In modern Western culture, death has generally been regarded as something to be put off for as long as possible. However, the idea of a “good death” — death as a natural part of life —has been taking hold in recent years. This concept is slowly changing how nurses treat critically ill and dying patients.
Nurses have traditionally taken on a large role at the bedside of dying patients and are often a trusted point of contact for them and their families, but their official responsibilities in end-of-life choices and care are still evolving. The health care industry is still researching and deciding on best practices and ethics regarding the end of life. Policies and laws can vary greatly by state and among health care systems.
In its 2010 statement “Registered Nurses’ Roles and Responsibilities in Providing Expert Care and Counseling at the End of Life,” the American Nurses Association wrote that “nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care, including the promotion of comfort, relief of pain, and support for patients, families, and their surrogates when a decision has been made to forgo life-sustaining treatments.”
The question of how best to make that decision, and how best to care for patients when the decision is made, is still being worked out. One thing is clear: Nursing will change as researchers continue to collect and analyze data regarding end-of-life care. Here are some areas in which nursing might adapt to new ideas and requirements about caring for the dying1.
1. More formal collaboration. Nurses can work with other health care professionals, palliative care experts, chaplains, and others to ease suffering. Effective end-of-life care addresses not just the physical but the psychological, social, and spiritual needs of patients. Reducing conflict and distress in all these areas contributes to high-quality care.
2. Increased communication about end-of-life care. Nurses should be prepared to provide information about the various options, which may include advance directives such as the Physician or Provider Order for Life-Sustaining Treatment (POLST), resuscitation status, palliative care, and hospice. Health care organizations should provide formal training and continuing education about these options and nurses should get comfortable talking about them. The course NU 490 Palliative Care Nursing in the online RN-BSN program at University of Saint Mary explores details of this type of care, including pain management, alternative therapies, and patient advocacy.
3. Extra sensitivity to diverse values. Personal, cultural, and religious beliefs regarding dying and death may impact decisions about end-of-life treatment, making it vital for nurses to be aware of them, as well as their own cultural biases.
4. More knowledge of applicable laws. Nurses should have a strong understanding of laws regarding death with dignity and assisted suicide, as well as their nuances and implications. For instance, Oregon’s Death With Dignity Act limits assisted suicide to terminally ill individuals with less than six months to live, as confirmed by two physicians.2 As more states pass legislation on this issue, nurses can expect more questions from patients and their families.
5. Awareness of one’s own feelings about end-of-life care. Nurses should be aware of their own values and beliefs about such care, which will help them avoid bias when assisting patients who are grappling with their own choices regarding treatment at the end of life.
Nurses are being called on to do more than ever before, from exploring end-of-life care options with patients to managing complicated new health care technologies. The online RN-Bachelor of Science in Nursing program at the University of Saint Mary can help prepare you for a successful career in the face of an evolving profession. To learn more, call 877-307-4915 to speak with an admissions advisor or request more information.
1Nursing World, End of Life Issues, accessed January 11, 2016.
Nursing World, Position Statement (PDF), accessed January 11, 2016.
The Ochsner Journal, The Nurse Advocate in End-of-Life Care, accessed January 11, 2016.
2Oregon Health Authority, Death With Dignity Act Requirements (PDF), accessed January 11, 2016.