Advance Care Planning and Analysis Essay

Advance Care Planning and Analysis Essay

Advance Care Planning and Analysis Essay

Begin reviewing and replying to peer postings/responses early in the week to enhance peer discussion. See the rubric for participation points. Participate in the discussion by asking a question, providing a statement of clarification, providing viewpoints with a rationale, challenging aspects of the discussion, or indicating relationships between two or more lines of reasoning in the discussion. Always use constructive language, even in criticism, to work toward the goal of positive progress.Advance Care Planning and Analysis Essay

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Advance Care Planning and Analysis
Read the section titled “Reflective Practice: Pants on Fire” from the chapter “Health Policy, Politics, and Professional Ethics” and address the questions below.

How do you judge Palin’s quote below, as an effective strategy to oppose Democrats’ plans for health care reform or unethical scaremongering?
“And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care. Such a system is downright evil.”
Reflect on what informs your judgment: commitment to advance care planning, analysis of facts, and/or political party loyalties?Advance Care Planning and Analysis Essay
Is it right for nurses to endorse health reform legislation even if the legislation is not perfect?
Does this apply to the recently failed American Health Care Act?
Peer 1

I think Palin’s stance was to much of a show of emotion related to her at home situation. I feel that when it comes to modern politics that emotions do not seem to get very much accomplished. I understand some of her frustrations with Obamacare. I honestly find myself have more conservative views when it comes to politics, but I do feel that it takes both parties to get every view point across. One reason that I do feel nurses should be involved with legislation is due to the amount of trust the public has for our profession. According to Huie (2017), “Nurses have consistently been ranked the most trusted profession in honesty and ethical standards above other healthcare professionals such as medical doctors, pharmacists and dentists” (p. 3). I think this raises the bar for nurses to become more involved in politics. My opinion on the AHCA is that its failure is due to Trump’s hast to get it passed. I believe there will be no perfect system to healthcare. Therefore, without being able to back an imperfect system nurses will never be able to get involved.Advance Care Planning and Analysis Essay

Huie, R. (2017). Nurses, The Most Trusted Profession! Alabama Nurse, 44(1), 3.

Peer 2

I feel that the above quote by Sarah Palin was both an effective strategy against the Democrats and unethical fear mongering. Playing on the emotions of people by naming the most vulnerable people in society is a good way to get someone’s attention and a good way for people to automatically dismiss the AHA without giving it a fair chance just by her statement and her analysis of it. Why take the time and go through the strenuous details when she gets to the gist of it in one short, powerful statement. I personally think it was a low blow, however this is politics and you have to hit them where it hurts to get results or to get people’s attention. My judgment is based on analysis of facts. Obamacare was created so Americans can have insurance coverage and to include more Americans to ensure they have coverage. The AHCA is similar to Obamacare so I think the statement can pertain to it as well.Advance Care Planning and Analysis Essay

EHealth Insurance. (2017, October 22). Trumpcare (AHCA) vs. Obamacare (ACA). Retrieved August 01, 2020, from https://www.ehealthinsurance.com/resources/affordable-care-act/trumpcare-vs-obamacare

Objective To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations. Design Systematic review and meta-analyses. Data Sources Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists. Study Selection Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English. Data Extraction and Synthesis Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: ‘advance directives’ and ‘communication.’ Main Outcomes and Measures Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms. Results Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication. Conclusions ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.Advance Care Planning and Analysis Essay

The purpose of this report is to compare and contrast two different nursing research articles. The report will critique and evaluate two qualitative studies, one being an original research report and the second being a review paper. The scope of comparison and contrast will include research design, theories or conceptual models, how the research was conducted, analysis and reporting of research data, usefulness of the research, and a conclusion.
Selection of Research Interest Area
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. In addition, the purpose of the study is to try and obtain guidance to integrate an ACP model into routine clinical practice in the community. The research question chosen for the analysis of this article Advance Care Planning and Analysis Essay

