End-of-Life Care in Intensive Care by Kristen Ranse

by - February 02, 2022

        The podcast is all about the end of life care in the intensive care unit. Kristen Ranse talked about the background, research available, gaps, and recommendation in end of life care in the critical care unit. Critical care unit or intensive care unit is a unique setting that provides end of life care. This area is challenging because it designs to save lives and control and influence death and dying. According to Ranse, end of life care is the phase where the decision is made to withhold or withdraw the life sustaining treatment of the patient and where death is the expected outcome. End of life care is a complex area of practice because nurses only withdraw the life sustaining treatment but they do not withdraw their care. The clients still need skilled and comprehensive care in order to maintain their comfort and ease the symptoms that they are experiencing. In providing care, it includes the physical, psychological, social, and spiritual care of the patient and the family. In addition, family centered care is ideal during the end of life care in the intensive care unit because it can support and bring quality care for the clients. Communication is important in facilitating this approach because it improves the family satisfaction with the care given to their relatives and a key to communicate effectively is to read the verbal and nonveral cues of the family. Ranse also mentioned some research available about end of life care. She stated that a shared decision making approach between multidisciplinary team, client, and family will achieve a good end of life care. Although, this may not always occur because of the timing, inexperience in difficult conversations, and consensus regarding treatment plans. She also shared that nurses being in the client’s bedside always has a key role in supporting the family to ensure that continuity of care is being given and clarification on the information will be made. Nurses also provide adequate preparation and support to the family members that may assist them to have a smooth transition from curative to comfort end of care. For the gaps in end of life care, Ranse said that nurses do not have a formal education about end of care but because of their experiences in providing care to end of life patients they started to learn about it. Nurses lack training about the actual care of the dying patient, symptom management, pharmacological and non pharmacological interventions, and after care of the dead body. That is why she recommended that interventional research studies should be made in order to have an advanced area of practice. She also recommended that end of life care should be included in the curriculum and professional development activities should be made in order to address the complex area of practice including physical and emotional support of the patient and the family and self-care of the nurses. 
        Upon listening to the podcast, I understand that end of life care is caring for clients who are in a palliative state. This phase is the most traumatic time for the family of the client, that is why nurses are helping each other in order to meet the families preference of care for their relatives who are in palliative state and answer their questions regarding the client's condition since this act contributes to achieve a good quality end of life care. I feel so proud of our nurses who are assigned in the critical care unit because they highly value their role in end of life care. Even if they experience the feeling of distress because they witness how their clients slowly die and they are not sure what to do with the bereaved family they are still able to do their roles properly. I am so happy for our nurses that despite the challenges they encounter in the critical care unit, they still still feel honor whenever they care for clients who are at the end of life because they have the privilege to provide care with them as they take their final journey of their life. 

        As a student nurse, I can apply my learnings from the podcast to the current practice by preparing myself emotionally and contributing to the practice by possibly doing a research study that will talk more on supporting our nurses doing end of life care. There is a perception that nurses are already used to witnessing a death and dying patient but they do not know that they feel distress too whenever it happens. That is why I need to emotionally prepare myself so that I will be ready enough if ever that I will be assigned to that area. I know that if my emotions engulf me I would not be able to do my job properly so I need to engage in support strategies in order to avoid these instances. I will apply the breathing exercises and do some clinical reflections that are supported by social workers or external counselors to help calm myself whenever I feel so down and affected by the death of a future client. Lastly, if there is a chance, I might do some research about the end of life care for the improvement of the practice in this area. Doing this may help our nurses to provide a more skilled compassionate care to the clients who are at the palliative care and to enhance their own understanding of their own practice. In addition, it may also increase the nurses’ confidence and skills on the care that they will provide.

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