ABSTRACT

Background: End-of-life care (EOLC) refers to health care for a person with a terminal condition that has become advanced, progressive, and/or incurable, it presents many challenges especially in the management of pain and suffering for nurses as well as for patients and their families. Moreover, the care of the dying patient must be considered within the context of the psychological, physical and social experience of the person. Methods: A descriptive cross sectional study was used on a sample of 100 nurses selected purposively in the BRH. Ethical consideration for this study was obtained from the department of nursing Biaka University Institute of Buea, Delegation of Public health SWR, Directors of Buea Regional Hospital etc. A well-structured questionnaire was used to collect data from January 2022 to March 2022 which was keyed into excel and exported to SPSS Version 20. Results: The results of this study show that lack of resources and increased workload were the greatest challenged encountered by the nurse in providing end-of-life care to patients and finally being unhappy was the psychological effect that affected the nurses. Conclusion: End-of-life care is challenging and can have far reaching detrimental effects which psychological and social effects on the personal life of the nurse as well as the family if not well managed will increase financial burden and thus cause the nurse to be unhappy. Recommendation: nurses should improve on the competencies on how to handle a patient at the end-of-life in order to reduce the effect on the nurses’ personal life.

Key terms: challenges, nurses, delivery, end of life, care.

CHAPTER ONE

INTRODUCTION

1.1 Background

End-of-life care encompasses the care for patients that are considered to be in the last stage of their lives it includes care provided to “all those with an advanced, progressive, incurable illness to live as well as possible until they die, it can either be female, male, children or elderly, it enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement, it includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support” (Claessens et al., 2008).

Patients with advanced and progressive diseases live with possible disruption of their daily routine, experience undue pain of all natures, suffer from dead and loneliness through the caring episode, End-of-life care has received an increased recognition in recent years as a critical opportunity to improve health care quality, it has been defined as the active, total care of patients whose disease is not responsive to curative treatment (Peters et al., 2013). The provision of excellent end-of-life care requires an excellent knowledge of the pathophysiology of terminal illness or injuries, nurses are often challenged when confronted by the patients and families on decisions concerning the painful realities of whether the patient will make it at the end or will not make it at the end-of-life (Bayle, Miller, 2005). One of the greatest challenges of end-of-life care in the twenty-first century is not offering care that cannot benefit the patient, but it requires the involvement and support of all levels in the health care system, from those who directly provide patient care to the administrators and regulators who address more system-based issues and also the nurses themselves (Wenger et al., 2015). Decisions about care at the end of a person’s life often involve quality-of-life considerations, Nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and other closed relatives to the patient (Ziegler et al., 2016). They are also in a very good position to make every effort to provide aggressive symptom management at the end-of-life, Since decision-making for the end of a patient’s life should occur over years rather than just in the minutes or days before a patient’s death, nurses can be a resource and support for patients and families at the end of a patient’s life and in the decision-making process that precedes it (De Haes et al., 2007) In this light, nurses are often ideally positioned to contribute to conversations about end-of-life care and decisions, including maintaining a focus on patients’ preferences, and to establish mechanisms to respect the patient’s autonomy (Godwin et al., 2008). Excellent, skilled, precise communication is essential for the physical and psycho-social care of the patients and their families, nurses must have the knowledge and communication skills to explain to patients why certain activities need to be done (Riley and Fenton., 2007) According to the London Department of Health 2008, Nurses who work in units such as the Critical Care Units (CCUs) or Intensive Care Unit (ICU), medical unit, pediatric unit, surgical units and the maternity have traditionally received little education and training in care of dying patients and the patients’ families, which ultimately affects the nursing professional and their practice at the end-of-life care in these units (Peter et al., 2013). Other factors that may be important for providing end-of-life care may include a work environment with strong communication and collaboration between nurses and physicians, availability of ethics consultations, and adequate support of patients, patients’ families, and staff (Phillips et al., 2012), the World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) conducted a global cancer research in 2012 and found that about 14.1 million new cancer cases were diagnosed with 8.2 million people dying from cancer and this number is expected to rise to about 15 million by 2020, In sub- Saharan Africa about 551200 people are being affected with over 421000 deaths recorded per year (Kocie et al., 2011). Although there is no reliable data on the incidence and pattern of cancer, it is still recognized as a public health problem in Cameroon as the incidence and mortality increases annually (Marcia Baraas et al., 2019)

1.2 Statement of the problem

End-of-life care presents many challenges especially in the management of pain (physical comfort). Moreover, the care of the dying patient must be considered within the context of the psychological, physical and social experience of the person (Della Santina and Bernstein, 2004). Majority of nurses hold negative attitude toward end-of-life care, since they struggled with a negative emotion of anger, doubt, fear, or anxiety, and dying (Holms et al., 2014).

Nurses personal attitude towards death may affect their care towards the dying patients and the consequences include physical pain, depression, a variety of intense emotions, the loss of dignity and hopelessness that need to be addressed at the end-of-life (Hayes et al., 2014).

Each year 56 million people die in the world, with 85% of these in developing countries, in many Western countries a deeper recognition for the need to improve end-of-life care is gradually emerging, it has been argued that technological advances in medicine have obscured the need for human compassion for the dying and their loved ones (Boyle, Miller et al., 2005).  Among those who require end-of-life care are the elderly who are more prone to loneliness and who frequently report pain and who have a greater sensitivity to drugs and drugs interaction due to their physiological changes (Lyness et al.,2004).

 1.3 Rationale

The aim or goal of this study is to identify the challenges faced by nurses in the delivery of end-of-life care and its effects on their personal life.  

1.4 Research questions

1. What are the challenges faced by nurses in the delivery of end-of-life care to patients at the Buea Regional Hospitals?
2. How does the delivery of end-of-life care affect the personal life of nurses in Buea Regional Hospitals?

1.5 Research hypothesis

1.5.1 Alternative Hypothesis (Ha)

There are significant challenges faced by nurses in the delivery of end-of-life care in the Buea Regional Hospital.

1.5.2 Null Hypothesis (Ho)

There are no significant challenges faced by nurses in the delivery of end-of-life care in the Buea Regional Hospital.

1.6 Objectives of the study

1.6.1 General Objective

To identify the challenges in the delivery of end-of-life care and the effects of end-of-life care on the personal life of nurses working in Buea Regional Hospitals.

1.6.2 Specific Objectives of the Study

1. To identify the challenges faced by nurses in the delivery of care to patients who are at the-end-of life in Buea Regional Hospitals.
2. To identify the effects of end-of-life care delivery on nurses in Buea Regional Hospitals.