End of Life Decision Assessment

Question: Discuss about the End of Life Decision Assessment. Answer: Role of Nurse in End of Life Decision Making Decision making in palliative care is a complex process. Although physicians play a role diagnosis of life-threatening illness and planning next course of treatment, however nurse also play a vital role in understanding patients response to treatment and their understanding facilitates trusting relationship with patients and family members. Nurse enrolled in intensive care unit has the responsibility to manage pain and adverse symptoms, assist patients and family members in dying process and ethical decision making and communicate compassionately with patients to create a healing environment (American Nurses Association, 2010). Advocacy is another core competency of nurses as they need to improve the quality of care at end stage of life and engage in culturally sensitive care (Gallagher et al., 2015). Therefore, nurses are responsible for providing safe, compassionate, ethical and evidence based palliative care. Legislation Affecting Policy on End-of-Life Care The key legislation that lead to the development of end-of-life policy in US include the Patient Protection Act and the Affordable Care Act in which reforms in end-of life care is stated to provide directive to state and local government to take actions to improve end-of-life health practices (Giovanni, 2012). Another important legislation related to the end-of-life care is the Palliative Care Information Act (PCIA) passed in 2010, which states that physician and nurse involved in palliative care have to provide all information regarding all treatment option available to terminally patients. They also need to make them aware of their prognosis, risk and benefit of treatment options and make them aware of patients right to pain and symptom management at the end-of-life. This is an attempt to better inform and identify patients in end-of-life (Popp, 2013). Primary Policies on End-of-Life Care According to US current policy, all health care staffs involved in end-of-life decision need to display professional values of compassion, altruism, trustworthiness and service in palliative care. They need to act in the best interest of patients and respect patients autonomy is decision making and deciding treatment goals. Professional competence is required to maintain legal and professional obligation in end-of life care (Ethics and Advance Planning for End-of-Life Care, 2016). The core health care practices policy in end-of-life care are as follows: Clinicians and nurses need to priorities alleviation of pain and physical symptoms of patients. They need to recognize and address psychological, religious and cultural issues in palliative care. They need to ensure continuity of care, advocate for patients right in decision to improve the quality of care. The core communication policy is to communicate effectively to build trust and confidence in patient-nurse relationship. Another core principle of palliative care is to engage in clinical and evidence based research to provide safe and high quality of care. The policy regarding maintaining quality care is to manage pain and distressing symptoms, preserve dignity of patients, strengthen therapeutic relationship and promote decision making through clear communication with patients (Planning for and Providing Quality End-of-Life Care, 2016). These policies have enabled health care staff to engage in wisely assist patients in treatment decisions and provide them necessary psychological support to initiate advanced treatment after shared decision making. It helps in maintaining ethical and professional requirement in end-of-life care. Effect of End-of-Life Regulation and Controls on Patient Outcome As end-of-life care delivery was fragmented and uncoordinated in US, the development of clear policies on core requirement of health care staff in palliative care decision making has helped in effective integration of acute care in ICU. he focus on core competencies of advocacy, active listening and communication skill has helped to build patient-nurse trusting relationship. Policy on cultural competency has improved patients response to treatment and the number of grievance and medical issues in palliative care has decreased. The presence of key legislation in end-of-life care has facilitated a good death and better control of symptoms and psychological issues of patients. The PCIA Act has helped to reduce biasness and discrimination in treatment and improve accuracy in hospice care. Ensuring a good death is a major challenges in palliative care and legislation in end-o-life care has helped health professional to realize the goal in palliative care. The Patient Self-Determination Ac t of 1990 gave patients the decision making power to allow or refuse care. This promotes advanced directive to patient on admission (Papadimos et al., 2011). For patients and families struggling with chronic disease, coordinated care and empathic communication has served to improve experience of terminally ill patients in acute care setting. Adequate control of pain and other symptoms has also served to improve patients satisfaction with end-of-life health care service and experience a healing environment at hospitals. The quality measurement and improvement strategies in end of life care have helped clinicians and other staffs to evaluate current service and bring improvement on a regular basis (Chan Webster, 2013). Ethical Consideration Behind End-of-Life Care Policies There are several ethical challenges in end-of-life care both for patients as well as physician. The prolonged suffering and life threatening illness often lead physicians to take difficult steps where they have to present difficult choices to patient and family members. They are related to the dying process or painful treatment procedure and health professional need to maintain ethical values of autonomy, justice, non-maleficence and beneficence during care of critically ill patients. Due to this legal consideration in palliative care, the policies of end-of-life care also focus on this aspect and stress on respecting patients choice and preference in palliative care and preserving their dignity during hospitalization. The understanding and knowledge of ethical consideration in care helps nurses and physician to overcome ethical dilemmas in practice and maintain trusting relationship with patients and family members (Jones et al., 2012). Reference | Planning for and Providing Quality End-of-Life Care | Policy | Policies Publications | College of Physicians and Surgeons of Ontario. (2016).Cpso.on.ca. Retrieved 26 December 2016, from https://www.cpso.on.ca/policies-publications/policy/planning-for-providing-quality-end-of-life-care#policy1 American Nurses Association. (2010). Position statement: Registered nurses' roles and responsibilities in providing expert care and counseling at the end-of-life ethics and human rights. Retrieved from https://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/etpain14426.pdf Chan, R. J., Webster, J. (2013). End?of?life care pathways for improving outcomes in caring for the dying.The Cochrane Library. Ethics and Advance Planning for End-of-Life Care. (2016).Aafp.org. Retrieved 26 December 2016, from https://www.aafp.org/about/policies/all/planning-care.html Gallagher, A., Bousso, R. S., McCarthy, J., Kohlen, H., Andrews, T., Paganini, M. C., ... Abu-El-Noor, M. K. (2015). Negotiated reorienting: A grounded theory of nurses end-of-life decision-making in the intensive care unit.International journal of nursing studies,52(4), 794-803. Giovanni, L. A. (2012). End-of-Life Care in the United States: Current Reality and Future Promise-A Policy Review.Nursing Economics,30(3), 127. Jones, D. A., Bagshaw, S. M., Barrett, J., Bellomo, R., Bhatia, G., Bucknall, T. K., ... Hillman, K. M. (2012). The role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study.Critical care medicine,40(1), 98-103. Papadimos, T. J., Maldonado, Y., Tripathi, R. S., Kothari, D. S., Rosenberg, A. L. (2011). An overview of endoflife issues in the intensive care unit.International journal of critical illness and injury science,1(2), 138. Popp, B. (2013). Legislative attempts to improve end-of-life care in New York State.The virtual mentor: VM,15(12), 1062.