ADN vs. BSN Abstract High

ADN vs. BSN

Abstract high 70% of people in the U.S. die in hospitals and between 16% and 37% of present-day deaths have been admitted in an ICU in the last six months of life. Although half of all hospitals provide suitable end-of-life care, the majority of Americans still want to spend the end of their lives at home where they can be more comfortable and cared for more personally. Eligibility for admission to an ICU also requires that the patient is not too sick enough and reserves its facilities to those whose chances of survival can be enhanced by its specialized care.

At present, admission to an intensive care unit or ICU is influenced by factors, such as the severity of illness, the probability of a particular diagnosis, the presence of an ICU medical director, the patient's treatment preferences, the location and type of the hospital, and the ICU bed census (Bone 1993). The primary criterion is the risk of death. Preadmission screening determines which patients are not too sick enough for admission or are too sick to benefit from intensive care. They are then referred to more suitable and less costly management facilities. This reserves the IVU to patients whose risk of death is likely to decrease from the care administered at the ICU. Only a few studies have shown that patients with moderately severe illnesses can now benefit from the care extended at the ICU. But guidelines still have to be established in insuring that such patients who can benefit will be able to receive it. The rest under the other categories may be referred to other hospital locations for more effective treatment (Bone).

A recently published study revealed a trend towards more aggressive treatment of elderly and terminally ill patients at the end of life and that those admitted at ICUs before their death increased in number (Earle et al. 2004). These were 28,000 people aged 65 and older with lung, breast and gastrointestinal cancer who died within a year from their respective diagnosis from 1993 to 1996. Trends showed that patients have been likelier to receive chemotherapy at this stage of life. About 9% of them visited an emergency department and were admitted at an ICU. The study also found that these elderly patients were also likelier to receive hospice care and less likely to die in a hospital recently than in the past. The availability of more and better chemotherapy drugs and more aggressive treatment at the ICU until their death accounted for the trend. Otherwise, they were encouraged to obtain less expensive and more comfortable care from hospitals and hospices (Earle et al.).

Statistics, however, still said that between 16% and 37% of deaths of Medicare recipients have been admitted in an ICU in the last six months of their lives (Peres 2003). Another study was conducted on cancer patients and found that 55-75% of them experienced moderate to severe pain, discomfort, anxiety, sleep disturbance or unsatisfied hunger or thirst. Overall figures indicated that the vast majority of Americans now prefer to die at home. On the national level, a high 70% die outside the home although most people want to die there. About half of all present-day deaths happen in hospitals. 60% of which provide specialized end-of-life services. About 14% of them offer palliative care, 23% hospice care, and 42% pain management services. These are becoming more and more available but the issue of reimbursement has remained. Funding has also been a problem, as it depends on inconsistent sources, such as donations and private grants (Peres).

Elderly and terminally ill patients prefer privacy (Peres 2003). At home, they can be visited at any hour and this is not the case in hospitals or ICUs. With appropriate palliative care, most cases are manageable at home. While there are good institutions, which can extend appropriate care, it is more generally viewed that letting the patient go home is a better decision. Good palliative care is a holistic concept, which consists of biological, psychological, social, and spiritual aspects. They can be addressed appropriately at home. It is aimed at treating the whole person. It provides comfort and seeks to eliminate all forms of suffering. That palliative care is confined to end-of-life service in hospitals and ICUs has been disputed. Pain management may appear to be a deficit, but it has been shown that 95% of all pain can be treated effectively in places other than hospitals or ICUs. Patients also say they want to awake and conscious when their pain is managed. The issue is that there are not many U.S. physicians and nurses who are certified to extend palliative care. There are only 33 physicians and only 41 nurses for every 10,000 patients (Peres).

The hospice movement has been changing the face of care for people at the end-of-life stage (Radulovic 2004). Hospices have been providing options and choices to these patients for the last three decades. The hospice movement began in the UK but spread to America in response to the need for more compassionate care for the dying and terminally ill. A hospice is not a place but a concept of palliative and support services for the terminally ill to be cared for primarily at home. A home can be the patient's residence or that of a loved one, a long-term care facility. It provides the specific care these patients demand. Almost 90% of adults surveyed expressed the preference to be cared for by their own family if they were terminally ill or were in the last six months of life. The American public's priorities at this time include home-based care, patient control and choices on services available to them, emotional and spiritual support for them and their families, pain control according to their wishes, and freedom from financial cares. Congress put the Medicare Hospice Benefit in place in 1982. It has enabled millions of Americans to receive end-of-life care. More than 96% of U.S. hospices are Medicare certified and more than 80.9% of Medicare beneficiaries made claims on it as their payment source in 2002. Most private insurance plans, managed care providers and Medicaid in most states cover hospice services. But as the population ages and life expectancy increases, more sophisticated and costlier medical interventions have been required for health care needs. Today's hospices address a wide range of terminal and end-of-life disease states and palliative care services. In 2002, 50.5% of admissions were cancer patients. Hospices now also serve those with end-stage heart, kidney and liver diseases, as well as dementia, lung disease, HIV / AIDS and other severe conditions. Treatments associated with curative care, such as chemotherapy and radiation, are being used to palliate end-of-life care (Radulovic).