Abstract

Background: End-of-life care (EOLC) refers to health care for a person with a terminal condition that has become advanced, progressive, and/or incurable. End-of-life care presents many challenges especially in the management of pain and suffering for nurses as well as for patients and their families. Moreover, the care of the dying patient must be considered within the context of the psychological, physical, and social experience of the person.

Aim: The aim of this study was to identify the challenges of EOLC and their effects on the personal life of the nurses working in Limbe and Buea Regional Hospitals.

Methods: A descriptive cross-sectional study was used on a sample of 100 nurses selected purposively in the LRH and BRH. Ethical consideration for this study was obtained from the Faculty of Health Sciences UB, Delegation of Public health SWR, Directors of hospitals, etc. A well-structured questionnaire was used to collect data for a period of two months June and July 2020 which was keyed into excel and exported to SPSS Version 20.

Results: The results of this study show that 22.01% of the nurses identified functional disability as the most common physical care provided to patients. On the challenges faced by the nurse, lack of resources (17.35%) and increased workload (13.06%) are the greatest challenges encountered by the nurse in providing care to patients, and finally being unhappy (44.03%) was the psychological effect that affected the nurses The was a statistically significant relationship between the socio-demographic data and perceived effectiveness of care with a p-value of 0.001

Conclusion: End of life care is challenging and can have far-reaching detrimental effects which are psychological and social effects on the personal life of the nurse as well as the family if not well managed will increase the financial burden and thus cause the nurse to be unhappy.

CHAPTER ONE

INTRODUCTION

1.1 Background

End-of-life care encompasses the care for patients that are considered to be in the last stage of their lives. It includes care provided to “all those with an advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support” (1).

End-of-life care (EOLC) refers to health care for a person with a terminal condition that has become advanced, progressive, and/or incurable. End-of-life care requires a range of decisions, including questions of palliative care, patients’ right to self-determination (of treatment, life), medical experimentation, the ethics and efficacy of extraordinary or hazardous medical interventions, and the ethics and efficacy even of continued routine medical interventions. In addition, end-of-life often touches upon rationing and the allocation of resources in hospitals and national medical systems.

Such decisions are informed both by technical, medical considerations, economic factors as well as bioethics. In addition, end-of-life treatments are subject to considerations of patient autonomy. (1-3) End-of-life care (EOLC) is an essential element of care provided in the health care institutions or the community. Patients with advanced and progressive diseases live with possible disruption of their daily routine, experience undue pain of all natures, suffer from death and loneliness through the caring episode (1, 2).

End-of-life care has received increased recognition in recent years as a critical opportunity to improve health care quality. It has been defined as the active, total care of patients whose disease is not responsive to curative treatment (3). The provision of excellent end-of-life care requires, first and foremost, excellent knowledge of the pathophysiology of terminal illness or injuries.

The most appropriate health care at the end of a person’s life is a worry whether it is ultimately likely to benefit the patient. Nurses are often challenged when confronted by the patients and families on decisions concerning the painful realities of whether the patient will make it at the end or will not make it at the end of life.

One of the greatest challenges of end-of-life care in the twenty-first century is not offering care that cannot benefit the patient, but it requires the involvement and support of all levels in the health care system, from those who directly provide patient care to the administrators and regulators who address more system-based issues and also the nurses themselves (4-6).

Decisions about care at the end of a person’s life often involve quality-of-life considerations. Nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and other closed relatives to the patient. They are also in a very good position to make every effort to provide aggressive symptom management at the end of life.

Since decision-making for the end of a patient’s life should occur over years rather than just in the minutes or days before a patient’s death, nurses can be a resource and support for patients and families at the end of a patient’s life and in the decision-making process that precedes it. In this light, nurses are often ideally positioned to contribute to conversations about end-of-life care and decisions, including maintaining a focus on patients’ preferences and establishing mechanisms to respect the patient’s autonomy (7-9).

Excellent, skilled, precise communication is essential for the physical and psycho-social care of the patients and their families. Nurses must have the knowledge and communication skills to explain to patients why certain activities need to be done (10). Nurses who work in such units as critical care units (CCUs), medical unit, pediatric unit surgical units, and the maternity have traditionally received little education and training in the care of dying patients and the patients’ families, which ultimately affects the nursing profession and their practice at the end of life care in these units (11).

Other factors that may be as important for providing end of life care may include a work environment with strong communication and collaboration between nurses and physicians, availability of ethics consultations, and adequate support of patients, patient’s families, and staff (12).

Globally, the need for compassionate and effective end-of-life care (EOLC) grows more critical as the number of people predicted to get ill is expected to increase in every region of the world (13). In the case of cancer which happens to be the second most common cause of death in the United States and around the world, as opposed to heart disease so far nurses are providing end-of-life care for these patients on a daily basis.(14)

The World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) conducted a global cancer research in 2012 and found that about 14.1 million new cancer cases were diagnosed with 8.2 million people dying from cancer and this number is expected to rise to about 15 million by 2020. In sub- Saharan Africa, about 551200 people are being affected with over 421000 deaths recorded per year (15). Although there is no reliable data on the incidence and pattern of cancer, it is still recognized as a public health problem in Cameroon as the incidence and mortality increase annually.

1.2 Statement Of The Problem

End-of-life care presents many challenges especially in the management of pain and suffering for nurses as well as for patients and their families. Moreover, the care of the dying patient must be considered within the context of the psychological, physical, and social experience of the person (Della Santina and Bernstein, 2004). (13)

Foremost among those who require end-of-life care are the elderly who are more prone to loneliness and who frequently under report pain and who have a greater sensitivity to drugs and drug interaction. (Lyness, 2004) (14) Unfortunately nurses who are responsible for the treatment of patients at the end of life commonly lack adequate training to help guide end of decisions and to deliver bad news to patients and their families (Boyle, Miller & Forbes, 2005; Gorman et al., 2005)(16).

Nurses lack knowledge on end-of-life care and its importance to both the patient and health care provider. They are also not able to care for themselves as they provide this care. Thus it is not clear how providing end-of-life care affects nurses. There are also few studies evaluating end-of-life care provided by nurses and its effects on their personal life.

1.3 Research Questions

1. What are the components of the care provided by nurses to patients at the end of life in Limbe and Buea Regional Hospitals?
2. What are the challenges faced by nurses in providing end-of-life care to patients at the Limbe and Buea Regional Hospitals?
3. What are the effects of end-of-life care on the personal life of the nurses in the Limbe and Buea Regional Hospitals?