RUNNING HEAD: Family preparedness and End of life support

Family preparedness and End-of-Life support before the death of a Nursing Home Resident
Student Name: Kushanvir Gill
Student Number: 820-420-024
Date of Submission: March 4, 2015

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The decision making had turned into an ethical, medical, legal and personal concern at
the End-of-Life. In End-of-life the clients are provided with the care at their final days of life.
End-of-life focuses on providing the quality of life at the minimal sufferings. (College of Nurses
of Ontario, 2009) The subject I have chosen is Family preparedness and End-of-Life support
before the death of a Nursing Home Resident. The planning of aid provided at the End-of-Life
for the residents holds a special importance. I believe End-of-Life care should focus on patients
physical, emotional and social needs that can be fulfilled in their last days of life. Individual at
the End-of-Life requires an active and compassionate approach to treat and provide comfort to
them. The approach is ought to be related to ones believes, cultural and spiritual values. I
wanted to exhibit the significance of the support and care provided at the End-of-life which
encouraged me to choose this topic. The goal for End of life is to provide comfort and support to
the patient, develop the quality of the life and help ensure a dignified death. This article has
focused on conveying the basic information necessary to promote the family preparedness
through ethical principles, care provided at end of life and special needs for the families and the
caregivers.
Firstly, the ethical principles are ought to be followed by the nurses for decision making.
Moreover, the patients decisions are considered to be given preference over others according to
the principle of autonomy and justice. In addition to these principles, the principle of beneficence
and non-maleficence states the responsibilities of a caregiver towards the patient. (Jimenez, M.,
Jaen, M., Garcia, M., & BarahonaAlvarez, H.; 2013) I think the responsibility of the nurse is to
work with the health care team and offer the patient and family with information about the legal
documents and rights involved in the end of life care. (Touhy, T., & Jett, K.; 2012) Some
common documents used in the end of life care are advanced directive, do not resuscitate (DNR),

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do not attempt resuscitation (DNAR), living will and power of attorney for personal care.
Advanced directive is a document that delivers the information about the substitute decision
maker on the behalf of the patient to the nurses. (College of Nurses of Ontario; 2009) Do not
resuscitate (DNR) and do not attempt resuscitation (DNAR) document provides the information
to the health care providers that CPR will not be attempted but the use of other forms of
treatment of care can be provided unless stated. (College of Nurses of Ontario; 2009) With the
DNR the natural physiological progression to death is not delayed or interrupted. (Lewis, S;
2009) I believe that the use of DNR provides the client with the natural death with the respect,
comfort and the dignity which is important for both the client as well as the family. Power of
attorney for personal care is a legal document that gives another person the right to act on the
clients behalf with regards to the clients personal decisions. (College of Nurses of Ontario;
2009) Nurses should be aware about these documents and contribute in the best possible way to
provide the client with the knowledge and understanding about the treatment and care in the best
interest of the client. These legal documents can help the nurses to improve the nursing practice
by implementing the evidence based practices and avoiding errors while caring for the patient.
However, if the preference of a patient is unidentifiable or he or she fails to provide the consent
to the treatments, it becomes really difficult to follow these principles.
Secondly, the patients become completely dependent on the caregivers for their all
personal care and are generally limited to the bed rest at the end stage of life. The caregivers
become responsible for all the needs and the necessities of a patient which he or she cant
express verbally. The caregivers can help patients by supporting them bearing the pain or
alleviating it as it cannot be eliminated. The needs of a patient are assessed through daily
monitoring the verbal and non-verbal actions of a patient. In reducing the pain, the soothing

