This human tendency to avoid the unpleasant makes end-of-life care and hospice decisions difficult for many patients to discuss with their families.

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 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.

ANSWER

Discussion 11

Most people in the present society do not desire to talk about their final journey and how they want to be taken care of as they near their death. Individuals think about the end times but are unable to open up about what they desire during the process towards the end (Stropp et al., 2017). The type of life a person wants to live, kind of food, the surrounding environment are all stuck in mind because of the fear to hurt the remaining family members.

In such situations, advanced practice nurses have to step in to facilitate the discussion of end of life between patients and their families.  Their primary roles are addressing the patient wishes about the end of life care to families sensitively to avoid hazardous effects. It is made possible by creating an environment for their patients to discuss end of life issues without fear of abandonment, and judgment (Steinhauser et al., 2000). Advanced practice nurses also educate family members to accept the situation of the patient and give maximum support in the last days.

It is always difficult to approach a family that needs maximum care for patients with limited time to live to convince them that it is an exercise in futility. Therefore, medical practitioners responsible for the task must be well trained with excellent communication skills to avoid affecting the family members severely (Teno et al., 2004). In this case, I will try make the family aware that treatment wasted on their patient can be used to save another life will convince them to allow care withdrawal. I will also give the patient and family an opportunity to ask questions concerning the way forward to give everyone a clear picture of what to expect. Hospice services must be considered anytime an….