Five Wishes Packet Case Summary

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Cultural consideration must be taken into account when discussing end-of-life issues with patients and family members. One cannot assume that cultural affiliation equals a deep connection to cultural beliefs and affiliation with one or more groups should not be used as an assumption about

Getting prepared for death can be an exhausting experience for the patient and their family. It is very important that the patient not only knows what they want as far as their right to receive or reject treatment and medications or knowing whether they want to receive palliative care at home or in a hospital setting to include the advantages and disadvantages of each. The main focus of this paper is to give the reader an in depth look on how an end of life crisis affects a patient and their family. Ella is a breast cancer patient who just came out of remission and is at the end of her life.

My first inclination is to better understand Rico’s culture and customs; by doing so, I would be able to better convey my feelings within the framework of his world view. In the PMH lecture on “Meeting Patients Where They Are,” Dr. Farr discussed twelve domains that comprise a culturally competent approach to healthcare. One domain involves communication, which I have discussed in detail above; using a medical translator eliminates errors and bridges the gap to the patient. The model of cultural competence emphasizes understanding the patient’s heritage, family roles and organization and religiosity. I was able to quickly research Mexican American culture, and its attitudes on death and dying, which provides me great insight into Rico’s case. I found that in Mexican culture caretakers are often female family members, and that the family as a unit is expected to care for the elderly. One quote in particular illustrated Rico’s particular resistance to palliative care, as “reluctance to use such programs may be attributed to a cultural resistance to sharing familial problems with outsiders.” By understanding Rico’s cultural background and long held beliefs, I feel I can best understand his mindsight and trepidations; I can also better understand his resistance to his son’s wishes for palliative care. In addition, to meet the patient where he is I would need to better understand his deep religiosity. I would likely call a spiritual care consult to talk with Rico about the benefits of palliative

On December 2nd, 2015 was the healthcare convention at Fletcher’s Meadow Secondary School. In the convention, all gr 10, 11, and 12 students of Mrs.Nightingale’s class participated and had booths talking about different topics. Grade 10 students do games based on health, grade 11 students research different countries and compare their healthcare system to Canada’s, and grade 12 students choose a “hot topic” and research it to present on the day of the convention. However, there were no grade 10 students this year, only grade 11 and 12.

During clinical time in the nursing program there are many opportunities for students to explore their new found nursing skills. While engaging in patient care responsibilities there are many languages, customs, values, lifestyles, beliefs, and behaviors that will differ from their own. Each patient may need healthcare providers to consider certain aspects in order to provide culturally competent care. There are many cultures that have migrated to the United States over the years including the people of Haiti. There are many aspects of their healthcare ideals that may need to be considered while providing healthcare in the hospital setting. This cultural assessment will consider the healthcare matters of an 81-year-old woman on the

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

To Kill a Mockingbird was published right as the Civil Rights Movement peaked in the 1960s. A controversial trial that occured during Lee’s childhood sparked her interest in the subject of civil injustices in the south. When she was five, it was rumored that nine black men raped two white women. After many long, harsh and highly publicized trials, the nine men were sentenced to lengthy prison time. Many lawyers and American citizens claimed that the suspected motivation for the result of the case was racial prejudice.

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

In accordance with previous studies, they found that higher education is correlated to positive attitudes toward Advance Directives. They found that when family members have higher education than patients, the family members also have more positive attitudes than patients about Advance Directives. Aside from looking at level of education and demographics, they also discovered that on one’s perceptions of the healthcare professionals’ role in treatment decisions, belief in opportunities for treatment choices, effect of an Advance Directive, and perceptions regarding the severity of illnesses all effect one’s decision to complete or reject an Advance Directive. This study also discovered that physicians, nurses, social workers, and other healthcare experts might contribute to the low percentage of individuals who complete an Advanced Directive. Physicians’ lack of discussion and nurse’s lack of education to patients about Advanced Directives may be the results of few completed Advance Directives. Due to time limitations and other possible legal complications that may occur, it can be challenging for healthcare professionals to adequately discuss an Advanced

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

Currently, I am two steps away from obtaining my BSN and once completed, I will pursue a Master’s Degree in Education. Since I am commitment to lifelong learning, I will equip myself with the necessary tools and resources that I need to succeed. According to (Finkleman, 2012, p.15), nurse leaders innovate, initiate, empower and compel others with their creative vision and translate that vision into action.” Therefore, from an ethical perspective I pledge to advocate for those patients who do not have a voice or a support system. The rights and confidentiality of all patients will be

First of all, I recognized that I was dealing with humans, and not just dealing with a disease process and application of the nursing process in the aspect of restoring patient health. I was dealing with emotions, and families, and cultural beliefs that influenced individual’s aspects of care. I started to see that health did not just incorporate healing the disease, but also recognized the importance of making sure patient’s felt that their

The case study based on the palliative patient Mrs. Mavis looks at issues both the family and the patient are dealing with in regards to the end of life treatment Mrs. Mavis is receiving. Mrs. Mavis is a palliative patient, currently unconscious, who is dying and only wants comfort measures within her nursing care. This was made clear through her advanced care directive, which was made weeks before beginning to receive her end of life care. Mrs. Mavis’ comfort measures include pain relief, hygiene and keeping her comfortable. Mrs. Mavis’ family want her to have fluids and medications to help improve her health. They also want oxygen and pain relief to help with her breathing. Issues such as educating and supporting the family, pain management, the effectiveness of having an advanced care directive and pain assessment will be evaluated to determine the best effective interventions for Mrs. Mavis and her families care. Interventions that will be discussed through-out this essay include the use of analgesia medication, the use of subcutaneous injections and syringe drivers, emotional support for the family, effective communication, educating the family on Mrs. Mavis’ wishes and the importance of having an advanced care directive. These interventions will be evaluated to ensure they are the best practice for Mrs. Mavis’ care.

(Schapira, 2010) It is important for patients to have all the facts in order to accept and prepare for death. Another area not always communicated well has to do with advance care planning. Many patients do not learn about options or talk about end of life issues until it is very late. Studies have shown that younger doctors are more likely to initiate conversations about end of life care options. (Pahwa, Babu & Bhatnagar, 2005)