The Quality of Life at the End of Life

TheQuality of Life at the End of Life

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Qualityof Life at the End of Life

Thequality of life at the end of life is a concept that is often ignoredby a majority of individuals, despite the fact that this is a processthat we all have to go through. The fact that death is part of lifemakes people familiar with palliative care offered during the lastmoments of life (Cheryn et al., 2015). The quality of life at the endof life is a critical concept especially with the nursing and medicalprofessions where one has to have the knowledge of how to handle theterminally ill patients, and those in the process of death. In caseswhere individuals perish in an abrupt manner, for example, due toheart attack or excessive trauma, the end of life is known inretrospect. Death is a phenomenon that is tough to define.Understanding the cycle of life is vital in comprehending the conceptof quality of life at the end of life.

Lossof life is an inevitable process, but one has to be given qualitycare at the culmination of their life. This is the reason whypatients with terminal illness are not ignored just because theircondition has no cure (Cheryn et al., 2015). The paper, therefore,aims at analysing the terminal process of life, and the quality ofcare provided to individuals during their last days of living. Thesignificance of the analysis is to portray how valuable life is,especially the end process.

Reviewof Literature

Theend of life process is an important phase of one’s living. Duringthat period, the patients are offered proper attention, and areusually placed under quality nursing care. The major aim of ensuringquality care during the final moments is usually to make sure thatthe individual has a dignified death (Deith, 2013). BeforeKubler-Ross’s work, the subject of death was mostly feared andviewed as a taboo thus, failure in addressing it. According to Deith(2013), the work of Kubler-Ross drew a limelight on the processes ofdeath, as she described the emotional and psychological process thatdrives terminal patients from initial denial to the succor ofacceptance. According to Kubler-Ross, the caregivers have theobligation of supporting their patients as they go through the fivestages of grief, which include: denial, anger, bargaining,depression, and acceptance (Deith, 2013). Kubler-Ross’s suggestionwas firmly supported by the nursing theories and principles. Byensuring that the processes are adhered to, the caregivers would havesucceeded in the provision of quality care at the end of life (Fine &ampKestenbaum, 2012). The process of addressing the spiritual,psychological, and emotional needs of a patient may at times be hard,especially in the situations where the patient suffers from cognitivedisorders such as dementia and delirium. In situations where patientsdevelop such complications, the caregivers or medical nurses shoulddo all they can to offer quality care despite the patient’scondition.

Fromthe text, therefore, it is clear that the end of life process doesnot only focus on ensuring that the patient receives physical caresuch as alleviation of pain, but is also concerned with the deliveryof the patient’s emotional, spiritual, and psychological needs.Quality care at the end of life is, therefore, an all-round concernof the patient’s well-being (Murtagh et al., 2013). As such, it isa process that ensures that the quality of life during the lastmoments is excellent. The concept of quality care dispensation duringthe end of life is multidisciplinary in its application since theissue of death is universal. The concept is, therefore, applicable toall aspects of nursing (Fine &amp Kestenbaum, 2012).

Thelife of a human being can be compared to the life of the cells wepossess. During the early stages of life, the cells multiply and growat a high rate. Although the rate might be different among people,the cells still undergo a growth process following a sequencedpattern. All cells undergo formation, they grow, and later on die.Human beings and other multicellular organisms have a limitedlifespan after which all the cells die (Deith, 2013). Before thedeath process, however, the cells go through an ageing process wheretheir rate of functioning is reduced. The same is evident in humanswhere ageing comes with the loss of energy to perform some tasks. Theageing process is part of the end of life process and due to theloss, or reduced ability to function, the quality of life of theseindividuals is usually rewarded by offering them eminent care, andensuring that they die in a peaceful manner (Fine &amp Kestenbaum,2012). In all the living organisms, death is seen as an unpredictablephenomenon, and therefore, due to the conscious state of humans, thesame should be treated with respect.

Accordingto Cheryn et al. (2015), it is usually tough to predict the death ofan individual in any given condition. However, some indicators ofdeath do exist. Some illnesses or health conditions of a person mayindicate that they are in their terminal stages of life. Suchconditions call for palliative care, which is usually offered as away of reducing pain, and ensuring that the death process does notinvolve much suffering. The end of life is often known in aretrospective manner by the onlookers, or sometimes at the end oflife when the individual is conscious of what is occurring. In mostcases, the patients with terminal illnesses such as cancer orAlzheimer’s usually know that they are living at the final stagesof their lives, and would therefore, prepare for the death process(Kaakinen et al., 2015). Such patients should be given quality careas they undergo the five stages of grief, and the nurses or thecaregivers should always ensure that they are offered an all-roundform of support as a way of respecting the worth of life at theterminal period.

Somedeaths occur in a sudden manner making it difficult to define theperson’s end of life. In some cases where a person might develop asudden health complication leading to death, the end of life takesplace at the emergency room of a hospital. A heart attack is a goodexample in which one develops a sudden medical condition, and isrushed to the hospital. In such cases, the individual might havespent the last hours in a normal health state, and could have evenbeen at the workplace, on a sporting field, with family, in ameeting, or just having fun. These could be described as the lastactivities of the person before demise, and such does not call forany specialised care or palliative care (Cheryn et al., 2015). Theevents that take place in the emergency room in trying to preventdeath, or reducing suffering are necessary during the end of lifeprocess. In other cases, some patients or individuals opt to stay athome and be close to their families when they feel that they havevery few days of living. Such people or patients depend on theirfamilies to provide quality care during the ultimate moments of theirlife. All the processes that take place in ensuring that anindividual receives a proper care during the end of life signify thesuperiority of life at that particular period.

