Developing quality decisions concerning patients' end-of-life care is a significant problem affecting numerous healthcare practitioners in their nursing practice. Additionally, the ease of making acceptable decisions by such healthcare workers is marred by the ethical and moral dilemmas involved in choosing the most logical healthcare care intervention to adopt. Nevertheless, effective communication is a supreme strategy that should be enforced by all stakeholders involved in providing end-of-life care to terminally ill patients. Furthermore, patients with chronic illnesses and their relatives should support the facilitation of effective communication with healthcare providers as a mandatory strategy of logic decision making that is paramount in issuing quality end-of-life care. Moreover, numerous communication tools and methodologies to help patients, relatives and healthcare providers in making end-of-life decisions have been published. Nevertheless, their effectiveness in satisfying their desired objectives has never been validated through evidence-based research (EBP). The research expounds on the problem of making logical and acceptable end-of-life decisions, through the formulation of a PICOT and execution of literature review to support the need for further exploration on the issue.
Population: Nursing providers that are responsible for providing end-of-life care services to the patients with chronic health conditions.
Intervention: Adoption of effective communication strategies between healthcare providers, patients, and relatives, in order to devise logical and acceptable decisions on chronic illnesses during the provisioning of the end-of-life care services.
Comparison: Contrast between the healthcare outcomes of chronically ill patients when good communication between nurses, patients, and relatives was facilitated and when poor or no communication at all was employed.
Outcome: The attainment of improved healthcare outcome among chronically ill patients when effective communication was employed in the development of logical and acceptable end-of-life care decisions.
Time: The proposed research will take six months to be implemented and reported.
The adoption of effective communication strategies by nursing practitioners, patients and relatives can aid in the development of logical and acceptable healthcare end-of-life decisions in relation to chronic illnesses.
The need for good communication in end-of-life care decisions has been supported by a number of psychologists in the past. Among them are Luce and White (2007) whom in their research publication asserted that good communication could avert conflict between nurses and patients on matters pertaining life-sustaining therapy (Luce & White, 2007). Moreover, the publication also pointed out that sometimes physicians exert pressure on relatives of chronically ill patients to either withhold or withdraw life-sustaining therapy treatment from patients. Furthermore, according to Luce and White (2007), such pressure often arises from social, economic, prognostic and professional factors facing a patient. Also, at times such pressure can cause resentment from the relatives of the terminally ill persons and then subjected towards the medical practitioners involved (Luce & White, 2007). Ultimately, such occurrence can turn into a full-blown conflict that also significantly affects the healthcare status of the concerned chronically ill patients.
The essentiality of seeking effective communication methodologies when making end-of-life decisions can also be supported by a scientific research publication that was authored by Oczkowski et al. (2016). According to their research, patients and relatives agree that better communication, as well as decision-making with physicians, should be offered a high priority in an effort to promote the attainment of quality end-of-life care (Oczkowski et al. 2016). Also, to support their hypothesis, Oczkowski et al. (2016) carried out an extensive review of randomized control trials (RCT) as well as non-randomized control trials on the need for end-of-life decisions' communication from 2014-2016. Furthermore, the findings of Oczkowski et al. (2016) research asserted that using structured communication tools can elevate the frequency of discussions between physicians, patients, and relatives when making end-of-life decisions. Nevertheless, Oczkowski et al. (2016) stated that there is a need for such communication tools to be developed using evidence-based research.
Moreover, the use of communication support programs for patients as well as caregivers is also an essential strategy that aid in promoting the attainment of improved end-of-life care for patients. Additionally, this theory was supported by research executed by Walczak et al. (2014) that sought to prove the importance of discussing the prognosis of terminally ill patients between clinicians and relatives. Moreover, the publication offered a description of the multisite randomized controlled trial protocols for implementing a nurse-led support program for communication. Also, the research illustrated that such a program would aid in facilitating the development of effective communication between patients and caregivers on issues that are relevant to end-of-life care decisions (Walczak et al., 2014).
The importance of proper communication in promoting quality of medical services offered to patients during end-of-life situations can also be supported by quantitative research that was executed by Sinuff et al. (2015). According to the research, the goal of an end-of-life communication and decision-making process is to develop a shared understanding of a patient's treatment preferences (Sinuff et al., 2015). Moreover, proper communication between patients and clinicians during end-of-life situations can aid in the development of a plan that is consistent with the patient's clinical intervention preferences (Sinuff et al., 2015). Consequently, this leads to the attainment of an improved standard of end-of-life care services offered to the chronically ill patient. Furthermore, Sinuff et al.'s (2015) research illustrated that proper communication between patients, relatives and nurses can be developed through constant measurement of quality indicators.
The effectiveness of good communication in the attainment of positive patients' outcome can also be supported by a quantitative study conducted by Norouzinia et al. (2016). Also, the study validated its findings by focusing on 70 nurses as well as 50 patients selected at the Alborz University of Medical Sciences (Norouzinia et al., 2016). Ultimately, the findings of the research ascertained that it is imperative for nurses to be trained on how to perform good communication with patients as a way of promoting the quality of services offered to the clients. Also, research performed by Anoosheh, Zarkhah, Faghihzadeh, and Vaismoradi (2009) supported the need for good communication between medical practitioners and healthcare providers. Additionally, a sample population of 61 patients and 75 nurses were employed to validate the findings of the research. Ultimately, the findings ascertained that nursing managers, as well as healthcare system planners, must eradicate the barriers to effective communication between the patients and nurses to facilitate the provisioning of improved healthcare services.
In conclusion, the adoption of effective communication strategies by nursing practitioners, patients and relatives can aid in the development of logical and acceptable healthcare end-of-life decisions in relation to chronic illnesses. In the execution of this research, the targeted population that will be focused on are nursing providers that are responsible for providing end-of-life care services to the patients with chronic health conditions. Moreover, the intervention that will be focused on includes the adoption of effective communication strategies between healthcare providers, patients, and relatives. Ultimately, the expected outcome of the research will be the attainment of improved healthcare outcome among chronically ill patients.
Anoosheh, M., Zarkhah, S., Faghihzadeh, S., & Vaismoradi, M. (2009). International Nursing Review. Nurse-patient communication barriers in Iranian nursing., 56(2), 243-249. doi:10.1111/j.1466-7657.2008.00697.x.
Luce, J. M., & White, D. B. (2007). The Pressure to Withhold or Withdraw Life-sustaining Therapy from Critically Ill Patients in the United States. American Journal of Respiratory and Critical Care Medicine, 175(11), 1104-1108. http://doi.org/10.1164/rccm.200609-1397CP
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication Barriers Perceived by Nurses and Patients. Global Journal of Health Science, 8(6), 65-74. http://doi.org/10.5539/gjhs.v8n6p65
Oczkowski S. J., Chung H-O., Hanvey L., Mbuagbaw L., & You J. J. (2016). Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis. PLoS ONE 11(4): e0150671. doi:10.1371/journal.pone.0150671
Sinuff, T., Dodek, P., J.You, J., Barwich, D., Tayler, C., Downar, J., ... K. Heyland, D. (2015). Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. Journal of Pain and Symptom Management, 49(6), 1070-1080. doi:10.1016/j.jpainsymman.2014.12.007
Walczak. A., Butow P.N., Clayton J. M., Tattersall M. H., Davidson P. M., Young J., & Epstein R. M. (2014). Discussing prognosis and end-of-life care in the final year of life: a randomized controlled trial of a nurse-led communication support program for patients and caregivers. BMJ Open 2014; 4: e005745. doi: 10.1136/ BMJ open-2014-005745
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