End-of-life (EOL) is the ultimate common pathway of many degenerative illnesses, characterized by an irreversible deterioration in functional ability before death; it can occur over days or weeks. End of life care intends to assist patients with a life-limiting or life-threatening medical condition.
This therapy emphasizes symptom management and includes assistance with emotional and mental health and spiritual and social needs.
End of life care also provides practical assistance with daily duties. The goal of EOL care is to improve the patient’s quality of life and the quality of life of their family, friends, and caregivers. End of life care is based on the patient’s needs rather than their diagnosis.
Signs of End of Life
The physical symptoms of end of life that the patient may experience are the following:
- Cool, clammy skin. The patient’s fingers, forearms, legs, and feet may become increasingly cold to touch. The patient’s skin color may vary and become uneven.
- Confusion. The patient may be unaware of time or place and unable to recognize individuals around them.
- Excessive sleeping. Sleeping may take up an enormous amount of the patient’s time. The patient may become apathetic, unresponsive, and difficult to rouse.
- Incontinence. The patient may lose control of his or her urine and bowel movements. This symptom is a frequent end-of-life transformation that can occur during the dying process.
- Restlessness. The patient may perform repetitive activities, such as pulling on the bed sheets or clothing. This symptom is partly due to an oxygen reduction.
- Congestion. There could be gurgling inside the chest. This condition is also known as a “Death Rattle” and can be rather loud.
- Oliguria. The output may diminish and turn tea-colored.
- Decrease in fluid and food consumption. The patient may prefer to consume little or no food or liquids. The body will instinctively preserve energy for the upcoming task. Food is no longer necessary.
- Breathing pattern alteration. The patient may produce short breaths followed by a period of no respiration lasting several seconds to a minute. They may pant rapidly and shallowly at times. These are common patterns that suggest a decline in blood circulation.
- Fever. Temperature rises are expected in patients at the end of life stage.
Goals of End of Life Care
- End of life care provides physical comfort for the patient. There are things nurses or health care practitioners can do to help make the dying patient more comfortable, depending on the reason for the distress. They may help the patient if the end-of-life stage to overcome or lessen the following:
- pain
- breathing problems
- skin irritation
- digestive problems
- temperature sensitivity
- End of life care aims to manage the mental and emotional needs of the patient. End-of-life care may also assist the dying individual in coping with psychological and emotional distress. Someone nearing the end of their life may understandably feel unhappy or worried. It is critical to address emotional anguish and suffering.
- End of life care aims to fulfill the spiritual needs of the patient. Spiritual demands may be as essential as physical concerns for those nearing the end of their lives. Finding meaning in one’s life, resolving problems with others, or seeking peace with one’s life circumstances are all examples of spiritual needs. Resolving unsettled difficulties with friends or family may provide consolation to the dying individual. A visit from a social worker or a counselor may be beneficial.
- End of life care provides support for practical tasks. Everyday duties can also cause anxiety for a dying person and overburden a caregiver. A family member or friend can provide the caregiver and the patient a much-needed break by assisting them with little daily activities.
Nursing Interventions for Patients on End of Life (EOL)
- Pain
- Provide the patient with pain relief treatments before it becomes severe.
- As directed, administer pharmacologic pain control.
- For pain management, offer the patient cognitive-behavioral therapy (CBT).
- During the maximal action of analgesics, provide nursing care for the patient.
- Examine the efficiency of analgesics as prescribed and keep an eye out for any indications and symptoms of adverse effects.
- Nutrition and Hydration
- Instead of a three-meal-a-day program, provide the patient with small, frequent meals high in protein throughout the day.
- Maintain the patient’s hydration by giving small, regular sips of drink during the day in between meals.
- Change the timing of meals to coincide with when the patient is pain-free and has the most energy.
- Do not force meals or fluids on the patient. Forcing foods and fluids will result in physical as well as emotional distress.
- Purée meals should be provided for patients who have difficulty swallowing.
- Delirium
- Examine the patient’s degree of anxiety and the actions that suggest an increase in anxiety.
