NURS 6540:Week 11: End-of-Life Care  Essay Assignment Paper

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NURS 6540:Week 11: End-of-Life Care  Essay Assignment Paper

NURS 6540: Advanced Practice Care of Frail Elders | Week 11

I want to suggest you keep two things in mind: What would your mother want? And what’s the real prognosis if she goes to the hospital?

—Nurse practitioner

These were the words that opened Len Fishman’s eyes. Fishman’s elderly mother was moved to a nursing home after her dementia prevented her from caring for herself at home. After 2 years of “joyless” nursing home life, his mother had been diagnosed with pneumonia for the second time. The doctor gave Fishman two options—they could make his mother as comfortable as possible at the nursing home or send her for exploratory surgery, which would place her in an intensive care unit at the hospital. While struggling with his impending decision, a nurse practitioner at the nursing home shared her thoughts and wisdom with Fishman. The nurse practitioner’s questions made him focus on his mother’s wishes. His mother was able to spend her remaining days surrounded by her family (Fishman, n.d.). Like the nurse practitioner who helped Fishman with end-of-life care decisions, you must be able to communicate with patients and their families and provide support during difficult times.

This week you explore the role of the advanced practice nurse in facilitating end-of-life care and hospice discussions. You also examine outcomes for frail elder patients.

Learning Objectives

By the end of this week, students will:

• Analyze the role of the advanced practice nurse in facilitating end-of-life care discussions
• Evaluate when to recommend hospice services for patients
• Assess outcomes for frail elder patients
• Apply key terms, concepts, and principles related to end-of-life care
• Evaluate diagnoses for patients
• Evaluate treatment and management plans
• Evaluate the use of advanced directives in nursing practice
• Evaluate patient outcomes for frail elders receiving treatments for specialized areas of care*
• Evaluate the impact of environmental factors on decision making for treatment and interventions*
• Analyze strategies and resources related to supporting abused elders*
• Analyze the impact of culture on the prevalence, detection, and prevention of elder abuse*

*These Learning Objectives support Assignments that are due this week, but were assigned in Weeks 9 and 10.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

 

• • Chapter 16, “Palliative Care” (pp. 112-121)

This chapter describes factors impacting palliative care for older adults. It then explains the role of hospice in palliative care and examines health issues that commonly impact older adults in palliative care, such as pain, loss of appetite, and loud respiration.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

 

• • Chapter 14, “A Good Death: Appropriate End-of-Life Care” (pp. 175–186)

This chapter identifies aspects of a good death. It then examines pain management in older adults, including recommended treatments.

Alsop, A. (2010). Collaborative working in end-of-life care: Developing a guide for health and social care professionals. International Journal of Palliative Nursing, 16(3), 120–125.

 

This article examines end-of-life care concerns that must be addressed by health care providers. It also proposes strategies for addressing these concerns with patients and their families through a collaborative approach.

Ehlenbach, W. J., Barnato, A. E., Curtis, J. R., Kreuter, W., Koepsell, T., Deyo, R., & Stapleton, R. (2009). Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. The New England Journal of Medicine, 361(1), 22–31.

 

This article examines survival rates of elderly patients undergoing cardiopulmonary resuscitation (CPR) in hospital settings. It also compares the incidence of CPR among patients of different races and sexes.

McGowan, C. M. (2011). Legal Issues. Legal aspects of end-of-life care. Critical Care Nurse, 31(5), 64–69.

 

This article examines legal implications associated with end-of-life care. It also provides information about decision making and collaboration between patients, their families, and the medical team.

American Geriatrics Society. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Retrieved from http://www.guideline.gov/content.aspx?id=49933

 

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.

FamilyDoctor.org. (2012). Advance directives and do not resuscitate orders. Retrieved from http://familydoctor.org/familydoctor/en/healthcare-management/end-of-life-issues/advance-directives-and-do-not-resuscitate-orders.html

 

This website explores advanced directives, living wills, powers of attorney, and do not resuscitate orders. It also provides links to other related resources.

