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End-of-Life Care: Public Health Approaches and Nursing Practices

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Introduction: Public Health Approaches and Nursing Practices

End-of-life care refers to the healthcare-giving process at the end of the life of a person until death. The carer provides physical, emotional, social, and spiritual support to the patients and their families. Home-based care influences the dying at home with usual care (Shepperd et al., 2021). This process also helps to treat the patient and recover them from any disease. The decision-making process, according to the situation, influences variation in the caregiving process (Avidan et al., 2021). The present study is concerned with the different aspects of this process and the impact of legal, ethical, and clinical issues on conducting an effective care process.

Aims and objectives

The aim of the present study is to understand the importance and effectiveness of end-of-life care and the role of public health in this process. The objectives of the present study are as follows:

  • To access the different approaches of public health to end-of-life care
  • To understand the impact of end-of-life care among patients and their families
  • To identify the role of the carer and different organizations to provide care at the end of life to a patient
  • To evaluate different ways or advanced plans of providing care at the end of life

Identification of issue

  • Background: End-of-life care is a major concern of public health organisations. It includes both medical and personal care as per the requirement of the patients. The caregiver including doctors, nurses, and family members, plays an important role to provide end-of-life care to ensure the well-being of human beings. Public health approaches are concerned with the initiatives of governments and other healthcare organizations to improve the caregiving process by establishing communication between the caregiver and the dying person (Radbruch et al. 2020). Palliative care is active holistic care that fulfils the needs of public health to provide quality service in serious cases. According to Griffiths (2019), at the end of life, patients need more care from their family members and other healthcare professionals. Nurses played an important role in the case of care in the intensive care unit at hospitals. Inappropriate care might affect the health of individuals, thus, educated and trained carers are required to ensure high quality, patient-centred care. On the other hand, O'Brien et al. (2019) stated that at the end of life, patients need the support of skilled carers, including nurses, who can acknowledge the importance of spiritual care and holistic care as well after addressing the central issues.
  • Rationale: Public health approaches concern the development of different policies and practices for dying people in end-of-life care. The public health palliative care approach helps to create a supportive environment by strengthening the community's actions. Different approaches to public health have created an impact on the improvement of end-of-life care services. It is concerned with the governmental policies that provide social, psychological, and financial support to dying individuals. End-of-life care includes palliative and hospice care intensive care, bereavement care, and aged care (Goodlifedeathgrief, 2023). It concerns the communication between the government and the community. Therefore, it provides care and education to the members of different communities. The lack of care at the end of life, the lack of knowledge of care, and the lack of government attention increase the concern for public health. Along with that, lack of application of public health policies decreases the effectiveness of its practices. Therefore, the carer has to follow the guidelines of the public health policies to provide proper end-of-life care to the patients (Hökkä et al. 2020). Nurses played a crucial role as they try to provide care to patients to maintain public health approaches. It is important to provide a comfortable life to the dying individual by providing relief from pain.

End-of-life care

Figure 1: End-of-life care

Influence of Social and Political Factors in end-of-life Care

Public health concerns with the social and political initiatives that create an impact on the functioning of the public health policies. Different social, and political factors along with economic factors help to shape end-life -care. Social influence encourages the functioning of nurses to provide appropriate care at the end of their life. The nurses and other healthcare member try to identify the reason behind the healthcare issues of the patient by establishing better communication with them. Therefore, providing care as per the need of the patient increases their satisfaction level. The societal influence created an impact on the psychological state of the individual. It increases the level of satisfaction with the care that leads to a meaningful life. The mental support of the family members, relatives, and neighbours helps to improve health conditions by building confidence and willingness of living among the dying people. Different political factors give rise to poor environmental conditions, unsafe neighbourhoods, psychological stress, inadequate transportation, and lack of food options. These influencing political factors increase the health risk of dying people. Therefore, different governmental norms are introduced to remove these hazardous factors from end-of-life care.

