According to Olade (2004), nursing practice using observed phenomena and evidences is an example of education which refers to formalized experiences designed to enlarge the knowledge or skills of nursing educators or practitioners. Through experiences and evidences, the ability to learn actual clinical practice and the orientation in health care protocols and policies in handling patients’ needs will be achieved. This method is also termed as Evidence-based practice. Evidence-based practice involves a combination of many disciplines, including aspects of multidisciplinary sciences to promote the restoration and maintenance of health in our clients (Davies, 2005). Much literature has been published on this topic in recent years, an evolving subject and concept for specific practices that promote more effective, safer and more efficient ways of caring (Drenkard & Cohen, 2004).
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Maintaining and improving high satisfaction among nurses is an important area to discover (Ebell, 2008). To achieve this, we need a workforce to continually strive for excellence, specifically in caring for clients experiencing loss and bereavement be responsible and flexible enough, have the confidence to face the challenges, and inspire everyone with a shared vision. These are strengths needed by nursing staff to motivate others health care provider to fulfill their potential and achieve goals (Littlefield, 2005). Researches, studies and articles were utilized and analyzed in gathering the necessary information needed. Clinical education, skills and practices are the key concepts used in this paper.
Possession of knowledge and competency in performing skills and interventions for clients experiencing grief and bereavement which can be acquired in hands on training are essential in practicing the profession especially in the palliative care unit of NHS hospital is important. As a nursing professional, tangible skills and knowledge in a hospital setting is very important in managing clients and supervising clients (Burns & Foley, 2005). Evidences were identified through thorough assessment and research. The challenges discussed below were identified through gathering of recent information in the palliative care unit and data that focuses on this subject.
Decisional Teachings and Interventions
As a nurse, you need to ensure that the client is treated with dignity, that is, with honor and respect. Dying clients often feel they have lost control over their lives and over life itself. Helping patient die with dignity involves maintaining their humanity, consistent with their values, beliefs, and culture. By introducing available options to the client and significant others, you can restore and support feelings of control. Some choices that clients’s family can make are location of care (home, hospital or hospice), time of appointments with health professionals, activity schedule, use of health resources, and times of visit (Matzo and Sherman, 2004). The family of dying patient wants `to be able to manage the events preceding death so she can die peacefully. You can help client to determine her own physical, psychological, and social priorities. Dying people often strive for self fulfillment more than for self preservation, and may need to find meaning in continuing to live while suffering. Part of the nurse’s challenge is to support the client’s hope and will (Smeltzer, 2009). Nevertheless, the communication between client’s families may not solve all decisional differences, her mother insist on interventions that health care professionals consider inadvisable. In case like this, the initial step is for all parties to focus on having clear goals of care.
Hospice Support to facilitate proper bereavement
The decision of client’s family for home care with hospice support focuses on symptoms control and pain management. Hospice care is always provided by a team of both health professionals and nonprofessionals to ensure a full range of care services. In the case of many patients, palliative care will be the option. This care may be given to meet their physiological need (Matzo, 2005). Ventilatory support for patient can improve her respiratory functioning and relieve symptoms of respiratory distress using mechanical ventilation. While the decisions made by the family wanting their family member to be vented are often reached by consensus with the patient and her family, patient does have an opportunity to designate a family member as a healthcare proxy.
Family Teachings and Interventions
The reaction of any person to another person’s impending death depends on all factors regarding loss and the development of the concept of death. In spite of the individual variations in person’s view about the cause of death, spiritual beliefs, availability of support systems, or other factor, responses tend to cluster in the process.
To help the family, spiritual support is of great importance in dealing with death. Although not all clients identify with specific religious faith or belief, most have a need for meaning in their lives, particularly as they experience a terminal illness. Establish a communication relationship that shows concern for and commitment to the family and client. There are also communication strategies that let client and her family knows that you are available to talk about death (Smeltzer, 2009). Caring for client’s family members is an important intervention in caring for the terminally ill patient. Family-centered interventions and care is focused on the goal, needs and values of the family and patient including their understanding of the treatment options, illness, prognosis and their preferences and expectations for decision making and treatment (Matzo and Sherman, 2004).
Specific interventions appropriate for client’s family includes providing hope within parameters of individual situations without giving false reassurance. Listening to their expressions regarding their perceptions of the situation is also important to determine how they handle the situation (Zerwekh, 2006). Giving honest answers to their questions and giving correct information will assist the family in dealing with the situation. Encouraging strength, promoting support systems and referring to other resources such as pastoral care, counseling and organized support groups will promote wellness and facilitate long term action (Smeltzer, 2009).
Communicating effectively at all levels is a common barrier in the implementation of change among health care in various settings (Kleinman, 2004). As a member of the hospital workforce, a nurse must have the capability to communicate effectively in a non-judgmental way and stimulate other colleagues to think critically. They must also arouse enthusiasm and develop quick thinking and imagination. Moreover, they must also demonstrate resourcefulness and professionalism with infinite patience, understanding, confidence and perseverance are also challenges (Bryar et al, 200).
Emotional and Physical Support
The skills most relevant to this situation of the family are attentive listening, silence, open and close questioning, clarifying and reflecting feeling. Less helpful to family members are responses that give advice and evaluation, those that interpret and analyze, and those that give unwarranted reassurance. To ensure effective communication, the nurse must make an accurate assessment of what is appropriate for the client. Communication with the family needs to be relevant to their feeling and situation. Whether the clients are angry or depressed affects how the client hears messages and how the nurse interprets the client’s statement (Matzo, 2005).
