End-of-Life Decision Making for Older Adults: Competent and Compassionate Care
The complexities and challenges older adults and their families confront during end-of-life transitions can be overwhelming. The interdisciplinary health care team plays an important role in helping ensure each older adult has individualized, compassionate, humanistic, and dignified care at the end of life. The following teaching strategy can be used to introduce end-of-life care and enhance the learning of students in beginning and/or advanced pre-licensure nursing courses. The teaching strategy can be utilized in a variety of teaching and learning situations, including didactic lectures; clinical settings, such as post-clinical conferences and debriefings; simulation scenario debriefings; and small seminar discussions.
End-of-Life Decision Making for Older Adults: Competent and Compassionate Care
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Learning Objectives
Students will:
- Appropriately assess client and family needs during end-of-life transitions for older adults.
- Assess and recognize the clients’ physical, emotional, and mental changes associated with the dying experience.
- Understand the complexities involved in coordinating and managing end- of-life care for older adults.
Learner Pre-Work
This teaching strategy focuses on assessing expectations, coordinating and managing care, and making situational decisions with older adults. The strategy enhances students’ human flourishing and nursing judgment.
- Ask students to review the following useful tools and websites when caring for older adults at the end of life:
Suggested Learning Activities
The following tools can be used in a variety of teaching and learning settings to enhance student learning and understanding of end-of-life care: videos, case studies, concept mapping.
- Videos can be useful to help students understand the human aspect of providing care for older adults and their families at the end of life. Using end-of-life (palliative care and/or hospice) videos helps demonstrate to students the difficulties older adults face when making decisions regarding end-of-life care. This may be particularly useful when introducing end-of-life concepts during large didactic lectures, as it provides students with real-life situations and a view of the complexity and challenges older adults face at the end of life.
- Case studies are useful to help students better understand the challenges individuals and families face during end-of-life transitions. Case studies foster students’ critical thinking by illustrating and contextualizing the complexities associated with end-of-life care. This approach may be best suited for small group discussions, or post-clinical debriefings and discussions.
- Concept mapping facilitates students’ critical thinking related to the needs of older adults and their families during end-of-life decision making. Concept mapping based on a clinical situations or case studies stimulates student thinking and broadens students’ conceptualization of important end-of-life care needs, as well as allowing them to individualize those needs to specific contexts, individuals, and family situations.
Each of the above approaches should emphasize the essential and important role of the interdisciplinary team regarding end-of-life care. Students should be introduced to various professional roles on the interdisciplinary end-of-life care team (nurse, physician, pharmacist, chaplain, social worker, bereavement counselor, and other relevant roles as appropriate), and the impact and specific role of nurses on the care of the older adults at the end of life.
- Hospice and palliative care videos can be found in a variety of locations. One video (and segments of the video) that has been used in the past comes from Graceful Passages, The Hospice Journals (2009, The Center for Hospice & Palliative Care, Inc). Any hospice or palliative care video can be used to implement this strategy.
- Case study material can also come from a variety of sources. There are several well-developed unfolding cases on the NLN ACE.S website. One unfolding case, Julia Morales and Lucy Grey, is particularly useful for addressing end-of-life care. Below is a case study example of Julia Morales, which can be used to stimulate discussion or creation of a concept map.
Case studies can also be used to help students explore issues with end-of-life caregiver strain and burden. The article from The Atlantic, “Letting Go of My Father” (Rauch, 2010), details the challenges and strain a caregiver might face when caring for family members during end of life transitions.
Suggested Reading
Strumpf, N., & Buhler-Wilkerson, K. (2010). Living with cancer: Perspectives on a five year journey. Nursing Clinics of North America, 45(3), 475-489. doi:10.1016/j.cnur.2010.04.003
Assessment Tools
The Try This:® Series from the Hartford Institute for Geriatric Nursing (HIGN) at the NYU Rory Meyers College of Nursing contains many evidence-based assessment tools. The tool, an article about using the tool, and a video illustrating the use of the tool, are all available for your use.
Author Information
Tamika Curry, MSN, RN
Community College of Philadelphia
Philadelphia, PA
Daniel D. Cline, MSN, RN, CRNP
2011-2012 John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholar (BAGNC) and PhD Candidate New York University College of Nursing