Assignment on Module 6001 Using Evidence to Support Practice

Module 6001
Using Evidence to support Practice.
‘Advantages and disadvantages of death at home’
Gabrielle Mendez
1504424
Word count:
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This literature review assignment aims to review available literature
relating to the topic of End Of Life Care (EOLC) and the advantages and
disadvantages of dying at home (Aveyard 2014). EOLC is a specialized
nursing practice that involves many multidisciplinary teams to support
people with terminal illnesses. It is a medical condition to which there is
no cure and the individual is expected to die prematurely (Soanes
et al.
2005). Articles included met the criteria of the full article available to
review, relevance to end of life care or dying at home, four core drugs,
pain in dying, research-based on adults, peer-reviewed, qualitative and
quantitative research were included if relevant to the search topic and
research articles within the last 10 to 15 years. Old articles were
considered for the review as the quality of old articles was good and
informative. Besides, primary studies and literature reviews were
examined from various journals and other sources to provide more
information around the topic of EOLC. Articles were excluded if they
included children at end of life, research articles older than 15 years, or
were from the non-peer reviewed source. Those articles were also
excluded that did not contain the keywords used and were not relevant to
the topic. These articles can be categorized into two themes: ‘patients’
level of distress with pain and mobility’ and ‘facilitating choice and
promoting autonomy’ in EOLC, discussing the advantages and
disadvantages of both.
The Nursing and Midwifery Council (NMC) (2018) says that all nurses
should uphold the Code of Conduct and listen to their patient’s personal
preferences about their care. Respecting their choice of accepting or
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refusing treatment, interventions or amount of individual evolvement they
wish to participate in (NMC 2018). A report by Age UK (2013) discovered
many people are unlikely to die in their chosen place of care and many die
in hospital despite their preferences. Therefore this review of the
literature highlights the importance of nurses and the involvement of the
patient and their families in holistic, patient-centered care. This enables
the focus on the management of pain and physiological stress and
promoting the individual’s right of choice, allowing autonomous decisions
and the nurse to be the patients advocate in their last days (Clark 2011).
This attempts to ensure that their wishes are met in their preferred place
of death.
Search Strategy
A literature search was undertaken using search engines; Google
Scholar, One Search, CINHAL, Cumbria University Library, Medline, RCN
Online Library and Science Direct and NHS Evidence. The specific
following keywords and phrases were used; Dying at home, End of life
care, EOLC*, Why choose to die at home, advantages of dying at home,
disadvantages of dying at home, choosing where to die, and why patients
want to die at home.
Inclusion criteria (Aveyard 2014)
Articles included met the criteria of full article available to review,
relevance to end of life care or dying at home, four core drugs, pain in
dying, research-based on adults, peer-reviewed, qualitative and
quantitative research were included if relevant to the search topic and
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research articles within the last 10 to 15 years. Old articles were
considered for the review as the quality of old articles was good and
informative. Also, primary studies and literature reviews were examined
from various journals and other sources to provide more information
around the topic of EOLC.
Exclusion criteria
Articles were excluded if they included; children at end of life,
research articles older than 15 years, or were from the non-peer reviewed
source. Those articles were also excluded that did not contain the
keywords used and were not relevant to the topic.
Themes
Although a number themes arose, two themes are highlighted by
these articles, they are: ‘patients’ level of distress with pain and mobility’
and ‘facilitating choice and promoting autonomy’ in EOLC, discussing the
advantages and disadvantages of both. As Hamano
et al. (2016) stated
that patients at home experience less pain but only up until the period of
terminal care, although concluding the patient receives more person-
centered care in a home environment as opposed to being in a hospital.
This is one piece of literature which focused the literature review to
discuss advantages and disadvantages because the initial focus of the
research was on reviewing the patient’s right to dying at home. However,
the topic was too broad therefore, it was changed to a comparison to
discuss and explore several key concepts of distress in pain and mobility
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and autonomy. This includes the advantages and disadvantages of dying
at home by analyzing the evidence base available.
Theme 1: Distress
In Great Britain there has been a national focus on reducing hospital
inpatient stays and increasing community support (Salisbury and Purdy
2007), allowing the fulfillment of patients wishing to die at home (Jarvis
et
al. 2016). Davies (2019) identifies patients suffer less pain in the weeks
leading up to EOLC when dying at home. However it must be noted carers
can be unaware of the signs of pain such as calling out, being confused
and aggressive, acting out of character which can be misunderstood
(Boluarte 2009) and so not given pain relief, which adds to guilt and all
very distressing too for families and as a result patients can go without
pain relief (Davies 2019). As stated previous Hamano
et al (2016)
recognizes in the home environment there is increased holistic person-
centered care thus reducing unnecessary emotional distress, for people at
EOLC in an environment which is safe and familiar. Public Health England
(2018) identified in 2016, 46.9% of people died in hospital with this
despite there being a documented significant increase in recent years of
the numbers of people however there has been a significant increase in
recent years of people wishing to die at home.
The need for EOLC and acceptance of program takes time (Wheatley
and Baker 2007), so nurses need to be skilled (NMC) in assisting in
decision making. Lack of bed space is another reason where decision
making gets interrupted whereas Davis (2019) suggests many palliative
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patients do not think about bed space when coming to terms with their
prognosis. (Meier
et al. 2016) the literature review identifies a patient's
main focus in on achieving a good death following their wishes. Out of the
36 Qualitative studies, they identified 11 core themes those most
frequently cited concerning a good death were freedom from pain, good
family relationship, control over treatment and maintaining dignity and
respect as the predominant factors.
Lynn (2001) proposes patients succumb to feelings of being a
burden on family or encounter isolation due to a lack of family network
when they are considering the preferred place of death. McPherson
et al.
(2007) systematic review states that there is a significant problem in 19-
65% of EOLC patients feeling they are a burden, which is a factor in
hastening death and influences choice of EOLC setting. In contrast,
Higginson et
al. (2013) explain family caregivers are eager to support and
facilitate anything to assist with the care of their loved one at the end of
life. Buck (2013) argued that EOLC at home is more of a suitable choice
for some patients as a peaceful death in familiar surroundings is the ideal
for many people. In contrast, a study by Flemming
et al. (2016) found that
the place of death was not the main priority of someone receiving the end
of life care, ultimately it was dying with dignity and achieving effective
pain management.
If the patient feels there is too much risk in the home and chooses
EOLC in hospital, there should be an awareness of how family
relationships could be effected as relatives may feel they have failed the
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