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Unlike other conditions and life experiences, which only affect a certain percentage of the world’s population, end-of-life is a stage in living all people will eventually face. It is estimated that twenty million people worldwide need some form of end-of-life care. In the United States, on average, seven thousand people die every day from various illnesses. At some point in their careers, all health professionals who provide direct patient care will likely encounter an actively dying patient. Therefore, they must be informed of the issues of concern and the clinical significance of this process. This activity reviews the management of end-of-life issues and examines the interprofessional team's role in evaluating, diagnosing, and managing the situation. Objectives: Assess the epidemiology of end-of-life events worldwide and in the United States. Identify possible definitions of end-of-life. Evaluate the variability of the timeline for end-of-life events. Communicate the interprofessional team's role in caring for a patient near the end of life and how the individual and family can be assisted to provide the best possible outcome. Access free multiple choice questions on this topic.

Unlike other conditions and life experiences, which only affect a certain percentage of the world’s population, end-of-life is a stage in living all people eventually face. Estimates are that twenty million people worldwide need some form of end-of-life care. In the United States, on average, 7,000 people die every day from various illnesses. At some point in their careers, all health professionals who provide direct patient care likely encounter an actively dying patient. Therefore, they must understand the issues of concern and the clinical significance of this process. End-of-life research states advances in healthcare have changed the trajectory of the end-of-life.[1] With advances in medicine, the average life has become longer. Thus, the end-of-life varies significantly from person to person, making the end-of-life period challenging to define. The definitions of the term end-of-life vary in the healthcare literature. One of the more common definitions gives a time frame to the estimated length of life, with the most commonly cited time frame as a period of fewer than 6 months of estimated life. Other end-of-life literature focuses on the last days, hours, or minutes of life.[2] Meanwhile, others define the end-of-life as synonymous with the dying process. The National Hospice and Palliative Care Organization (NHPCO) states that end-of-life care or hospice care commences when a person has a diagnosis of a terminal illness with less than 6 months to live, and curative treatments are no longer options. Healthcare professionals must be aware that while the definitions of end-of-life may vary for everyone, the end-of-life is a process that all humans experience. Some patients may receive end-of-life care for months, while others may only receive it for days. Healthcare professionals must be aware of and recognize disease trajectory in those with terminal or life-limiting illnesses. In this way, they can prepare for the issues of concern that these patients face.

The interprofessional team providing care for the dying patient consists of several team members, each with a unique role. The hospice physician directs the care of the dying patient. However, it is essential to consult with an interprofessional healthcare team. These include nurses, therapists, social workers, and spiritual providers. Nurses provide direct patient care and medication administration, as well as a continual assessment of the progression of symptoms. Respiratory therapists administer oxygen therapy and monitor the deterioration of the respiratory system. Physical and occupational therapists work with the patient to enhance the functional activities of daily living. Social workers direct patients and families to social resources and facilitate the application and delivery of these resources. Spiritual providers support the spirituality and religiosity of the dying patient. Interprofessional care requires effective communication among team members and can be streamlined using communication tools such as SBAR and the Milestones Communication Approach.[40] These tools help healthcare team members communicate necessary patient information effectively and in a streamlined manner. Further, these communication tools allow different disciplines to communicate important information for patient safety to enhance the quality of care. Research consistently shows that better patient outcomes occur when all healthcare team members remain informed of patient statuses and changes to those statuses.[41] For the best patient outcomes, all healthcare team members must understand their roles for the patients and those of the other disciplines involved with patient care. Understanding how their part of care integrates with the scope and standards of others is paramount to functioning effectively as a team. When healthcare team members clearly understand their roles and the roles of their colleagues, patient outcomes are enhanced.[42] End of life care requires an interprofessional team approach, including physicians, specialists, specialty-trained nurses, therapists, counselors, pharmacists, and even other non-medical staff, as well as the patient and their family, all collaborating across disciplines to achieve optimal patient results. Every interprofessional team member should communicate with the team so that 1 universal message is sent to the family and patient.

The end of life is never a pleasant experience for the family or the clinicians. Nurses play a vital role in relieving anxiety in the caregivers/family members and developing a relationship with them. Nurses continually monitor the patient's level of impairment, physical limitations, and cognitive decline. This has to be explained to the patient when the patient has abnormal behavior. Nurses should also educate the family that it is normal to feel guilty, but no one is at fault. The family has to be educated on all the medications and ways to make the patient comfortable. The key is not to erode the patient's and family's quality of life.

Nursing, allied health, and interprofessional team monitoring for end-of-life care include: During the end of life, the nurse should monitor the following: Assess sleep patterns and recommend changes such as reducing distractions and noise Behavior and encourage the family to be understanding. Get the patient out of bed, if possible. Educate the family on providing rest to the patient and limiting the amount of stress Assess the level of ADLs the patient can perform and involve the social worker in assessing the home environment Encourage nutrition, especially fluid intake. Monitor lung sounds, respiratory distress Provide oxygen if necessary