hoping to spend more time with her mother and is not ready to let go of her yet. The nurse
assured her that her mother is comfortable and in no distress; therefore, it is the right time for her
to say good-bye. During our subsequent visit to pronounce EG dead, consistent behavior was
noted.
Social Well-being
In their tough time, family received support from their relatives and friends. As we went
to pronounce EG dead, we met several other family members of EG and few others were still
coming in. They were assisting the family with meals, cleaning, making calls to more relatives,
and handling children. The daughters desired to wait to call the funeral services, as few relatives
were coming from out of town.
Spiritual Well-being
EG and her family followed Catholicism. The spiritual well-being was evident with the
Bible placed on EGs bed, several candles lit across the home, and a cross displayed on the table

END OF LIFE CARE

next to EGs bed. The younger daughter shared that it helps her to realize that her mom will be in
a better place soon and will no longer be suffering from the chronic pain.
Role of the Nurse
During the hospice rotation, it was noticed that the nurse conveys few basic skills similar
to regular medical surgical floors including administering medications, taking vital signs,
inserting catheter, etc. However, the nurses delivery of care is enhanced in the end-of-life care.
According to Dobrina, Tenze, and Palese (2014), the nurse delivers care through presence, nonjudgmental approach, and self-reflection. The presence of the nurse may soothe the patient on his
or her end of life journey; however, the presence requires the nurse to be desirable and focused to
be there. In addition, the nurse must withhold any judgmental thoughts to build an efficient
therapeutic relationship with the client and the family. Most importantly, the nurses must be
aware of their values, beliefs, spirituality and experiences of life and death to be self-competent,
to be genuinely present with the client, and to escape any persecution by other healthcare
professionals (Dobrina et al., 2014).
Death is the hardest emotion to deal with for person of any age. It is perhaps the fear of the
unknown that triggers an anxiety when thinking about death. The most important thing I learned
from this experience is that dealing with death is tough, but it can be handled effectively through
guidance. Having a hand to hold, a face to see, and a voice to listen makes a huge difference
when loneliness is at its best. Through promotion of comfort and therapeutic nurse-client
relationship, hospice eases the process of end-of-life journey.

END OF LIFE CARE

References
Bonebrake, D., Culver, C., Call, K., & Ward-Smith, P. (2010). Clinically differentiating
palliative care and hospice. Clinical Journal of Oncology Nursing, 14(3), 273275.
Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care
nursing models and theories. International Journal of Palliative Nursing, 20(2),
75.