Master of Science in Emergency Nursing: End of Life Care Report

This report provides a comprehensive concept analysis of end-of-life care, crucial for nursing practice. It defines end-of-life care as the process of enhancing a terminally ill patient's comfort and quality of life, differentiating it from palliative and hospice care. The report reviews relevant literature, emphasizing the importance of empathy, family support, and spiritual care. Attributes discussed include patient autonomy, family support, and integrated care management. It explores the role of multidisciplinary teams, including nurses, psychiatrists, and psychologists, in providing psychosocial harmony. The report highlights the transition from biomedical treatments to patient-centered care, focusing on emotional well-being and peaceful death, making it a valuable resource for nursing students and healthcare professionals. The report also follows the assignment brief provided, which requires the student to define the concept of interest, identify surrogate terms, provide a literature review, and discuss the attributes of the concept of interest.

Running head: END OF LIFE CARE
END OF LIFE CARE
Name of Student
Name of University
Author note

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Definition of the concept of interest
In cancer and other terminal diseases where the patient has no chances of recovery,
given the biomedical and the surgical treatments along with the allied health treatment cannot
aid the complete recovery of the patient, in other words, there is no cure for the disease, the
patient is transitioned to end of life care. Decision for end of life care is based on patient’s
physical and mental sufferings. As far as psychological sufferings of the patient are
concerned, it can be said that when a person is nearing death and the subject is concerned
about it – there develops a fear, an anxiety and more importantly an existential crisis that is
very perturbing and disruption (Zaccara et al., 2017). Hence, a transition to improve the
comfort level as well as the quality of life of the terminally ill patient thus preparing him for a
peaceful death – is end of life care. By definition, end of life care refers to the clinical, family
oriented caring process of patient in where the comfort and peace of the patient is enhanced
or at least maintained despite the disease being incurable, advanced and progressive.
The surrogate terms
There are various surrogate terms that are used along, such as palliative care, pain and
palliative care, hospice care which are somewhere related to end of life care. Palliative care
encompasses the use of high quality medications, often in medical experimentation for a
chance recovery of the terminally ill patient. The advanced life support devices, family
support also are the major components of this recovery oriented high quality clinical
intervention. When not succeeded, the patient moves to end of life care. Hospice care is a
more focused end of life care where the patient only some days to live and is attributed by
more deep spiritual and psychosocial support. End of life care is also considered by some, as
a form of passive euthanasia.

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Literature review
Gott, M., Robinson et al., (2019) aims to understand the underpinnings of a good end
of life care services being delivered to the aged patients in the health care institutions. The
study found out empathy, family and staff support, strengthening and involving of family
framework in care process of old patient and family education are the important components
of the end of life care (Oliver, 2016).
Jang et al., (2019) aimed to understand the important aspects of humanistic and
spiritual nursing in the end of life care processes. The strength of the study is that the critical
care nurses identified the existential crisis in the patient, preparedness as a nurse and
emphasizing with the patient’s spiritual transition is very critical to ‘end of life care’ (Bolt et
al., 2019).
The attributes
It is critical to note that in certain diseases such as cancer and other terminal
conditions, the patient’s suffers unbearably in certain situations or throughout, provided the
terminal disease is progressing and the clinical, biomedical treatments are not being able to
treat the patient. In treatment of terminal cancer or even in critical neurologically ill patients
admitted in the intensive care unit for a prolonged period of time, the critical questions
concerns the subjects of organ donation, withdrawal of the life supporting services and the
ethics concerning the patient’s right to autonomy, integrity, right to self -determination, right
to participate or withdraw his or her own self from the disease – arises. Hence, the patient
who has a sound cognition and proper judgment to decide for himself can opt for an ‘End of
Life Care’ (EoLC) where all the active medical and clinical treatments targeted at treating of
the disease or condition is withdrawn and focus is transitioned to taking care of needs and last
desires of the patient (emotional, psychological and spiritual) in order to improve his or

