Attitudes Toward Hospice Care
There is perhaps no more confusing mental process in life than attempting to define attitudes toward death. This process is even more complicated and impacting when it must be formulated by health practitioners who work in a hospice setting. It has been found that there exists a significant percentage (33%) of hospice nurses which found difficulty in knowing who controlled the overall responsibility of hospice patient care. Such confusion has led to an overwhelming desire by both community nurses and general practitioners for additional educational input from domiciliary services (Seamark, Thorne, Jones, Gray, & Searle, 1993, p. 57). There is little doubt that the health care professional finds themselves in a complex organizational system and must find a way to form their own outlook within that system. Nurses want to simultaneously maintain fidelity to patients and their family members, follow physician colleague orders, work in interdisciplinary family-centered teams, and yet follow their consciences when order care or treatments appear harmful to patients (Catlin et al., 2008, p. 106). The complexities of the situation in which hospice professionals find themselves in makes the defining of personal attitudes toward hospice care even more difficult.
There were an estimated 1.5 million patients who received hospice services in 2012 (NHPCO, 2013, p. 4). Therefore, a large patient population is directly effected by the outlooks which hospice clinicians take towards end of life care. Since the main focus of palliative care should be maximizing the quality of care of the hospice patient, health practitioners must adopt an attitude towards patients which maximizes the probability of the highest quality of life.
It is my personal belief that an ethically normative position towards dying patients and hospice which considers the input of patient and patients’ families, along with a culturally empathetic outlook, should be adopted by health care professionals. Barrocas et al. (2010) defines normative ethics as “the branch of philosophical ethics concerned with formulating general standards or norms of ethical behavior and moral judgment.” Health practitioners may find themselves in cases of hospice and end of life care where patients have to choose between respecting and obeying the wishes of the family of a dying patient or honoring the duty of patient by avoiding burdensome treatment which may produce detrimental harm through related complications (p. 676).
Normative ethics attempts to specify conditions which are non-ethical and determine when actions are correct. Such an example could include act-utilitarianism, which states that actions are only correct when they produce a minimum of an equal amount of happiness as would have been obtained from any other available alternative (Goldman, 1979, p. 90). This is why a normative outlook provides an excellent platform for hospice care providers as it considers crucial input from the patients themselves who are the only ones who actually know how they feel. Also, under a view of utility, one can provide a basis of recognizing true individual moral rights (Daniels, 2001, p. 316). Therefore, the considerations of the patient will be an utmost consideration in such ethical frameworks.
Patient Characteristic Considerations
The normative outlook also considers patient characteristics which may act as barriers to optimal patient health outcomes. One of the most effecting of such characteristics is the cultural/ethnic background of the patient. A culturally-sensitive approach is very applicable in a hospice care setting as there exist real and distinct cultural variations toward death and in the care of dying patients (Blair, 1995, p. 515).
The main goal of nursing is the aiding of individuals with the goal of attaining and maintaining an increases level of self-accord within their physical being, consciousness, and their spiritual essence (Barnett, 1991, p. 226). Therefore, it should be expected that variations in care outlooks will lead to alterations of patient input which will remain in line with their individual cultural perspectives. After all, it has been found that ethnicity influences common values and cultural beliefs which combine to influence end of life decision-making (Johnson, Kuchibhatla, & Tulsky, 2008, p. 1).
Ethnic characteristics of patients might also lead to barriers to hospice treatment in some circumstances. For example, it has been found that among African Americans there exist several barriers to hospice enrollment including misconceptions about hospice services, lacking of hospice service knowledge and awareness, preferences of more aggressive treatment, and deficits of trust in providers and the health system (Enguidanos, Kogan, Lorenz, & Taylor, 2011, p. 161).
Hospice clinicians should also consider additional characteristics of individuals so that they may tailor care plans accordingly. The presence of pain in older and minority hospice patients has been associated with race, physical function, gender, cognitive impairment, under treatment, and depression (Miller & Vince, 2002, p. 2). Even the sex of patients can have an impact on patient outcomes and treatment adherence as it has been found that women will entertain more positive attitudes toward the notion of hospice services than men due to long-long established observations that women tend to use health services more frequently as well as maintaining more positive attitudes toward them (Rainey, Crane, Breslow, & Ganz, 1984, p. 1999).
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- Carol Nganga (Author), 2013, Attitudes Toward Hospice Care, Munich, GRIN Verlag, https://www.grin.com/document/280536