The Effect of Spirituality at the End of Life Nursing Care

The Effect of Spirituality at the End of Life Nursing Care
The development of advanced nursing practice has greatly contributed to the improvement of healthcare in response to the ever-changing needs of patients. This advancement allows nurses to assume important medical tasks initially performed by doctors and this has increased access to healthcare. While practicing as an advanced care practitioner, the nurse must be able to evidence additional core capabilities in the areas of clinical practice, research, education, and leadership or management (Woo et al., 2017). Advanced practice nurses (APNs) must be grounded in theory and research to provide quality services to the patients. While they perform almost similar tasks as registered nurses, APNs have considerably more freedom to make clinical decisions and determine the treatment course for their patients.

Area of Interest

Advanced practice nurses work in four main areas including research, education, clinical practice, and management or leadership. My area of interest is in the clinical practice specialty which involves the provision of direct care services to patients. Clinical practice nurses care for patients as well as interacting with the public and often serve as links between the doctors and the patients/families. In the United States, the scope of practice for advanced clinical practice nurses is defined by the state. Despite these state regulations, advanced practice nurses perform tasks such as diagnosing patients, ordering investigations, dispensing medications, maintaining patient records, and appropriate referral of patients (Woo et al., 2017). Upon completion of the advanced nursing practice program, APNs work in four main specialties as a certified nurse practitioner certified registered nurse anesthetist, certified nurse-midwife, or clinical nurse specialist. Upon completion of my advanced practice nurse program, I will like to work as a clinical nurse specialist in the area of palliative care.

Clinical Problem

Every year, millions of people die in the United States and most of the deaths occur in hospitals. Although some deaths occur suddenly, the majority of the people die after a long period of chronic illnesses. Chronic illnesses refer to conditions that the last fr more than a year and cause functional restrictions or require continuous medical treatment. Recent data indicates that more than half of Americans suffer from at least one chronic illness and the numbers have increased recently (Mistry et al., 2015). During this time of illness, patients require a special type of care to cope with their conditions including end-of-life care. End-of-life care or palliative care encompasses a team approach to care coordination primarily focusing on the comfort of the patient when a cure is no longer feasible (Sonemanghkara et al., 2019). This care ensures that patients get to live well and die with dignity. Additionally, end-of-life care serves to include the patient’s family in the care while addressing their concerns. Among the top approaches used during the end of life, care is the provision of spiritual support. The goal of this care is to help the patient feel peace and to comfort the family as they prepare for the worst.

Spiritual support is part of the hospice and palliative care services that helps patients transition well from life to death. Evidence-based practice suggests that care and compassion are the most critical aspects of dealing with dying patients (Finocchiaro, 2017). Spiritual care is mostly provided by the hospital chaplains and the local religious leaders. The advanced nurse practitioner helps in organizing the availability of these leaders depending on the needs of the patient and the family. Sometimes, the wrong spiritual support could do more damage during the end of life care and it requires the APN to perform routine spiritual assessments before encouraging the practice.

PICOT Question

In terminally ill adult patients (P) with chronic conditions, how effective is spiritual care (I) compared to no spiritual care (C) in promoting a dignified and peaceful death (O) during end-of-life nursing care (T)?

Population: The population of focus is terminally ill adult patients suffering from chronic conditions. This population forms the majority of those requiring spiritual care and family support.

Intervention: The intervention is to provide spiritual care through the use of hospital chaplains and local religious leaders according to the patient’s preferences.

Comparison: The alternative intervention is to avoid the provision of spiritual support and continue with routine nursing care.

Outcome: The expected outcome in providing the intervention is to promote a peaceful and dignified death while supporting the family emotionally.

Time: The spiritual intervention will be provided during the end-of-life nursing care delivery in nursing homes or acute care facilities.

Interest in the Clinical problem

Nurses have a huge responsibility in end-of-life care for patients including having sensitive conversations with the patient, identifying patient needs, and supporting the family. I am interested at end of life patient care because it involves the provision of high-standard nursing care. Many individuals do not understand that death is a process that requires the provision of compassionate care to the affected individuals. These patients often feel confused, lost and have unanswered questions about the end of their lives. The nurse needs to be sensitive when addressing the health concerns of the patient including the provision of support to the family. Most importantly, I am interested at end of life patient care because of the spiritual support required. Having knowledge on how to improve spiritual care for the patient is crucial because it helps in promoting a peaceful death.

