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End of Life

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End of life (EOL) care is a sensitive topic that presents challenges to health care professionals, patients, and their families (Walczac et al., 2014). Diseases such as cancer are often lethal and patients are commonly given a set life expectancy (Walczac et al., 2014). In addition, reports state that a significant rise in deaths will occur over the next few decades (Sprinks, 2011). Thus, prompting an increasing need for healthcare professionals to be well prepared in providing care for these individuals. However, nurses and doctors are often challenged with discussing end of life with their patients (Walczack et al., 2014). Research states that healthcare professionals avoid discussing end of life with their patients due to fears of disappointment (Sprinks, 2011). Timely communication and patient readiness also present challenges to many healthcare professionals (Walczack et al., 2014). Nonetheless, understanding how to improve end of life care, communication, and skills is crucial to providing quality patient care.

Communicating with patients at the end of life can be made easier by initiating the process of Advanced Care Planning (ACP), which essentially involves discussing patient prognosis (Walczack et al., 2014). By initiating ACP, patient questions related to timing and progression of disease can be answered and an increasing balance in care can be provided (Walczack et al., 2014). Evidence also suggests that patients should be involved in their care as much as possible (Walczack et al., 2014). Further supporting this idea, reports state that patient needs at the end of life are often not met due to a lack of staff communication and patient involvement (Sprinks, 2011). Aside from communicating with patients, communicating with caregivers and family plays a crucial role in end of life care because they are often given the role of making health decisions for patients who are no longer fit to do so (Walczack et al., 2014). In a study implementing the use of a Question Prompt List (QPL), which contained a list of questions related to EOL that patients and families were encouraged to ask, results indicated that patients and caregivers asked twice as many questions and had fewer unmet information needs regarding future care (Walczack et al., 2014). Thus, patients can be expected to have fewer concerns and a potential decrease in anxiety related to end of life. End of life is something that everyone will have to experience one day or another. Regardless of how prepared an individual is, end of life is never easy. I hope you enjoyed reading my blog, I look forward to reading all of your responses and blogs as well!

References

Sprinks, J. (2011). Nurses lack confidence in providing end of life care. Nursing Older People, 23(2), 6-7. http://dx.doi.org/10.7748/nop2011.03.23.2.6.p5035

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 control trial of a nurse-led communication support program for patients and caregivers. BMJ Open, 4(6), e005745. doi:10.1136/bmjopen-2014-005745.

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End of Life Care

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Death is evident, it can occur to any one at any time. It is important to have a clear understanding of end of life care and what your desires are for when that day approaches. Would you like to be intubated? In a vegetative state? Would you like to be resuscitated or would you prefer to pass away without any resuscitation measures? It is important to have an end of life talk with your family members and the important people in your life. Who will be able to make these decisions for you? Will you write a living will? These are important questions that we should consider and discuss with our family, I did so and the following describes my family’s end of life thoughts.

The topic of death is something I have always avoided. I cannot imagine losing my parents, it brings me to tears. My mom has always expressed her desires to me if something tragic or her death was to occur. She wants to be cremated and not have a memorial service. She does not want me to cry, and she wants me to believe that she has passed away to a better life. She will not be suffering and she would be able to look down upon our family. This may be easy for her to say, but hard for me to believe. The thought of losing my mother is something I cannot imagine. My confident, my best friend, the woman who gave birth to me. I just love her so much that the thought of death is unreal, a reason I believe I would never be able to be her power of attorney nor implement her end of life wishes. My father is the same way. He would like to be cremated, and he would like his ashes scattered in the ocean. My father has never been one to talk about death nor show much emotion. I think it would be easier for me to implement his end of life wishes than my mothers. Why, I don’t know.

In regards to myself, if something tragic was to occur and I was still young I would like to be kept alive. If I have children I would like to be kept alive at all costs because my children deserve to grow up with their mother and father. If I was to have a very low chance of survival it would be ideal to let me go. There would be no point in prolonging my families suffering. I know that my mother would do anything in her power to keep me alive; therefore I would not appoint her as my power of attorney. At this moment I am still unsure of my end of life wishes. It is something that I have to put more thought into and I believe once I have a family of my own I will be able to make a better decision.

It is very hard to have a conversation where end of life decisions are discussed. It is not pleasant and sometimes we are in denial. I am guilty because I cannot imagine my parents passing away. I cannot get over the idea of never seeing my parents or sister; my loved ones being taken away without even saying goodbye or letting them know how much I love them. This topic is difficult for everyone but it is an important conversation that we all must have.

