020 Discussing Healthcare: A look at end of life care

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Gloria Lewis, EdD, MSN, MHA, RN, CCM

Gloria Lewis, EdD, MSN, MHA, RN, CCM

Gloria Lewis, EdD, MSN, MHA, RN, CCM currently works as a per diem palliative care nurse at the John Muir Medical Center in Walnut Creek, California.  She is also a faculty member at the University of Phoenix where she teaches in the nursing and health science program.  Gloria earned her RN (registered nurse) degree in 1986 and after working in many roles as a nurse she obtained a BSN (bachelor of science in nursing) in 2001.  She continued her education and went on to earn her MSN (masters of science in nursing) and MHA (masters of healthcare administration) in 2007 and most recently in 2013 obtained her EdD (doctorate of education) with a focus on nursing education.  Her dissertation was titled “Burnout and Stress: a phenomenological study of ICU nurses experiences caring for dying patients.”  She is also a Certified Case Manager (CCM). Gloria’s experiences in nursing include: medical/surgical, critical care, same-day surgery, long-term care, home health hospice, palliative care, and case management.

 

If you are a young adult and think that you are immune to death, then I want you to remember some recent cases that have been publicized in the news.  The first is a 13-year-old female who is now brain dead after a dental procedure.  Then second is a 33-year-old female who was pregnant and had a spontaneous brain hemorrhage and was also brain dead. Neither of these young ladies expected to suffer life-threatening medical conditions, but they did, suddenly and without warning. Their stories are very different, but both came to the same decision point…their families were left to decide what path to take for their medical care. Undoubtedly, this is a difficult decision for any family to make, but it is done every day across our country.

Death is inevitable. It is a part of life that most of us would rather not consider until it is upon us. But, we all deserve a to die with our dignity. Unfortunately, it does not always happen.  Impending death can often bring the worst out in patients and their families. Issues that have been swept under the rug often resurface creating emotional, social, and financial turmoil. Medical diagnoses and potential treatment regimens can be difficult to understand and confuse the patient and family.  Family members frequently have a difference of opinion when considering withdrawal of care for a terminally ill patient.

All of these issues related to end of life care create a very difficult situation for the patient, families and healthcare providers. Fortunately, there are physicians and nurses that provide end of life care for patients. They are able to address all of these issues and more while preserving the patients dignity and allowing them to die peacefully.

Gloria Lewis, EdD, MSN, MHA, RN, CCM is an experienced nurse who has spent the past 10 years caring for patients in the end stages of their lives. She has helped many patients and families deal with the very difficult issue of dying. Gloria has been part of a palliative care team that cares for patients in the hospital during the end stages of life.  She has also worked in hospice.

It is important to understand some of the terms that are associated with end of life care, such as:

  •  Palliative care – a holistic team approach to support care of patients and families with life threatening illnesses.
  •  Hospice – a philosophy and way to care for patients and their families in the last 6 months of life in hopes to prevent suffering and address the emotional and spiritual needs of the patient and loved ones.
  •  Comfort care – medical care given to a patient in hopes of keeping the patient comfortable by treating the patient’s symptoms and addressing the emotional needs of the patient and family.  Care for the underlying medical problem(s) is stopped.
  •  Advanced directive – legal documents that state your wishes for end of life care. Often, this document will include a living will which will tell your family and physician what kind of care you would or would not like in certain medical scenarios. Also, a durable power of attorney is often included which gives a loved one the ability to make medical decisions on your behalf.

There are relatively simple steps you and your loved ones can take to ensure you receive the care you want at the end of your life:

  • Discuss what kind of care you would like in a life-threatening situation:
    • Do you want CPR given?
    • Do you want life saving medications given?
    • Do you want to be shocked, if needed?
    • Do you want to be on life support
      • Ventilator (breathing machine)
      • Tube feeding (liquid nutrients given by a tube to your stomach)
  • Do you want life saving surgeries?
  • Obtain advanced directives
    • Living will (to document your answers to the questions above)
    • Durable Power of Attorney (to give someone you trust the right to make medical decisions on your behalf)

The advantage of having these discussions with your family is that you save them heartache and turmoil in the event you become gravely ill. Families often have guilt about the decision that is made in relation to end of life care of a loved one. The decision maker is left to wonder if he/she made the right decision.  If the above conversations are documented on paper and signed then the family has no choice but to honor the patient by letting the physician know what the patient wanted. This relieves the patient’s loved ones of any guilt associated with the care given or withheld and it allows the healthcare providers to honor the patient’s wishes and treat the patient with the dignity and respect that is deserved.

 

 

About the Author

I am Joshua Lewis, MD, the creator of Discussing Healthcare, LLC and a board certified Emergency Physician who currently practices in the Phoenix, Arizona area. I hope you will gain meaningful insight into our healthcare system through the information provided by Discussing Healthcare. Thank you for your interest and I encourage you to contribute by calling, emailing, or leaving comments on the website.

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