Hospice Foundation of America. (n.d.). Retrieved August 4, 2014, from http://www.hospicefoundation.org/

 

This website provides information related to end-of-life care. Hospice locations and caregiving resources are essential components of this website.

Discussion: Discussing End-of-Life Care

There is a human tendency to postpone uncomfortable or unpleasant tasks.

—Nancy Kummer, geriatric patient

This human tendency to avoid the unpleasant makes end-of-life care and hospice decisions difficult for many patients to discuss with their families. Kummer is a former social worker who used to counsel patients with terminal illnesses, yet she avoided discussing her own end-of-life wishes with her children. While many Americans, like Kummer, agree that these discussions need to take place, few have actually had these conversations with their families (Lazar, 2012). Although initiating conversations about end-of-life care and hospice might be difficult for patients, as an advanced practice nurse, facilitating these conversations is an integral part of your geriatric nursing practice. For this Discussion, consider how you would facilitate care conversations with the patients and families in the following case studies:

Case Study 1

Mrs. Sloan, a 69-year-old widow, is about to enter the hospital for an elective cholecystectomy; she is being medically cleared by her primary care provider. During the discussion, she requests to be placed on a no code status during her hospitalization. Mrs. Sloan claims that besides her gallbladder problem, her general health status is good. She wishes to have the surgery to avoid any further attacks, which have been very painful. She states, however, that if during surgery or her postoperative period, she undergoes a cardiac arrest, she would prefer not to be resuscitated. She has read about the chances of successful resuscitation, and has determined that the risk of brain damage is too high. For this reason, she is requesting a no code status.

Case Study 2

Ms. Stearns is an 83-year-old nursing home resident with hypertension, coronary artery disease, arthritis, renal insufficiency, hearing impairment, and a previous history of stroke. She also has a foot deformity from childhood polio. She is disoriented at times. She has lived in the nursing home for 10 years and rarely leaves the chair beside her bed. She has recently developed urinary incontinence, but has refused a bladder catheterization to determine postvoid residual urine or possible bladder infection. She does not have a diagnosis of dementia; however, current testing reveals that she performs poorly on a standardized mental status examination. She can, however, identify all the staff in the nursing home, and she can describe each patient who has been in the bed next to hers over the past 10 years. When asked to explain why she does not want bladder catheterization, she gives several reasons. She states that the incontinence does not bother her, and that she has always been a very private person. She particularly dislikes and objects to any examination of her pelvic organs; in fact, she has never had a pelvic examination nor has she ever had sexual intercourse. She realizes that she has a number of medical problems and that any one of them could worsen at any time. She states she is not willing to undergo any treatment for any of her current problems should they become worse.

Case Study 3

Mr. Marley, age 91, is admitted to the intensive care unit following a stroke. The stroke progressed from mild hemiparesis and difficulty speaking to complete unresponsiveness and an inability to swallow. His daughter feels certain, based on prior explicit conversations with her father, that he would not want to have any treatment that would prolong his life and leave him in a severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s assessment of their father. The son claims that their father still has a strong desire to live, and that he has been very active in his church until this stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is asked about insertion of a feeding tube. It is explained to the family that without food and fluids, their father will die fairly quickly. There are no existing advance directives or a designated health care decision maker noted for Mr. Marley.

To prepare:

• Review Chapter 14 of the Holroyd-Leduc and Reddy text.
• Reflect on the role of the advanced practice nurse in facilitating the discussion of end-of-life care with patients and their families.
• Think about how you, as an advanced practice nurse, would approach a family who wants “everything” done for a patient with only a limited time to live.
• Consider when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services.
• Select one of the three provided case studies related to the end-of-life care of the frail elderly. Reflect on potential patient outcomes and how you would facilitate the discussion of care with this patient’s family.

By Day 3

Post 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.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days  who selected different case studies than you. Based on the site of care, suggest strategies for establishing the role of advanced practice nurses in end-of-life discussions with patients.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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