End-of-Life Care

Approaching the end-of-life can be daunting. As America’s population ages, more and more people are faced with care decisions for themselves and their loved ones.

Anne Elizabeth Denny explained, “It’s important for all of us to prepare for these future healthcare decisions.” Denny, an independent healthcare consultant, created Plan Well Live Well Finish Well, a resource for starting a conversation around end-of-life healthcare choices. She brought both her experience on the business end of healthcare and her personal experiences to the project. “Though the life experience of my mom having Alzheimer’s, I learned what it’s like when families don’t agree.” Her aim is to encourage pro-active conversations around death and dying.

Forming Priorities
“Nurses can be helpful in guiding patients,” said Denny. They are instrumental in prioritizing advanced care planning. Plan Well Live Well Finish well developed different modalities that help people do more than check boxes on a list. Nurses should go beyond the broad statements. For example, the patient could indicate he or she does not want extraordinary measures. What is extraordinary? A healthcare provider could have a different definition. Clarity is so important in creating healthcare directives.

Those directives include healthcare power of attorney, a legal document that enables a patient to empower decision makers. Denny recommended, “Cho0se someone who is willing to set aside personal feelings to honor your wishes.” Having a back-up person is strongly encouraged, but one person needs final decision-making authority to avoid prolonged battles. The directive also includes healthcare instructions. Formerly called living wills, these documents spell out what the patient wants in terms of medical, emotional, and spiritual care.

Discussions need to happen before a medical crisis. “In the emergency room, we are not clear thinkers. That’s the worst time to have the first conversation,” Denny explained.

To encourage these care conversations, Denny launched Healthcare Choices from the Heart. This online course guides participants through writing and sharing their healthcare directives.

Quality of Life
These end-of-life conversations are necessary not just for patients, but for the nurses and their own families too. At Dartmouth-Hitchcock Medical Center in New Hampshire, every practitioner on the palliative care team has his or her own healthcare directive. They can bring up their own directives when encouraging patients to create their versions. It is then seen as a universal healthcare issue and not just one reserved for those patients at the end-of-life.

Nurses can help patients understand their options by urging them to focus on quality of life. They can help patients recognize what living well means to them, as it’s different for everybody. What are the values and beliefs that drive decisions?

SEE ALSO: Nothing Fake About Dying

Emotional Support
Most adults want a peaceful end-of-life journey. Denny remarked that it’s often family members who don’t want to let go. In those situations, she asks the family, whose interests are being served? Often, the emotional needs of the family trump the best decisions for mom or dad. It’s not just about medical treatments, it’s about supporting loved ones both physically and emotionally.

Denny explained that we now live with technocratic medical systems, where technology drives many care decisions. There needs to be an emphasis on what should be done for patients and not what could be done. “Each nurse knows her patients and can advocate for them.”

For more information on Plan Well Finish Well, visit anneelizabethdenny.com Healthcare Choices from the heart is available at http://healthcarechoicesfromtheheart.com/

Danielle Bullen is on staff at ADVANCE. Contact: dbullen@advanceweb.com

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