Background On End Of Life Care

Each person experiences a different end to life. Death may come suddenly, or it may also linger for days, weeks, months, or even years in a near- death state. During the end of life, for most adults their body weakens and cognitive function starts declining which increases the need for end of life care (Albert 2017). End of life care is the support that is offered to individuals who are in the last months or years of their life to provide comfort to them and to relieve them of their sufferings as much as possible (Coyne, Mulvenon and Paice 2018). End of life care enables the person to live their life as well as possible by ensuring that the quality of life is maintained as much as possible. This allows the person to live the last few months or years of their life with dignity and also respect their last wishes and preferences (Thomas, Lobo and Detering 2017). An individual possesses the right to express their wishes regarding where they would want to receive care and where they want to die. They can receive end of life care at their home, hospices, at care homes, or in hospitals which vary according to the needs and preferences of the individual (Shepperd et al. 2021).

One end of life care issue that is relevant to health and social care is pain and its management. Pain is identified to be a prevalent symptom at the end of life. It results due to a variety of reasons and negatively impacts the quality of life of the affected person (Sjöberg et al. 2021). Palliative care is therefore a crucial aspect of end of life care. It is defined to be a specialized form of care that does not aim to treat the person from their existing morbidities but instead focuses on offering relief from the symptoms that the person experiences during chronic illnesses such as heart failure, or cancer (Sholjakova et al. 2018). Palliative care helps in managing the disease or the underlying medical issue by easing the pain and also by helping the patient in managing and coping with other physical, psychological, social, and emotional symptoms such as fatigue, anxiety, insomnia, or shortness of breath (Altilio et al.  2019). The aim of this assignment is to critically analyze the issue of pain and its management during the end of life with reference to the module learning outcomes and to explore the relationship of pain to clinical practice and the implications for continuing professional and personal development. Any reference to clients, patients, medical/nursing documentation, or health care organizations will be anonymised.  Pain Management In End Of Life Care Essay Paper

The incidence of pain towards the end of life is found to be increasingly high. Pain according to the International Association for the Study of Pain, is defined to be an “unpleasant emotional and sensory experience that is linked with real or potential tissue damage” (Cohen, Quintner and van Rysewyk 2018). Pain during end of life can be either acute or chronic or a mix of both, either of which profoundly impacts the quality of life by contributing significantly to suffering. Although pain is sensed by the nociceptive system, but it is mediated by the subjective perceptions of the patient and is hence perceived by each patient in a unique manner. A number of other factors also impact experience of pain at the end of life which contributes to the overall suffering, which will too be discussed shortly. This increasing incidence of pain among terminally ill patients has made it a common fear among those who contemplate the end of life. Poorly managed pain not only increases the patient’s suffering but also demotivates them and decreases their will to overcome the illness which negatively impacts patient’s outcomes, thereby making pain an important issue in the end of life (Steins et al. 2017).

Palliative Care As A Specialized Form Of Care

Severe pain faced by patients during the end of life can be distracting, and destructive. However, implementing strategies for pain management and control can improve a patient’s life significantly. Recent advancements in pain treatments can cause substantial relief from pain in approximately 90- 95% of patients who are at the end stage of their life. Although obtaining complete freedom from pain during the end of life is not very realistic however attempts can be made to manage pain in a more successful manner that can bring down pain levels of patients from 9-10 to 2-3, on a scale of 0- 10 (Dalal and Bruera 2017). It is important to make pain relief a top priority for end of life care as it can not only make the last days of the patient more comfortable but also allow them to die with dignity. In a number of cases, the array of distress and symptoms that the patients with advanced diseases experience can be effectively prevented via optimal care. Effective pain management at the end of life increases the quality of life and also prolongs life rather than accelerating death. Pain is a highly treatable symptom in palliative care, therefore making pain and its management an important issue in end of life care (Dalal and Bruera 2017).

