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What is important in the end of life care essay

A Trust was set up in his name in 2003 to promote education in the recognition and treatment of cancer pain and it provided funds for an annual essay prize, open to those undergraduate medical students of Queen's University, Belfast, who had completed their fourth year palliative care teaching.

The first competition took place in 2010 and the winning entry appeared in the Ulster Medical Journal in 2011. The Trust itself was dissolved in 2014 but the essay prize continues and the Trust's website can still be accessed at http: While no-one is likely to dispute that patient dignity is an important concept, it is much more difficult to translate this abstract concept into the clinical setting.

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Maintaining patient dignity is something we often hear mentioned when discussing the principles of palliative care; however it is possible that this almost becomes a phrase of vain repetition with little relevance to the quality of care the patient actually receives.

The purpose of this essay is to consider why dignity is important in palliative care and how the concept of dignity can affect one's day-to-day practice. The word dignity originates from two Latin words, dignitus merit and dignus worth.

The International Council for Nurses Code of Ethics 2012 instructs that the observance of dignity should not be limited by the individual's age, colour, creed, culture, gender, sex, nationality, race, social status, or health status.

The concepts of respect, autonomy, empowerment and communication have been identified within the literature as being key defining attributes of dignity. In turn, each of these attributes is multidimensional, further contributing to the complex, ambiguous nature of the concept.

For example, respect may involve self-respect, respect for others, and respect for people's privacy; autonomy may involve having choice, giving choice, making decisions, competence and independence; empowerment may involve self-esteem, self-worth, modesty and pride; and communication may involve explaining and understanding information using verbal and non-verbal modalities 2. Most end-of-life interventions focus predominantly on symptom control, rather than holistic care 4. Therefore it may be helpful to consider the physical, emotional and spiritual needs of patients in palliative care settings.

  1. They also reported increased job satisfaction 25. Measures such as getting acquainted with new living structures or involvement with staff and other residents have been shown to encourage a sense of dignity among nursing home residents — measures which may be transferred to palliative care units 17.
  2. The contract is based on four core services, namely the acute medication service, the minor ailment service, the public health service and chronic medication service CMS 45 of which palliative care is one. Spiritual care has been shown to be hindered by a lack of privacy and discontinuity in care 11.
  3. The LCP is designed to enable all healthcare workers to provide optimal care to dying patients, whether they are specialists in palliative care or not, by guiding clinical decision making.

Regarding physical needs, when trying to enhance and preserve dignity, a systematic review found that symptom control and being placed in the correct environment are important in delivering dignified end-of-life care 5. Good management of physical symptoms such as pain, dyspnoea, constipation, nausea, and respiratory secretions may allow for opportunities to work through unfinished emotional, psychological and spiritual issues, and promote a sense of closure towards the end of life 6.

However, invasive and inappropriate investigations should be avoided 7. Regarding emotional needs, a review found that important actions for healthcare professionals providing end-of-life care include communicating, listening, conveying empathy, and involving patients in decision-making 8.

Furthermore, good communication between the patient and their partner about their feelings should be promoted 9. What is important in the end of life care essay needs should also be addressed 7. An observational study evaluated the spiritual needs of patients with terminal cancer. The two most relevant needs were the need to be recognised as a person until the end of life without losing their identity, and the need to know the truth about their illness.

Less importance was placed on concerns for the past and future, and for religious matters 10. It would appear that, as spiritual care goes beyond the scope of religion, it involves more than facilitating access to the relevant chaplains.

Any healthcare professional can be involved in spiritual care by being present, understanding the patient's perspective, and creating with the patient a holistic care plan which considers dignity issues 11. Other measures found to promote dignity include enabling of the management of finances, facilitating activities such as reading or watching television, allowing the patient to spend time with their family, providing choices regarding the place of death, remembering the dignity of the family after the death of the individual, and offering emotional support 7.

In addition, life storytelling has been shown to help individuals with dementia maintain their dignity of identity. This may be helpful in end-of-life care also, and may help carers better understand the patient's needs 12. The age of the patient may influence how one thinks of dignity in end-of-life care.

  1. Hospice staff also rated dignity therapy as worthwhile, felt it reduced pain and suffering, and felt it enabled a greater connection with patients.
  2. However, effective communication and co-ordination between professionals, especially across organisational boundaries, systems and structures, can play an even more crucial role in ensuring the quality of care and enhancing patient and carer experience. The dignified approach to care.
  3. Jpn J Clin Oncol. A lack of caring may result in the patient being less forthcoming with concerns — leading to missed treatment opportunities, medical errors, and ultimately compromised patient safety.
  4. As dignity is a value- and culture-laden concept that encompasses a wide spectrum of physical, psychosocial, spiritual, familial and cultural issues, an awareness of ethnic diversity is required for all healthcare professionals 4.
  5. Seamless care helps patients to move across healthcare boundaries without experiencing a gap in the standard of healthcare delivery, but this requires effective communication between primary and secondary care. The recent NHS pharmacy plan advocates that personal medicine management services should be provided by community pharmacists in the future.

Thus the child should be offered sufficient opportunities to play freely, access to their usual activities and relationships, a sense that others acknowledge and respect the patient's childhood, and symptomatic care.

