Decision making essay resit: To support discharge home for end of life care. This essay aims to look at the authors role (a third year student nurse on an elderly ward) in regards to a decision making scenario in which an eighty six year old lady is severely unwell and the decision to support discharge home for end of life care needs to be made. The decision to discharge Barbara home was to be decided upon by the multi-disciplinary team (MDT) and therefore this essay will look into how the decision was made, the role of the author and team as well as the factors that facilitated the decision. It will explore a range of decision making models before identifying the one used (cognitive continuum) and evaluating whether or not it was …show more content…
At a recent yearly routine appointment to dilate her urostomy she was informed that she had kidney stones and was awaiting further guidance. After arriving in A&E blood tests and further assessments were completed and it quickly became clear Barbara had a kidney infection, fluids and antibiotics were administered. Two days after admission Barbara showed no signs of improvement and continued to slip in and out of consciousness, at this stage the family were told to prepare for the worst. After Barbara was diagnosed with bladder cancer herself and husband Peter both decided to include do not resuscitate forms (DNR) as part of their will. It was stipulated that if Barbara was going to die Peter wanted her to be at home surrounded by family and friends. This was something that he and the family said Barbara would have wanted. Due to Barbara deteriorating quite quickly the ward sister held an emergency MDT meeting and it was agreed that they would aim to get Barbara home by the following day. This aim was met and two days later Barbara passed away peacefully at home in her sleep. In order for Barbara to return home a variety of decisions had to be made. The aim of these important decisions being to promote positive patient outcomes (Benner, Hughes and Sutphen, 2008). Standing (2014) reports that learning skills and knowledge used within nursing should not be secondary to developing decision making skills, and that in theory decisions should be
The main theme identified in this research focused on the Hospital readmission rate that has gained increasing attention because it reflects the effectiveness of healthcare system performance and the quality of patient care. The five articles studied all highlighted that an effective discharge planning is crucial to improve continuity of care between hospital and home/elderly home so as to improve patient’s health and reduce patient readmission. The themes that emerged described discharge planning in the hospital as pivotal in the continuing care of people who are in need of medical, social and rehabilitation care. Additionally as the needs of patients increase and become more complex, it is also important that an effective discharge planning system should have the capacity to discriminate and respond to different levels of need for coordination and post-discharge care (Central, 2012).
There are some ethical dilemmas evident in this scenario, starting with an End of life dilemma, refusal of care and informed consent.“End of
This assignment will critically analyse and justify the decisions based around a fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate clinical decision making skills in the care planning process. The patient’s condition will be discussed in-depth explaining the pathophysiology, social, cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed and
Many families considering next care site options are not prepared and in need of some type of direction. Families may not know the range of available options or understand the benefits of each or have well-thought-out plan for therapeutic goals. The Case manager should be the advocator and organizer for their patients. Making a good long-term care decision requires proper information, but one must realize such decisions are often made during a stressful period as part of a hospital discharge. Case management intervention and guidance is well suited for this role. The case managers have two major roles in these transitions: one to ensure the continuous delivery of care and secondly to advocate to ensure decision making is in the best interest
This essay will discuss issues that nurses have to consider when caring for a person that either lacks or have compromised capacity. At the same time, the author will explain important terminology in the essay such as the meaning of consent, capacity, best interest, Deprivation of liberty, advanced decisions, risk assessment, including several examples from experience during placement
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
This assignment will discuss and examine an account of care given to an elderly male, who has recently turned eighty years old. He has lived in a nursing home for two years, in the North-West region. In accordance with the Nursing and Midwifery Council (NMC, 2015, p.6), this resident will be referred to as Johnny (Murphy) to maintain confidentiality and ensure patient anonymity regarding his identity. For the consent to be valid, it must be informed, voluntary and the patient must understand what the participation involves (Hardicre, 2014). As Johnny has early stage Lewy Body’s Dementia and lacks full capacity to consent, his Independent Mental Capacity Advocate (IMCA)- his daughter, has given verbal consent to utilise his personal clinical
According to Mary Gillespie nurses do range of thinking process before making a decision in the clinical settings. It is subjective and is made on the basis of data collected by various assessments (Gillespie M. , 2014). This assignment gave us opportunity to study and analyze a case study where we witnessed the effects of clinical decision making directly on a patient’s health. Through this case scenario we see the main factors that influenced Kathy’s clinical decision making are assessments, personal knowledge, previous experience, collaborative practice, information from family, and most of all ethics.