Inmost circumstances, the type of care offered to patients at the endof life is mainly focused on patients with terminal illnesses such ascancer. In present days however, technology has changed people’slifestyles, and some get to know the approximate time left for themto live. This happens when they are suffering from a particularterminal disease, thus making it easier for them to secure acomfortable hospice for their end days as suggested by Fine &ampKestenbaum (2012).

TheDefining Attributes

Theessential attributes of a concept are the characteristics of theconcept that occur over and over again. These attributes are the mostfrequently associated with the concept being analysed, and they allowthe broadest insight into the concept being studied (Walker &ampAvant, 2011). The defining attributes are only characteristic of thetheory being considered and help to differentiate it from anothersimilar concepts. The quality of life at the end of life ischaracterised by four main components, which include the notion ofdeath, acceptance of death, living a normal life even in the processof death, and alleviation of pain and other symptoms before death.

Painis one of the fundamental components that characterises loss. Duringthe late nineteen sixties, Dame C. Saunders focused much of her workon studying patients at the culmination of life, and it was duringthis time that she came up with the definition of the concept oftotal pain. She stated that absolute pain involves social, spiritual,psychological, and physical aspects. She went on to state that, thevarious aspects of pain combine and interact with the individual’sperceptions and experiences to produce a personalised form of painthat is unique to each person (Cheryn et al., 2015). As acharacteristic of the concept, and with the prominence of life, painis a primary concern during the end of life. The eminence of lifeduring the terminal times call for the provision of “good death,”which can be achieved through controlling troublesome symptoms suchas pain (Cheryn et al., 2015). The same is emphasised in the End ofLife Care Strategy, which is endorsed within the perspective ofBritish Medicine. In some instances, terminal patients ask for thephysician-assisted suicide due to the fear of undergoing pain andother symptoms that take place just before death. Amid the greatefforts made to prevent or lessen the pain and other disturbingsymptoms that occur before death in patients with terminal illnessessuch as cancer, the achievements of controlling pain are still lessthan optimal.

Individualswith prolonged suffering from a particular condition are alwaysallowed to go through Kubler-Ross’s stages of grief. They are ledtowards the point of accepting the situation and the fact thatnothing can be done to prevent death. Acceptance of death is,therefore, one of the defining attributes of the concept of qualityof life at the end of life (Murtagh et al., 2013). During the end oflife, individuals should be allowed to have the best of life. This isone of the things, which people wish for during their death process.


Theconstruction of the model case is a significant step in the conceptanalysis of the subject. Such includes all the critical attributes ofthe concept. An example of the model case of quality of life at theend of life is presented in this section.

Jamesis an 84-year-old single man, and a father of two. His wife died acouple of years ago. He was diagnosed with cancer, which had reacheda stage that it could not be treated. Due to his condition, the twosons opted to take their father to a comfortable hospice and paid himregular visits. During the visits, they would give the old man hisfavourite food, newspapers, and books. The nurses at the institutionoffered psychological, spiritual, and physical assistance to thepatient to ensure that he does not experience pain or any suffering.The nurses also comforted the family, and shared the condition of thepatient to the family on a regular basis. The family was also askedto visit frequently and spend more time with the patient when it wasjudged that death was near. Eventually, James passed on in apeaceful, pain-free manner, and with all his wishes honoured.

Themodel illustrates all the three attributes of quality of life at theend of life as previously discussed in the analysis. The two sonsdecided to take their father to a comfortable place where proper carewas offered to him. They also made his life more comfortable byensuring that he has the things he loves. The nurses alleviated thepatient’s pain and suffering, and made sure that he died a peacefuldeath.

Antecedentsand Consequences

Theprimary antecedent of the end of life process is perceived to be theconclusion that one is suffering from a terminal illness, and theacceptance of the outcomes by the patient. It is important that theprognosis is made known to both the patient and the family so as toenable both parties to conduct spiritual, emotional, andpsychological adjustments (Kaakinen et al., 2015). These adjustmentswould be substantial in accepting death.

Oneof the antecedents is an individual’s set of beliefs about dying.Before the quality of life at the end of life is realised in a personwith a terminal illness, it is important to note what the individualexpects, and what he or she believes in. Some patients, for example,would not want to die in the hospital therefore, forcing them to geta “hospitalized” kind of attention would be dishonouring theirwish. The consequence of dishonouring the wish would be an elevatedemotional pain and discomfort.


Thelast step in the concept analysis of the subject is theidentification of empirical referents (Walker &amp Avant, 2011).They are the categories of actual phenomena that reveal the presenceof the concept in its contextual framework. Different tools can beapplied in the analysis of the psychological state of the patientwith a terminal illness and the quality of palliative care that thepatient receives. Some of these include the level of depression,grief, burden, hope, self-esteem, resiliency, and the caregiver’sstrain.


Thequality of life at the end of life refers to the kind of life that aperson is offered during the period just before his or her death.This type of life includes palliative care where the person is madeto undergo less suffering during the death process. It also includesallowing the patient to experience the five stages of cognitivedissonance as put by Kubler-Ross. The nursing literature clearlyagrees that patients should be cared for even in their dying processso as to make the death less painful, and one that occurs with lesssuffering. Analysis of the concept is critical as it ensures that onehas an explicit knowledge of the end of life, and the expected carefor individuals with terminal illness.


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