Pain during end of life is influenced by a number of factors. Age, cause of illness, demographic factors, race, spiritual beliefs, support systems, and income levels are some factors. Breathing issues, skin irritation, digestive issues and increased sensitivity to temperature are factors that cause physical pain in patients who are at the end of their lives. Other factors such as social isolation, psychological stress, and spiritual crises also contribute negatively by increasing sense of pain experienced by the patient. Pain among patients who experience terminal illness is also influenced by emotions, which interrelates the cycle of pain with emotions. Emotions of any individual directly impacts the physical change such as being anxious can cause the tightening of muscles which can further increase the pain experienced. Family factors such as increased stress, impact on relationships, financial burden, and resentment can also impact levels of pain experienced and increase likelihood of depression and anxiety (Goubert et al. 2021).

Pain that is managed inadequately can result in adverse psychological and physical outcomes for the patient as well as for their family. As stated by Wells, Pasero, and McCaffery in “Improving the Quality of Care Through Pain Assessment and Management”, patient that is not relieved can further impacts patient’s mobility and increase occurrence of complications such as pulmonary embolism, deep vein thrombosis, or pneumonia. This can impact the patient’s welfare during the end of life and also extend their length of stay and readmissions to the hospital thereby also increasing the cost of care which can be a financial burden on the patient during their last days of life. Common psychological responses that can develop in the patient as a result of pain include depression and anxiety (Michaelides and Zis 2019). Inability to deal with pain can also result in creation of a sense of hopelessness as well as helplessness which can predispose the patient to chronic depression.

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The Issue Of Pain In End Of Life Care

As it is discussed above, pain interferes with the ability of the patient to carry out daily activities of living (ADLs) and also interferes with the proper functioning of the body and/or the mind. As any patient approaches the end of life, nursing interventions that must be carried out include eliciting the goals of care for the patient, listening to the need of the patient and their family members, communicating with the patient and members of the interdisciplinary team and advocating for the wishes of the patient, and managing the symptoms experienced by the patient (Butcher et al. 2018). Therefore, one of the primary goals of chronic pain management is to limit its impact on the patient’s function. Nursing care can help the patient to deal with pain through pharmacological as well as non- pharmacological aspects during the end of life which can help the patient to retain their activity, maintain an overall positive mood, and achieve proper sleep. It improves patient care by alleviating anxiety and emotional distress, improves the overall well being of the patient and also enhances their functional capacity thereby easing suffering (Schroeder and Lorenz 2018).

Nursing professionals have the ethical responsibility of offering care that is clinically excellent to the patient so as to effectively manage pain. According to the Nursing and Midwifery Council (NMC) which is an independent regulator for nurses, nursing associates, and midwifes, the standards of proficiency for registered nurses includes that the nurses are accountable for their professional actions, they are responsible for promoting the health of their patient and preventing ill health of the patient, responsible for assessing the needs of the patient and planning care, responsible for offering and evaluating care that is offered to the patient, responsible for improving safety of care that is offered and ensure that quality care is delivered at all times (Dimond 2002).

Nursing professionals being a part of the collaborative team therefore play an important role in offering end of life care and managing pain for patients who are at the end of their lives for which they are also liable to legal action. They consider the clinical indications displayed by the patient, identify non- verbal cues, and mutually identify goals for alleviating pain for the patient. Nurses utilize evidence- based practices to administer effective dosage of medication prescribed for controlling the pain and they also play a role in advocating for the patient when the prescribed medication is unable to effectively manage pain and other distressing symptoms for the patient (Nedjat-Haiem et al. 2017).

Through the module and the course of study in health and social care, the learning outcomes expected include knowing what is end of life care, pain as an important and primary symptom in end of life, importance of pain management in end of life care, importance of offering physical comfort, and managing the mental and emotional needs of the person to ensure that they live their life with dignity and respect. This work on pain and pain management as an end of life care issue has incorporated the learning outcomes of the module (Dalal and Bruera 2017). This work has first described what end of life care is and why one usually experiences pain during end of life. To reiterate, pain is experienced by the terminally ill due to a number of morbidities and as a result of the consequence of their underlying pathologies. Pain is identified to be a symptom of end of life. This work has also discussed why managing pain is an essential aspect of end of life care. It not only improves the patient’s life significantly by offering substantial relief, but also improves the overall quality of life of the patient and overall well being (Hooten et al. 2017).

