End of Life Decisions Essay.

End of Life Decisions Essay.


Assignment Instructions

There are two parts to the week 5 assignments. Please complete both.End of Life Decisions Essay.
Describe some of the legal and ethical aspects associated with consent. What is the role of the organization with regards to consent?
Define the following terms: living wills, advance medical directives, surrogate decision making, ordinary care, extraordinary care.
Assignments are to be a minimum of 2 full pages of text and 3 reputable references in proper APA format.End of Life Decisions Essay.


End-of-Life Decisions

The discussion about end-of-life and the decisions that need to be made prior to getting to that point is not an easy one but does require careful attention and consideration. In this article you will find information explaining laws, policies, and choices you can make surrounding end-of-life health care decisions.

Role of the Nurse

The nurse is responsible for very many factors of a patient’s health. One of them includes end-of-life care and involves assisting with making difficult decisions.

Nurses are the part of the health care team who are at the bedside during the entire patient’s process. They are the ones that spend whole shifts with patients and their families, build strong relationships, and are competent to assess the needs of the patients and families. Due to this, along with being able to know when patients are no longer responding to treatment, nurses are in a position to be able to assist with end-of-life decision making (Adams, Bailey, Anderson & Docherty, 2011).

Nurses and physicians do not want to give up too soon, remove all hope for families of acutely ill patients, or making the wrong prognoses. This is the reason why there is so much fear for health care professionals when it comes to initiating these discussions.

The nurse is also the advocate for the patient in end-of-life (EOL) care. This type of nursing includes assisting patients and families throughout the dying process, being professionally culturally sensitive, and pain and symptom management for the patient (Hebert, Moore & Rooney, 2011). Other domains of EOL nursing practice include:End of Life Decisions Essay.

  • The helping role
  • Teaching or coaching function
  • Diagnostic client-monitoring functions
  • Effective management of rapidly changing situations
  • Administering and monitoring therapeutic interventions and regimens
  • Monitoring and ensuring quality of health care practice, and
  • Organizational work-role competencies (Hebert, Moore & Rooney, 2011).

Primary Policies Regarding End-of-Life Decisions

In current health care, there are certain issues that exist in relation to end-of-life care. Some of these include: financing the care, end-of-life conversation readiness for professionals, and the quality of EOL care (Giovanni, 2012). End of Life Decisions Essay.

The Patient Order for Life Sustaining Care (POLST) is an advance care planning tool that turns patient treatment preferences into medical orders. The goal is to ensure that chronically ill patients’ wishes for treatment are honored. It includes a discussion between the patient or surrogate and the health care practitioner about end-of-life care treatment options, which then are incorporated into doctor’s orders. They include several key decisions common to seriously chronically ill patients and the POLST form stays with the patient in any setting (Sabatino, 2010).

Advance directives are forms that were created to ensure autonomy for patients who become unable to make their own health care decisions.The overall goal is to allow patients to retain control over the life-prolonging treatments they receive. The completion of advanced directives is essential, but studies show that majority of individuals do not have the forms completed (Morhaim & Pollack, 2013).

The Patient Self-Determination Act of 1991 was passed and requires that all organizations which participate in Medicare must notify their patients their rights to complete an advance directive for health treatments (Giovanni, 2012).

Effect on Patient Outcomes

Patient outcomes in relation of end-of-life care include health status, quality of life, similarity between preferred and actual care, survival, and costs. Different approaches and regulations exist, such as advance care planning, in efforts to improve patient outcomes. Research shows that early planning for health care– specifically, facilitated discussions about end-of-life care preferences between trained facilitators and patients and support individuals—improves adherence to wishes, improves overall satisfaction, reduces stress, anxiety and depression among older patients and their caregivers.End of Life Decisions Essay.

Research shows that regulations regarding the completion of Advanced Care Directives benefits patient outcomes, health care utilization and costs. Other benefits include lower total costs, longer hospice stays, and improved symptoms (Waller, Dodd, Tattersall, Nair&Sanson-Fisher, 2017).

Legislation That Generated Policies

Advanced directives began in the 1970’s as a tool to officially and formally communicate an individual’s health care wishes regarding end-of-life care, as well as to increase the chances that the wishes are carried out by health care professionals. A document called the Living Will was introduced, which included information regarding a patient’s wishes about life-sustaining treatment in the event of a terminal illness or a permanent unconsciousness. There were policy concerns regarding terminating treatment when it came to maintaining life by artificial means and shortening the suffering of aged and terminally ill patients.

Over time, the durable power of attorney law emerged which empowered an agent to act on an individual’s behalf. This tool delegated authority and was used as a health care decision making tool. In the 1990’s more medical crises arose relating to unwanted resuscitations of elderly or terminally ill patients and gave way to CPR directives (also called comfort care orders or do-not-attempt-resuscitation orders).  These DNR orders were to be signed by physicians and patients or surrogates, and identification bracelet to be worn by the patient.

Further legislation involves default surrogate consent or family consent for situations where no advance directives exist. This legislation provides clear hierarchical list of decision-making authority, starting with a spouse and next-of-kin priority list.

Eventually, many of these health care decision acts overlapped and had to be merged. Beginning in year 2000, many states combined the directives into a single advance directive for health care which include living wills, durable power of attorney, default surrogate decision makers, and even organ donation instructions.

The primary model for the law has been the Uniform Health-Care Decisions Act and establishes rules for recognizing a statement, with a witness requirement, as an advanced directive. This act was an amendment to the federal Medicare and Medicaid law and encourages individuals to plan for health care decisions in advance. (Sabatino, 2010).End of Life Decisions Essay.

Ethical Considerations

Individuals and the global population are aging, medical advancements continue to evolve over time permitting prolongation of life, and various ethical considerations are surfacing surrounding end-of-life health care. Medical technologies and advanced treatments are opening up doors and providing capabilities to intervene at the time of death and sustain life with secondary support such as feeding tubes and ventilators. These advancements have made it necessary for patients and families to make choices regarding their treatment preferences during end-of-life care.  The need for health care decisions to be made is continuously increasing and policies are being made and amended to reflect the need for clarity during end-of-life health care.End of Life Decisions Essay.

An example of an ethical consideration is the right to autonomy and the patient being able to make their own end-of-life treatment preferences. This right, however, has its limitations and faces an ethical dilemma. Many times, a patient receives end-of-life care which is inconsistent with their chosen preferences. This situation requires that health care professionals provide detailed information, as well as explain the benefits and risks about advanced medical treatments that may be used during EOL care. The physician should respect the patient’s beliefs before withholding or withdrawing treatment or inflicting hard by continuing medically futile treatments.

Health care organizations must continuously work on developing and implementing guidelines and policies for end-of-life decision making to avoid ethical dilemmas. These organizations can provide support through ethics committees and employee assistance programs to address any ethical issues, increase patient satisfaction and avoid ethical crises.End of Life Decisions Essay.

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