- Maintain a low level of stimuli in the patient’s environment, such as low lighting, a small number of people, plain decorations, and a low noise level, because anxiety rises in a highly stimulating atmosphere.
- Eliminate all potentially hazardous objects from the patient’s environment; patients who are disoriented or confused may use them to hurt themselves or others.
- Ensure that there is enough healthcare personnel on standby during emergencies.
- Respiratory Secretions
- Explain to the family or caregiver why secretions form and assure them that it is a normal part of the process of death that is not usually distressing or unpleasant for the patient.
- Shift the patient side to side with the edge of the bed slightly raised. This approach is enough to redistribute respiratory secretions and lessen noise.
- If anticholinergic medicines are required, they should be administered sooner.
Advance Care Planning during End of Life
Advance care planning during the end of life expresses a patient’s preferences for medical treatment based on values and principles. Advance care planning is used when a person cannot do so or refuses to decide for himself or herself. A surrogate, who will represent the patient’s choices in decision-making, is also mentioned in advance care planning during the end of life. Advance directives include the following examples:
- Do Not Resuscitate Orders (DNRs). DNR is a medical order, either written or oral, advising that a patient should not get CPR (cardiopulmonary resuscitation) if his or her heart stops beating.
- Orders for Life-Sustaining Treatment
- Physician Orders for Life-Sustaining Treatment (POLST). POLST is a written medical directive from a healthcare professional, nurse, or medical assistant that gives patients with serious illnesses more autonomy over their care by stating the kinds of medical treatment they want to undergo while suffering from a severe disease.
- Medical Orders for Life-Sustaining Treatment (MOLST). MOLST is a program that translates patient care objectives and preferences into medical orders to enhance the quality of care patients get at the end of life.
- Physician Orders for Scope of Treatment (POST). POST is a collection of medical instructions for health care providers to identify and respect a patient’s health care decisions for life-sustaining treatments such as CPR, a respiratory tube, and a feeding tube
- Medical Orders for Scope of Treatment (MOST). MOST is a physician’s order (also known as a medical order) that specifies a treatment regimen that respects the patient’s preferences about care at the end of life.
Critical Nursing Skills for End of Life Care
- Provision of hands-on care. Hands-on care is one of the primary roles of nurses who provide end-of-life care. Nurses must provide various services daily to enable their patients to remain as relaxed and pain-free as necessary. Medication administration, vital sign reading and reporting, and wound management are examples of healthcare services. In most in-home care agency settings, nurses are also responsible for keeping the patient clean and hygienic to prevent infection.
- Effective management of pain symptoms. Nurses are also responsible for helping patients manage their pain. In addition to assessing pain levels, a nurse may implement various strategies to help reduce discomfort experienced by the patient.
- Great communication skills. Nurses must have excellent communication skills to receive and convey information to patients and their families effectively. End-of-life care nurses are trained to speak in a concise yet sympathetic manner.
- Nurses as health educators. In addition to their many tasks, nurses serve as healthcare educators for patients and family members. They assist patients in better understanding and dealing with their illnesses or conditions by explaining health issues and how they influence the body and mind. They also assist families by providing extensive information about how specific health issues affect a person near the end of their life.
- Nurses as emotional support providers. Nurses frequently serve as confidants for family members who may find it challenging to discuss their end-of-life wishes with others. End-of-life nurses recognize the significance of being attentive and compassionate to family members dealing with death or dying.
End of Life Nursing Diagnosis
End of Life Nursing Care Plan 1
Compromised Family Coping
Nursing Diagnosis: Compromised Family Coping related to insufficient or inaccurate comprehension of the patient’s condition by the significant person, unreasonable expectations, and lack of sufficient resources to provide the care required secondary to end of life as evidenced by the patient conveying or verifying a concern or complaint about significant other’s response to patient’s medical condition, hopelessness about family reactions or lack of engagement, history of poor caregiver-care receiver connection, neglectful relationships with other family members and friends, failure to finish caregiving tasks, and disrupted caregiver health status.
