End of Life Care Essay

When a loved one is dying, conversations about the end of life can be uncomfortable and difficult. Still, discussing end-of-life care is important. Depending on the circumstances, you might be able to help your loved one make important end-of-life decisions — such as whether to remain at home, move to a nursing home or other facility, or seek hospice care. Also, you can work with your loved one’s health care team to make sure your loved one remains comfortable at the end of life. Pain, anxiety and other end-of-life symptoms can often be treated. Even at the end of life, you can continue to support and nurture your relationship with your loved one. Simply being there can be an important source of strength and comfort for everyone. Grief When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you’ll ever pick up the pieces and heal your wounds — yet not feel as if you’re betraying your loved one’s memory. There are no quick fixes for the grief and anguish that follow a loved one’s death. As you face your grief, acknowledge the pain and know that it’s part of the healing process. Take good care of yourself, and seek support from friends and loved ones. Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new â€Å"normal† can help you reconcile your losses and move on with your life. Hospice Care Also called: End-of-life care Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient’s family. Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place * At home * At a hospice center * In a hospital * In a skilled nursing facility ————————————————- What is the role of the family? Family members often make sacrifices to care for relatives. Families provide care, pain management, and protect the patient. Although they may lack knowledge, caregivers gain satisfaction and pride from providing care, but are also at risk for depression and health problems related to caregiver stress (Haley & Bailey, 1999: Haley et al., 2001; Weitzner, Haley, & Chen, 2000). Some cultures may believe caring is the community’s duty and obligation. Caregivers benefit from social support, maintaining social activities and roles, and psychological interventions that teach coping skills. Most people want their family to be given choices about treatment and few wanted the physician to decide alone (Bradley, 1998). End of life: Caring for a dying loved one Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life. Caring for a dying loved one isn’t easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one’s comfort — can help. * Choosing where to die Your loved one may have various choices for end-of-life care. Options may include: * Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well. * Inpatient care. Some people may prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility. Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments. When you discuss the options with your loved one, consider his or her preferences as well as special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one’s health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life. * Spirituality at the end of life As your loved one approaches the end of life, he or she may talk about spirituality or the meaning of life. Don’t force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences or most meaningful moments. You may want to invite a spiritual leader to visit your loved one as well. * Saying goodbye You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This may stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone. Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events. * Recognizing when death is near It’s difficult to predict exactly when someone will die. As death approaches, however, your loved one may show various signs and symptoms indicating that the end of life is near. Look for: * Restlessness and agitation. Your loved one may frequently change positions. * Withdrawal. Your loved one may no longer want to participate in social events or other favorite activities. * Drowsiness. Your loved one may spend most of his or her time asleep. * Loss of appetite. Your loved one may eat and drink less than usual. * Pauses or other changes in breathing. This may happen when your loved one is asleep or awake. Providing comfort The active phase of dying usually begins several days before death. Although you can’t change what’s happening to your loved one, you can help him or her feel as comfortable as possible — ideally with the support of palliative or hospice care specialists. Your loved one also may experience a brief, final surge of energy. Though it can be confusing to see your loved one with renewed vitality, remember that this is a normal part of dying. If it happens, take advantage of the opportunity to enjoy your loved one and say your final goodbyes. * Keeping vigil For many families, keeping vigil near a dying loved one’s bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one. If you think your loved one would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it’s all right to let go. What is working? Mental health providers with palliative expertise can improve communication and resources. Mental health experts help providers understand the patient’s concerns and culture. They explain confusing medical terms and clarify CPR, pain management, and other treatments and encourage collaboration. Mental health providers also help relieve the common emotional distress and grief resulting from a terminal illness or care giving. COPING WITH BEREAVEMENT â€Å"IN OUR HEARTS, WE ALL KNOW THAT DEATH IS A PART OF LIFE. IN FACT, DEATH GIVES MEANING TO OUR EXISTENCE BECAUSE IT REMINDS US HOW PRECIOUS LIFE IS.† * Coping With Loss The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of someone you love, you experience bereavement, which literally means â€Å"to be deprived by death.† Remember — It takes time to fully absorb the impact of a major loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life. * Knowing What to Expect When a death takes place, you may experience a wide range of emotions, even when the death is expected. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. Some emotions you may experience include: * Denial * Disbelief * Confusion * Shock * Sadness * Yearning * Anger * Humiliation * Despair * Guilt These feelings are normal and common reactions to loss. You may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. You may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss. * Mourning A Loved One It is not easy to cope after a loved one dies. You will mourn and grieve. Mourning is the natural process you go through to accept a major loss. Mourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. Mourning is personal and may last months or years. Grieving is the outward expression of your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression. It is very important to allow yourself to express these feelings. Often, death is a subject that is avoided, ignored or denied. At first it may seem helpful to separate yourself from the pain, but you cannot avoid grieving forever. Someday those feelings will need to be resolved or they may cause physical or emotional illness. Many people report physical symptoms that accompany grief. Stomach pain, loss of appetite, intestinal upsets, sleep disturbances and loss of energy are all common symptoms of acute grief. Of all life’s stresses, mourning can seriously test your natural defense systems. Existing illnesses may worsen or new conditions may develop. Profound emotional reactions may occur. These reactions include anxiety attacks, chronic fatigue, depression and thoughts of suicide. An obsession with the deceased is also a common reaction to death. * Dealing with a Major Loss The death of a loved one is always difficult. Your reactions are influenced by the circumstances of a death, particularly when it is sudden or accidental. Your reactions are also influenced by your relationship with the person who died. A child’s death arouses an overwhelming sense of injustice — for lost potential, unfulfilled dreams and senseless suffering. Parents may feel responsible for the child’s death, no matter how irrational that may seem. Parents may also feel that they have lost a vital part of their own identity. A spouse’s death is very traumatic. In addition to the severe emotional shock, the death may cause a potential financial crisis if the spouse was the family’s main income source. The death may necessitate major social adjustments requiring the surviving spouse to parent alone, adjust to single life and maybe even return to work. Elderly people may be especially vulnerable when they lose a spouse because it means losing a lifetime of shared experiences. At this time, feelings of loneliness may be compounded by the death of close friends. A loss due to suicide can be among the most difficult losses to bear. They may leave the survivors with a tremendous burden of guilt, anger and shame. Survivors may even feel responsible for the death. Seeking counseling during the first weeks after the suicide is particularly beneficial and advisable. Living with Grief Coping with death is vital to your mental health. It is only natural to experience grief when a loved one dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with your pain. * Seek out caring people. Find relatives and friends who can understand your feelings of loss. Join support groups with others who are experiencing similar losses. * Express your feelings. Tell others how you are feeling; it will help you to work through the grieving process. * Take care of your health. Maintain regular contact with your family physician and be sure to eat well and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief. * Accept that life is for the living. It takes effort to begin to live again in the present and not dwell on the past. * Postpone major life changes. Try to hold off on making any major changes, such as moving, remarrying, changing jobs or having another child. You should give yourself time to adjust to your loss. * Be patient. It can take months or even years to absorb a major loss and accept your changed life. * Seek outside help when necessary. If your grief seems like it is too much to bear, seek professional assistance to help work through your grief. It’s a sign of strength, not weakness, to seek help.