Introduction Having a patient on life support is a mentally challenging and exhausting time for the patient’s family members. It is an even more mentally exhausting for that patients attending healthcare provider. As Advanced practice nurse step more into the role of primary attending healthcare provider, they are faced with the dilemma of how and when to wean a patient from a ventilator without causing the patient any psychological distress. Many healthcare facilities have a written protocol on specific criteria that the patient needs to meet before terminal weaning is considered. Even if these criteria are met, a family can object to the wean and prevent it from happening. There is certain thing that the advanced practice nurse must think about before considering to discontinue life support. These include, patient’s quality of life, family of the patient and their concerns, hospital protocol, and most importantly, the wishes of the patient. Case Scenario Mary is a patient in the local hospitals Intensive Care Unit. Mary has a history of end stage COPD, lung cancer and renal failure. Mary is currently on life support via a ventilator. Knowing that her life would end due to her health complications, Mary had a living will and an Advance Directive written by an attorney in case that someday she would not be able to make her healthcare wishes be known. Mary did not name a Durable Power of Attorney in her living will. Mary’s family is aware of her wishes but thinks
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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
Any situation that erupts which can disturb the other residents is something that must be diffused immediately, as a healthcare administrator I would have to address this state of affairs with empathy and genuine concern for the opinions of the family members not in agreement with the do not resuscitate (DNR) order. First, I would ask that we move to a private location where we could speak and if voices are elevated it would not interfere with the day to day operation of the nursing home. Second, I would ask to see the Power of Attorney if it is available to speak to the legality of the document. Provided that, all the previous terms set in place are up to par, I would directly talk about the statement made about the family member making me aware of her position with the Department of Health and Human Services. Moreover, going through the document to point out the date signed, to make note if the new resident signed it before here memory was too far gone and if the Power of Attorney would not be substantial. Then I’d call attention to the difference between a Power of Attorney and Durable Power of Attorney. Grammarly states, “The biggest difference is in when the power ends. A general power of attorney ends when a person becomes mentally incapable because of sickness or injury to handle his or her own affairs… To get a durable power of attorney, you must show in the
A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.
Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.
As a patient advocate, the nurse should engage in multidisciplinary support to help family understand the legal aspects and obligation of the power of attorney in making life end decisions and the legal obligations of the Advance Directives. Nurse must be firm in stressing these considerations to family so they may realize the full legal and ethical implications of their decisions.
Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the
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).
In the US state laws allow a person to make decisions when it comes to their own healthcare. Most states are different but all include a Power of Attorney or Medical Power of Attorney and a Living Will. Power of attorney allows a person to give another person the power to make decisions when the persons healthcare. Living Will is a document that is in writing that explains what medical treatment a person wants if they are unable to express it.
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
Every seriously ill patient and their family should have decided the following issues: proxy, resuscitation, hospitalization, and specific treatments. Every seriously ill person needs to have pointed out a person to speak on their behalf when they get too sick to do so. A “proxy” can be filled out at any hospital or nursing home granting “power of attorney” to a loved one to be able to make decisions. A person
This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brain hemispheres which has left her unconscious and unable to make medical decisions for herself. She only has some brain stem reflexes and requires a ventilator for life support. Mrs. Smith did not set up an advanced directive, which is defined by Miracle (2011) “mechanism by which individuals make known how they want medical treatment decisions made when they can no longer make them for themselves” (p.229). Without an advanced directive, medical decisions will fall to Mrs. Smith’s children, Sara and Frank. Each of which have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life with continued medical intervention, as Sara would like to do, or stop all treatments and care, as Frank
With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient
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.
The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.
Primary health care evolves from the economic, cultural, social, and political conditions of a country, and it is described as an essential part of health care that is universally provided to individuals in a community at the country's and community's expense (World Health Organisation [WHO], 1978). The goal of primary health care is to address the main local health problems, but it involves community education about these problems in addition to providing disease treatments (WHO, 1978). Furthermore, primary health care is concerned with nutrition promotion, sanitation standards, family planning, immunisation, disease control and prevention, and it promotes and relies on community and individual participation in primary health