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Close to Home

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Who knows about drugs?? Take an informal survey of family members, friends, or coworkers. Do they know the medications they take? If they don’t take medications, do they know about over the counter medications – drug/pharmacological/generic/brand names? Do they know the side effects and safe doses? What about homeopathic remedies and herbal medications? Let’s do some “close to home” education and see what happens! In class we can decide if you want to blog, voicethread, or just talk about what you found out…

Mom takes:

Glipizide (used to take Metformin) – “for my diabetes”

Simvastatin – “to control my cholesterol”

Amlodipine – “to manage my high blood pressure”

Cozaar (losartan) – “this is also for my high blood pressure”

My mom did a good job of telling me both the trade and generic names of her medications. She knew what each one was for, and even knew the actions of glipizide. However, she did not know the side effects of all her drugs. She said she’s never experienced any side effects, so she didn’t bother to look them up.

Dad takes:

Norco – “for shoulder pain” (he broke his arm and it gives him pain every once in a while)

Tramadol – “also for shoulder pain”

My dad knows the trade/generic names of the pain medications he takes, their pharmacological actions, the side effects, and safe doses. (He’s a healthcare provider and knows what’s up!)

Following this activity, I realized that my family is much more in tune with their medications and their indication for use because of my dad’s career as a healthcare provider. I work as a med tech at a retirement community and often find that many of the residents don’t really know what they are taking. Of course, they are on medication management because of their inability to manage their medication scheduling, or can’t remember to take their medications at all–but I feel that anyone taking medications should know what they are taking, what they’re for, and what side effects are associated with their medications (in case that these side effects affect normal activity). I’ve also known friends who would take Tylenol throughout the day, not realizing there is a suggested “not to exceed” or maximum dose per day due to its deleterious effects on the liver.

During my study abroad trip to Ireland this past winter, we were asked to go through the Irish pharmacies/drugstores and see how they were different from ours back in the US. We all immediately noticed that medications that were normally over the counter (like Tylenol, or Advil) were behind the counter, and required patient education from a pharmacist. I thought this was both weird and interesting, but coming back and thinking about it I realize the importance of patient education–even for OTC drugs.

Medication Education

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My family is fairly well educated and able to search out the information they need when self-administering. However, there are still typically gaps in knowledge due to a lack of understanding of foundational aspects of pharmacology and pathophysiology. I have one family member who is on many medications, and she is actually highly motivated to educate herself; she knows most of her medications fairly well. However, there are certain aspects of which she is not aware and so I’m careful to ask her questions pretty regularly about which medications and doses she is taking currently. Some months ago, her physician changed some of her meds and forgot to add a potassium sparing diuretic to her medication regimen, which includes Lasix and Digoxin…and her labs that week indicated K+ of 3.4. Since she was not aware of the implications regarding potassium, I had the opportunity to educate her on signs of hypokalemia and Digoxin toxicity, and on the need to supplement her diet with potassium until her physician came back from vacation and could correct her medication regimen.

In terms of homeopathic and “natural/herbal” medications, I find that even my friends/family who are knowledgeable about the broad spectrum of supplements do not base their beliefs on evidence, but simply what is reported by respected individuals or magazines; there is a strong media influence on adoption of these supplements into a person’s lifestyle. They are especially not aware of the act that these natural supplements can interact with most medications, the most serious of which include the anticoagulants and anticonvulsants.  I have also found that this is the most difficult education in terms of meeting resistance.  Some of my family members will keep using homeopathic medications despite my explanations.

In conclusion, in addition to educating our patients in the facility, there is a need for us to ensure that those closest to us are practicing caution with the medications needed for their health. I am grateful for the opportunity to be a resource to my family and friends in this way; even if I do not know the answer, I know where to find a good source that can offer an explanation.

Medication Knowledge

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So after interviewing my friends and family I realized many of them are unaware of the medication that they take. The individuals who were most aware were my parents and in laws. I’m not sure if it is an age reason, or the fact that they take daily medication for comorbidities such as hypertension and cancer. Not only did they know the name of the medication they were taking, but they also knew dosing and side effects. The people closer to my own age however  were very unaware about  the medications they take. Most of the people I asked do not take anything on a regular basis,  but when asked about common over the counter medicines, many of them were naive to the side effects and correct dosing. To be totally honest, even my own husband has no idea how much Tylenol to take. When he is sick I have to remind him to check labels on cold medicine so he doesn’t consume too much acetaminophen. This is an issue nurses must be aware of though,  and we must know the right questions to ask to assess the history of our patients. In regards to homeopathic medications, I know that many of the individuals who use these remedies do not know that side effects are common and should be anticipated. I have never checked the label on homeopathic remedies, but I would hope that side effects are listed somewhere on the container for consumers to access.

