Nursing care involves the support of general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible, a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers.
Hospice care provides comprehensive physical, psychological, social, and spiritual care for terminally ill patients. Most hospice programs serve terminally ill patients from the comforts and relaxed surroundings of their own home, although there are some located in inpatient settings. The goal of hospice care team is to help the patient achieve as full life as possible, with minimal pain, discomfort, and restriction. It also emphasizes a coordinated team effort to help the patient and family members overcome the severe anxiety, fear, and depression that occur with terminal illness. To that end, hospice staffs encourage family members to help and participate in patient care, thereby providing the patient with warmth and security and helping the family caregivers begin the grieving process even before the patient dies.
Everyone involved in this method of care must be committed to high-quality patient care, unafraid of emotional involvement, and comfortable with personal feelings about death and dying. Good hospice care also requires open communication among team members, not just for evaluating patient care but also for helping the staff cope with their own feelings.
Recent studies have identified barriers to end-of-life care including patient or family member’s avoidance of death, influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.
The best opportunity for quality care occurs when patients facing death, and their family, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.
Nursing Care Plans
During end-of-life care the nursing care planning revolves around controlling pain, preventing or managing complications, maintaining quality of life as possible, and planning in place to meet patient’s and/or family’s last wishes.
Here are 4 End-of-Life Care (Hospice Care) Nursing Care Plans (NCP):
- Compromised Family Coping
- Activity Intolerance
- Anticipatory Grieving
- Other Possible Nursing Care Plans
Compromised Family Coping
Compromised Family Coping: A usually supportive primary person (family member, significant other, or close friend) insufficient, ineffective, or compromised support, comfort, assistance or encouragement that may be needed by the individual to manage or master adaptive tasks related to his or her health challenge.
Risk for Caregiver Role Strain: The state in which an individual is at high risk to experience physical, emotional, social, and/or financial burden(s) in the process of giving care to another.
May be related to
- Inadequate or incorrect information or understanding by a primary person; unrealistic expectations
- Temporary preoccupation by significant person who is trying to manage emotional conflicts and personal suffering and is unable to perceive or to act effectively with regard to patient’s needs; does not have enough resources to provide the care needed
- Temporary family disorganization and role changes; feel that caregiving interferes with other important roles in their lives
- Patient providing little support in turn for the primary person
- Prolonged disease/disability progression that exhausts the supportive capacity of significant persons
- Significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair
- Highly ambivalent family relationships; feel stress or nervousness in their relationship with the care receiver
Possibly evidenced by
- Patient expressing/confirming a concern or complaint about SO’s response to patient’s health problem, despair about family reactions/lack of involvement; history of poor relationship between caregiver and care receiver
- Neglectful relationships with other family members
- Inability to complete caregiving tasks; altered caregiver health status
- SO describing preoccupation about personal reactions; displaying intolerance, abandonment, rejection; caregiver not developmentally ready for caregiver role
- SO attempting assistive/supportive behaviors with less than satisfactory results; withdrawing or entering into limited or temporary personal communication with patient; displaying protective behavior disproportionate (too little or too much) to patient’s abilities or need for autonomy
- Apprehension about future regarding care receiver’s health and the caregiver’s ability to provide care
- Identify resources within themselves to deal with situation.
- Visit regularly and participate positively in care of patient, within limits of abilities.
- Express more realistic understanding and expectations of patient.
- Provide opportunity for patient to deal with situation in own way.
|Assess level of anxiety present in family and/or SO.||Anxiety level needs to be dealt with before problem solving can begin. Individuals may be so preoccupied with own reactions to situation that they are unable to respond to another’s needs.|
|Establish rapport and acknowledge difficulty of the situation for the family.||May assist SO to accept what is happening and be willing to share problems with staff.|
|Determine the level of impairment of perceptual, cognitive, and/or physical abilities. Evaluate illness and current behaviors that are interfering with the care of the patient.||Information about family problems will be helpful in determining options and developing an appropriate plan of care.|
|Note patient’s emotional and behavioral responses resulting from increasing weakness and dependency||Approaching death is most stressful when patient and/or family coping responses are strained, resulting in increased frustration, guilt, and anguish.|
|Discuss underlying reasons for patient behaviors with family.||When family members know why patient is behaving differently, it may help them understand and accept or deal with unusual behaviors.|
|Assist family and patient to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt.||When these boundaries are defined, each individual can begin to take care of own self and stop taking care of others in inappropriate ways.|
|Determine current knowledge and/or perception of the situation.||Provides information on which to begin planning care and make informed decisions.|
|Assess current actions of SO and how they are received by patient.||Lack of information or unrealistic perceptions can interfere with caregiver’s and/or care receiver’s response to illness situation.|
|Involve SO in information giving, problem solving, and care of patient as feasible. Instruct in medication administration techniques, needed treatments, and ascertain adeptness with required equipment.||SO may be trying to be helpful, but actions are not perceived as being helpful by patient. SO may be withdrawn or can be too protective.|
|Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs.||Information can reduce feelings of helplessness and uselessness. Helping a patient or family find comfort is often more important than adhering to strict routines. However, family caregivers need to feel confident with specific care activities and equipment.|
You may also like the following posts and care plans:
- 500+ Nursing Care Plans for Free – wide variety of nursing care plans for different diseases and conditions
Other Care Plans
Miscellaneous nursing care plans that don’t fit other categories:
- Alcohol Withdrawal | 5 Care Plans
- Benign Febrile Convulsions | 5 Care Plans
- Cancer Nursing | 13 Care Plans
- End-of-Life Care (Hospice Care) | 4 Care Plans
- Substance Dependence and Abuse | 8 Care Plans
- Surgery (Perioperative Client) | 13 Care Plans
- Systemic Lupus Erythematosus | 4 Care Plans
- Total Parenteral Nutrition | 4 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans