In the nursing practice, similar standards of medical interventions should be accorded to all patients irrespective of their stages of illness. Nevertheless, patients have different preferences on the form of care that they should be offered to them during their last stages of life. Occasionally, such patients' preferences raise ethical and moral conundrums that hinder the appropriate administration of healthcare interventions by healthcare practitioners as well as the patients' primary home caregivers. Despite the prevalence of knowledge that good communication is fundamental in the development of effective decisions at the end of life, there is a gap in research on the most effective communication strategies that should be adopted.
Population: Nursing providers that are responsible for issuing end-of-life care services to the patients with chronic health conditions.
Intervention: Use of effective communication strategies between healthcare providers, patients, and relatives, so as to devise logical and acceptable decisions on chronic health conditions during the issuance of end-life care services.
Comparison: Compare between the healthcare outcomes of terminally ill persons when good communication between nurses, patients, and caregivers was enabled and when poor or no communication was employed.
Outcome: The attainment of quality and acceptable end-life decisions among terminally ill persons when effective communication strategies are employed in the development of logical end-of-life care decisions.
Time: The proposed research will take six months to be implemented and reported.
PICOT Statement: The attainment of highly effective communication strategies for patients, clinicians, and caregivers can aid in facilitating good decision-making process on the forms of healthcare interventions that should be employed to address chronic health conditions.
Background of the Study
The provisioning of quality end-of-life (EOL) care today is a major phenomenon affecting patients, relatives as well as healthcare providers. Today, EOL care issuance has become person-centered, which means that the care offered is focused on addressing the patients' needs as distinct individuals (Smith, 2013). Furthermore, through EOL provisions, patients are offered a chance to make informed decisions concerning the form of care and treatment that they would prefer to be accorded by the healthcare practitioners (Faull & Blankley, 2015). Also, in most cases, the terminally ill population is the most affected demographic in reference to the development of quality EOL decisions that may affect their health's outcomes.
Nevertheless, the EOL tenet in offering quality care to patients has been affected by ethical and moral impasses, particularly in deciding the form of medical intervention to use on a patient. For instance, some patients facing terminal medical conditions may prefer to have the life support systems attached to them disconnected to save their relatives from bearing the burden of costs associated with medical bills (Warraich, 2018). Contrary, the patients' relatives or caregivers may view a decision to knowingly discontinue the life of a patient to be morally wrong and unethical for the nursing practice. Such an occurrence creates an impasse, especially when making decisions on the EOL care that should be accorded to chronically ill individuals.
Nevertheless, the use of good communication between patients, caretakers, and healthcare practitioners has been ascertained to be an essential remedy that promotes the effective creation of EOL decisions. Additionally, the involvement of the three stakeholders - patients, relatives, and clinicians - in the communication infrastructure governing the EOL care of terminally ill clients is of paramount significance in the creation of acceptable EOL decisions (Taboada, 2014). Nevertheless, there is still no evidence-based practice (EBP)-certified communication methodologies that can be stated to be supreme in the development of high-quality EOL decisions. As such, research is warranted, which will seek to investigate the most effective communication strategies that can be employed for EOL decision-making process.
The identification of effective EBP communication strategies for making appropriate and acceptable EOL decisions will be immensely significant to the nursing practice. Additionally, this is in that it will limit ethical and moral conflicts between patients, clinicians, and caregivers in generating acceptable EOL decisions on preferred healthcare interventions. Also, the purpose of this research will be to seek the most effective communication methodologies supported by EBP that can be used to minimize conflicts between the stated stakeholders of EOL decision making process. Ultimately, the primary objective of the research will be to attain EBP-certified communication methodologies that can be implemented in the clinical practice in facilitating the attainment of a seamless EOL decision-making process.
Method of Study
Quantitative and qualitative designs will be employed to seek the findings of this research. In the fore design, a sample population of 50 nurses, 50 chronically ill patients, and 50 informal caregivers will be chosen as participants in the research aimed at seeking the most effective communication strategy that can be employed for the EOL decision making process. Also, data will be gathered through research questionnaires and later presented to the researchers for analysis and interpretation. Moreover, a systematic review of publications will be conducted to support the findings of the research. Additionally, the databases that will be employed for the literature review will include CINAHL, MEDLINE, ERIC, Cochrane Library, HAPI, and EMBASE.
