Academic journal article Perspectives in Psychiatric Care

Nursing Care at the End of Life

Academic journal article Perspectives in Psychiatric Care

Nursing Care at the End of Life

Article excerpt

A woman, her husband, and their 22-year-old daughter needed help not long after another daughter had been killed in a car accident. While they were foreign born, the parents were well adapted to American life. They had an excellent network of friends but no close relatives in the state or any nearby state. They had a simple request: They wanted to know how to manage grief.

A second woman told her story: "I had promised my husband that there would be no heroics at the end of his life. He had been ill and in failing health for 5 years and was 86 years old. But when I took him to the emergency room for a chest x-ray as the doctor had ordered, they started all kinds of procedures on him. Eventually he was on a respirator. I had promised him he would die at home. I didn't keep my promise; and I regret taking him to the hospital."

A third woman, Ruth, was 45 years old and lived with her husband and two teenage sons. She was in the final stages of life due to Ewing's sarcoma. They lived in a frontier area on a ranch 20 miles from their nearest neighbor. In the last few weeks of her life, Ruth would scream with pain, until the last few days, when she only moaned. Afraid that Ruth might become addicted to pain medication and frightened by the controversies over end-of-life pain management, the physician prescribed only moderate pain control. The tortured last few weeks of Ruth's life weighed heavily on the family.

There are many decisions and management issues in providing quality end-of-life care. Healthcare professionals often are unaware of the issues, practices, or consequences to families experiencing death and dying. There is a national effort by healthcare organizations to improve end-of-life care in America. The International Society of Psychiatric-Mental Health Nurses (ISPN) has developed a national agenda for psychiatric nurses to provide information, and to develop activities to improve end-of-life care in America. …

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