The increasing rate of chronic diseases globally has led to an increased focus on palliative and end-of-life patient care. These diseases which include heart disease, cancer, stroke, diabetes, and chronic obstructive pulmonary disease cause more than half of the deaths observed annually. In the United States, chronic diseases are responsible for seven out of ten deaths killing more than 1.7 million people yearly (Mistry et al., 2015). Because of the increasing number of chronically ill people, nurses have to prepare to provide palliative and end-of-life care services. Preparations to take care of this special population group involves recognition of the patients’ needs, understanding effective communication ways, and the benefits of providing end-of-life nursing care.

Relevance to the Current Society

End-of-life spiritual care is important to society because it provides practical support to families, friends, and caregivers. People who have reached old age often feel lonely and end-of-life care can serve to promote companionship. End-of-life care can be used as an approach to prolong life in some situations. The approach is also important in improving the quality of life during illness while helping the patient to find peace (Sonemanghkara et al., 2019). Spiritual care during the end of life can enable the patient to have freedom from regret and lessen the fear of death.

Evidence-based Practice Change

At the end of life, a person’s religious beliefs are often challenged and spirituality becomes more prominent. Many patients often want to achieve a peaceful death which includes having faith in God and hoping for eternal life. Studies suggest that spirituality is crucial in helping the patient cope by embracing hope (Finocchiaro, 2017). It is observed that even those individuals who did not believe in spirituality before tend to find meaning during the end stages of life. Spirituality can be different from religion because it is influenced by factors such as culture and personal experiences. Despite the many approaches to spirituality, end-of-life spiritual care helps to connect the patient with the family and helps in decreasing fear and worry for the terminally ill.

In the final stages of terminal illness, the focus of the family and healthcare providers shifts to making the patient comfortable. In many institutions, nurses usually focus on the physical needs of the patient like pain control and management of symptoms such as constipation and shortness of breath. There s a need for a change of this approach because spiritually, death does not mean the end of life. Spiritual care ensures that the patient leaves the family at peace, addresses family conflicts, and reduces fear among the family members (Sonemanghkara et al., 2019). The nurse uses this opportunity to call for spiritual guidance from the chaplains to care for the emotional needs of the family members and the patient.

Relevance to DNP Prepared Nurse

Doctor of Nursing Practice (DNP) faculty plays a critical role in preparing nurses to assume palliative care roles. These nurses are prepared to meet the physical, emotional, and spiritual needs of patients and families using evidence-based practice (Woo et al., 2017). The DNP nurse can engage In the promotion of end of life patient care through research activities. Research focusing on the importance of spiritual care can help to enlighten other healthcare providers on how to effectively care for dying patients. The nurse can also engage in policy formulation at all levels to ensure spiritual care is provided to all patients with terminal illnesses.

Plan for Dissemination

My plan for sharing knowledge gained during this project involves the use of discussion forums and social media platforms. I will share my understanding of spiritual care for the terminally ill through our online discussion board. I will ensure to respond to my peers on questions raised and provide evidence supporting my arguments. Secondly, I will share my knowledge with students and other healthcare professionals on media platforms like Facebook, Twitter, and LinkedIn. Upon approval of my project, I will seek permission to make it available in one of the nursing journals for easy access by students and other healthcare professionals.

References

Finocchiaro D. N. (2017). Supporting the patient’s spiritual needs at the end of life. Nursing, 46(5), 56–59. https://doi.org/10.1097/01.NURSE.0000482263.86390.b9

Mistry, B., Bainbridge, D., Bryant, D., Toyofuku, S. T., & Seow, H. (2015). What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators. BMJ Open, 5(6). http://dx.doi.org/10.1136/bmjopen-2014-007492

Sonemanghkara, R., Rozo, J. A., & Stutsman, S. (2019). The Nurse-Chaplain-Family Spiritual Care Triad: A Qualitative Study. Journal of Christian Nursing : Aquarterly Publication of Nurses Christian Fellowship, 36(2), 112–118. https://doi.org/10.1097/CNJ.0000000000000592

Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human Resources for Health, 15(1), 1-22. https://doi.org/10.1186/s12960-017-0237-9

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