Applying Theory to Hospice Patients
Michelle Franklin
Grand Canyon University
NUR-502
December 14, 2014
Applying Theory to Hospice Patients Introduction The purpose of this paper is to reveal the ineffective pain control of the hospice patient, the reluctance on the part of some hospice nurses to give pain medications to their patients resulting in ineffective pain control and decreased comfort and satisfaction during the hospice patient’s end of life.
Betty Neuman’s system model will be applied in a comprehensive manner to nursing practice in order to ascertain the interpersonal, intrapersonal and extrapersonal stressors of hospice patients from various aspects. The application of this theory will reveal how well the primary, secondary and tertiary prevention interventions can be used for solving the problems associated with ineffective pain control and the nurse’s role in the hospice patient.
Hospice is an area of medicine specific to the care of terminally ill patients. Hospice is a service that offers assistance, resources and support to terminally ill patients and their families. The main goal of hospice is to provide a peaceful, symptom-free, and dignified transition to death for end-stage patients. The main focus of hospice care is to have their patients not suffer and to maintain quality of life. In order to receive hospice, a physician must be willing to state that a death is expected within six months. Hospice provides care as long as the person’s physician and hospice team certifies the patient’s condition is life threatening. The role of the hospice nurse is to assess, manage and eliminate distressing symptoms, and prevent adverse symptoms from occurring. The hospice team focuses on managing pain and other symptoms, provide medications, and provide emotional and spiritual support and counseling to family and loved ones.
According to Betty Neuman’s Systems Theory on stressors, a stressor is defined as any environmental force which can potentially affect the stability of the system. The system is a wholistic view of the client. Stressors can occur within person, occur between individuals or outside the individual such as job or finance pressures. (Fawcett, 2001) Some stressors are not being addressed within the hospice community. The stressor that needs to be addressed within the hospice community is the reluctance on the part of some hospice nurses to give pain medications to their patients. It became very apparent after shadowing a hospice nurse for several days during this writers Bachelor of Science clinical rotation, and then again recently during a discussion with a hospice nurse, that this was a problem not being properly addressed and a disservice in honoring our patients during the end of their lives.
According to an article from Hospice Patients Alliance (2011) “Pain control is one of the central goals of hospice care.” They go on to say that patients and families expect the main objective of hospice is to provide pain relief and comfort. (Hospice patients Alliance, 2011)
There are many barriers to effective pain control in hospice patients. An article in the Journal of Hospice and Palliative Nursing entitled Fearing to Comfort: A Grounded Theory of Constraints to Opioid Use in Hospice Care from 2002 points out some of these barriers and strategies for eliminating these barriers. (Zerwekh, Riddell, Richard, 2002) The authors say fifty percent of dying patients report moderate to severe pain three days prior to death. Nurses do not have enough knowledge about pain management, nursing schools do not teach effective pain