Carla’s Case study

Advance care planning is the process that helps people to plan for their future medical treatment and end-of-life care in advance when they are healthy and able to make thoughtful decisions. It enables individuals to express their wishes, priorities, beliefs, values and life goals to their doctors, family, friends and carer before any healthcare crisis occurs. Advance care planning ensures that patient’s preferences are known, understood and respected which influences the treatment and client-centred care (Holman & Hockley, 2010). Carla is a 54-year-old woman with metastatic ovarian cancer. Carla’s disease progression allowed her to be dependent upon her family. Conflicting views within the family arise when Carla discuss her wishes and preferences related to end-of-life care. The following assignment describes three nursing care plans related to Carla’s case study which includes patient’s assessment data, nursing diagnosis, goals, interventions and rationales, and evaluations. It also includes referrals needed for the client and family members to facilitate client-centred care. Moreover, it explains the barriers and facilitators related to Carla’s case study and advance care planning model in order to provide effective client-centred care.Advance Care Planning and Analysis Essay

ASSESSMENT DATA

Chronic pain due to the progression of the disease (metastatic ovarian cancer) prevents Carla from performing her daily self-care activities. In addition, Carla has expressed her wish to be kept pain free at the end of life. Carla may show the signs and symptoms of chronic pain such as fatigue, anxiety, depression, irritability, restlessness and crying or moaning at the end-of-life. Carla has undergone multiple therapies including surgery and chemotherapy.

NURSING

DIAGNOSIS

GOALS

INTERVENTIONS AND RATIONALS

EVALUATION

Chronic pain related to disease progression as evidenced by patient expressed her desire to be kept pain free (Ackley, Ladwig, & Makic, 2016).

Within 4 hours of nursing interventions, Carla’s feels comfortable due to the decrease in pain level.Advance Care Planning and Analysis Essay

Within 8 hours of increasing sense of comfort, the patient will not show any signs or symptoms of pain (Gulanick & Myers, 2013).

Perform regular pain assessment including quality, severity, location, characteristics, onset, duration, frequency, precipitating factors and patient’s expression of pain to develop the baseline information of the pain through systematic assessment and documentation of pain that provides direction for a pain management plan (Lee, et al., 2015; Linl et al., 2011; Pasero and McCaffery, 2011). Assess the client for signs or symptoms of chronic pain such as such as fatigue, anxiety, restlessness, irritability, or depressed because it is associated with disease progression which leads to physiological and behavioural changes to ensure that the patient is treated for symptoms accompanying pain or its management (Wilkie & Ezenwa, 2012). Non-pharmacological pain management strategies such as distraction, imagery, music therapy, simple massage, positioning, relaxation, and application of heat and cold to help control pain level and to provide comfort (Hökkä, Kaakinen, & Pölkki, 2014). Administration of analgesics as ordered around-the-clock for continuous pain and PRN medication for intermittent or breakthrough pain as may be experienced by clients with cancer pain to provide a consistent level of pain relief and to reduce sufferings and improve the quality of life (Mashaqbeh & AbuRuz, 2017). Assess patient’s sedation level and respiratory status at regular interval during pain management with opioid analgesics to check any sign of opioid-induced respiratory depression and oversedation (VanItallie & Plante, 2011).Advance Care Planning and Analysis Essay

Referrals:

Palliative care nurse to improve patient’s quality of life by reducing symptoms of pain and providing comfort during pain management.

GP or palliative care physician to monitor the overall health of the patient. Pain medicine specialist if pain is not controlled (Howie & Peppercorn, 2013).

Within 4 hours of nursing intervention, Carla appears to be relaxed and comfortable as result of the decrease in the level of pain

Within 8 hours of increasing sense of comfort, Carla showed no signs and symptoms of pain (Gulanick & Myers, 2013).Advance Care Planning and Analysis Essay

ASSESSMENT DATA

Lack of knowledge and understanding of Carla’s disease, treatment plan, and advance care planning result in arguments within the family. Carla expressed a lack of support from daughter and husband as they refused to accept her wishes. There are conflicting views and expectations of the family towards Carla’s treatment and care. Her husband could not tolerate the thought of her dying and want everything possible done for her in the hospital. Both, her daughter and husband want her to receive all possible treatment to see the birth of their granddaughter. Carla communicated about her fear to Josey that she will be forced to have more treatment by her husband and daughter.