Factors Influencing Pain At The End Of Life

This work has also discussed the importance of palliative care in end of life care, which has been discussed in the course module. Palliative care helps in managing the diseases or medical conditions that one suffers from during the end of life by easing pain and other associated symptoms. Pain management is identified to be a key component of palliative care and end of life care. Managing pain in a better manner improves the quality of life of the patient and also reduces development of further complications (Hallenbeck 2022). The work has next identified the factors that impact and influence pain levels of a patient during the end of their life. These include morbidities, age, gender, lifestyle, income levels, and other demographic factors. Other social and spiritual factors and emotions experience by the patient by directly impact their levels of pain by increasing the level of stress, etc. This course has given an insight into the role of nursing practice in management of pain during provision of end of life care. The NMC standards of practice for nurses that is a core theoretical component has been discussed in this essay which highlights the importance of nurses and the role they play in offering pain relief to patients receiving end of life care by pharmacological as well as non- pharmacological means (Leigh and Roberts 2017).

Pain is recognized to be a great concern when it is untreated and unrecognized.  Nursing as a profession has given nurses the ethical obligation to act in a way that reduces suffering of patients, identify barriers to adequate pain management, and implement strategies that can help in effectively educing pain experienced by patients during end of life care. Nursing as a profession can develop better understanding of pain and pain management by allowing nurses to advocate for their patients for safe, effective, and efficient management of pain for every patient who receives end of life care irrespective of their disease, site of care, age, history of medical illness, etc. (Hooten et al. 2017).  Nursing profession allows nurses to use evidence- based practice, to administer medications and to advocate for non- pharmacological therapies such as integrative therapies, physical measures, psychological approaches, and interventional techniques, when appropriate. Nursing as a profession makes nurses aware of the barriers that can exist to assessment and treatment interventions. Nurses also possess knowledge of the global nature of pain that includes social, cultural, psychosocial, and spiritual aspects (Ellis, Standing and Roberts 2020).

Nursing profession is also associated with ethical considerations. It is the ethical responsibility of nurses to relieve the suffering and pain of patients which is also included in the standards for nurses by NMC. Nurses offer care by ensuring that nursing care is consistent with the accepted legal and ethical professions. The ethical tenets of autonomy, non- maleficence, beneficence, and justice govern the nursing practice and guide the provision of end of life care (Burns 2018). Beneficence is defined as the duty of nursing professionals to benefit others which is displayed by nurses to offer compassionate care and manage pain. The principle of non- maleficence is defined as the duty to do no harm which guides the nursing professionals to alleviate pain since it is not only physically taxing but also psychologically harmful. The principle of autonomy is defined as the right of the patient to self- determination. Nursing as a profession is guided by these ethical principles which guide the action of nursing professionals to support the autonomy of patients, give them all necessary information to participate effectively in pain management and take informed decisions. Nursing as a profession also offers the nurses with education of pain management that is a human right and a core health care value. Education allows nurses to possess an understanding of pain and pain management in end of life care (Hernández-Marrero, Fradique and Pereira 2019).

Importance Of Pain Management In End Of Life Care

To manage pain effectively during end of life care, nurses need to possess adequate knowledge, skills, and the right attitude. Firstly, effective pain management requires strong written as well as verbal skills of communications that must be displayed by the nursing professionals. This is because the first step in managing pain is assessment. Pain assessment comprises of five main components which are as follows: a) physical and patient history assessment, b) a complete functional assessment, c) psychosocial assessment, and d) multidimensional assessment. To accurately assess the level of pain of the patient, the nursing professionals should be able to perform a complete assessment which requires them to facilitate communication (Hooten et al. 2017). It is only after a proper communication between the patient and the nurse following which adequate information can be retrieved from the patient which can help in assessing the patient’s level of pain in an accurate manner (Jóhannesdóttir and Hjörleifsdóttir 2018). Nurses must also possess strong listening skills to be able to fully understand and comprehend the patient’s feelings and make necessary changes to improve their level of comport. Nurses must possess empathy towards the patient. To display empathy, nurses can make eye contact with the patient, make gestures that will help in making the patient feel comfortable, be aware of own body language, and record details that will help in humanizing with the patient.

