Question: An explanation of the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families. Explain how you would approach a family who wants “everything” done for a patient with only a limited time to live. Then, explain when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services. Finally, explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family. We are in a unique position to guide patients and their families through an increasingly complex health care system toward the goal of a “good death” one that is comfortable and self-determined.
An explanation of the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families
With the aging of the US population, the number of seriously ill patients with complex conditions is expected to rise and the overwhelming majority of deaths occur among the older adult population. Older adults typically die slowly of chronic diseases, with multiple coexisting problems, progressive dependency on others and heavy care needs that are met mostly by family members. The dilemma of end-of-life care becomes a crucial issue for the advance practical nurses. As a nurse practitioner, we have a crucial role in facilitating end-of-life care discussion with patients and families. It is not that easy to explain to them about hospice or comfort measures. A lot of patients and families have misconception about end-of-life care. They are thinking about the literal word of killing or giving up someone’s life. We are here to assist elderly patients with their advanced chronic illness and their families as they experience the final phase of life. We are here to serve the patients and family members caring for patients to promote excellent communication with family, encourage appropriate advance care planning and decision making, support home care, demonstrate empathy for family emotions and relationships, and attend to family grief and bereavement (Rabow, 2004). We should have the ability to listen which is the most valuable skill that can be used and allow them the opportunity to tell “their story.” End-of-life issues are very sensitive. That is when we are all most vulnerable, cared and thinking of what we did or did not do in our lifetime. NPs who can be empathetic and “be” with the patient at this very important time will have one of the most rewarding experiences of their career (Knox, 2010).
The value of the advanced practice palliative nursing role extends beyond specialized and expanded knowledge, critical thinking, and evidence-based practice to enhanced communication skills that facilitate direct patient care through informed decision-making, patient and family education, and psychosocial-spiritual care. Nurses have the communication skills necessary to engender trust and draw patients and their families into a partnership of care. Their commitment to quality and safety motivates them to continuously improve the care they provide and make valuable contributions to the interdisciplinary team (Yeager, 2014).
The interdisciplinary team helps ensure that the right care at the right time and in the right place is going to happen for the person. The NP often calls on the case manager, social worker and chaplains to assist with identifying and meeting the critical needs in a timely manner. As a nurse practitioner in palliative care, we need to be skilled in communication, diagnosis, treatment and pharmacology, and they need to counsel and support patients and families emotionally. Providing pain and symptom management and addressing patient suffering are important parts of the role (Knox, 2010).
Explain how you would approach a family who wants “everything” done for a patient with only a limited time to live
The amorphous relationship between practitioners and the families of patients at the end of life presents both challenges and opportunities for which nurse practitioner’s may be unprepared. Families play important roles in the practical and emotional aspects of patient care and in decision making at the end of life. At the same time, family members may carry significant burdens as a result of their work. The discussion of death and dying is one that most people and also most healthcare professionals find very difficult to talk about. As a nurse practitioner, I would be more empathetic and be a good listener on their feelings about the situation. I will let them tell their stories, verbalized their feelings and thoughts and find the reason why they want everything done for the patient. Being a good listener and empathetic to their feelings will help them be more comfortable in discussing the prognosis of the patient. I will respect their opinions but at the same time I will explain to them thoroughly the minimal benefits that the patient could get if will do everything for him. I will be more realistic to them and show them the outcome if patient will go for an aggressive treatments. I will make a reasonable effort to clarify their doubts, questions, and communicate with them the risk and its potential benefits. Considering the patient’s advanced age and poor prognosis, I will have them a clear understanding of the patient’s prognosis and the pros and cons of doing everything for the patient like CPR. Although all patients who require CPR have severe acute illness by virtue of needing CPR, there may be differences in the type or severity of the acute illness leading to CPR that could influence outcomes. I will emphasize to them the minimal benefits that the patient gets from such procedures and at the same time I will explain to them the advantages and benefits that the patient gets from palliative care and the quality of life that he would have on his last days of his life. The final months of the patient is the most precious one and we want the patient to spend the rest of his life in a comfortable and peaceful way of living (Ehlenbach, et al, 2009).
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