Issues Surrounding End of Life Care Conversations in the Acute Care Setting
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Problem: Failure to set realistic goals of care for terminally ill patients contributes to decreased satisfaction with care delivery and increased cost of care at the end of life. Objective: Identification of barriers that providers encounter in their clinical practice is the first step in setting appropriate limitations on aggressive treatments which offer little to no benefit to patients with a poor prognosis. Theoretical Framework: Fawcett and Russell’s (2001) conceptual model focuses on how nursing practice can apply research findings to influence health care policy and improve care delivery and efficiency in the clinical setting Methods: Data from interviews with Nurse Practitioners regarding their experience with end of life care management in the acute care setting will be transcribed and assessed for reoccurring themes through the use of conventional content analysis. Results: Barriers to the establishment of realistic goals of care at the end of life include poor health literacy and limited understanding of long-term prognosis on the part of the patients and their families, as well as lack of adequate training for providers on how to effectively initiate and lead conversations regarding end of life care. Potential Significance: Results of this project demonstrate potential clinical value regarding the need for greater educational emphasis and training on how to manage end of life care for terminally ill patients. Implications: Patients whose providers fail to guide discussion on limitations of aggressive treatments at the end of life may suffer unnecessarily from treatments which offer little benefit other than to prolong death and suffering.