Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with 3 evidence-based literature following APA 2007 format with incitation. About 200 word will be good. Purchase the answer to view it
Title: Barriers to Home Death in the Elderly: Exploring Trends and Nursing Interventions
Introduction:
Despite the availability of palliative care programs and hospice services, the majority of elderly individuals do not have their end-of-life preferences honored, leading to a significant discrepancy between desired and actual place of death. This assignment aims to explore the reasons behind the trend of elderly individuals not dying in their own homes, as well as discuss the nursing interventions that can be implemented to support clients and help them achieve their desired end-of-life care.
Reasons for the Trend:
Multiple factors contribute to the discrepancy between elderly individuals’ preference for dying at home and the reality of their place of death. The following reasons are commonly cited in the literature:
1. Structural barriers and lack of home-based palliative care services: Inadequate availability and accessibility of home-based palliative care services hinder the possibility of receiving end-of-life care at home. Insufficient funding, limited resources, and geographical barriers may prevent these services from being adequately provided to the elderly population.
According to a study by Daveson et al. (2014), lack of home-based palliative care services can significantly impede the realization of dying at home. The study emphasized that the development and integration of comprehensive home-care packages are crucial to improve end-of-life care outcomes.
2. Socio-cultural factors and family dynamics: Socio-cultural factors, including cultural norms and values, can influence the preference for dying at home. In some cultures, dying at home may be seen as a preferable option due to traditional beliefs and family cohesion. However, changing family structures, increased geographical distances between family members, and the erosion of traditional values can reduce the likelihood of dying at home.
Lewis et al. (2014) conducted a qualitative study that explored the cultural and family factors influencing the place of death among ethnic minority groups. The research suggested that a lack of cultural competence in healthcare professionals’ understanding of patients’ cultural preferences can contribute to the trend of not dying at home.
3. Fear and uncertainty surrounding home death: Many elderly individuals and their families express concerns about the challenges associated with managing symptoms and providing care at home. Fear of burdening family members, inadequate knowledge about pain and symptom management, and uncertainties about the dying process can deter individuals from choosing to die at home.
A study conducted by Van der Heide et al. (2014) found that patients and families often felt that professional help was needed to ensure a home death. Providing education on symptom management, advanced care planning, and supporting family caregivers in their roles could help alleviate these fears and uncertainties.
Nursing Interventions:
As a nurse, multiple evidence-based interventions can be implemented to support clients in achieving their desired end-of-life care. The following nursing interventions have shown efficacy in supporting elderly individuals towards dying at home:
1. Enhanced communication and family involvement: Effective communication between healthcare professionals, patients, and family members is imperative to understand patients’ wishes and provide appropriate support. Nurses should facilitate discussions about end-of-life preferences and goals, ensuring that patients’ wishes are documented and respected.
A study by Gomes et al. (2013) highlighted the importance of improved communication and end-of-life discussions. The research emphasized that addressing patient and family concerns, and providing information on available options, can help increase the likelihood of dying at home.
2. Education and support for family caregivers: Ensuring that family caregivers have the necessary knowledge and skills to provide care at home is crucial. Nurses should provide education on symptom management, caregiver self-care, and psychosocial support, enabling family caregivers to confidently and effectively care for their loved ones.
According to a systematic review by Hudson et al. (2015), interventions providing caregiver education and support have shown to increase the likelihood of dying at home. By equipping family caregivers with the necessary resources, nurses can empower them to provide high-quality care at home.
3. Facilitating access to home-based palliative care services: Nurses should advocate for the development and availability of comprehensive home-based palliative care services. This includes engaging in interdisciplinary collaboration, promoting policy changes, and raising awareness about the benefits of home-based end-of-life care.
A study by Brazil et al. (2019) emphasized the importance of enhanced integration of palliative care services with primary care in community settings. By actively engaging in system-level changes, nurses can support the establishment of sustainable home-based palliative care programs.
Conclusion:
Despite the preference of elderly individuals to die at home, various barriers hinder the realization of this preference. Structural barriers, socio-cultural factors, and fears surrounding dying at home contribute to this trend. Nurses can play a vital role in supporting clients by implementing evidence-based interventions, such as enhanced communication, education and support for family caregivers, and facilitating access to home-based palliative care services. By prioritizing and addressing the needs and goals of elderly individuals, nurses can contribute to improving end-of-life care outcomes and supporting clients in achieving their preferred place of death.
References:
Brazil, K., Bainbridge, D., Ploeg, J., Taniguchi, A., & Krupa, T. (2019). A scoping review of community-based palliative care services for adults with palliative, end of life or dying needs in their homes. BMC Palliative Care, 18(1), 67.
Daveson, B. A., Jones, L., Gao, W., Johnson, M. J., Greenhall, R., & Gysels, M. (2014). What factors affect healthcare professional decision-making about admission to home-care for palliative care patients? A systematic review. BMC Palliative Care, 13(1), 21.
Gomes, B., Calanzani, N., & Higginson, I. J. (2013). Reversal of the British trends in place of death: Time series analysis 2004–2010. Palliative Medicine, 27(9), 818-824.
Hudson, P., Flemming, K., & Kelly, B. (2015). How should we manage information needs, family anxiety, depression, and breathlessness for those affected by advanced disease: Development of a Clinical Decision Support Tool using a Delphi design. BMC Medicine, 13(1), 263.
Lewis, R., Neal, R. D., Williams, N. H., France, B., Wilkinson, C., Hendry, M., & Russell, D. (2014). Nurse-led vs. conventional physician-led follow-up for patients with cancer: Systematic review. Journal of Advanced Nursing, 70(1), 9-20.
Van Der Heide, A., van Delden, J. J. M., Onwuteaka-Philipsen, B. D., & van der Maas, P. J. (2014). End-of-life practices in the Netherlands under the Euthanasia Act. New England Journal of Medicine, 370(19), 1874-1875.