Introduction
‘While death cannot be avoided, patients can still strive to die a good death’ - Stenhauser, (2000)
The above statement was made by Steinhause et all in the year 2000 to emphasize the fact that patients of terminal illnesses who are well informed of their closeness to death due to the incurable nature of their illness derive solace in their involvement in the planning of their end of life care, which includes finding and determining a befitting place of death for a patient of the administration of quality healthcare to a patient whose time of death is closer.
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An illness is considered to be terminal when it cannot be cured and it is possibly leading to the death of the patient, Examples of terminal illnesses are cancer (at an advanced stage), dementia, lung disease, heart disease, etc. Terminal illness also known as the end-stage disease is a disease that will lead to death irrespective of treatment and care given to the patient. Therefore, end-of-life care is mostly considered as the appropriate treatment for patients with terminal illnesses (www.Mariecure.org). An end of life care is the assistance given to people who are in the last months or years of their life. This care is majorly put in place so that patients with terminal illnesses could access quality health care, live a well-fulfilled life for the shortest period available, and die with their dignitaries intact (www.nhs.uk).
Since death is inevitable evitable to patients with terminal illnesses, palliative care is required to make patient experience quality life care and reduce their suffering by introducing them to all necessary physical, psychological, spiritual, and medical support that will help to make them comfortable (WHO, 2003). Palliative treatment is provided by a team of multi-discipline which involves doctors, nurses, therapists, psychologists, social workers, and others depending on the need for them and the nature of the illness or the place of treatment death as decided upon by the patient and the patient's relative at the end of life care.
One of the major ways of administering quality health care at an end of life care is that the patient is given their desired place of death. A place of death connotes the desired place a patient will love to be during the period of treatment and at the time death will knock on them. Most patients preferred dyeing at home than in the hospital (Teggi, 2020), critics have pointed to so many reasons why patients preferred place of death should not be honored while many professionals in health are in support of allowing the wish of patients to be treated and died at home be honored for the hospital to have enough space that will accommodate continuous intake of fresh victims of illnesses.
This study will be examining the most preferred place of death for patients at the end of life care, consider the various factors that influence and determine the place of death for patients at an end of life care, and to note the role of nursing practice in influencing, preparing, and fulfilling patient's preferred place of death.
Identification of issues, prepared place of death for a patient of end-of-life care
Palliative care is a form of treatment made available to make life comfortable for patients with terminal illnesses by managing their pains and symptoms, with the provision of psychological, social, and spiritual support for them. One of the major palliative care available for patients of terminal illness is end-of-life care; this care is for people who are in the last sphere (months or years) of their life. End-of-life care helps the patient to live and enjoy living through quality health care until they die. End-of-life care also allows patients to wish on the preferred place they want to receive care and they would want to be at the time of death to be taken into consideration when planning for suitable palliative care to manage patients' terminal illness till death (www.nhs.uk).
There are three major places in which a patient of terminal illness can choose as a place o death, i.e. where to receive treatment and die, which are the hospital, care home, and home. Patient choice of place of death can be influenced by their family, caregivers, nature of the illness, and the required palliative care team suitable for the patient, to give the patient a well deserve attention and quality healthcare that will make living comfortable for the shortest period of leave for such patient to die. The concern of health practitioners is how to consider patients preferred place of death and still be able to give such patients the necessary physical, social, and spiritual support required by end-of-life care.
Sama Jamshidi, Jan S. Parker, and Seyedehnestaran hashemi (2020) found out that a hospital environment may have a potential impact on the lives of patients and it could contribute to positive health outcomes. Sama et al further asserted that a patient's psychological state can influence the process of healing, recovering, and response to treatment. Several scholars and health professionals have opined that patients' environments have an immense impact on their health conditions and outcome. It is inarguable that how comfortable a patient can be during treatment could be influenced by the patient's environment (Uirich, 2001). Therefore, in deciding the place of death for a patient the comfort of the patient and the impact such an environment will have on the overall care of the patient should be put into consideration.
This study focuses on the preferred place of death for a patient of end-of-life care. Notably, it is not all patients with a terminal illness need end-of-life care but palliative care is meant for all terminally ill individuals. End-of-life care is majorly meant for patients that are aware of the fact that they have few days or months to live irrespective of the level of health care they are exposed to. This study is been carried out to determine the most suitable place for patients of end-of-life care, the right and comfortable place the patient can be receiving necessary medical aid, psychological support, spiritual help, and other assistance needed by the period of death.
A patient preferred place of death, if the choice of the patient is honored, has a psychological impact on the patient by making the patient feel important and invulnerable. Patient care and patient response to care are likely to be influenced by their preferred place of death. Research shows that a patient whose preferred place of death is honored seems to be comfortable and cherish every moment they spent receiving care. This overall, makes the nursing practice easier and helps nurses establish trust and connection with the patient. Therefore, how effective an end of life care is for a patient depends on the role the nursing profession played in making sure that the patient's preferred place of death is honored.
The rationale for the choice of topic
The topic of this study is selected because it forms part of the basis for palliative care in which the nursing profession plays an active role in executing it. Patient preferred place of death have an immense impact on making patient of end of life care comfortable and it determine the success of and end of life care. Research and empirical evidence show that most patients of end-of-life care preferred to die at home and healthcare providers must support patients who preferred to pave death. While supporting patients' choice of place of death, which might be to die at the hospital, care home, or private apartments, the health care provider is expected to give quality health care to patients no matter the challenges the environment might pose to them.