Desired Outcomes:
- The patient will discover their capabilities to address the situation.
- The patient’s family will visit frequently and actively participate in the patient’s treatment within their abilities.
- The family members and significant others will have a more realistic knowledge of the patient’s situation and expectations.
- The family members and significant others will provide the patient the chance to deal with the situation in their way.
| End of Life Care Nursing Interventions | Rationale |
| Determine the level of anxiety of the patient’s family and significant other. | Addressing anxiety is necessary before problem-solving can be effective. Individuals may be distracted by their personal reactions to a circumstance to the point where they are unable to respond to the needs of others. |
| Establish relationships and appreciate the family’s difficulty in the situation. | This intervention may help the significant other accept what is going on and be willing to communicate concerns with professionals. |
| Determine the degree of perceptual, cognitive, and physical disability. | Examine the patient’s condition and present behaviors interfering with his or her care. Information regarding family problems will aid in determining options and developing an effective treatment plan. |
| Take note of the patient’s behavioral and emotional reactions to increasing weakness and dependence. | When a patient’s and family’s coping responses are compromised, it increases disappointment, remorse, and misery. |
| Discuss the underlying causes of patients behaviors with family members | When family members comprehend why their loved one behaves strangely, this approach might help them understand, embrace, or cope with the patient’s odd behaviors. |
| Assist the patient’s family in determining “who owns the problem” and who is responsible for its resolution. Advise the patient to avoid putting blame or guilt on others. | When these limits are established, each individual may begin to care for himself or herself and stop inappropriately caring for others. |
| Determine the patient’s present understanding and perception of the situation. | This strategy gives information on which to base care planning and decision-making. |
| Examine the significant other’s current actions and how the sufferer perceives them. | Lack of information or incorrect beliefs can impede caregiver or care receiver responses to health situations. |
| As much as possible, involve the significant other in information sharing, problem-solving, and patient care. Instruct the significant other on medicine delivery practices, necessary treatments, and equipment proficiency. | The significant other may strive to be supportive, but the behaviors are not recognized as beneficial by the sufferer. Significant others may withdraw or be overly protective. |
| Include all family members in conversations as appropriate. Provide and reinforce knowledge concerning terminal illness and death and future family needs. | Information might help to alleviate feelings of powerlessness and despair. It is often more vital to assist a patient or family in finding comfort than to follow precise regimens. Family caregivers, on the other hand, must be comfortable with specific care tasks and equipment. |
End of Life Nursing Care Plan 2
Nursing Diagnosis: Activity Intolerance related to lethargy, bedrest or immobilization, worsening disease condition or severe illness, oxygen supply and demand imbalances, cognitive impairments, discomfort, and acute stress secondary to end of life as evidenced by the patient’s report of loss of energy, failure to sustain typical routines, expresses a lack of willingness and enthusiasm in activity, sluggish, drowsy, poor performance, and being uninterested in surroundings.
Desired Outcomes:
- The patient will identify unfavorable productivity factors and eliminate or lessen their impacts.
- The patient’s lifestyle will change to accommodate his or her energy level.
- The patient will learn to verbally express his or her understanding of the probably reduced ability concerning the current condition.
- The patient’s activity tolerance will be maintained or slightly increased, as shown by an appropriate level of weariness or weakness.
- The patient will be able to avoid preventable pain and complications.
| End of Life Care Nursing Interventions | Rationale |
| Examine the patient’s sleep patterns and note cognitive processes or behavior changes. | Sleep loss, mental discomfort, pharmaceutical side effects, and illness development are all factors that might worsen lethargy. |
| Provide supplemental oxygen as needed and monitor the patient’s response. | This technique improves oxygenation and assesses the efficacy of therapy. |
| Thoroughly observe the patient’s breath sounds and note any symptoms of panic or oxygen starvation. | Hypoxia causes fatigue and reduces the ability to perform. |
| Keep records of the patient’s cardiopulmonary responses to activities (weakness, fatigue, dyspnea, arrhythmias, and diaphoresis). | This technique can guide the patient’s activity participation. |
| Encourage nutritional consumption and the use of supplements as needed. | This intervention is required to meet the energy requirements of activities. |
| Demonstrate activities of daily living (ADLs), ambulation, and position changes correctly. Determine safety issues such as using assistive devices, the temperature of bath water, and keeping the surroundings clear of furniture and other unnecessary things that may cause accidents. | This method safeguards the patient or caregiver from harm during activities. |
| Teach the patient, family, and caregiver how to conserve energy. Emphasize the importance of allowing for periodic rest periods after activity. | This technique aims to improve performance while saving limited energy and reducing weariness. |
| Encourage the patient to do whatever they can, such as self-care, sitting in a chair, or visiting with family or friends. | This intervention promotes a sense of control and accomplishment. |
| Schedule the patient’s activities when he has the highest energy level. Adjust activities as needed, lowering the intensity and ceasing activities as advised. | This technique allows for exercise within the patient’s ability while preventing overexertion. |
End of Life Nursing Care Plan 3
Nursing Diagnosis: Anticipatory Grieving related to the expected impairment of physiological well-being and patient death secondary to end of life as evidenced by sudden adjustments in eating habits, sleeping habits, energy levels, sexual appetite, and communication patterns, fear of possible loss, constricted feelings, anger, fear of the dying process, and loss of physical or mental capacities.
Desired Outcomes:
- The patient will recognize and express emotions appropriately.
- The patient can continue with his or her regular daily routines, looking ahead or planning for the future one day at a time.
- The patient will be able to verbalize his or her knowledge about the dying process.
- The patient will discover personal empowerment while gaining spiritual strength and tools to help find the meaning and purpose of grieving.
| End of Life Care Nursing Interventions | Rationale |
| Help the patient and the family establish a trusting relationship. | Before the patient and family can feel free to open private lines of communication with the hospice staff and address challenging problems, trust must be established. |
| Reinforce disease processes and treatments and provide knowledge about dying as asked or as appropriate. Be truthful with the patient, and do not give false hope while offering emotional comfort. | Factual knowledge is beneficial to the patient and significant others. The patient may raise straightforward questions about death, and honest replies foster trust and reassurance that accurate information will be provided. |
| Examine the patient for indications of depressive moods, such as utterances of hopelessness and a wish to “end it now.” Inquire directly about the patient’s mental state. | Patients may be highly vulnerable if they have recently been diagnosed with an end-stage disease process and recently discharged from the hospital. Some patient who is afraid of losing control or is concerned about adequately managing pain considers committing suicide. |
| Determine the patient’s and significant others’ current stage of sorrow. Explain the process as needed. | Understanding the mourning process validates the appropriateness of the feelings or reactions being encountered and can help the patient cope with them more efficiently. |
| Encourage the expression of thoughts or worries, as well as the expression of sorrow, wrath, and disappointment. Recognize that these feelings are normal. | The understanding that profound and frequently conflicting emotions are common and encountered by others in this challenging situation may help the patient feel supported in expressing feelings. |
| Thoroughly observe the patient for mood swings, aggression, and other outbursts. Limit the patient’s incorrect actions and divert unpleasant thoughts. | Mood swing is one of the indicators of poor coping and the need for different interventions. Preventing damaging behaviors allows the patient to preserve control and self-esteem. |
| Examine the patient’s indications of conflict, rage, and sentiments of hopelessness, remorse, despair, and reluctance to mourn. | Interpersonal conflicts or aggressive behavior may be the patient’s or significant other’s means of expressing or coping with feelings of despair or mental distress, requiring additional assessment and care. |
End of Life Nursing Care Plan 4
Nursing Diagnosis: Pain related to harmful biological, mental, and physical agents and persistent physical impairment related to end of life as evidenced by alterations in appetite, eating habits, weight, sleep patterns, changed capacity to continue preferred activities, exhaustion, muscle tone changes, and autonomic reactions such as diaphoresis, changes in BP, breathing, and pulse.
Desired Outcomes:
- The patient will report that acute or chronic pain is already relieved or controlled.
- The patient will be able to explain the strategies that bring pain alleviation.
- The patient will adhere to the pharmaceutical regimen suggested.
- The patient will use relaxation techniques and recreational activities as directed.
| End of Life Care Nursing Interventions | Rationale |
| Perform a thorough pain assessment, including location, features, intensity, persistence, recurrence, quality, the severity on a 0-10 pain scale, and causative or exacerbating factors. Take note of the patient’s cultural concerns that influence pain reporting and expression. Determine the patient’s pain tolerance. | This intervention gives a baseline from which a realistic strategy can be established while bearing in mind that verbal or behavioral cues may not directly relate to the degree of pain reported. When pain is at a lower level on the pain scale, the patient often does not feel the urge to be entirely pain-free. |
| Plan and administer analgesics to maximum dosage as prescribed. Inform the doctor if the patient’s pain-control regimen is insufficient. | This method aids in maintaining an “acceptable” degree of pain. Drug dosage or combination changes may be necessary. |
| Develop a pain management plan with the patient, family, and healthcare practitioner that includes approaches for managing breakthrough pain. | Inadequate pain management is still one of the most severe shortcomings in the care of dying patients. A planned approach boosts the patient’s confidence that their comfort will be maintained, minimizing anxiety. |
| Check for present and previous analgesic and narcotic drug use (including alcohol). | This method may provide information about what has or has not worked successfully or may impact the therapy strategy. |
| Determine whether the pain has a pathophysiological or psychological cause. | Pain is connected with numerous factors, some of which may interact and exacerbate the degree of pain experienced. |
| Examine the patient’s pain perception as well as psychological and behavioral responses. | Assess the patient’s perspective concerning the use of pain drugs, as well as his or her internal and external locus of control This intervention assists in identifying the patient’s demands and pain control strategies that have been beneficial or ineffective in the past. Patients with an external locus of control may take little or no accountability for pain control. |
| Encourage patients and their families to share their feelings or worries about narcotic use. | Incorrect information about drug use and fear of addiction or oversedation can stymie pain management efforts. |
End of Life Nursing Care Plan 5
Nursing Diagnosis: Powerlessness related to uncertainty regarding events, illness duration and progress, prognosis, and reliance on others for guidance and treatments secondary to end of life as evidenced by vulnerability, despair, loss of control, and power to attain the specified recovery and adaptive outcomes.
Desired Outcome: The patient will be able to overcome despair and hopelessness.
| End of Life Care Nursing Interventions | Rationale |
| Examine the patient for signs of apathy, despair, or sadness. | These moods are common indications of powerlessness. It is necessary to thoroughly observe the patient if they experience these moods due to their fear of the end of life. |
| Determine the patient’s point of control. | The locus of control determines how much responsibility people attribute to themselves (internal control) against outside sources (external control). Patients who have a strong external locus of control may be more vulnerable to emotions of powerlessness. |
| Evaluate the effect of powerlessness on the patient’s physical condition, including looks, oral intake, hygiene, and sleeping habits. | Individuals may appear unable to construct fundamental components of life and self-care activities. |
| Encourage the patient to express his or her feelings, thoughts, and worries about making decisions. | This technique fosters a positive environment and conveys a caring attitude. |
| Discuss the patient’s care with him or her, such as treatment options, the convenience of visits, or time of activities of daily living. | Allowing the patient to engage in talks will give him or her a greater sense of freedom or autonomy. |
| Recognize situations or interactions that may contribute to the patient’s feeling of powerlessness. | Healthcare practitioners must accept the patient’s right to refuse specific procedures. Some routines are performed on patients without their knowledge or agreement, creating a sensation of powerlessness. |
| Encourage the patient to recognize his or her strengths. | This method will assist the patient in recognizing his or her inner strengths, and it will help in overcoming powerlessness. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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