Creating a Change

Creating a Change

The focus of this paper will be direct at creating a change. This change will have an impact on patients as they approach the end of their life, with in the health care system that I work for. While there are many care aspects to end of life care I try to focus on one end of life secretions. End of life secretions, although natural, are a symptom faced by approximate 95% of patients as they approach the end of their life (Wee, Coleman, Hillier, & Holegate, 2006). The death rattle, as it has been called, is a sound that can make it seem like the person is drowning. As nurses we strive to ensure that the last memories that loved ones have of their family member are good ones. This sound is one that can leave a negative lasting memory. Beyond simply educating the family there are interventions that are evidenced based that been shown to be effective in the management of this symptom. While some find end of life symptom management unconventional having plans in place to address end of life symptoms such as the death rattle can help the patient to pass with ease (Treece, 2007).

When a patient in Lee Memorial Health system is approaching end of life the hospital system usually calls upon hospice to evaluate the patient. Given that the patient is at end of life they may not always make to a hospice house. That in turns mean they may not always be given the same management of the symptoms at end of life. This creates and area of concern as doctors and nurses typically in a hospital setting are not use to treating patients that are dying and managing their symptoms (Ellershaw, Dewar & Murphy, 2010).

In this area of medicine end of life care is not always welcomed with open arms. This can be attributed to the fact that doctors and nurses in this area are treating patients on a technical level and not a symptom management level (Walling, Ettner, Barry, Yamamoto, & Wenger, 2011). Studies have shown that doctors that provide their main practice through clinical care are not always open to ordering medications used in end of life care (Bailey, Burgio, Woodby, Williams, Redden, Kovac, Durham, & Goode, 2005). . The apprehension involved can be related to many areas including lack of knowledge and fear of high doses of medications used in hospice care (Ghafoor,& Silus, 2011).

Hospice care differs from hospital care in that it is primarily based on symptom management. When patients present with sudden changes hospice uses algorithms to address these end of life changes. These algorithms are based on evidenced based practices that treat changes at the end of life (Stegman, 2011). These algorithms may be started and carried out by the patients nurse without consulting the patient’s physician. This can be done because all algorithms are preapproved by the hospice board of medical directors, researched