NR 601 Week 7 Discussing Advanced Directives

Sample Answer

Advanced care directives include instructions that govern healthcare choices and end-of-life treatment, considering a patient’s convictions and principles when they cannot make such decisions independently (Bazargan et al., 2021). As nurse practitioners, our primary responsibility with advance care directives is to advocate for, assist, and educate patients and their family members in implementing an advance directive.

This entails evaluating the optimal approach to impart the knowledge required for a patient to comprehend their treatment alternatives and choices at the end of life. This entails actively listening to their concerns and ideals and assisting them in completing necessary documentation. After implementing an advance directive, our responsibility as healthcare professionals is to maintain a copy of it in patients’ medical records and support their legal entitlement to self-determination.

State Laws

In California, advance directives do not need the endorsement of a physician. Instead, they may be established with the patient’s signature and the presence of two witnesses or the patient’s signature and a notary acting as the second witness. An advanced directive does not require the signature of a physician or nurse practitioner (NP); however, a POLST (Physician Orders for Life-Sustaining Treatment) requires the signature of a physician, nurse practitioner, or physician assistant, in addition to the patient’s signature.

A physician assistant (PA) needs a medical doctor (MD) to co-sign the order. Starting from January 1st, 2016, in California, a Nurse Practitioner has the authority to autonomously sign a POLST, which includes the patient’s preferences for life-sustaining medical treatment (Bazargan et al., 2021). Section 480 is a part of the Legislation bill AB 637. While these standards apply specifically to California, it is important to note that criteria may differ in other states. It may not be automatically included in the scope of practice for nurse practitioners.

Hospice/Palliative Care

During the practicum last week, I saw an 89-year-old female patient who was in the advanced stage of heart failure. Aside from heart disease, she has intricate comorbidities. She has a high level of consciousness about her healthcare condition and has conveyed her dissatisfaction with the ongoing intensive treatment. Contrarily, her daughter wants the patient to persist in all available measures to extend her lifespan. During the previous clinic session, we analyzed the patient’s laboratory findings and informed her that her deteriorating kidney function has now progressed to the point where dialysis is necessary.

The patient expressed her fatigue from many hospitalizations and the invasive medical procedures she had undergone. This patient would benefit from hospice care, as she is too elderly and exhausted to continue commuting to the hospital. She has the cognitive capacity to make that choice. If the patient or a relative is not yet prepared to consent to hospice care, palliative care may serve as the necessary intervention to assist the patient. Given the potential difficulty of these discussions with patients, they must be centered on their needs.

Concerns regarding their comprehension of the disease process, prognosis, and diagnosis should be investigated. Considering cultural factors, evaluate their understanding and viewpoint on hospice and palliative care. After evaluating these regions, elucidate the advantages of palliative or hospice care and how these benefits might address their requirements, such as increased assistance at home, regular nurse visits, or home-based providers (Kang et al., 2021).

Recommendations

The first suggestion for enhancing access to palliative and hospice care among vulnerable and marginalized groups in my community is to focus on boosting education or community sensitization. Lower socioeconomic and educational level patients are often the most vulnerable and neglected. Offering comprehensive education on the benefits and purpose of hospice care or palliative care might enhance patients’ and their families’ willingness to accept and use these specific healthcare treatments. Many people associate hospice or palliative care with expediting the process of dying. Palliative care sometimes assists patients who are unprepared to cease all treatments, effectively bridging this transitional period fully.

Additionally, I have observed patients admitted to hospice recover within six months due to the additional support and services. To effectively educate the patients under our care, it is essential that we, as providers, possess knowledge about the range of treatments offered in hospice and palliative care. The second recommendation is that, as nurses, we should feel at ease while discussing this option with patients. It is essential to have the ability to confidently recognize patients who may get advantages from these services and engage in difficult discussions with them (Kang et al., 2021). Frequently, particularly in the field of cancer, we see the commencement of hospice treatments when patients are already in the latter stages of dying.

Therefore, it is advisable to provide training programs for the office staff, including in-services conducted by hospice firms and the provision of easily comprehensible instructional materials for patients and their families. Collaboration is essential for enhancing any domain. Enhancing Hospice/Palliative care will enable patients to have a serene and honorable end of life.

References

• Bazargan, M., Cobb, S., Assari, S., & Kibe, L. W. (2021). Awareness of palliative care, hospice care, and advance directives in a racially and ethnically diverse sample of California adults. American Journal of Hospice and Palliative Medicine, 38(6), 601–609. https //doi.org/10.1177/1049909121991522Links to an external site.
• French, M., Keegan, T., & Preston, N. (2022). Facilitating equitable access to hospice care in socially deprived areas A mixed methods multiple case study. Palliative Medicine, 37(4), 508–519. https //doi.org/10.1177/02692163221133977
• Kang, K., Chun, J., Kim, H. Y., & Kim, H. (2021). Hospice palliative care nurses’ perceptions of spiritual care and their spiritual care competence A mixed‐methods study. Journal of Clinical Nursing, 30(7–8), 961–974. https //doi.org/10.1111/jocn.15638Links to an external site.