End-of-life care provided by nurses in palliative settings necessitates conscious awareness of several factors that contribute to the effectiveness of care. Factors that are significantly important components of nursing in end-of-life care include communication skills, advance care planning, sensitivity to contextual and cultural factors, support from the healthcare team, and continuing education.
The importance of communication skills in end-of-life care was acknowledged by Clayton et al. (2007), who developed a set of communication guidelines that nurses could adhere to in the deliverance of end-of-life care. These guidelines were represented by the acronym PREPARED, and they included: to prepare for discussion, relate to patients and their families, elicit preferences held by patients and families, present information, acknowledgement of emotions and concerns, realistic hope, encourage questions, and documentation of information and documents (Clayton et al., 2007). Specific factors regarding the details of information communicated to patients are important in discussions in end-of-life care.
Advance care planning
Advance care planning is a critical component to end-of-life care provided by nurses. This essentially refers to the discussion of decisions regarding treatment, as well as choices and goals that occur as part of end-of-life care (Clayton et al., 2007). . This also involves any wishes the patient may have in regard to future medical care if they are not able to communicate in the discussion any longer (Clayton et al., 2007). . This also involves any wishes the patient may have in regard to future medical care if they are not able to communicate in the discussion any longer (Clayton et al., 2007).
Sensitivity to cultural and contextual issues
The involvement in families of patients in the discussions surrounding end-of-life care is important. In regards to communicating with families, it is important that nurses remain aware of and sensitive to any cultural or contextual issues that may influence the level of comfort and quality of life for patients during end-of-life care (Shanmugasundaram & O'Connor, 2009).
Support from the healthcare team
Communication between staff members of the healthcare team involved in end-of-life care is important for effective nursing care. This was emphasized by Clayton et al. (2007) by the final guideline they devised, which suggested thorough documentation of information and discussions to facilitate communication within the healthcare team. Estathiou & Clifford (2011) also determined that the availability of support for nurses involved in end-of-life care was an important contributing factor to effective care.
The availability of educational workshops and seminars for end-of-life care nurses contributes to more effective deliverance of care to patients and their families. This was recognized by Efstathiou & Clifford (2011), who suggested that skills development focusing on communication skills is advantageous for nurses delivering end-of-life care. Education may significantly improve the knowledge nurses are able to convey to patients, which in turn positively impacts the confidence level of nurses caring for patients and their families in end-of-life care.
End-of-life care is a complex and potentially highly stressful area within the field of nursing, and highly developed decision-making abilities, psychosocial skills, and planning strategies serve as attributes for nurses within this field. Quality of life is one of the most important aspects for patients receiving end-of-life care (Grant & Sun, 2010). The following discussion explores concepts involved in end-of-life care in the field of nursing and looks at how nurses ensure that competent and appropriate end-of-life care is provided to patients.
One of the most important skills nurses working in end-of-life care is the ability to effectively communicate to patients, their families, as well as other members of the healthcare team (Clayton et al., 2007). Clayton et al. (2007) developed a set of guidelines for nurses to adhere to in order to most effectively communicate prognostic and end-of-life information to patients and caregivers. These researchers developed this set of guidelines through a system literature review of pertinent studies, review of previous guidelines and expert opinions deemed relevant, and through the redefinition of drafted guidelines by an advisory panel (Clayton et al., 2007). The set of guidelines devised by Clayton et al. (2007) were labeled by the acronym PREPARED.
The first guideline is to prepare for discussion (Clayton et al., 2007). This means that nurses should ensure confirmation of pathological diagnosis and results of any examinations or investigations before initiating any discussions with patients and their families. It is also very important that discussions take place when privacy can be ensured without any interruptions. It is also important that nurses communicate with other members of the healthcare team to negotiate who should be present for the planned discussions (Clayton et al., 2007).
The second guideline is to put efforts toward effectively relating toward the person involved (Clayton et al., 2007). Nurses need to develop rapport with patients and their families in order to ensure effective care. This is accomplished through a demonstration of empathy, compassion, and a caring attitude toward the patient and their family during the consultation process (Clayton et al., 2007).
The third guideline is to effectively elicit any preferences that may be held by the patient or their family (Clayton et al., 2007). The first step is to identify why the consultation is taking place and elicit any expectations that may be held by the patient (Clayton et al., 2007). It is important that the nurse has a firm grasp on the understanding of the present situation that is held by the patient and their family as well as how much detailed information should be conveyed in the consultation. It is also crucial that the nurse is cognizant of any cultural or contextual factors that may be influential on andy preferences held by the patient or their family (Clayton et al., 2007).
The fourth guideline devised by Clayton et al. (2007) is to present information to patients and their families that is tailored specifically to suit their particular situation and needs. It is important that patients are given options as to how much information they want to discuss, and then present the information at a pace that fits in with the preferences and understanding of the patient in the context of their particular circumstances (Clayton et al., 2007). Communication style is of the utmost importance, and nurses must use language that is clear and accessible, free from any jargon that may confuse or alienate the patient or their family. Education on specific communication methods, such as Ask-Tell-Ask, Tell Me More, and Situation-Background-Assessment-Recommendation have been demonstrated to assist nurses in dealing with situations that may be difficult and emotionally charged in end-of-life care (Shannon et al., 2011).
Nurses must clearly explain the inherent limitations, uncertainty, and unreliability of prognostic information in end-of-life care (Clayton et al., 2007). Therefore, it is critical that nurses involved in these discussions communicate timeframe information without being too exact, unless the patient is in their last few days of life (Clayton et al., 2007). It is also necessary for the nurse to assess whether a separate discussion needs to take place with the caregiver who may have information needs and preferences that are different than that of the patient (Clayton et al., 2007). Furthermore, it is also important that the nurse ensures that information communicate to different family members is consistent in content as well as approach (Clayton et al., 2007).
The fifth guideline to effective communication in end-of-life care is the acknowledgement of emotions and concerns (Clayton et al., 2007). Nurses must demonstrate an exploration and recognition of fears or concerns patients or their families may have as well as emotional reactions that occur in response to discussions (Clayton et al., 2007). Nurses need to assess and provide appropriate care in response to any distress patients or their families may have in response to discussions (Clayton et al., 2007).
The sixth guideline involves nurses' involvement in the fostering of realistic hope in end-of-life care (Clayton et al., 2007). The manner in which information is delivered is important and impacts the experience of patients and their families. Nurses need to deliver information with honesty, and practice balance in communication. This involves sensitivity toward not being blunt in communication or giving information that contains more details that exceed preferences communicated by the patient (Clayton et al., 2007). Nurses must be conscientious to not deliver any information that may be false or misleading, while ensuring that the discussion positively influences the patient in providing some hope (Clayton et al., 2007). Information regarding resources and treatments available for pain and symptom control must be provided in a reassuring manner (Clayton et al., 2007). It is most effective if nurses approach this discussion with an emphasis on realistic wishes, goals and coping that can be achieved on a day-to-day basis (Clayton et al., 2007).
Providing crucial information to patients and their families in end-of-life care discussions while still remaining supportive of patents hopes is challenging for nurses (Reinke et al., 2010). Reinke et al. (2010) investigated nurses' perspectives on their roles when caring for patients in end-of-life care scenarios. Results indicated three themes in the experiences of…