Apart from this, another skills that nurses must possess to able to effectively manage pain is interpersonal skills. These skills will allow the nursing professionals to develop a trustworthy, and professional relationship with the patient where the patient will feel comfortable in sharing their thoughts and fears (Hallenbeck 2022). Possessing interpersonal skills will also aid the nurse in effectively collaborating with the patient and other members of the healthcare team that will ensure that best care is delivered to the patient. Interpersonal skills will also allow the patient to interact successfully and will increase adherence of the patient to the treatment regime, thereby improving overall patient health and well being (Hallenbeck 2022). Lastly, possessing current and updated knowledge is essential as it will positively influence nursing practice and will raise awareness among the nursing professionals regarding personal and professional accountability. Knowledge about various pharmacological and non- pharmacological methods of managing pain can improve delivery of care. Attitudes that can positively influence pain management in end of life care includes professional behavior such as being compassionate, holding accountability for own actions, effectively collaborating, and having sense of duty (Harden et al. 2017).

Pain management is one of the major responsibilities of the nursing practitioners for patients who are getting end of life care. However, it has been extensively reported by the researchers that nursing professionals may encounter different challenges or might get influenced by a number of factors which interrupt their care approaches for pain management. First of all, it has been indicated that cultural factors are the major ones which impact the delivery of pain management care to the patients. According to the study by Givler, Bhatt and Maani-Fogelman (2020) residing in ethnically as well as culturally diverse society needs healthcare professionals to dignify and consider specific cultures which the patients belong to. Healthcare personnel are often influenced by the cultural background of the patients while assessing pain for the patients while providing end- of- life care.

Consequences Of Inadequate Pain Management

Secondly, time constrain might also be held responsible for influencing care for the patients. As indicated by Conroy (2018), availability of time is one of the important factors that influence delivery of fundamental care by the nurses. In clinical setting nurses are relied for performing several tasks during their shift hours. At the same, they have to provide care more than one patient in the hospital setting. As a result of this excessive workload, they might face time management issues which interrupt their care for pain management for patients. Thirdly, it has also been evidenced that nurse’s self-concept might also influence nurses’ decision about pain management of the clients. According to the research conducted by Denness et al. (2017) complexity of the clinical environment along with nurses’ individual concepts had affected decisions regarding pain management for the orthopedic patients due to perceived significance of pain control as well as due to perceived responsibilities to administer analgesics to their patients.

According to the study conducted by Jiang et al. (2019) nurses ‘knowledge deficit about pain management and negative attitudes might be considered as influencing factors for ineffective palliative care as well as end of-life care facilities to the patients. This has been supported by Hussin et al. (2018) who have mentioned that it is highly essential to prioritize improvement of nurses’ knowledge and enhancement of positive attitude towards end-of-life care in order to uphold the quality of living of the dying patients. At last but not the least, it can also be mentioned that pain is a subjective sensation which might be perceived different by individuals. According to Lundin and Godskesen (2021) nurses faces challenges in managing pain for the patients in end of life care stage since they often fail to communicate effectively with patients who have been diagnosed with several comorbid conditions. Thus providing standardized care may lead to inadequate management of pain among these patients.