Only peer-reviewed publications published within the last five years will be considered for the research. Also, data triangulation, as well as participants' feedback, will be employed to check the validity of the data collected. The conceptual framework that will be employed for the study will entail analyzing the research problem using the quantitative and qualitative approach separately. Also, the framework will be employed as an analytical tool and used in creating conceptual distinctions of the collected data during the research. Moreover, the theoretical framework will be used to organize key ideas derived from the research. The image below represents a simple model of the conceptual framework that will be employed for the study.
Figure 1: A self-created image of the conceptual framework that will guide the execution of the proposed research.
Discussion of the Study Results
The systematic review of literature publications has validated the effectiveness of using communication methods in promoting the developing EOL decisions between patients and medical practitioners. Among the publications used was a journal article developed by Oczkowski et al. (2016) that portrayed that using structured communication tools can increase the frequency of discussions between clinicians, patients, and caregivers when making end-of-life decisions. Additionally, a different research publication authored by Walczak et al. (2014) validated that the use of communication support programs for patients as well as medical practitioners in EOL decision-making process. Also, the publication stated that communication support programs could be an effective strategy that would aid in promoting the attainment of improved end-of-life care for patients (Walczak et al., 2014).
In a different publication created by Sinuff et al. (2015), it was ascertained that proper communication between patients, caregivers, and nurses could aid in the attained of a shared understanding of patients' EOL treatment preferences (Sinuff et al., 2015). Ultimately, research publications that were performed by Norouzinia et al. (2016) and Anoosheh, Zarkhah, Faghihzadeh, and Vaismoradi (2009) affirmed that healthcare planners must eliminate the barriers to effective communication between the patients and caregivers. Additionally, this is in an effort to facilitate the provisioning of improved healthcare services as a result of creating appropriate EOL decisions. Ultimately, the collective findings of the research have made a positive impact on the nursing practice in that they promoted the attainment of knowledge pertaining the importance of good communication in the EOL decision-making process.
Two primary ethical considerations were emphasized when conducting the research. First, the researcher ensured that all the research participants had an informed consent when participating in the research. In this case, all participants were offered a consent form, which they signed to indicate their consent to the research. Second, the confidentiality and anonymity aspects of the research participants were maintained. Additionally, this means that no personal information like names and address were exposed by the researcher.
In conclusion, the attainment of highly effective communication strategies for patients, clinicians, and caregivers can aid in facilitating good decision-making process on the forms of healthcare interventions that should be employed during EOL care. Additionally, using structured communication tools can increase the frequency of discussions among clinicians, patients, and caregivers when making end-of-life decisions. Also, the use of communication support programs for patients as well as medical practitioners can promote EOL decision making process. Also, proper communication between patients, caregivers, and nurses can aid in the attained of a shared understanding of the patients' EOL treatment preferences. Ultimately, the use of structured communication tools can aid in the development of fast decisions and improved quality of EOL care that is issued to patients.
The Link between the PICOT Statement, Research Articles, As Well As the Nursing Practice Problem
There exists a link between the three factors stated in this research. Additionally, this is because the three factors emphasize on the importance of having effective communication tools or methodologies for promoting easy decision-making process in a health setting. Also, the articles featured presented provided validated information and studies that illustrated that effective communication is supported the issuance of improved healthcare services to patients. For instance, Oczkowski et al. (2016) validated that structured communication tools can be employed to promote good communication between patients and health practitioners. On the other hand, Walczak et al.'s (2014) research validated that the using communication support programs can help patients and medical practitioners in EOL decision-making process. Also, Sinuff et al. (2015), certified that proper communication between patients, caregivers, and nurses could aid in the attained of a shared understanding of patients' EOL treatment preferences.
Finally, Norouzinia et al. (2016) and Anoosheh, Zarkhah, Faghihzadeh, and Vaismoradi (2009) researched confirmed that healthcare planners must eliminate the barriers to effective communication to promote good decision making and healthcare outcomes on the patients. Ultimately, the nursing practice problem used to define the parameters of the study indicated that there existed a gap in research, on the best methods of communication that can be employed during EOL decision-making process. Subsequently, this shows that the three components - PICOT statement, research articles, and nursing practice problem all illustrated the necessity of ha...
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