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properties of touch, massage, fragrance, and music can also help. The changes can be applied in
the treatment according to the situation and needs of a patient. Nurses should provide the
families and the friends with the support and also provide them with the time for bereavement.
(Potter, P., & Perry, A; 2009) I believe it is important as well as useful to communicate with
people in the last stages to keep them involved and informed. Families and friends should be
encouraged to form a healthy communication with the patient, having positive vibes around the
patient would be a great help. Communication is an important skill that nurses need to develop
with experience in order to provide a qualitative care to the patients. Nurses should have the
communication skills in order to provide the client with the goals of care and treatment. The care
givers should plan the end-of-life care prior to the last stage of the patient. To avoid the problem
of decision making the caregivers must plan the End-of-life care before the patients condition
get worst. (Davidson, K.M; 2011) Planning before clarifies any concern or doubt regarding the
treatments and preference. Discussing the problems among each other in the family before the
medical crises takes place, help families to understand the wishes of a patient. Active and careful
listening can help the nurses to build the therapeutic communication with the client and family
by providing respect and understanding.
Lastly, after the death of the patient is pronounced the nurse respectfully prepare the body
for immediate viewing following the cultural customs for the family. The loss of a loved one is
very disheartened feeling which shatters the family members. In this situation the role of a nurse
is very important in providing support to the family of the patient. The patients family tend to not
accept the reality of the loss in that case a nurse can console the family and involve them to
express their feelings in order to help them to resolve the grief. The loss of a family member not

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only affects the families but it also affects the nurses who care for them as well. An emotional
bond is being developed while caring for the patient. Being a nurse caring for the patient at end
of life care, the nurses should reflect upon themselves about how the loss of a patient would
affect them. The loss of a patient could develop the feelings of failure that could build the feeling
of guilt and frustration. Nurses should seek support from the team members or support groups in
order to resolve conflicts whenever needed. Self-care is an important aspect to relieve stress for
nurses. Involvement in activities, exercise, relaxation therapies and developing a support system
could be found useful to ease stress. (Touhy, T., & Jett, K.; 2012)
In conclusion, the loss of the loved one is very painful that any human being can suffer.
Death is inevitable thus all the family members should be prepared and accept this truth even if
its about their loved one and receive End-of-Life support to make the last stage of their life
peaceful. Denial and lack of preparedness has resulted in complicated grief disorder. (Davidson,
K.M; 2011) Nurses can play a vital role in educating and preparing families for the End-of-Life
support both to the patient as well as to their families. I believe additional training to prepare the
nurses to grief and to overcome the stress while caring for the patients at the end of life is very
essential. A nurse should have the knowledge about the palliative care options and should have
that comfort level where they can talk to the family members about the sensitive topics about the
death and the loss. As our population continues to age, the demand of the long term facilities as
well as the knowledgeable nurses is going to increase. There will be more need to prepare the
families and provide the end of life support before the death of a nursing home resident. Caring
for the patient and preparing their families at the end of life care is very challenging as well as a
rewarding experience.

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Bibliography
College of Nurses of Ontario. (2009). Guiding Decisions About End-of-Life Care. Retrieved
February 2, 2015 from http://www.cno.org/Global/docs/prac/43001_Resuscitation.pdf.
Davidson, K.M. (edited by D.O. Schoenfelder). (2011). Evidence-Based Practice Guideline:
Family preparedness and end-of-life support before the death of a nursing home resident.
Retrieved February 2, 2015 from Journal of Gerontological Nursing, 37(2), 11-16.
Jimenez, M., Jaen, M., Garcia, M., & BarahonaAlvarez, H. (2013). Decision-making in older
people with dementia. Retrieved February 2, 2015 from Reviews in Clinical
Gerontology, 307-316.
Lewis, S. (2009). Palliative Care at the End of Life. Retrieved February 4, 2015 from Medicalsurgical nursing in Canada: Assessment and management of clinical problems (3nd
Canadian ed., pp. 230-245). Toronto: Mosby Elsevier Canada.
Potter, P., & Perry, A. (2009). The Experience of Loss, Death, and Grief. Retrieved February 10,
2015 from Canadian fundamentals of Nursing (4th ed., pp. 452-475). Toronto:
Mosby/Elsevier Canada.
Touhy, T., & Jett, K. (2012). Loss, Grief, Dying, and Death in Later Life. Retrieved February 26,
2015 from Ebersole and Hess' gerontological nursing & healthy aging (1st ed., pp. 454471). Toronto: Elsevier.