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quality of life, thus imparting peace from pain and other sufferings (Becker, Wright &
Schmit, 2017). As another attribute, family is an important component of the end of life care
and due to the increased tension over decision making due to emotional blurring, the clinical
teams focus to support their social and psychosocial needs as well through counseling and
empathic care, thus maintaining a harmony between the patient and his family members. The
integrated care management and the emotional plus social support to the family and the
patient by the clinical, medical and the nursing teams are critical attributes of ‘End of Life
Care’.
The referents
The terminally ill patients such as cancer patients, neuromuscular and
neurodegenerative patients are generally transitioned to end of life care when the palliative
care is not being able to cure the condition for a considerable period of time and the disease is
advancing, making the condition unbearable for the patient (Fleming et al., 2016).
The antecedents
As mentioned, the patient is preceded by a palliative care, the incompetency and
failure of which gradually transitions the care to end of life care.
Consequences
The expected consequences of end of life care are improved emotional well-being,
improved quality of life and feelings of fulfillment leading to peaceful death.
Discussion
In most of the cases, the physical sufferings are unbearable such as pain and agony in
cases of cancer and in other cases, physically, the patient has developed so many paralytic or
self-deficit symptoms that the subject is completely dependent on others and the neurological

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disease is progressively degenerative, rendering the subject’s suffering more severe and
worsening day by day. Hence, the modern day approaches in the health care and clinical
sciences – often a very patient-centered care is developed where the quality of life of the
patient is taken into consideration and the comfort level of the patient against his physical and
mental sufferings is also addressed with a biopsychosoical model of care (Choudry, Latif &
Warburton, 2018). In these form of care, the physical, social and the psychological aspects of
the care are delivered to comfort the patient from all the sides. In nursing of the terminal
cases, a more advanced form of nursing using humanistic and the human becoming nursing is
used and the biomedical care such as pain and palliative care where it does not help the
recovery of the patient but increases the pain perception of the patient through the continuous
application of the high dose analgesic medications – in such cases, the clinical decision
making to make a shift from biomedical care to ‘end of life care’ in order to at least improve
the quality of life of the patient in his last days is undertaken.
Model case
The model case would include a multidisciplinary team should include trained critical
care nursing professionals, the psychiatrists, the clinical psychologists who would collaborate
with the family members of the patient in order to develop a psychosocial harmony in the end
stages of life.

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References
Becker, C. A., Wright, G., & Schmit, K. (2017). Perceptions of dying well and distressing
death by acute care nurses. Applied Nursing Research, 33, 149-154.
Bolt, S. R., Verbeek, L., Meijers, J. M., & van der Steen, J. T. (2019). Families' experiences
with end-of-life care in nursing homes and associations with dying peacefully with
dementia. Journal of the American Medical Directors Association, 20(3), 268-272.
Choudry, M., Latif, A., & Warburton, K. G. (2018). An overview of the spiritual importances
of end-of-life care among the five major faiths of the United Kingdom. Clinical
Medicine, 18(1), 23.
Fleming, J., Farquhar, M., Cambridge City over-75s Cohort (CC75C) Study Collaboration,
Brayne, C., & Barclay, S. (2016). Death and the oldest old: attitudes and preferences
for end-of-life care-qualitative research within a population-based cohort study. PloS
one, 11(4), e0150686.
Gott, M., Robinson, J., Moeke-Maxwell, T., Black, S., Williams, L., Wharemate, R., &
Wiles, J. (2019). ‘It was peaceful, it was beautiful’: A qualitative study of family
understandings of good end-of-life care in hospital for people dying in advanced
age. Palliative medicine, 33(7), 793-801.
Jang, S. K., Park, W. H., Kim, H. I., & Chang, S. O. (2019). Exploring nurses’ end-of-life
care for dying patients in the ICU using focus group interviews. Intensive and Critical
Care Nursing, 52, 3-8.
Oliver, D. J. (2016). Peaceful, pain free and dignified: palliative and end of life care. Tizard
Learning Disability Review, 0-0.

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Zaccara, A. A. L., Da Costa, S. F. G., Da Nóbrega, M. M., Rúbia, J., de Sá França, F., da
Nóbrega Morais, G. S., & Fernandes, M. A. (2017). ANALYSIS AND
ASSESSMENT OF THE PEACEFUL END OF LIFE THEORY ACCORDING TO
FAWCETT’S CRITERIA1. Campus Universitário Trindade [cit. 2018-03-25].
Dostupné z: http://www. scielo. br/scielo. php.