Suzie's Therapeutic Relationship With Vivian

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

This essay will discuss the importance of communication as an aspect of partnership within current nursing care. As stated by Brooks and Heath (1985, as cited in Bramhall, 2014), communication is “a process during which information is shared through the exchange of verbal or non-verbal messages” (p 53). Maintaining communication between the nurse and the patient regarding treatments and emotions contributes to improved patient-centred care. The communication between the nurse and their family is equally as important when the patient is unable to make medical decisions for themselves. With the implementation of family centred communication, a partnership can further be established. With reference to literature, the benefits of maintaining

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

Although nurses have their experience to guide their practice, as the health professional most involved with the client at the end of life, there is a need for review of current assessment tools and management strategies to ensure the care given is evidence based and best practice.

Nurses: Assist the patients and families to cope with the end-of-life process such as assessing and

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.”

Effective communication among nurse and patient/family can improve care and relieve suffering. The diagnosis and treatment for cancer is a major challenge and it affects all aspects of life. By therapeutic communication, providing information, encouraging optimistic outlook, teaching how to reduce stress patient care will have better outcomes. (Yarbro, Wujchik, & Gobel,  2010).

When caring for a terminally ill patient, each member of the health care team contributes in providing end-of-life (EOL) care. In order to know our role in the care, it is important to understand the legal rights of the patient. In 1991, the United States legislated the Patient Self-Determination Act (PSDA) in regards to EOL decision-making. According to our textbook, the PDSA “relies on state laws related to EOL care and was designed to encourage communication about end of life issues” (Grace, 2013, p. 123). This act helps ensure that patients receive adequate information regarding advanced directives and offers protection of their right to self-determination in health care decisions (K, 1992).

According to the Journal of Nurse Practitioners (2009), one common nursing diagnosis related to end of life care is ineffective family coping related to prolonged disease/disability progression that exhausts the supportive capacity of significant persons. Some nursing interventions that can be employed towards this diagnosis are 1. Determine the level of impairment of perceptual, cognitive, and/or physical abilities of the patient. 2. Evaluate illness and current behaviors that are interfering with the care of the patient. 3. Establish rapport and acknowledge difficulty of the situation for the family. 4. Involve significant other in information giving, problem solving, and care of patient as feasible. Instruct in medication administration techniques, needed treatments, and ascertain adeptness with required equipment, and 5. Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs (p.

It is important to educate patients and families about their terminal illness and end of life care. Knowledge of what to expect can decrease anxiety related to the patients expected decline and empower the patient and family to direct care to meet their needs. Knowledge also brings about understanding and acceptance of the death and dying process. Alleviating anxiety allows for a higher quality of life for the patient and higher satisfaction of care provided.

Incorporating education about patient death can provide emotional support for what is to come. Marilyn Smith-Stoner (2011) suggested that the most commonly taught curriculum, "Patient-centered care" is useful for nurses for coping with the event that they have a hospice patient. Patient-centered care (PCC) involves five dimensions: biopsychosocial, patient-as-person, sharing power and responsibility, therapeutic alliance, and doctor-as-person. Patient-centered care's focal point is communication. Skilled communication that includes descriptions of events, time for questions to be asked by the patient and family, for the nurse to listen to whatever they need at the time of death. "End of life care and communication that is patient centered may need to be accomplished in a short time frame of minutes to a few hours. Because the dying period can go so quickly, we need to educate healthcare workers and students in the unique needs of patients who are imminently dying" (Stoner, 2011). Proper education for proper communication benefits the nurse and the patient for a better and smoother end of life care. It prevents and reduces ethical complications during their

He immediately calls the resuscitation team and tries reviving her because he still sees her has a potential research subject, despite Vivian's decision to have the "do not resuscitate". As I reflect on what I've seen in this movie, I can say that, being a medical doctor is not all about the knowledge of every disease, or the making of a miracle drug. A doctor should see from different perspectives to truly understand their patients. This film taught me that saving lives is not merely preventing their hearts from stopping but letting them acquire the quality of life they need and deserve. As a nursing major, I will keep in mind the moral lessons of this film and will use it as a foundation to treat my future patients, and as to how I want to be treated by my doctors, especially with respect, empathy, and

Since the inception of the Patient Self-Determination Act (PSDA) in 1990, Modan and Brill (2014) stated that modification has been made to reflect the true intention of clarifying and protecting the patient’s wishes for his end of life care. However, despite the improvement in advanced care planning (ACP), Modan and Brill (2014) reported that public participation remains low. Moreover, due to the fact that ACP requires communication strategies, Modan and Brill (2014) also commented that there is a disconnection between the patient and providers – when health care workers tend to focus more on protocols than the patient’s experiences. Thus, to effectively engage the patient in ACP conversations, a nurse must look into his

This research article indicates addressing the communication problems in a hospital setting between the doctors, nurses and any other medical team member since effective communication is paramount with end-of-life care. Having effective communication with the patient and patient’s family members will improve the overall satisfaction of care during a loved one’s end-of-life care. In a time of a health crisis, the patient and patient’s family members may not be sure of what is going on or what is to be expected. They may not have enough knowledge about their diagnosis or comprehend the meaning. In the research most family members felt they had unfilled communication needs, had feelings of being a burden, left abandoned, felt a lack of trust

During the palliative care intake visit, the patient and family are questioned about advanced directives and life plans, setting the stage for further end of life discussions. Ideally, during the second and subsequent visits, the advanced care-planning process continues where the wishes, hopes, dreams, and desires of the patient begin to unfold. Within the registered nurse patient assessment are questions