Advance Care Planning And Preparation: A Case Study

Depending on a person’s physical and mental state, will depend on whether they are able to complete their end of life care planning. If an individual is unable to plan their end of life care then key people like next of kin, friends or social worker will plan their end of life care, using background information about the individual, trying at best to keep to their religious beliefs and wishes.

In case study 1; David had been referred to the nursing home by his son and daughter-in-law because he had been diagnosed with dementia which made his family members unable to provide him 24/7 care that David would need. After his admission in the nursing home, his care plan manager holistically assessed all the needs and preferences by asking him and his son and daughter-in-law. The resources were identified such as his preference to eat vegetarian food and visit Church during weekends. The care plan manager set targets while making a care plan which involved David and other professionals such as speech and language therapist, health care assistants and a nurse. Then, the care plan manager recorded all the professionals, his family members and David himself who were involved in his care planning. The care plan manager also ensured that there was regular communication between the professionals and individuals who participated in providing him provision of care so that everyone is aware of their roles and responsibilities. The date was identified for when the services were to be implemented for him by the care plan manager discussing with David and the professionals. Then, the care plan manager monitored if the services being available for David were working well and if it needed changing by discussing with David and other professionals. The provision of care was reviewed and new goals were identified by the team. Ultimately, the care plan manager and David decided a date to

Key people could be family, doctors, carers, religious leaders etc. Each may own distinctive role to play in order for the choices and preferences of the individual to be respected and carried out. [ Every person’s end-of-life trajectory is different and needs differ in intensity and quality over time. End-of-life care must adapt to the varying and changing needs of the individual over time and that it cannot be limited to certain settings or services. The provision of good

Other barriers in implementation might include the legality of certain medical interventions, associated costs and limited resources for providing the best care possible (Mason, 2013, p.12). As nurses, a barrier in implementing advance directives might also arise when advocated end-of-life wishes are undervalued or poorly recognized by others who do not share the same comfort or high priority in the medical workplace. Finally, the patient, families, and healthcare professionals face barriers in misconceptions regarding advance directives, especially in regards to

Advanced care planning is critical element in the therapeutic alliance between healthcare team and patient in providing adequate patient-centered care, with the patient a more willing collaborator. This process provides patient, family, and caregiver with realistic expectations about result of treatment and prudent preparation for possible outcomes. Effective advance care planning has been shown to increase satisfaction with care, lower moral distress, lead to healthier bereavement after death, provide timely

Many patients and families in this situation have understood that all treatment options have been exhausted, and the focus then shifts to a peaceful, respectable, and comfortable dying process for the patient. The healthcare team desires what is best for the patient. As members of the health care team, nurses may often find themselves in situations where establishing patient wishes and preparing for end-of-life care decisions falls on them. According to evidence-based guidelines for initiating end-of-life care planning “discussions should be driven by the philosophy of hope for the best, prepare for the worst.”

There are many ways that we can be advocates as nurses, educating and iniciating discussions about end-of-life care is a very important one for many patients. I have seen many people suffer for extended periods when most doctors knew they only had weeks to live and wouldn’t make it out of the hospital. Often doctors tend to give the best possible outcome and families do not get the whole picture. I believe in the right to choice to die with dignity, but I also have seen small issues not be fixed due to advance dirrectives. I hope that in the future more doctors can have honest talks with patients about realistic outcome and where there goal of recovery

It’s very important to respect client wishes to die with dignity and implement those wishes. However; in some cases, nurses often encounter ethical dilemmas where the patient’s wishes may conflict with those of his or her family. Patients have autonomy of their health. For instance, if client decided to not have any g-tube or be intubated in times of terminal illness, their wish should be implemented once patient is not cognitive impaired. Some people chose to die with dignity because they don’t want to go through pain or becomes a burden for the family. That’s why it’s essential to educate and encourage patients’ about advance directives.

The medical and ethical concerns focus on the health care delivery system as it impacts end-of-life decisions. There are three categories that this can be broken into. They are the quality of life, how decisions at the end of life are made, and the physician’s changing role in end-of-life

Nurses have been at the bedside of the dying since the beginning of the profession. At any given time a nurse may face someone in the last stages of life, whether they are newly diagnosed with a terminal illness, currently fighting a terminal illness, in a traumatic accident, etc. Since end of life care has been a controversial issue, many laws have been enacted to protect health care professionals and to respect the wishes of the patient. End-of-life choices are a quality of life issue. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care, including the promotion of comfort, relief of pain, and support for patients, families, and their surrogates when a decision has been made

End of life decision making and care are critical aspects of the delivery of patient centered healthcare. Advances in scientific knowledge and medical technology can now prolong the dying process indefinitely. Many Americans fear the possibility of dying a painful, protracted, or undignified death, in an institutional setting, absent personal control or meaning (Schwarz, 2004). With the modernizations of medical technology today, individuals are now given the option to choose how, when and where they die. This topic has prompted many ethical and legal debates regarding end of life care. As a result it has made it challenging for nurses and other healthcare professionals to provide appropriate care. Nurses need to incorporate the American Nurses Association (ANA) Code of Ethics and the professional standards of the Association of Hospice and Palliative Care Nurses when addressing end of life issues.

Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity

Helping professionals such as doctors, nurses, hospital managers, mental health professionals, relatives or ethicists may become involved in the process of assisting a terminally-ill patient with regards to end-of-life decisions. Helping professionals can best respond to client’s issues of end-of-life decisions through active listening and an empathic position (Duba & Magenta, 2008). Understanding the patient wholeheartedly should be practiced and considered as a significant aspect of the professional fiduciary relationship. He or she must be competent to assist dying patient from making the best end-of-life choices. Also, professional helpers must comply to the governing law and ethical guidelines to safeguard the patient from potential dangers

As individuals access the end of their lives, people and their families commonly face many decisions that consist a lot of choices ranging from simple and complex issues. People that die have to make choices about family involvement in caregiving and making decisions. End of life choices have a major impact on the quality of life and dying. The end of life cost medical arrangements are challenging for ill individuals and for people who care about them. Decisions should ideally be done in terms of the relief of values and suffering and beliefs of people dying and their families.

According to the publication Dying in America, “More than one-quarter of all adults, including those aged 75 and older, have given little or no thought to their end-of-life wishes, and even fewer have captured these wishes in writing or through conversation.” (pg 18)