NURSING

DIAGNOSIS

GOALS

INTERVENTIONS AND RATIONALS

EVALUATION

Ineffective family coping related to patient’s wish to discontinue further acute care treatment as evidenced by patient expressing the fear that her husband and daughter are against her wishes and want her to receive continuous care and treatment to see the birth of their first granddaughter (Ackley, Ladwig, & Makic, 2016).Advance Care Planning and Analysis Essay

Within 2 hours of nursing interventions, family members will demonstrate an understanding of a patient’s disease and treatment.

Within few hours of nursing interventions, patient’s family members will cope and support her wish to not to continue any acute care treatment at the end-of-life (Gulanick & Myers, 2013).

Provide education and knowledge to the family members related to the patient’s progressive disease and end-of-life care treatment to ensure a better understanding of patient’s wishes (Washington, Meadows, Elliott, & Koopman, 2011). Palliative care nurse or GP should assist patient to make advance care directive to avoid any future conflicts among family members (Palliative Care Australia, 2017). Schedule meeting to facilitate open communication with family members and patient to help the patient to express her wishes and preferences at end-of-life care. Thus, reduces fear and stress within the family (Walshe et al., 2017). Providing palliative care at home will allow patient and family members to spend quality of time and share meaningful moments together (Dhiliwal & Muckaden, 2015). Discuss patient’s needs and reason of not continuing acute care treatment with family members to allow family members to understand, respect and support patient’s preferences (Moir, Roberts, Martz, Perry, & Tivis, 2015). Palliative care nurse should increase home visits to ensure the safety of the patient and to provide support and reassurance to the family related to end-of-life care (Lang et al., 2015). Promote family relaxation and stress-reduction strategies to reduce stress and enhances coping (McMillan, et al., 2015).Advance Care Planning and Analysis Essay

Referrals:

Medical social support for the family that serves as an advocate to provide information related to advance care planning for care needed by the client. Grief and bereavement support that allow family members to cope with grief after the death of the client.

Psychiatric home health care service for family counselling to allow family members the ability to support patient’s treatment plan (Ackley, Ladwig, & Makic, 2016).

Within 2 hours of nursing interventions, family members demonstrated an understanding of a patient’s disease and treatment.

Within few hours of nursing interventions, Carla’s family members understood, respected and supported her wish to not to continue any acute care treatment (Gulanick & Myers, 2013).Advance Care Planning and Analysis Essay

ASSESSMENT DATA

Carla is unable to perform activities of daily living due to her disease progression and cancer pain, which allowed her to be dependent upon her family in order to meet her daily needs such as bathing, grooming, toileting and eating.

The patient had undergone surgery and chemotherapy for ovarian cancer in the past.

NURSING

DIAGNOSIS

GOALS

INTERVENTIONS AND RATIONALS

EVALUATION

Activity intolerance related weakness from cancer as evidenced by the patient being increasingly depended upon her family to meet her care needs (Ackley, Ladwig, & Makic, 2016).

Within 4 hours of nursing interventions, the patient will be able to recognise techniques to enhance activity tolerance and to participate in desired activities.Advance Care Planning and Analysis Essay

Within 6 hours of nursing interventions, the patient will maintain skin integrity (Gulanick & Myers, 2013).

Establish trust to allow the patient to cooperate and to reduce anxiety related to lack of self-care activities. Assess patient’s level of mobility to identify the capability of the patient to perform activities. Assist patient with activities of daily living to allow conservation of energy and to enhance patient’s self-esteem. Provide emotional support to the individual to gradually increase activity (Brown, Winters-Stone, Lee, & Schmitz, 2012). Nurses should position the patient every two hourly to reduce the development of pressure ulcer and to maintain skin integrity. Support patient with pillows during positioning and air mattress to provide comfort to the patient (Stephen-Haynes, 2012).Advance Care Planning and Analysis Essay

Referral:

The physiotherapist will assist patient with the passive range of motion exercises to increase blood circulation and to promote comfort to the patient. Home support and assistance that will allow caregivers (family members) and patient to adjust to the changes in living patterns (Ackley, Ladwig, & Makic, 2016).