The purpose of this assignment is to explore the psychological and sociological factors that influence health choices. As a Trainee Assistant Practitioner (TAP) on surgical ward, clinical experiences will be used in addition to academic resources in order to explore the major psychological, sociological and social-economical influences on health and well being on a patient with Alzheimer’s. An explanation of communication and barriers to communication will be given and how it can affect the therapeutic relationship between the TAP and the patient. Confidentiality and anonymity will be maintained throughout the essay by following the Skills for Health and Skills for Care (2013) Code of Conduct for Health Care Support Workers.
Transformational Leadership Theory as a Guide. My leadership philosophy closely mirrors the transformational approach to leadership. Like the transformational theory suggests, I believe that true leadership inspires the team to rise above its individual components in order to reach a shared goal (Huber, 2014). Some of the individual components are areas that I have personal strength in such as: desire to learn and ability to get the job done (Rath & Conchie, 2008). Additionally, some of the components are the ability to influence and connect with others; strengths that I do not possess (Rath & Conchie, 2008). Recognition of my own personal strengths and weaknesses led me to a democratic philosophy of leadership because I realized that one
Transformational Leadership, is grounded on building relationships and motivating staff members through a shared vision and mission. Transformational leaders naturally have charisma to communicate vision, confidence to act in a way that inspires others, staff respect and loyalty from letting the team know they are important, and are masters at helping people do things they weren’t sure they could do by giving encouragement and praise.
Further characteristics of transformational leadership include concern for others, relationship building, communication, innovation, and other positive rapport building, leadership characteristics and values. Relationship building, communication strategies, and innovation have significant meaning for SAHC leadership who has the responsibility to form partnerships and coalitions to advance goals with workers. A leadership style that complements the values and principles of the individual leader and supports the culture of the organization, candid cognizance and comprehension of their own principles and philosophies, self-assured, and dependable signifies effective leadership (Avolio & Gardner, 2005; Gardner, et al., 2005; Smith et al., 2010). Effective leaders display competency, trustworthiness, performance abilities, and ability to motivate employees to adopt these same characteristics (Zubair & Kama, 2015).
Effective nurse participation in the discharge planning process facilitates successful patients discharge from hospitals. The perception among nurses that discharge planning requires a set of activities requiring time commitment contributes to delays in discharges. Therefore, the nurses are always more concerned about taking time away from the immediate nursing care responsibilities. Therefore, the nurses should be made to realize that discharge planning involves being aware of long term medical care needs, taking the time to educate and help family members understand what is required after discharge as well as communicating effectively with caregivers. There are various aspects of coordination and implementation of a discharge that require a considerable amount of time and the nurses are often reluctant to commit themselves thinking that the process will consume much of their time. As such, the nurses normally find it difficult to present relevant patient issues during medical rounds as well as introduce new problems in the discussions regarding patients’ welfare. Improper documentation of the communication between nurses
Discuss three leadership attributes this person possessed AND provide specific examples you witnessed when these attributes were used to demonstrate effective clinical leadership
The first problem with Holland Community Hospital is their inadequate organization of services when discharging patients, stemming from a lack of preparation. The biggest organizational issue is the shortage of hospital beds in the institution. These beds serve to provide a place for patients to recover and prepare for their discharge. The disparity that is often encountered in hospitals is the need to serve an increased number of patients while reducing bed numbers in an effort to move more people in and out of the hospital. (Maloney, Wolfe, Gesteland, Hales, & Nkoy, 2007). Limited bed allotment has contributed to the accelerated need for the hospital to discharge Mr. Mitchell and is supported by a member of the medical staff explaining, “It’s busy in the ER this afternoon, and we need a bed.” (Scales & Wolfer, 2006, p. 104). The hospital’s pushing of the discharge process in an effort to free bed space, leaves Diana and the other social workers little time to fully create a plan that will make the transition from hospital to home much more manageable. In justifying Mr. Mitchell’s expedited discharge through the need for bed space the hospital has placed its needs above the patient’s in an effort to secure resources. HCH is experiencing many power struggles the first of which being who has authority and responsibility for discharge. The scare resource of beds has caused an influx in power in where the hospital