Academic journal article Journal of Allied Health

Promoting Health, Wellness, and Quality of Life at the End of Life: Hospice Interdisciplinary Perspectives on Creating a Good Death

Academic journal article Journal of Allied Health

Promoting Health, Wellness, and Quality of Life at the End of Life: Hospice Interdisciplinary Perspectives on Creating a Good Death

Article excerpt

The purpose of this phenomenological study was to answer the broad questions: what do professional caregivers for the dying think about what they do, and how does that thinking influence their practice in end-of-life care? The participants were 12 hospice professionals working in four specific disciplines: occupational therapy, physical therapy, social work, and nursing. Indepth interviews were conducted and audiotaped, and transcripts were printed. Constant comparison and thematic analysis was performed. One overarching theme and five subthemes were generated. The central theme, "promoting a good death," emerged from the data, as the participants continually discussed health, wellness, and quality-of-life work in which they engaged that were discipline-specific yet overlapping. The subthemes that emerged were: holism; framing and re-framing practice; client- and family-centered care; being with dying; and interdisciplinary team. All participants concluded that their work emanated from a health and wellness lens, and that quality of life at the end of life was their ultimate goal. Quality of life, for each discipline, included doing, being, and becoming one's authentic self until the end of life. J Allied Health 2014; 43(4):212-220.

PROFESSIONALS who work with people at the end of life ascribe to the principles of compassionate care understood by hospice professionals. The hospice philosophy embraces and promotes the concepts of dignity and the promotion of quality of life until the end of a life. Hospice also focuses on the family as the unit of care. This unique form of care promotes the health, well-being, and healing of the dying and their families at the end of life. To that end, health professionals have a profound understanding of the importance of active participation in one's life until the end of life, the creation of meaning and connecting through active participation in daily life activity, and the positive impact on the implementation of those concepts on the well-being and quality of life for clients and families.1,2

The professionals who work within a hospice philosophy have unique views and attitudes towards developing caring and compassionate relationships. Overlapping roles and responsibilities require teamwork and professional attitudes and behaviors while maintaining one's professional identity. This teamwork facilitates well-being and health promotion for all people at the end of life so that physical, social, emotional, and spiritual needs of clients and families are fulfilled as much as possible. When the quality of life and well-being of individuals are enhanced, the vision and philosophy of hospice care is realized.

The intent of this paper is to describe hospice professionals' views on end-of-life care, what they think about what they do as professionals, and how that thinking influences their practice in end-of-life care. Professional attitudes about end-of-life care will be discussed, followed by the integration and application of health and well-being in end-of-life care. The study that follows the literature explores the perspectives of hospice health professionals on health, well-being, quality of life, and end-of-life care.

Professional Attitudes and End-of-Life Care

Each discipline discussed in this study has professional documents related to end-of-life care. Professional attitudes, ethics, and best practice are described in all of the documents. Occupational therapy (OT) and social work (SW) position papers discuss the need for compassion, dignity, and respect for clients; being adaptable to the needs of clients and families; and having deep self- reflection, or therapeutic use of self, to monitor one's own attitudes, values, beliefs, and feelings when working in endoflife care.3,4 Physical therapy (PT) discusses the need for compassionate care with an emphasis on how physical therapy practice can improve quality of life.5 Nursing emphasizes the skills a nurse possesses to implement patient-centered, competent, and compassionate care. …

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