Advance Care Planning Analysis

Could you imagen dealing with terminal illness and, the health care providers does not show strong grasp on respecting your wishes to have a peaceful death. Working as a nurse in long term care, and observing older patients’ end of life experiences from different prospective, I realized that death and dying are very complex issues and not always well addressed by the our health care system. People in long term care express fear of losing control over their lives, and express concerns about possible long and painful end days of their lives. Nurses express moral distress and struggle in their understanding of end of life care and express unpreparedness to engage in the process of advance directives. Advance care planning (ACP) is an international

concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care (L. Thoresen et al, 2016, p. 1).
Nature of the Issue
Advance care planning is a “process of reflection and communication in which a capable person makes decisions with respect to future health and/or personal care in the event that they become incapable of giving informed consent. The process may involve discussions with health care providers and significant others with whom the person has a relationship” (Health Canada, 2008). Nurses play an important role in patient care. They interact with patient and families on regular bases to discuss their choices and their plans about future care. However, nursing literature reveals the discipline of nursing, have variable or limited participation in ACP practices (Badzek et al., 2006; Baughman et al., 2013; Baughman et al., 2012; Ceccarelli et al., 2008; Stewart et al., 2011; Yee et al., 2011; Zhou et al., 2010). In many cases, the discussions regarding end-of-life care often comes too late and the patient is not able to make their own decisions (Lachman, 2010).

Article annotation
https://journals-scholarsportal-info.librweb.laurentian.ca/pdf/09697330/v21i0001/53_naoteipacp.xml
This paper will discuss the advance care planning and role of nurse. The article I choose from the Laurentian library database is “Narrative analysis of the ethics in providing advance care planning” published in the journal “Nursing Ethics” 2014. The purpose of the article is to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging (Baughman et al., 2014, p. 54)
The article I choose is a secondary data analysis of a larger qualitative study (Baughman et al., 2014, p. 54). Baughman et al. (2014) study, led to the identification of a recurring theme of conflict between professional and moral responsibilities related to ACP for nurse (n = 25) and social work (n = 37) care managers working in the community. In this study it was identified that the nurses and social workers felt a substantial responsibility to meet and support the diverse needs of their community-based patients when planning for future anticipatory care (e.g., health, finances, and social supports). The care managers felt their limited “knowledge and training” in ACP compromised their ability to implement ACP with their patients (p. 57). I like the positive attitude of health care workers expressed in the article, despite the conflict with the care perspectives of others involved in anticipatory care planning (e.g., family members, care managers), patients have the right to decide for themselves what their wishes for care will be and that right needs to be respected (Baughman et al., 2014, p. 57). The article is important for nurses and other health care workers involved in advance care planning of individuals.

The themes of the humility, respect for the values, moral and professional responsibilities, boundaries initiated by care managers, empowerment, courage and the advocacy of veracity are discussed.(Baughman et al., 2014, p. 56) throughout the article.
Position statement annotation:
Canadian Nurses Association (2008). Position statement on Providing Nursing Care at the end of life. http://tools.hhr-rhs.ca/index.php?option=com_mtree&task=att_download&link_id=7966&cf_id=68&lang=en
The CNA position paper on providing nursing care at the end of life defines the nurses’ role by “foster comfort, alleviate suffering, advocate for adequate relief, of discomfort and pain and support a dignified and peaceful death. This includes support to the family during and following the death” (CAN, 2008, p. 1). The main points made are that the nurses should provide quality end-of life care to dying person and their families by applying a holistic approach, incorporating with patient’s priorities, values and choices in all aspect of care (CNA, 2008). Moreover, the paper emphasizes nurse’s knowledge of legislation, ethical and practical issues. I like how information is provided in the about the significant improvement been made in the provision of end-of life care to all age groups in Canada and the importance of supporting the patient’s decision by imperial, informative discussion with the health care-team. This position paper is very important paper for nurses involved in patient care and end of life care to provide safe, compassionate, competent and ethical care.
Compare and contrast of articles:
Both articles relate to issue of Advance care planning and nurses role.

Baughman et al ‘s article focused more on community based setting and care planning of older adults it emphasis on nurses ethical dilemma dealing with advance directives due to lack of knowledge and training( p. 57),on the other hand, the position statement form CNA reflects all age groups nursing values and need to seek education or support (p. 2). Both articles elaborate need of education for nurses in the field of Advanced Care Planning and improve patient’s autonomy. CAN statement emphasis on advocacy and symptom management in palliative care and Baughman. et. Al’s article expresses care managers working with patients in the community described “a common feeling of discomfort, fear, or inadequacy” (p. 59); lowers psychological and financial burden and serves the interests of patients, families and medical care providers, alike. Timely advance care planning allows health care providers and patients to effectively plan patients’ desired care and satisfy their end of life needs, such as dying with

dignity.
Nursing Implications:
As mentioned by Canadian Nursing association “nurses witness life-prolonging treatment that seems inherently wrong but which they feel powerless to change and often perceive that their voices are not heard in discussions about these situations”(CNA, 2015.

P. 5). The CNA code of ethics (2008) provides important guidance for nurses caring for individuals at end of life. CNA emphases on providing the person’s informed consent and person’s right to refuse or withdraw consent for care or treatment at any time” (C4, p. 11). It focus on to relieve pain and suffering including appropriate and effective symptom and pain management, to allow persons to live with dignity” (D8, p. 14) and nurses to foster comfort, alleviate suffering, advocate for adequate relief or discomfort and pain and support a dignified and peaceful death. This includes support of the family during and following the death, and care of the person’s body after death” (D9, p.

14).

The discipline of nursing is a major part of the interdisciplinary team providing direct clinical care to patients (Canadian Nurses Association, 2008), nurses plays intergral part in meeting the advance care planning needs of various patient populations (Baughman et al., 2013; Ceccarelli et al., 2008; Minto & Strickland, 2011; ; Zhou et al., 2010). Despite of that, nurses hesitant to participate in advance acre planning due to lack of comprehensive knowledge in the “meaning, scope and associated administrative processes” of ACP (Boddy et al. 2013, p. 42), limited “knowledge and training” (Baughman et al. 2014, p. 57), nurse’s limited involvement in related discussions with patients, lack of institutional support, lack of time and discomfort with the topic (Spoelhof and Elliot 2012.) are some other barriers in ACP.
Conclusion
A number of organizations have recognized that there is a clear role for nursing in the advance care planning process in Canada (Canadian Hospice Palliative Care Association, 2012; Canadian Nurses Association, 2008; RNAO, 2011) More specifically, a large aspect of this is that nurse’s deal with emotions generally described or identified in some way as difficult or distressing when involved in planning for future clinical care with patients and families (Baughman et al., 2014).
Research show that the completion of ACP is less common among some cultures compared to the majority population (Johnstone & Kanitsaki, 2009; Maciejewski et al., 2012). Managing cultural beliefs and values at the end of-life is a significant indicator for the quality of care and quality of death that patients and families experience. Cultural and religious beliefs play