Hospice care impacted both the family and the patient as compared to dying in the hospital



Abstract

In the past, severely ill and injured patients admitted to the ICU who were expected to die were made as comfortable as possible for the time that they had left to live. These patients were made as physically and emotionally comfortable as possible with the expectation that they were dying. Family members, religious representatives, and close friends often would gather at the dying person's bedside to ease them into their final destination. In today's health care settings, improved medical knowledge and technology have increased the public's expectations of prolonging life. Most people believe they will recover when they get sick, and expect to live longer than their ancestors. Because of this, the focus of the general population (as well as the medical population) has changed from keeping the patient comfortable to keeping the patient alive at all costs. In the late 1950's the first intensive care units were created. These units were designed to care for the very ill patient who needed one-to-one nursing care (Glavan, 1999). In order to accomplish this, nursing education has become more extensive to better educate nurses in the realm of critical care. In this paper, we try to focus on the hospice care. The paper discussed how has in home hospice care impacted both the family and the patient as compared to dying in the hospital. Hospice care impacted both the family and the patient as compared to dying in the hospital

Introduction

Modern medicine and technology have enabled health care professionals to improve the prognosis of many critically ill and injured patients. Caring for and improving the health of critically ill patients can be a rewarding experience for nurses. Unfortunately, some patients with a very poor prognosis are maintained for days, weeks, or months on life support devices such as ventilators, intra-aortic balloon pumps, and continuous veno-venous hemodialysis machines (Zimmerman, 1986).

Many of these patients have an advance directive that is ignored by family members and health care providers. Others are so hemodynamically unstable that pain medications and sedatives are withheld because these “comfort” medications may make the patient's status even more unstable, possibly causing the patient to expire. Intractable pain is one of the major fears of dying patients and their families (Bruce et al, 2006). Whether the patient is in a critical care unit or in hospice care, palliative sedation should be initiated if the following four criteria are met: symptoms are unbearable and refractory, the patient has a terminal diagnosis, and the patient has an active DNR (do not resuscitate) order and death is imminent (Bruce et al, 2006).

Background

Unfortunately for many dying patients in the ICU, palliative sedation does not happen. Fortunately, there is an alternative to enduring futile efforts to prolong life. Outpatient hospice care is an option for the critically ill patient with a poor prognosis. In this setting, the patient is able to live out his or her last days at home or in ...