Link to Clinical Practice

Relevance of end-of-life care to professional nursing practices

Nurses are trained to take care of patients having different health issues. Irrespective of age and gender, they provide quality healthcare services to patients as per their needs. Nurses play an important role inside and outside the hospitals as well. The experience, monitoring process, and understanding of the issues of the individual helps to provide an effective solution as they improve their care process according to the severity of the health issue. It is important to monitor and take care of dying or aged people carefully and provide them with proper medication without any mistakes. Public health approaches guide nurses to improve their service strategies to make the patient comfortable at the end of life. As opined by Strautmann et al. (2020), nursing homes become the more important factor for the end care of dying individuals. The nurses are provided with appropriate training to develop their caregiving skills to satisfy the public health approaches. The stronger bond between nursing homes and palliative care is strongly influenced by the high-1quality education of the nurses. Nurses apply different ty strategies to treat patients in an effective way. They have the ability to control the patients in any situation. At the end of life, the patients become arrogant and stubborn, which created difficulties in providing healthcare services. 

Nursing practices

Figure 2: Nursing practices

Nurses took care of both the psychological and physical health of an individual. On the contrary, Blaževi?ien?, Laurs& Newland (2020), stated that public health approaches followed by end-of-life care services provide a variety of healthcare settings. This care is provided to patients and aged people as well to increase their comfort level by eliminating the irritation of diseases. Therefore, the attitude and behaviour of the nurses increase the effectiveness of the care and result in the improvement of the patient's health. Different philosophical and organizational development provides nursing services to patients and develops different strategies to improve the quality of services. According to the public health guideline, different nursing care organizations provide different training programs to increase awareness among nurses. The initiatives of the governmental organizations provide support to this process by offering different public health policies. 

Current nursing practices and their impact on end-of-life care

At present, due to changing patterns of medical treatment, the process of caring for nurses has undergone some improvements. The philosophy of palliative care is to maximise the quality of life of the patients by controlling their effective symptoms and providing psychological and spiritual support in a socially meaningful way (Papworth et al., 2022). Different disciplines, including medical treatment, psychological treatment, and governmental policies, influence the functioning of healthcare organisations to incorporate innovative technologies in their nursing process to monitor and assess patients at the end of life in an effective way. According to Spacey et al. (2021), after the global pandemic covid-19, nursing practices improved significantly. This incident increases awareness among the nurses and other healthcare personalities to maintain hygiene and social distancing to stop the spreading of diseases. The use of PPE kits, sanitizers, sterilisation, and other medical care helps to improve the quality of services. Along with that, the observation of the eating pattern and maintenance of the psychological state influences the efficiency of healthcare organisations. The collaborative work of the nurses with the other medical personalities helps to provide a better end-care environment. Psychological beliefs and practices affected the health status of individuals. Therefore, nurses encourage the patients by providing them with positive vibes to influence their recovery. This also creates an impact on the spiritual health of an individual by developing a balance between the psychological, physical, and social aspects of the patients. 

Factors of End-of-Life Care

Figure 3: Factors of End-of-Life Care

The healthcare personalities, including nurses, updated themselves according to the changing legislation. On the other hand, Dutta et al. (2020) stated that they also manage tough situations by developing their skills effectively. The ethical and legal factors influence the decision-making process of the carers after the end of care of the dying individual. Respect for the feeling and morale of patients is an important practice of nurses. Withholding and withdrawing treatment creates ethical dilemmas (Jo, Park, & Yun, 2023). The method of documentation about the medical history of the dying patient helps nurses and healthcare organisations avoid ethical issues in any accidental cases. Nurses adopted therapeutic communication techniques, which include accepting, maintaining silence, and giving recognition, and value to the thoughts of dying individuals. Along with that, it also includes actively listening to the opinions of the nurses, providing care and attention at a time, seeking clarification, and applying strategies according to the situation (Karlsson, Karlsson, & Kasén, 2022). Nurses are the experts in clinical management that leads to providing emergency services to dying patients in any situation. 

