Case Study: Response To Tammie From Nancy

This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role

I also agree with you that nurses should collaborate with other members of the patient's health care team. Collaborating is an important part of the patient's plan of care. In this particular situation the nurse, could use the collaboration to gather information to aid in the plan to approach the patient's family about their mother's decision pertaining to end of life

The increased use of advanced directives, such as do-not-resuscitate orders, has made discussions on end-of-life care much easier for patients and professionals alike.

An 89 year old patient came to the emergency room from a nursing home. Per the nursing home staff, the patient had a “floppy leg” and grimaced when that leg was moved. The patient’s advance directive paperwork was provided. The patient is non-verbal. An advance directive is a document composed by competent patient’s that ensure the right of self-determination: the right of every person to make their own decisions about their medical treatment, including the right to refuse treatment (Martin, 2013).

When you are able, you should put thought into the physical process you will go through. All of us love you and want to make sure that when the time comes, we know and can follow your wishes regarding the care you wish to receive. Having your decisions thoroughly and clearly stated in an advance directive will make this possible. (Berger, 2014, p. 590). Your advance directive document may contain a living will, a signed consent for Do Not Resuscitate (DNR), and information identifying your healthcare proxy. Understanding these things now, will help you make clear choices. A living will clarifies what care, or lack of care, you wish to have (Berger, 2014, p. 590). This is helpful for reference if you are ever unconscious or in any way incapable

Advanced care directives are legal documents provided to physicians and health care workers with an outline containing preferences for the treatment at end of life. Patients often do not discuss their wishes regarding end-of-life care with family members or health care providers prior to the event of a serious illness or traumatic event. Educational interventions focus on raising awareness and providing patients with information on advance care planning.

There are two types of advance directives: a Living Will and the Durable Power of Attorney for Health Care. A Living Will requires a witness or be notarized and consists of a directive that instruct the acting physicians to not utilize medical interventions in an instance that the patient is unable to make their immediate medical decision. The Living Will is the oldest form of advanced directives, requires a patient be terminally ill and it states that its interpretation is only to be assumed by the patient and their physician, there is never to be any family influence or interpretation of a Living Will. Durable Power of Attorney for Health Care is also witnessed or notarized and identifies an ‘agent’ to make health care decisions if the signer is unable to make their own decision. An agent is an individual that the patient chooses with great care, due to the amount of power/authority that is assumed to making such decisions. The Durable Power of Attorney does not require that a patient be terminally ill and is interpreted by the identified ‘agent’. There have also been known to be hybrid documents that combine elements of a Living Will and Durable Power of Attorney for Health Care that acts as an Advanced Directive. (Advanced Directives.,

What is your understanding on Patient Self-determination Act? Explain. What is the advance directive process used in your organization?

The Advance Directives form is somewhat different but its purpose is the same: to let an individual make end of life decisions. It is a longer form, with more involved questions.

PER REPORTER: Keshia said she received the following information from a Nurse Practitioner by the name of (Tammie) that works with her. She said according to Tammie, Malia was brought into the clinic today by her babysitter (Linda) to be seen by a physician due to her suspecting that the child has been sexually abused. Tammie said Linda told her that she keeps the child for her uncle due to him being her caretaker at this time due to her mother being in jail. However, Tammie said Linda is suspicious that the child’s uncle may be sexually abuses her. Tammie mentioned that the Linda also told her that Malia has been displaying inappropriate behavior problems. Tammie said Malia is currently being taken to UMMC by the AMR due to her having scar

Hi Lisa, you have stated well, often, we (nurses) get in the way of our patients’ independence by thinking that we have to make all their decisions for them; it should never be like that. We are our patient’s helpers, we need to listen to their concerns, determine their weaknesses and figure out what we can do to enhance those weaknesses so that they can have the feeling of being “complete” instead of allowing them to fully depend on us. I agree with you that the nurse should work with Mr. R and his family to determine on how they want to deal with the “cancer” and we must respect whichever choices they make without interfering with them. I wouldn’t want any nurse to make all my decisions for me, I will always ask questions whenever things

However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope

Working as an oncology nurse has been a life changing experience. I have grown not only as a nurse, but also as a person. My eyes have been opened to the value of life, and not just life itself, but the precious thing that is a healthy life. I cannot count the number of patients from the beginning of my nursing career until now that have told me, “Well, I just didn’t think my symptoms were a big deal” or “The doctor told me I needed additional tests but it didn’t seem important at the time and I didn’t have any money”. The lack of patient education and provider follow-up in situations such as these is disheartening to observe. Experiences I have had with patients combined with their life stories have fueled my desire to become a family nurse practitioner. A healthy life is something that I want everyone to know.

My decision for choosing nursing as a career is not only due to my own health concerns but also from seeing and hearing the experiences of my cousin Chase. My cousin was diagnosed with stage 4 medistinial testicular cancer when he was 24 years old . This effected my family in an unimangible way, not only for his own diagnosis but for the fact that this was the third cancer diagnosis within my family in 4 years. Throughout the duration of his care and treatment the doctors and nurses were able to help not only him but also my family in a way that I’ve never seen before. From my grandfather and Chase being admitted into the hospital at the same time and allowing them to be in rooms close to each other to allowing his sister Katrina stay overnight with him on occasions. As Chase’s cancer progressed and he moved to different areas in the hospital and to other hospitals his doctors and nurses would continuely check in on him and the rest of my family, even going as far as attending his funeral and giving a supporting shoulder to my

Nurses can help by facilitating discussions about the end of life early in treatment plan discussion. Strengthening communication between staff, and encouraging reflection by providers are also issues to be addressed. Nurses today accomplish more than simply give solace to patients at the end of their life. They additionally support patients in making troublesome choices with