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Patient centered care in nursing
Essay on patient centered care
Role of palliative care in dying patient
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Palliative care encompasses advanced care planning, legal issues, and ethical decisions which help ensure that the patient maintains their autonomy (Buttaro, Trybulski, Bailey & Sandberg-Cook, 2016). The problem of advanced planning should be discussed with every adult patient with the first exam and then yearly. (Buttaro et al., 2016). Knowing what the patient’s wishes are and having affairs in order is important for every family to have a plan for when the time comes. The Terri Schiavo court battle that brought patients’ rights for an end of life, palliative care and persistent vegetative states and how life and death are determined (Caplan, 2015). There is no standard to how the end of life decisions is made and living wills, and advance directives are not common place for everyone (Caplan, 2015). Palliative care can offer the patient and their family an improved experience in end of life care with patient-centered care (Buttaro et al., 2016). The beginning is understanding what the patient's wishes, which is best achieved with the patient before any disease processes make the patient unable to participate (Buttaro et al., 2016) are. …show more content…
Palliative care encompasses “physical, psychological, social and spiritual distress of the patient and the family (Buttaro et al., 2016, p.
XXX). The services can manage a patient comprehensively for chronic medical issues (Buttaro et al., 2016). The trend is to offer palliative care in the patient’s home before hospice services begin in the hopes to keep the patient home and comfortable as long as possible (Hammond, Zimmermann & Sheehy, 2013). I my hospital hospice and palliative care are the same departments they work together to holistically treat patients and attend clinical rounds to involve themselves in all patients that would benefit from their
service. The timing for the discussion on an initial visit should be up front after the review of systems and history and physical. A certain level of trust and communication should occur before the conversation, so there is a developing relationship. The discussion of for an established patient should be dynamic during the debate on the treatment pain and during the exam to take advantage of those teachable moments when you sense it can have the best impact. I have not been involved during an office visit; my experience is unfortunately only in the ICU when it is too late for the patient to be involved. I watched families anguish and fight over what their loved one would want and who is allowed to make this decision. After all of the family drama and anxiety, I strongly advocate all adults make their wishes known in a written form and designate who gets to decide. Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2016). Primary care: A Collaborative practice (5th ed.). St. Louis: Elsevier Mosby. Caplan, A. (2015). Ten Years After Terri Shiavo, Death Debate Still Divides Us: Bioethics. Retrieved from: http://www.nbcnews.com/health/health-news/bioethicist-tk-n333536 Hammond, B., Zimmermann, P., & Sheehy, S. (2013). Sheehy's manual of emergency care. St. Louis, MO: Elsevier/Mosby.
As we get older and delve into the real world, it is important to start thinking about end-of-life care and advance directives. Although it is something no one wants to imagine, there is an absolute necessity for living wills and a power of attorney. Learning about the Patient Self-Determination Act and the different legal basis in where you live is important because it will help people understand why advance care directives are so important. Although there are several barriers in implementing advance care directives, there are also several actions that healthcare professionals can take to overcome these obstacles. These are also important to know about, especially for someone going into the medical field.
Currently, in the United States, 12% of states including Vermont, Oregon, and California have legalized the Right to Die. This ongoing debate whether or not to assist in death with patients who have terminal illness has been and is still far from over. Before continuing, the definition of Right to Die is, “an individual who has been certified by a physician as having an illness or physical condition which can be reasonably be expected to result in death in 24 months or less after the date of the certification” (Terminally Ill Law & Legal Definition 1). With this definition, the Right to die ought to be available to any person that is determined terminally ill by a professional, upon this; with the request of Right to Die, euthanasia must be
We consider the legislation consistent with the principle that "respect for that person [who is capable of participating] mandates that he or she be recognized as the prime decision-maker" in treatment. [2] The patient is a person in relationship, not an isolated individual. Her or his decisions should take others into account and be made in supportive consultation with family members, close friends, pastor, and health care professionals. Christians face end-of-life decisions in all their ambiguity, knowing we are responsible ultimately to God, whose grace comforts, forgives, and frees us in our dilemmas.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
The first journal article is about advance care planning (ACP) in palliative care. This is of interest due to several clinical experiences and the realization that many families either ignore the patient’s request for end of life (EOL) care or who have no idea of how to plan for EOL care. By reading the research and understanding the methods used, this will allow for insight into how to implement palliative care into clinical practice across different sites. The authors of this original research are Jeanine Blackford PhD, RN, senior lecturer at La Trobe University in Australia, and Annette Street PhD, associate dean of research and professor of cancer and palliative care studies. According to Blackford & Street (2011), this research is important as there are many countries that “report a low percentage of people who have completed an advance care plan” (p. 2022), and ACP is needed upon admission to facilities that offer palliative care.
End-of-life care in the United States is often fraught with difficult decisions and borne with great expense. Americans are often uncomfortable discussing death and
Palliative care - treatment that helps to comfort patients, while slowing the progress of a disease.
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
While navigating the abundant and sometimes confusing legal language of advance directives can be time consuming, it would benefit every person to consider their end of life wishes and have some form of written statement available for their doctor and family to understand those wishes. Doing this in advance can prevent emotional anguish, suffering and expensive litigation. In the end, clearly and when possible, written, documentation of a medical directive, a living will, or a chosen health care power of attorney will lessen the burden for the medical professionals and family of a dying or incapacitated person.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Any discussion that pertains to the topic of euthanasia must first include a clear definition of the key terms and issues. With this in mind, it should be noted that euthanasia includes both what has been called physician-assisted "suicide" and voluntary active euthanasia. Physician-assisted suicide involves providing lethal medication(s) available to the patient to be used at a time of the patient’s own choosing (Boudreau, p.2, 2014). Indifferently, voluntary active euthanasia involves the physician taking an active role in carrying out the patient’s request, and usually involves intravenous delivery of a lethal substance. Physician-assisted suicide is felt to be easier psychologically for the physician and patient than euthanasia because
Today, most states have some laws that allow patients to make informed decisions about how they wish to die. Almost every state allows one to have a living will. This simply states that if one is surviving via ...
Palliative care “focuses more broadly on improving life and providing comfort to people of all ages with serious, chronic, and life-threatening illnesses” (http://www.WebMD.com). Palliative care is not the same as hospice, since it is not only for the dying. According ...