Critical care nurses provide care to seriously ill clients who often have multiple concurring illnesses. Some of the clients they care for lose their battle with their illnesses and pass away. It is important that nurses continue to provide quality end-of-life (EOL) care to their clients despite their terminal state. This paper will discuss research related to providing quality EOL care, the nursing interventions proposed, strengths and limitations of these interventions and a plan of quality, end-of-life care for the client.

T.L. is a 69 year old, Caucasian male hospitalized for respiratory hemorrhage, sepsis, decreased blood pressure and an intracranial hemorrhage. During his admission assessment, TL indicated that he is a minister and husband. He and his wife own and operate a radio station for Hispanics in his community. His wife stated "he is a good, Christian man". A health history taken revealed he is allergic to Penicillin and it's derivatives.

T.L. has been hospitalized since April 5, 2002. He has a "No Harvey Team" order per his physician. He had a chest CT on 6/12 to check the status of his empyema. He has a chest tube that is draining

With relation to T.L., an acute on-site informational and educational approach to providing care to T.L. without promoting death would be beneficial. This approach would eliminate fears nurses have in providing adequate pain management without promoting death. The consumer demand in the case is T.L's wife and family. Her focus on the quality of his care will ensure their demands and desires are respected and remain the most important goal. Policy reform with respect to managed care organizations is outside of the realm of the staff caring for T.L. Everyday is valuable and an obstacle for T.L. and everyone's focus must remain on providing him with quality EOL care. Policy reform is an issue his wife may decide to advocate for in the future. A lack of continuity of care in nursing is an issue at Baptist Memorial Hospital. Having nurses maintain the same assignments on a weekly basis would promote more continuity with the client and family. Assigning a primary nurse to terminal clients is also an option available.

T.L.'s primary psychosocial nursing diagnosis is Fear related to loss of control and unpredictable outcome secondary to disabling illnesses as evidenced by client being hospitalized since April 5, 2002, his wife expressing concern that client does not suffer, and the No Harvey Team order in his chart. This is T.L.'s primary nursing diagnosis because he was a relatively healthy 69-year-old minister and husband until his intracranial bleed in April. Since then his life has been completely disarrayed and he is now in the Critical Care Unit on the ventilator, completely bed-ridden. This has been a stressful, frightening time for him and his wife. In a brief conversation with her, she expressed that it is their faith in God that has allowed them to endure the last few months.

Research supports there are many interventions that can be utilized to facilitate providing quality EOL care to our clients. It is important that as client advocates, nurses make every effort to provide quality EOL care to the client and the family. The integration of these interventions could form a theoretical foundation for an effort to increase the quality of EOL care provided by current and future health care workers.

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Approximate Word count = 1537
Approximate Pages = 6 (250 words per page double spaced)