After 4 hours of nursing interventions, patient recognised techniques to enhance activity tolerance and participated in desired activities.

After 6 hours of nursing interventions, patient maintained skin integrity (Gulanick & Myers, 2013).

Some barriers and facilitators are identified related to Carla’s case study and advance care planning model in order to provide effective client-centred care. Understanding these barriers and facilitators are helpful in the development of interventions which aimed at implementation of advance care planning in practice. Carla’s husband William and Daughter Penny are the main barriers who can impact the implementation of the advance care planning. In fact, Carla’s husband William is in denial of Carla’s impending death and want her to receive every possible treatment in the hospital to keep her alive. On the other hand, Penny is pregnant and wants to prolong her mother’s life for as long as possible for her to see the birth of her first granddaughter. Both Carla’s daughter and her husband do not support or accept her wish to discontinue any further acute treatment. Unfortunately, this leads to the family conflict and arguments among the family members which might impact Carla’s decisions.Advance Care Planning and Analysis Essay Another barrier that can impact the effective facilitation of advance care planning is Fear. Carla’s fear in relation to her current family situation might concern her about distressing her family members by making decisions in regards to end-of-life care rather than continuing all possible treatment. Lack of knowledge of advance care planning can be defined as a barrier. Lack of patient knowledge in particularly related to the processes involved in making advance care directives. Also, no clear understanding or misinterpretation of palliative nurse and GP’s explanation related to advance care planning (Lund, Richardson, & May, 2015; Pung, 2011; Kononovas & McGee, 2017; De Vleminck, Houttekier, Pardon, Deschepper, Van Audenhove, Vander Stichele, & Deliens, 2013).

However, Carla’s son Harry is one of the main facilitators who can help to implement the advance care planning. Moreover, Harry supports her mother’s wish to discontinue further acute care treatment and to remain at home during her end-of-life. Carla will be able to appoint Harry as her substitute decision-maker who can speak on her behalf with healthcare teams and family members in the event of loss of capacity to communicate or to make decisions. Carla’s palliative nurse Josey and GP’s can assist Carla to facilitate the advance care planning model. The knowledge and experience of Carla’s palliative nurse and GP will allow Carla to identify the suitable time for initiating discussion and open communication with family members in regards to expressing and documenting her wishes for future care or treatment. Patient Centred Care can also be linked to the facilitators as it focuses on patient’s wishes and preferences for future care or treatment. As in the case study, Carla has already expressed her decision related to her treatment and end-of-life care. She stated that she does not want to continue any future acute care treatment and would prefer to stay at home and to be kept pain free. She will be able to bring an open communication with family member and health practitioners about her wishes and preferences discussed and documented in advance care planning.Advance Care Planning and Analysis Essay Thus, patient centred care will help Carla to get her wishes and preferences to be understood and respected by everyone. This will increase the patient’s satisfaction with the care received (Kononovas & McGee, 2017; De Vleminck et al., 2013; Paladino, Bernacki, Hutch, Billings, & Block, 2014).

In conclusion, Advance Care Planning will help patient to overcome family conflicts, relieves burden from family or healthcare teams to make decisions in stressful situations, improve patient and family satisfaction with care and treatment, and reduce stress, anxiety, and depression within family. Nursing care plans will help patient to achieve quality of life and ensure patient wishes and preferences are understood and respected by everyone during end-of-life care. Nursing diagnosis is implemented by keeping patient at the centre of care to provide better quality of care according to patient’s wishes documented in advance care directives. Moreover, barriers and facilitators related to Carla’s case study and advance care planning helped to implement effective client-centred care.Advance Care Planning and Analysis Essay

 

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