PhD, MS, MSN, RN, APRN-BC, CDCES, CCRN
End of life planning can sound academic when the focus is on legal documents; however, it can be one of the most emotional, painful, and stressful life events for an individual and entire family. Most individuals do not like to talk about death let alone plan ahead.
Many families are never given more details about the complicated choices involving feeding tubes, comfort care, palliative care, or hospice care.
The medical field is missing the opportunity to educate our general public about the array of choices and resources. Even working in the medical profession, some are not always aware of the many steps, processes, and decisions that have to be made.
End of life planning involves making decisions about how one wants to be cared for and how one’s affairs should be handled as the end of one’s life is approached. This includes decisions about medical treatment such as life-sustaining treatments, pain management, and palliative care.
End of life planning also involves making plans for personal and financial affairs, such as creating a will, appointing someone to make medical decisions on one’s behalf, and designating someone to manage finances in the event one becomes unable to do so. It also includes the process of post-mortem care after death such as deciding about cremation or burial arrangements, requesting death certificates, writing an obituary, and notifying legal entities about the person’s death.
It is a process to ensure one’s wishes are carried out and that other loved ones have a clear understanding of one’s desires in the event that one is unable to communicate. One of the best gifts to give other family members is a clear outline of one’s wishes.
Nurses play a vital role in end of life planning as they are often the primary caregivers for patients who are nearing the end of their lives. Their compassion, knowledge, support, and advocacy can make a huge difference.
Some nurses specialize in hospice or palliative care, but for those who do not, being knowledgeable about end of life care is crucially important as death can occur in any clinical setting.
Knowing one’s role and serving with compassion and possessing effective communication can make the difference between a horrific experience for the patient and family, or one that is gentle, peaceful and supportive.
Some of the key roles that nurses may serve are as follows:
Nurses are trained to assess a patient’s physical, emotional, and even spiritual needs. Nurses can help patients identify their needs and preferences for end of life care and can work with other healthcare providers to develop a plan of care that is tailored to each patient’s unique needs.
Nurses can help patients and their families communicate effectively with healthcare providers and the team. Nurses can serve as a liaison between patients and their families and can help translate the often confusing medical jargon that is a part of the medical profession.
Nurses can provide emotional support to patients and their families and help them navigate the many challenges that arise as they approach the end of life. There are many difficult decisions families must make beyond “code or no code.” Even if a living will and advance directives have been outlined, the emotional toll on family members can be extremely painful to let their loved one die without extraordinary measures.
Nurses can help patients and their families understand their options for end of life care such as hospice and palliative care. The difference can be confusing to patients and families. Nurses can help them make informed decisions about medical treatments and care plans.
Nurses can advocate for patients’ rights and preferences and can work to ensure that their wishes are respected and that they receive the highest quality care possible.
The nurse can provide patients with a variety of resources to support end of life planning. The following are a few examples:
Nurses can provide information on advance directives, which are legal documents that allow patients to specify their wishes for medical treatment and end of life care. In many hospitals, it is a requirement for the admitting nurse to ask the patient if they have or want the form. Often, the first encounter with advance directives is when a patient is admitted for a surgery or treatment. The nurse has the opportunity to provide patient education about the purpose of the document and answer any questions.
Nurses can provide information on these areas which are specialized manners of care that focus on improving the quality of life for patients with serious illness. It is important that the patient is clear about the end goal of each type of care.
Nurses can provide information on financial and legal resources, although they are not qualified to give financial or legal advice. Nurses can connect the patient with estate planning or financial services contacts, which can be extremely helpful. Many people do not even know the right questions to ask, and nurses can help connect them with experts in their community or where to find the individuals.
Nurses can provide information about support groups for patients and families dealing with serious illnesses. Within support groups they can find additional resources such as websites, books, lectures, friendships, and more.
Nurses are in a unique position to ask about a patient’s preference for a spiritual leader or support. Some hospitals have chaplains and can serve as an additional resource to connect the patient and family to their preferred religious clergy.
Nurses are in a very fragile and unique position to care for patients at the end of their life. End of life can be a tremendously emotional time in a family’s life. The compassion and medical knowledge offered by a nurse places the nurse in a powerful position to make a positive difference in the experience of death for all involved.
Overall, the nurse’s role in end of life planning is to provide compassionate, patient-centered care that supports both the patient and their families through the entire process.
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