Numerous strategies can be employed to ensure that nursing care in relation to pain and pain management in end of life care is improved. The aim of these strategies is to ensure that the patient demonstrates relaxation skills, rates the pain level at less than 3 or 4 in a scale of 0- 10, and displays improved mood and overall improved sense of well being and increased ability to cope. One effective strategy that can be employed is to accurately determine the patient’s perception of pain. While nursing professionals take the history of the patient, they must offer an opportunity to the patient to express their view on the level of pain experienced in their own words. This can help in gaining an overall improved understanding of the situation of what the pain implies to the patient (Hallenbeck 2022). Nursing professionals can ask open ended questions which can give the patient an opportunity to describe their feelings in details. Since pain responses are unique for every individual, therefore a descriptive answer can help in understanding the patient’s concerns which can improve delivery of patient care (Beckstrand et al. 2017).

Psychological And Emotional Impact Of Pain At The End Of Life

Another strategy that can be employed is to determine the level of anticipation that is displayed by the patient for pain relief. Some individuals during the end of life may consider pain to be an unavoidable aspect of life and may be satisfied when pain is not intense. Other may however demand complete elimination of pain. This anticipation of the patient also influences the effectiveness of the treatment regime and the provision of nursing care. Therefore, by gaining an understanding of the perception of the patient, efforts can be made accordingly to alleviate the patient’s pain (Turk and Meichenbaum 2017). The perception of the patient also directly influences their willingness to engage, participate, and adhere to their treatment routine. The willingness of patients to explore a diverse range of pain management techniques during the end of life also differs. Some accept death as it comes, whereas others may want to die with dignity. Thus by assessing the patient’s ability to engage in different methods of pain management can influence the nursing care that is offered to them (Liu and Chiang 2017). Increased willingness of patient can improve nursing care by introducing traditional as well as new methods for pain management.

Conclusion

Thus in conclusion, this paper has discussed in great details the impact of pain as an issue in end of life care. The paper has also highlighted the importance of pain management in end of life care. End of life care describes the health care and support that is offered to patients during the time surrounding death. Palliative care is a specialized medical care that is offered to people during the end of life when they experience pain. Pain management is therefore a key component of palliative care. Managing pain well improves the overall quality of life of the patient and reduces risk of developing further complications. This paper has discussed why pain is an important issue in end of life care. This is because it increases patient’s suffering, demotivates them, and allows makes their last few days of life much stressful. Major factors influencing pain were discussed next which includes age, race, demographic factors, emotions and income levels. Pain and its management is highly relevant to nursing practice an patient care as it improves patient’s overall mood by alleviating anxiety and thereby improving the well being.

The work has next discussed how nursing as a profession allows better understanding of pain and pain management in end of life care. This is guided by the ethical principles of nursing such as autonomy, non- maleficence, beneficence which promotes patient care and safety. The knowledge, skills, and attitude needed by nurses to understand pain and facilitate pain management includes skills of communication, empathy, interpersonal skills, and effective collaboration. The paper has next discussed several factors which might influence the pain management skills of nurses which includes cultural factors, nurses’ knowledge and attitudes towards end of life care. Time constrain and excessive workload have also been recognized as important factors for influencing this particular aspect of care. Nurse’s self-concept might also influence nurses’ decision about pain management of the clients. Individual subjectivity to pain might also be held responsible for ineffective pain management by the nurses. Lastly, the paper has discussed strategies that can be employed to improve nursing care which includes accurately determine the patient’s perception of pain, asking open ended questions which can give the patient an opportunity to describe their feelings in details, and determining the level of anticipation that is displayed by the patient for pain relief.

References

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Beckstrand, R.L., Hadley, K.H., Luthy, K.E. and Macintosh, J.L., 2017. Critical care nurses’ suggestions to improve end-of-life care obstacles: minimal change over 17 years. Dimensions of Critical Care Nursing, 36(4), pp.264-270.

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Conroy, T., 2018. Factors influencing the delivery of the fundamentals of care: Perceptions of nurses, nursing leaders and healthcare consumers. Journal of Clinical Nursing, 27(11-12), pp.2373-2386.

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Dalal, S. and Bruera, E., 2017. End?of?life care matters: Palliative cancer care results in better care and lower costs. The Oncologist, 22(4), pp.361-368.  Pain Management In End Of Life Care Essay Paper