Knowledge is Power

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When it comes to my family, my step-dad is the only one that takes prescription medications. He has hypertension and hyperlipidemia. Prior to this assignment, I was even unsure what he was taking so it was interesting for me to ask him. Here is a recap of what was said:

Me: “Do you know what medication/s you are taking?”

Ray: “Yeeeea, ummm- let me walk into the bathroom and look at it.”

Me: “Would you recognize it if I said it, or have you never looked at the label?”

Ray: “No, I would recognize it, it’s fairly new becuase the last one I was on didn’t have a generic version so it was super expensive. Ok, its Benicar HCT.

Me: “Do you know what that is or what that means?”

Ray: “Yea, I did ask my doctor and from what I understand, it’s a heart medication with a diruetic to get rid of some of the fluids in my body.”

Me: “Wow, I am impressed. That is right.”

Ray: “Well honey, I only am on one medication. If I was on more than one, I would most likely mix them all up and have no idea what is what!”

Me: “See, that’s the problem that most people face….”

So, my stepdad passed my test! I was actually impressed becasuse he isn’t really the kind of guy that would care too much about the medication he is on. He is more of a “do what the doctor says and don’t ask questions” sort of guy. I thought his comment on him only knowing the medication because it is only on one was interesting. As I told him, that is a major issue with non-compliance today. People have so many prescriptions, they can’t keep them all straight and because of that, the desire to maintain their treatment because they “know” why they need the medication falls to the wayside. Then, they are back in the hospital- a trend that is happening far to often in America. This emphasis once again, the importance of patient education.

 

 

 

“I’ll just have itchy, watery eyes!”

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Let’s start with a little comic relief…

While Jeff Foxworthy makes a funny joke with some exaggerated side effects caused from medications, sadly, he isn’t far from the truth!  You only have to watch about 15 minutes of tv in order to see a commercial advertising a new medication. The commercials always present the drugs as the quick-fix, miracle pill that will make that specific health problem disappear in a snap. The drug may be effective in treating the specific health concern, but the commercials fail to paint the whole picture of the medication. They  always save the potential side effects for the very end of the commercial and list them off at a barely comprehensible speed, usually ending in “and in rare cases may cause serious injury or death.”  As Jeff Foxworthy so candidly stated, “I’ll just have itchy, watery eyes.”

With the combination of pharmaceutical advertisements and uninformed media coverage of medications, most of the American population approaches prescription medication in one of two ways. They either blindly take whatever their doctor prescribes or their neighbor lets them try because it “worked wonders” for them, or they stay as far away from all medications because they just poison the body. As nurses, we have a great opportunity to step into both camps of thinking and help our patients (and family and friends) have a more accurate understanding of medications so that they can make informed decisions about their health.

For my informal survey, I decided to ask my mom about the medicines that she takes. Thankfully, she does not take any prescription medications and is very healthy. However, she does take some OTC medicines.

-Do you know the names of the medications you take? And why you take each of them?

“Yes, I take ibuprofen for joint pain and headaches. And I recently started taking melatonin at night to help me go to sleep. I very rarely take Tylenol with ibuprofen instead of melatonin. Ibuprofen is the same the as Advil and Tylenol is acetaminophen.”

-Do you know the potential side effects of those medicines?

“Well, ibuprofen can cause stomach bleeding or something like that so I have to take it with food and not on an empty stomach. I took it on an empty stomach when I was also sick and I had bad stomach pain after. Now I always take it with food. I don’t know about any side effects of melatonin; it’s a natural supplement.”

-Do you know if any of those medications interact with each other when you take them together?

“Well, for a long time I thought that ibuprofen and tylenol could not be taken at the same time, but I looked into it a bit and it seems like it is totally fine to take them together. I don’t know about the melatonin.”

I have talked with my mom about some of the medications she takes, so I was encouraged to know that she is understanding and retaining a lot of the information. Talking with her about melatonin reminded me that most people take vitamins and natural supplements without thinking twice about potential side effects or whether or not they even need it  because they do not consider it a medicine. I didn’t know much about melatonin (as a natural supplement) either so we looked it up and made sure it was okay to take with ibuprofen and was appropriate for her to be taking on a regular basis.

I think this was a good reminder for her as well to be more aware of the medications she is taking and gave her some specific key questions to ask before taking new medicines.