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In facilitating nursing interventions, the nurse must explore and respect the family’s ethnic, cultural, religious and personal values inn their expressions of feelings. Teach the family what to expect in the process, such as certain thought and feelings and that labile emotions, feeling of sadness, anger, guilt, loneliness and fear will lessen or stabilize over time. Knowing what to expect may lessen the intensity of some reactions. Encourage her family to express their thoughts and feelings, not to push the family to move on or enforce their own expectations of inappropriate reactions. Encourage the family to resume normal activities after death on schedule that promotes psychological and physical health. Some family member may also try to return to normal activities too quickly. However, a prolonged delay in return may indicate dysfunctional grieving (Matzo and Sherman, 2004).
Physiological and other specific end-life care Support
Nursing management of the client experiencing a loss is important. Physiological need must be addressed first including palliative care such as pain management and life support. Weakness and paresis are common symptoms that may affect muscle groups. With the loss of muscle innervations the muscles athrophy, paralysis and progressive fatigue result. Dysphagia, dysathria, fasciculations, hyperreflexia, immobility, respiratory failure and aspiration will likely occur. Emotional effects such as lability, loss of control and depression are also common. The goal of management in end-of-life care for every client is the prevention or alleviation of these symptoms. Hygiene and psychological support is also important factor to consider (Zerwekh, 2006). To gather a complete database that allows accurate analysis and identification of appropriate nursing diagnoses for dying client and their family, the nurse first needs to recognize the states of awareness manifested by the client and the family members (Smeltzer, 2009). In case of many patients, the state of awareness shared by the dying person and the family affects the nurse ability to communicate freely with clients and other health care team members and to assist in the grieving process. The nurse must also need to be knowledgeable about the client’s death related rituals such as last rites, chanting at the bedside and other rituals. The nurse must also recognize the states of awareness manifested by the client and family members. As nurses, we also need to maintain physiologic and psychological comfort and achieving a peaceful and dignified death, which includes maintaining personal control and accepting declining health status (Matzo and Sherman, 2004). The roles of health care team in care management of dying patient are very important. This implies the vital responsibilities of nurse to do the best and competent care to achieve the peaceful death of the patient. The primary role is to ensure that the patient received the highest possible intervention best suited for her. Nurses must include the family of the patient in the care management, emphasizing nurses’ role as essential factor to maintain dignity of dying client (Matzo, 2005).
Knowledge and competitiveness is a product of excellent nursing practice. In caring for patient experiencing grief and bereavement, experience and effective learning are essential processes in actual clinical practice of the nursing profession. To be an effective nurse, one should begin with the individual appraisal of one’s self competency and enhanced education based on practices and trainings taken previously during undergraduate and graduate studies, workshops, trainings, continuing education, and preparation for teaching seminars or modules including the conceptual, academic and clinical orientation (Foster, 2007). Competitiveness is largely based on innate potentials and motivations afforded by the familiarity of a learning environment. Accordingly, the primary responsibility of the nurse to the patient is to give him/her the kind of care the patient condition needs regardless of race, creed, color, nationality or status (Salsberg, 2008). Advocate the rights and serve as facilitator of patient’s well being (Foster, 2007).
In doing so, the patient’s care shall be based on subjective and objective evidence, needs, the physician’s order and the ailment; shall involve the patient and the family. It promotes understanding of the differing values held by people in other cultures (Henderson, 2009). For example, it helps client to understand why other people in one culture may regard with approval of their practices of exposing their elderly members to the harmful elements, while people in other cultures may abhor such practice. The strength this critical thinking and decision making is its recognition of the relationship between personal values and a choice of action and it equates personal values and wrong action, it also recognize limits of personal experience and perspective and it implies that a person’s moral judgments are infallible.
I believe the richness or intensity of the inculcation of knowledge, positive values and skills of a person is not simply based on the innate capacity of one to evaluate, think, reason and interact in a learning situation. It also equally depends on the quality of the nursing experiences which are either limited by the nurses’ ability and will to choose or by what is desirable to her which is readily accessible in the environment. Nursing education, concepts and programs for improving the knowledge in health facility should also be provided to maintain theoretical and clinical competence of health setting and facilities. From what I have learned in my own area of practice, the key to successful knowledge development is competent learning and effective communication during the practice to achieve the goal of competency. This will determine the path of being an effective and competent nursing professional.
In general, the main role of nurses in palliative care unit is focused on providing effective, quality care. Hence, more advanced and competent means of preparing nurses to supervise and manage their patient is important (Briggs et al., 2004). These challenges must be addressed properly by the implementation of appropriate approach and programs to increase the knowledge and experience. Skill development for nursing educators must constantly be framed within the context of individualized patients. Nursing educators should make themselves aware of every situation happening in the field and make it a motivational means to improve the profession by proper preparation and education (Welk, 2007). Therefore, the need for implementing evidenced-based approach to nursing practice is essential in addressing these issues.
As nursing profession enter a new era not knowing what to expect. Yes, patient care is the “same” everywhere, but they must be comfortable with the environment they are placed in. Adaptation is crucial in the clinical arena (Kleinman (2004). Evidenced-based practice and clinical experience may become a highly useful and effective strategy in clinical practice. The nurse becomes less apprehensive about the clinical environment and becomes more client-focused, therefore increasing the effectiveness of care. This also provides the nurse an opportunity for role modeling as the client and family maintains and develops standards of practice and competent care in a familiar environment (Foster, 2007).
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