Describe the role of the nurse in end-of-life decision making with patients and their families.

Assessment 3 Brainstorming

 

Instructions

 

Your manager asked you to prepare an article for a community newsletter for a local retirement village.  The editor wants you to talk about the laws, policies, and choices surrounding end-of-life health care decisions.

 

Preparation

Search for scholarly and professional peer-reviewed articles on end-of-life care.  You will need at least three articles to use as support for your work on this assessment.

 

Directions

Write an article of 750 words (3 pages) that discusses the laws, policies, and choices surrounding end-of-life health care decisions.

Address the following in paper:

• Describe the role of the nurse in end-of-life decision making with patients and their families.

 

• Explain the legislation that generated end-of-life health care policies.  Was the legislation an outcome of a specific medical case?

 

• Identify the primary policies regarding current health care practices related to end-of-life health care decisions.  How to these policies affect treatment decisions?

 

• Explain the effect of end-of-life regulations and controls on patient outcomes.  What effect does this have on the nurse-patient relationship?

 

• Describe the ethical considerations that have influenced policy decisions in regard to end-of-life decisions.

 

Additional Requirements

Your article should meet the following requirements:

• Written communication: Written communication should be free of errors that detract from the overall message.
• References: Cite a minimum of three resources; a majority of these should be peer-reviewed sources. Your reference list should be appropriate to the body of literature available on this topic that has been published in the past 5 years.
• APA format: Resources and citations should be formatted according to current APA style and formatting.
• Length: 750 words or 3 typed, double-spaced pages, excluding title page and reference page. Use Microsoft Word to complete the assessment.
• Font and font size: Times New Roman, 12-point.

 

 

 

Grading Points

 

1. Describes the role of the nurse in end-of-life decision making with patients and their families, and identifies strategies for an effective process.

The role of the nurse is to educate, inform, answer questions, allow the family to make THEIR decision.

(Skilled) nurse

Advocate

Guide (through the process of dying)

 

• Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.
• What do patients & families want for care at end of life
• Truth
• Touch
• Time
• Pain mgmt.
• Family involvement
• Care at home
• Education-what to expect/happen when death is near
• Opportunity to say goodbyes
• Recognized and treated like a person while dying

 

2. Identifies the primary policies that define current health care practices in regard to end-of-life health care decisions, and explains how the policies have changed the way health care professionals work with patients.

 

3. Explains the effect of end-of-life regulations and controls on patient outcomes and why it is important to make end-of-life decisions with a health care professional.

Succession of responsibility

Legality

Control of emotions

Communication is clear…of wants/needs/desires…when unable to speak for self

Stops disagreement among family members

Without planning…care can be expensive (costly)

 

 

4. Explains the legislation that generated end-of- life health care policies and includes a brief summary of why these laws were passed.

 

5. Describes the ethical considerations that have influenced policy decisions in regard to end-of-life decisions and illustrates with real-world examples.

 

Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care (2nd ed.). Indianapolis, IN: Sigma Theta Tau International

 

Healthcare ethics  (also called bioethics  or medical ethics ) is the “study of moral obligations of health care providers and society in preventing and treating disease and injury and in caring for people with illness and injury” (Berry, 2005, p. 263).

The most common healthcare ethics framework is based on four principles (Butts & Rich, 2007):

 

❖ Beneficence: the obligation to act for another’s benefit. In end-of-life care this means looking at the benefits and burdens of a particular action or treatment. For example, is the treatment going to relieve pain and suffering but place a heavy burden on the family trying to care for the patient at home?

❖ Nonmaleficence:  the obligation to “do no harm.” In end-of-life care, it involves looking at the harm a treatment or course of action might cause. Is the treatment going to prolong the patient’s dying without increasing quality or comfort?Chapter 13

❖ Ethical Issues in End-of-Life Care 157

❖ Autonomy: based on a person’s right to choose independently. In end-of-life care, the right to choose also means the right to refuse treatment. ❖ Justice: encompasses fair and equitable treatment. It can also have a broader meaning in looking at the best use of limited resources.

 

6. Writes clearly and logically, with correct use spelling, grammar, punctuation, and mechanics, and uses relevant evidence to support a central idea.

 

7. Correctly formats citations and references using APA style. Citations are free from all errors.

 

My professor is brutal with the APA formatting

 

 

References

Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.

Hebert, K., Moore, H., & Rooney, J. (2011). The nurse advocate in end-of-life care. The Ochsner Journal, 11(4), 325–329.

Lewis, K. (2013). How nurses can help ease patient transitions to end of life care. Nursing Older People, 25(8), 22–26.

Lund, S., Richardson, A., & May, C. (2015). Barriers to advance care planning at the end of life: An explanatory systematic review of implementation studies. PLoS One, 10(2).

Aoun, S., O’Connor, M., Skett, K., Deas, K., & Smith, J. (2012). Do models of care designed for terminally ill ‘home alone’ people improve their end-of-life experience? A patient perspective. Health & Social Care in the Community, 20(6), 599–606.

Nakano, K., Sato, K., Katayama, H., & Miyashita, M. (2013). Living with pleasure in daily life at the end of life: Recommended care strategy for cancer patients from the perspective of physicians and nurses. Palliative & Supportive Care, 11(5), 405–413.

Adams, J. A., Bailey, D. E., Jr., Anderson, R. A., & Docherty, S. L. (2011). Nursing roles and strategies in end-of-life decision making in acute care: A systematic review of the literature. Nursing Research and Practice, 2011.

American Nurses Association. (2010). Position statement: Registered nurses’ roles and responsibilities in providing expert care and counseling at the end-of-life ethics and human rights. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/etpain14426.pdf

Giovanni, L. A. (2012). End-of-Life Care in the United States: Current Reality and Future Promise – A Policy Review. Nursing Economic$, 30(3), 127-135.

Abood, S. (2007). INFLUENCING HEALTH CARE IN THE LEGISLATIVE ARENA. Online Journal Of Issues In Nursing, 12(1), 5.

Other Resources

American Medical Association Code of Ethics (http://www.ama-assn.org/ama/pub/ physician-resources/medical-ethics.page) includes a physician’s guide, along with frequently asked questions regarding ethical issues, including issues around end-oflife decision making.

Self assessment (http://www11.georgetown.edu/research/gucchd/nccc/ foundations/assessment.html) is an essential aspect of culturally competent care. Self-assessment tools for healthcare providers are found here.

United States Department of Health and Human Services (http://www. thinkculturalhealth.org) offers nursing modules for culturally competent care.

How should nurses manage patients whose end-of-life decisions may run contrary to their personal beliefs and values?

Try to understand the patient and family…meaning of treatment/illness/goal

Seek support from other team members

Ethics Committees

 

How can nurses influence new policies, laws, or legislation regarding end-of life decisions?

Abood, S. (2007). INFLUENCING HEALTH CARE IN THE LEGISLATIVE ARENA. Online Journal Of Issues In Nursing, 12(1), 5.

 

Advocate

Power in numbers

Get involved in government/process

What are some of the most difficult decisions patients and families have to make at the end of the patient’s life?

Starting the grieving process before the loss occurs

Taking the opportunity to talk about those “socially inappropriate” planning aspects with the person that is dying

Failure to reach acceptance of the condition