Decades ago most people died at home according to The National Institute on Aging (2012) , medical improvements have changed that. Where we die is usually not our choice but if it is each person or family needs to consider what type of care is needed. What care can be provided, is family or friends available to help and can they manage the cost (NIH, 2012). The study conducted by BMC Medicine (2015) suggests that dying at home is better than in a hospital for peace and grief, but require a discussion of preference, GP home visits and relative availability (time off work etc.) (Gomes et al. 2015). This study also showed the different areas around the world felt differently about where they would prefer to die. In the U.S., U.K., and Canada at home was their preference, in Japan, Germany, Greece, and Portugal a trend toward dying institutionalized is preferred (Gomes et al. 2015). In this study those patients with cancer, 80 percent where they died was also where they lived the last week of life. Those who died at home had not been hospitalized for the whole last 6 months of life (Gomes et al. 2015).
Nurses need to practice what they peach and make sure they and their families have completed advanced directives. Nearly 80 percent of patients’ surveyed by California Healthcare Foundation, said they definitely wanted to talk with a doctor about end of life care, but only 7 percent actually had the conversation (Wood, 2012). We need to be there for the patients’ and get them thinking about advanced directives and end of life care. It’s never too early and it shouldn’t be taboo. Initiating that conversation and helping people create the document is within the nurse’s scope of practice and should be as routine as asking about immunizations (Wood, 2012). Many times according to Wood (2012) physicians and other members of the healthcare team are focused on curative care that discussion about end of life care is postponed. She states it is important that patient, families and healthcare providers meet with one another to determine the plan for final hours. All family members need to be involved and without a health care proxy, some family members will want everything done and others disagree (Wood, 2012). Decisions need to be made ahead of time. Nurses need to educate and support patient and family members.

References:
Gomes, B. Calanzani, N. Koffman, J. Higginson, I. (2015). BMC Medicine. Is dying in hospital better than home in incurable cancer and what factors influence this? DOI: 10.1186/s 12916-015.0466-5. Retrieved from http://bmcmedicine.biomedcentral.com/
National Institute of Aging. (NIH). (2012) end of life: Helping with comfort and care. Retrieved from https://www.nia.nih.gov
Wood, D. (2012). Nursing news: Nurses critical to fulfilling patients’ end of life wishes. Retrieved from http://www.nursezone.com/