This study is then necessary to understand the various choice of place of death, why most patients usually chose to die at home rather than care home or hospital, and to identify the role of the nursing profession in fulfilling the desire of the patient coupled with quality healthcare delivery at the patient's preferred place of death. The relevance of this study to the nursing practice is inevitable. The nurses are the intermediary between a patient, the hospital, the relative of the patient, and other health providers. The nursing practice connects all parties through communication and liaison to ensure that patients of end-of-life care are comfortable and have access to quality health care.
Since the nurse must manage the patient's pain and attend to the patient's psychological, interpersonal, and spiritual needs by liaising with other caregivers and the patient's family to make sure the patient's wishes are honored it becomes imperative for this study to be carried out for a better understanding of the way nurses can help make sure patient preferred place of death is respected.
The role of Nurses at an end of life care
The looming actuality of a patient's loss of life can essentially be extraordinarily tough for both patients and family contributors to accept, which is quite significant in a typical hospital setting. This is the time when many difficult choices specifically have to particularly be made concerning mostly redress that will advantage the patient in their ultimate weeks or months, regularly bringing excellent of existence issues into play, or so they thought. It is at this time that nurses step in to supply guidance for victims of incurable illnesses and families confronting those challenging selections and helping them adapt to painful realities. The Nurses are often instances the sole source of support at this refined time in a subtle way. Families are regularly confused, scared, and overwhelmed at this juncture in a major way. They particularly are receiving statistics from doctors about medications, redress, and timelines, however, the family of victims of terminal illness often appear to nurses to particularly lean on for emotional aid as soon as the doctor delivered their messages and left the scene for the family. Therefore, nurses are there to help the affected person and household as they warfare to specifically modify to the truth they're facing, which is quite significant. The nurse's principal duty is to the affected person and makes certain their kind of needs are honored, most especially their preferred place of death. These for the most part needs are always not by the family's wishes, for all intents and purposes contrary to popular belief. That's where the function of a professional nurse receives tricky in a generally major way. They have to kind of hold a focal point on the patient's preferences and respect their autonomy whilst at the identical time supporting the household as they navigate a procedure they've probably never been thru before, which generally is quite significant. Nurses need to be professional in pain administration to make sure their patients continue to be as satisfied as possible. In addition to disorder management, they particularly have to also generally attend to the psychological, interpersonal, and religious desires of the affected person as well. No other expert inside the hospital putting wears pretty so many hats as the hospice nurse in a big way.
A professional nurse is the center of attention completely on end-of-life care, offering hands-on nursing care without rest - both in a facility or in the patient's home. Not only do they control pain and pretty other symptoms, but they also aid in the procedure of death with dignity. Because every affected person and family both have a unique viewpoint concerning end-of-life needs, it will generally become the job of the nurse to make cultural assessments and adjust care accordingly. A nurse's role at an end of life care is to provide respite care for household individuals who need a break, order splendid scientific materials mostly wanted through the patient, perform affected person assessments, create a format of care for all caregivers to follow, provide touchy care and emotional support, arrange for religious guide offerings from priests, provide crisis care that alleviates signs and symptoms to result in alleviation maintenance in a kind of big way, act as a mediator between the household and patient, prescribe medications or treatments, and generally supervise or manage scientific care.
Apart from the role stated above, the nurse also frequently sits down by their patients' side, hold their hand and look them in the eye, share tales about developing up, and is normally just mostly there for them in a subtle way. This is done to make the patient feel special. The demise process essentially is regularly actually long and bewildering, lonely and painful, frequently instances undignified, and fraught with the unknown, which essentially is fairly significant. Nurses soar into the fray to grant that significant connection and essentially ease the transition from existence to death.
Honoring the patient's prepared place of death
The experience of a patient during the care process and with healthcare workers such as the nurse is a standard that determines a patient's exposure to quality healthcare. Since the nurse spends a lot of time with the patient, they influence patient access to care and serve as the link that determines the interrelationship patients have with their family and caregivers. The nurse must consider various factors that will affect the effective delivery of care to patients at their preferred place of death.
Whether a nursing practitioner is going to ensure that the patient's preferred place of death is honored or not should heshe should subject the quest for a choice to the nature of the illness the patient is suffering from. The level of damage an illness has done to a patient and the necessary team needed to manage the patient should form the basis on which a nurse decides the selection of the patient's place of death. Patient mobility is another key factor to be considered, many a time patients' care requires extra hands that will take care of their feeding, mobility, and cleaning because the illness made them suffer paralysis. The family most time prefers such a patient to stay in the hospital in contrast to the patient's wish to be receiving care from home, it is the duty of the nursing practitioner attending to such a patient to convince either the patient or the family to accept one of the choices made by the nurse after considering the best place that will make the patient more comfortable. At times, patiently make choices of their preferred place of death based on memories they which to keep or their psychological attachment to their home, or the feeling of staying around their loved ones at the time of death. Also, the patient's family seems to believe they know the best for their relative by deciding on their preferred place of death for the patient, the nurse must see through all reasons and try as much as possible to harmonize different views and factors in favor of the patient's access to comfort and necessary care at the end of life care. Likewise, the nurse is subjected to make sure the patient preferred place of death will give room for all hands that will care for the patient and easy access to the patient.
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