Identify Barriers and Challenges 

Challenges or barriers of nursing care

There are different factors that exist that act as barriers to the functioning of nurses. Long shifts, changing schedule of duties, critical cases, emotional involvement, and exposure to illness, changing technology, and poor behaviour from patients or hierarchy create challenges for the functioning of the nurses (Rhee et al. 2020). The different challenges decrease the confidence level of nurses, which created a negative impact on their care quality. As stated by Joo, & Liu (2021), the covid-19 pandemic affected many nurses and caused death while treating dying individuals. The nurses faced different difficult situations while providing end-of-life care to dying individuals. The patients are mostly suffer from mental misbalance during the end of their life, which causes different deviant behaviour that the nurses have to control in a strategic way. Therefore, the nurses practice different healthcare strategies to improve their quality of work. They attended different training and developmental programmes to increase their working efficiency, especially towards the area of end-care services. On the contrary, Babaei and Taleghani (2019), describe that the behaviour of nurses provides an effective care environment for dying patients. They maintain different ethical and legal factors and update their knowledge of nursing through practices and innovative concepts of the care giving process. Apart from that, they learn and adapt different technologies to improve their working efficiency. Public health organisations provide different strategic policies and practices for nurses to conduct their services to provide satisfaction to patients. Public health policies support nurses in all possible ways to improve their working involvement and experiences. Nurses include their knowledge of clinical education in their practices to overcome the challenges and barriers of their work (Alshammari et al., 2022). Organisational nurses, along with family nurses, influence the health improvement process of patients. 

The professional nursing practice could enhance end-of-life care

A professional nursing care model describes the different aspects of nursing practices that reflect the collaboration, communication, and development of the professional understanding to provide care to dying patients of the highest quality. The organisation ensures the services of the nurses as they provide training and developmental knowledge to enhance their quality of services to the elderly and dying individuals. The increasing number of professional nurses influences the improvement of end-care services for patients Emotional intelligences create an effective impact on the morale of nurses and their functioning (Lewis, 2019). Professional nurses are well aware of the process of assessment, diagnosis, planning, implementation, and evaluation of the health of the patient. Therefore, they can easily understand the condition of the dying individuals and improve their healthcare services towards them. According to Ho et al. (2021), Improvement of healthcare organisational practices following the guidance of public health influences the service quality of professional nurses. Resource enhancement training and effective practices help the nurses provide support and treat dying patients in an emergency in the absence of doctors as well. They provide both mental and medication support to the patients. They are able to influence the patients at the end of their life by establishing better communication with them and motivating them to live longer by increasing their physical activity (Kim et al. 2019). The carte pattern of professional nurses is quite different from the family nursing pattern. Therefore, in the presence of professional nurses, the patients remain safer, especially at the end of their life. They provide the required care to dying people as per their medical conditions without any mistakes. It influences the increase of the lifespan of the dying individual. On the other hand, De Brasi et al. (2021) stated that lack of communication created challenges for nurses; therefore, nurses adopted different ways of communicating with patients to improve their care of them. Thus, it is important to prevent distressing events and provide a good service to dying patients through professional nursing practices. 


End-of-life care is a major public health concern now. The lack of care causes the deaths or serious conditions of the elderly or dying people. Different healthcare practices and public health approaches influence healthcare practices at the end of life. There are advanced care-planning plans that help increase the effectiveness of the caregiving process, which is influenced by different organisations, agencies, and disciplines. It helps to maintain the physical and psychological well-being of an individual. Social and political factors affected both the psychological and physiological health of dying people. The communication development to understand the opinion and perspectives of the saying people increases the effectiveness of the nursing process. Professional nurses, family, and relatives provide support to the dying people at the end of the slide. The nurses and other carers follow the public health guidelines to avoid any legal and ethical issues while taking care of the dying individual at the end of life. Psychological state influences health status significantly. There are public health policies, along with the initiatives of governments and healthcare organisations, that are able to spread end-of-life care awareness among the people. The advanced training for effective care processes, with the implication of modified technological processes to monitor patients, helps to increase the effectiveness of end-care services for dying or elderly people. Therefore, carers and public health policies provided effective care to the end-of-life of an individual. 



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