BMJ Supportive and Palliative Care

Question: Discuss aboiut the BMJ Supportive and Palliative Care. Answer: Introduction In palliative acute care, the patients are subjected to care whereby they are taken care of as they wait to meet their death, but in an as peaceful way as possible. This is because some diseases are terminal. Decision making in the end of life care in acute settings is usually complicated by the protocols that need to be followed. Most decisions are thus left to the family members. This creates problems to the givers of end of life care because they need to consult. This paper, explores the issues that the givers of the end of life care undergo. Prognostic uncertainty and the determination of the exact time to start the discussions of this form of care with the family members is among the most common challenges faced by the health caregivers (Johnstone et al., 2016). For instance, the nurses fear to give the family members the hopes of continued treatment to the patients, giving up or making other wrong decisions that appertain the patients early enough. It becomes even more difficult for the health caregivers and family members to decide on the withdrawal of curative health care. As such, the health caregivers feel as though they are not competent in initiating such discussions with families because they are not aware of the reception of such topics (Hui et al.,2014). Thus, the control of pain, as well as the onset of other disease symptoms, is the primary goal of the end of life care to the patients and their families as well. It is important to note that the social, psychological and social problems which might affect the patients are also taken care of. The best opportunity becomes a point when a patient is not able to participate in care and hence the family members are asked to be closely involved. For instance, the decision to use methods such as endoscopy in the end of life patients are said to be only allowed by the family members at a point when the patient is dying and this becomes one of the remaining options (Mayland et al., 2014). It is also important to note that making of decisions in the provision of end of life care involves several health care providers such as the social workers, physicians, and nurses who have specific roles to play in patient care. During the end of life care, communication is prime because it enables the caregiver to offer services according to the needs of the patients. For instance, poor communication can make a nurse to give a life-sustaining care which could be subjecting a patient in a painful experience whereas the patient does not need such a care (Teno et al., 2013). On the other hand, the family members are required to be conversant with the health condition that the patient is battling with as well as the end of life care which is available. This, in turn, makes them be able to be prepared for the outcomes of the said care (Brinkman-Stoppelenburg et al., 2014). In this case, the families should trust that when they ask questions concerning the patients, they are likely to get the actual information. In the end, meeting the needs of the family creates a feeling of satisfaction with the care being given to the patient. Issues that nurses face At times, the nurses are required to give other support services like education and emotional support to the critically ill patients as well as their families so that they do not lose hope early enough (Cherry Jacob, 2016). Moreover, such education enables the families in making decisions to either continue or withdraw the end of life care support. It is worth noting that on most occasions, the nurses are at the bedside when the patient who has been receiving the end of care is dying. As a result, they are actively involved in the assessing of the needs of the family and the patients as they exchange shifts in which further improves their competencies. Such experience makes the nurses be able to note when a patient is not responding to certain or all forms of treatments. As a result, the nurses can effectively make decisions concerning the best course of action for patients who are on end of life care (Reinhardt et al., 2014). An important role played by nurses is thus in the provis ion of communication between the family and the health care givers concerning the patient. The exact functions of communications include giving information to the family, information to the physicians and playing a mediator role. In other cases, the caregivers are afraid that when they involve the families at the end of life care decision-making processes, the families might suffer guilt and have a feeling of being burdened. If the transition from curative to palliative care is smooth, then the caregivers are able to manage the symptoms of the diseases as well as the resulting pain (Verhofstede et al., 2015). However if there is no transition, the caregivers have no choice other than using the available options as the patient's journeys to death. Moreover, the caregivers play a role in making the families come to a reality that the patient will certainly die. This, in turn, should be able to help the families to accept the truth and let go (Oshima Emanuel, 2013). The decision makin g the role of caregivers have been found to accept the prognosis being given in health care and thus be prepared for the death of their kin. On the side of the families, they believe the role of nurses can be either beneficial or harmful to them. The harmful effect arises when some nurse gives false information which makes the families develop false hopes (Visser et al., 2014). Consequently, there is no relationship between the specific roles of the health care givers, the strategies that they use and the outcomes of members of the family in the provision of end of life care. Conclusion The role of caregivers in decision-making related to the patients is very important for the families of the patient too. This is because the family members on most occasions are faced with challenges of making proper decisions concerning their patients on their own in an acute care center. Proper communication between the caregivers and the families are very important to arrive at sound decisions concerning the patient on the end of life care in an acute environment. Discussions concerning death should also be done openly between the family and caregivers so that appropriate measures concerning the patient can be taken early enough. References Brinkman-Stoppelenburg, A., Rietjens, J. A., van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-1025. Cherry, B., Jacob, S. R. (2016). Contemporary nursing: Issues, trends, management. Elsevier Health Sciences. Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), 1743-1749. Johnstone, M. J., Hutchinson, A. M., Redley, B., Rawson, H. (2016). Nursing roles and strategies in end-of-life decision making concerning elderly immigrants admitted to acute care hospitals: an Australian study. Journal of Transcultural Nursing, 27(5), 471-479. Mayland, C., Gent, M., Raj, J. (2014). Being with you. Evaluation of a novel volunteer companionship training programmefor supporting end-of-life care within an acute hospital setting. BMJ supportive palliative care, 4(Suppl 1), A80-A80. Oshima Lee, E., Emanuel, E. J. (2013). Shared decision making to improve care and reduce costs. New England Journal of Medicine, 368(1), 6-8. Reinhardt, J. P., Chichin, E., Posner, L., Kassabian, S. (2014). Vital conversations with family in the nursing home: preparation for end-stage dementia care. Journal of social work in end-of-life palliative care, 10(2), 112-126. Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.