There should also be less emphasis on the prospect of impending death 13. Religious and cultural factors may also influence how one thinks of dignity in end-of-life care. As dignity is a value- and culture-laden concept that encompasses a wide spectrum of physical, psychosocial, spiritual, familial and cultural issues, an awareness of ethnic diversity is required for all healthcare professionals 4. A Hindu may accept or reject certain treatments based on their interpretation of suffering in relation to beliefs about Karma 15.

A longitudinal study found that a downward trend in the sense of dignity following admission to a nursing home was associated with the feeling of a loss of control and a loss of self-worth 17. Considerations of patient dignity may also be set aside unintentionally due to time constraints and heavy workloads, for example in the Emergency Department 2. Lack of feeling empathy or the inability to emotionally engage with patients may indicate healthcare provider burnout 18.

Spiritual what is important in the end of life care essay has been shown to be hindered by a lack of privacy and discontinuity in care 11. Furthermore, the concept of dignity may be forsaken due to the pressures of modern medicine, where the emphasis is on providing care i. Francis Peabody in his famous address to Harvard medical students in 1925 18. A lack of caring may result in the patient being less forthcoming with concerns — leading to missed treatment opportunities, medical errors, and ultimately compromised patient safety.

Furthermore, studies consistently show that most complaints against healthcare professionals derive, not from medical errors, but from a failure to communicate and the absence of caring — in other words, compromised patient dignity 18.

Spiritual care has been shown to be facilitated by having sufficient time, employing effective communication, and reflecting on one's personal experiences 11. It is clear that involvement of the palliative care team encourages a sense of dignity as the emphasis is less on the disease and more on the person 16.

Measures such as getting acquainted with new living structures or involvement with staff and other residents have been shown to encourage a sense of dignity among nursing home residents — measures which may be transferred to palliative care units 17. A sense of depersonalisation reduces the perception of patient dignity 10 ; thus getting to know the patient as a person is likely to help promote dignity.

The PDQ was found to be acceptable to patients with palliative care needs 21. Asking this question was found to make improvements to a person-centred environment and levels of empathy perceived by patients, and also supported disclosure of information previously unknown to healthcare professionals 22. Encouraging life review can also promote patient dignity 16. In a formal sense, this may involve dignity therapy, a psychotherapeutic intervention proposed by Chochinov. Dignity therapy focuses on dignity conservation tasks such as settling relationships, sharing words of love, and preparing a legacy document for loved ones.

Patients have reported high satisfaction and benefits for themselves and their families including an increased sense of meaning and purpose 23. Compared with standard palliative care, patients undergoing dignity therapy reported that it improved their quality of life, increased their sense of dignity, changed how their family saw and appreciated them, was helpful to their family, and was superior to standard care in lessening sadness or depression 24.

Hospice staff also rated dignity therapy as worthwhile, felt it reduced pain and suffering, and felt it enabled a greater connection with patients. They also reported increased job satisfaction 25. Commonly discussed topics during dignity therapy were autobiographical information, love, lessons learned in life, defining roles in vocations or hobbies, accomplishments, character traits, unfinished business, hopes and dreams, and guidance for others 26.

What is important in the end of life care essay has been suggested that there is actually a decline in the level of empathy shown by medical students as they progress through medical school, perhaps driven by the greater emphasis placed upon technology and innovation than on individual patient's needs 27. There appears to be nothing in the literature relating to dignity in the Objective Structured Clinical Examinations; however it has been suggested that the subject of dignity should be incorporated in its own right within the curriculum for those studying to become healthcare professionals, perhaps in an inter-professional education setting 28.

I propose that the concept of dignity may be likened to that of love — important, widely understood, difficult to define, and cannot be taught in a black-or-white manner. As dignity is subjectively experienced and each patient is unique in their requirements, it is important that healthcare professionals use an open approach to assess each patient's needs and aim to meet these accordingly, using discretion as to what is appropriate when providing care for patients of different ages, cultures and religions.

Reflection On End Of Life Care Essay

Simple measures such as the PDQ and life storytelling can help healthcare professionals view the patient receiving end-of-life care as a person; thereby helping them to promote patient dignity and address needs which would otherwise not be known. Adib-Hajbaghery M, Aghajani M. Patients dignity in nursing. An analysis of the concept dignity. Assessment of factors influencing preservation of dignity at life's end: Living and dying with dignity in Chinese society: Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: Clary PL, Lawson P.

Pharmacologic pearls for end-of-life care. Indian J Palliat Care. Dignity-conserving care in palliative care settings: A preliminary study to develop an intervention to facilitate communication between couples in advanced cancer. Evaluation of spiritual needs of patients with advanced cancer in a palliative care unit.

An exploratory study of spiritual care at the end of life.

The Importance of Patient Dignity in Care at the End of Life

How individuals with dementia in nursing homes maintain their dignity through life storytelling - a case study. Good death for children with cancer: Jpn J Clin Oncol. Hinduism and death with dignity: Disease, dignity and palliative care. Changes in the personal dignity of nursing home residents: J Pain Symptom Manage. Patient and family perspectives on respect and dignity in the intensive care unit.

Eliciting personhood within clinical practice: The person behind the patient: Int J Palliat Nurs. The dignified approach to care: Care of the human spirit and the role of dignity therapy: Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: Hospice staff perspectives on Dignity Therapy. Dignity therapy implementation in a community-based hospice setting.

Science in the service of patients: Yale J Biol Med. Learning to promote patient dignity: