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  • Subject Name : Nursing

Assessment 

Introduction 

Evidence-based practice (EBP) is defined as the use of best and current evidences explicitly, conscientiously and judiciously in healthcare decision making according to Schmidt, & Brown, (2017). Healthcare professionals have to integrate the external clinical evidence into their clinical expertise in order to improve the quality of healthcare imparted by them to the patients. In the given scenario, the patients under the hospice care are taken into consideration. The family members for such a patient have to work in collaboration with the healthcare professional so as to provide improved healthcare outcome for the patient according to Van Groenou, & De Boer, (2016). In this case, the family members are withdrawn, this will impact the healthcare quality. Hence, a literature search is being done with the help of PICO framework so as to derive the best clinical practice to respond to this situation. 

Research problem

The research problem is to assess the impact of withdrawing family members from the hospice patients on the caregivers. This is significant as these caregivers provide substantial informal care to the hospice patients which collaborate with the healthcare professionals in providing optimum care to the patients. 

PICO

picture of the PICO table

The first stage in the EBP process is to define out the question for finding the best literature for supporting EBP. The PICO table is shown below:


For finding the literature for this question of how the family members are impacted when they are withdrawn from giving care to the patient and how does it impact them and hence the overall healthcare quality received by the hospice patient. Search strategy

Two databases are used for finding the relevant literature on this questions and these were pubmed and semantic scholar. The evidences selected for this PICO table are given below:

picture showing selected evidences for the ICO table

Two pieces of evidence relevant to the given scenario

The first one is the review done by Oechsle, (2019) and he maintained that the family and relatives support and care for the patients suffering from life-threatening situations and end of life care. Therefore, they represent significant resource and reference person for the patient. The family caregivers have significant influence on the wellbeing, caring situations and life quality of the patients. However, when near to patients with communicable diseases they are also likely to be negatively impacted. Further, they may suffer from care burden by attending the patients for longer periods of time. 

Hospice care according to Oechsle, (2019) is aims at improving life quality of patients’ relative but it is needed to discover their needs and problems. Relatives have been noted to report of higher rates of existential and psychosocial distress and morbidity and burden during the disease period of any patient. Need of information by the relatives and the family caregivers has been of the utmost importance in the hospice care. This review has noted that the family caregivers have important role in imparting quality healthcare to the patients. The family caregivers must be addressed to an increased extent in the hospice care as they are reference and resource persons for the patients as also suggested by Phongtankuel, et al (2017). This review also pointed out that the supportive needs of the family caregivers are relevant clinically during the disease period of the patients. These must not be neglected during the hospice as well as the palliative care. The family caregivers and relatives work as a care unit for the patients and thus help to impact improved healthcare quality.

The second study is a systematic review conducted by Hughes, et al (2019). According to this review there are attributes of care which are valued by the patients and family caregivers during the hospice care. This knowledge is integral in providing better services and it facilitates many opportunities for further improvisation in the provision of the hospice care. It has been noted from this review that social support given to the patients in the day-healthcare units is significant. They require 24- hours’ support from their families in addition to the symptom and pain management within their inpatient units. 

An important finding from this review which is relevant for this scenario is that the support of family members has been noted to be highly significant particularly for the patients getting end-of life care. Crucial attributes have been linked to the ‘good death’ experience of the patient irrespective of the healthcare settings as suggested by Kinghorn, & Coast, (2018). This makes the role of family caregivers highly important for such patients under hospice care. The ability of healthcare professionals in the hospice care in the psychosocial domains of care was regarded to be significant. An important area of the hospice care has been the social model of care where they have to support the patients in a psychosocial manner. This requires the healthcare professional to collaborate with the family members so as to understand the social situation of the patient and hence impart quality care. 

EBP cycle

In this cycle there are five steps which are asking, acquiring, appraising, applying and assessing. In this assessment the first two steps have been completed and these are asking and acquiring. In asking step, the problem of impact of withdrawing family caregivers on them has been explored from the searched evidences. The second step is of the acquiring evidence and in this case two databases have been searched. Two evidences have been selected for exploring the impact on family members when they are withdrawn away from the patients in the hospice care.

Conclusion 

From the above two evidences it is concluded that the hospice patients must receive quality healthcare during their disease trajectory. The family members are more satisfied with the care received, however, when they are withdrawn from the hospice care settings then they are not able to receive information about the patient which leaves a negative impact on them. Further, they may feel more burden as being away from the patient and not being able to present during the stressing times. This is more crucial for the patients in the hospice care when they are at the end of life stages as the family caregivers and relatives may suffer emotionally in not being able to provide good death to the patient which was in the presence of the family members. 

Involvement of family caregivers is beneficial for the patients as they provide psychosocial support to the patients and act as reference and resource person for them. Further, they also help the healthcare professional to understand the social and psychological situation of the patient. This helps the healthcare professionals to render quality healthcare to the patient as per the social model of care. Therefore, they must be incorporated into the healthcare team for providing quality care to the patient. Hence, as per the EBP cycle, the first two steps of asking and acquiring has been accomplished with this exercise. 

References 

Hughes, N. M., Noyes, J., Eckley, L., & Pritchard, T. (2019). What do patients and family-caregivers value from hospice care? A systematic mixed studies review. BMC palliative care, 18(1), 18.

Kinghorn, P., & Coast, J. (2018). Assessing the capability to experience a'good death': A qualitative study to directly elicit expert views on a new supportive care measure grounded in Sen's capability approach. PloS one, 13(2).

Phongtankuel, V., Paustian, S., Reid, M. C., Finley, A., Martin, A., Delfs, J., ... & Adelman, R. D. (2017). Events leading to hospital-related disenrollment of home hospice patients: A study of primary caregivers' perspectives. Journal of palliative medicine, 20(3), 260-265.

Oechsle, K. (2019). Current advances in palliative & hospice care: Problems and needs of relatives and family caregivers during palliative and hospice care—An overview of current literature. Medical Sciences, 7(3), 43.

Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses: Appraisal and application of research. Jones & Bartlett Learning.

Van Groenou, M. I. B., & De Boer, A. (2016). Providing informal care in a changing society. European Journal of Ageing, 13(3), 271-279.

 

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