Questions concerning end-of-life care are challenging to discuss with patients and their families for many reasons. Many people may feel uncomfortable talking about death, and some individuals find these conversations unnecessary or frightful. However, end-of-life care discussions are vital for ensuring that people will voice their opinions about their health. The role of the advanced nurse in these conversations, therefore, is crucial for patients’ awareness. Medical professionals have a level of authority and understanding that assists them in talking to patients’ family members who also actively participate in their relatives’ lives (Resnick, 2016). An advanced practice nurse has to approach complicated topics with the principles of autonomy, beneficence, and nonmaleficence.
When interacting with a patient’s family, the nurse has to account for their legal right to making decisions. In cases where a family requests for “everything” to be done to treat the patient, it is vital to encourage a more in-depth discussion about further steps. Family members may not understand what “everything means,” leading to unrealistic expectations about the scope of provided care (Moir, Roberts, Martz, Perry, & Tivis, 2015). Furthermore, such a wish can disregard the patient’s personal preferences. The nurse has to consult the patient if possible or determine whether any legal documents are present that regulate the patient’s health-related choices, including advance care directives and orders. Next, one needs to meet with the patient’s family to understand what exactly they are expecting from treatment and propose a treatment plan. It is also vital to remind the family of the patient’s dignity and the right to spend their last days in a peaceful and loving environment. The principle of harm-reduction is fundamental in these discussions, as unnecessary, aggressive, or excessive treatment can cause more pain to the patient than palliative care.
Hospice care is appropriate in situations where a person is in the last phase of an incurable disease and wishes to spend their remaining time in a comfortable environment. The nurse can suggest this approach for patients who want to treat symptoms of their illness and alleviate pain and distress, rather than engaging in aggressive therapy. If a patient is refusing hospice services, even though it could help them manage their conditions, the nurse can propose different ways of assistance. Home-based care assisted living, and other strategies can be suggested to patients who refuse hospice care (Holroyd-Leduc, & Reddy, 2012). If the patient wants to enter a hospice, but their family protests, the nurse must communicate with both parties to discuss the benefits of hospice care and address the arguments of the family.
In the case study, the patient, Mrs. Sloan, requests a do-not-resuscitate (DNR) order to be followed after her surgery. Her overall health seems to be good, but the patient wishes to avoid brain damage as a result of cardiac arrest. To ensure that the patient is making an informed decision, the nurse needs to emphasize the meaning of the DNR order as well as its implications for the patient’s family members. Then, one can talk about filling in an advance directive to document the patient’s wishes (Garrido, Balboni, Maciejewski, Bao, & Prigerson, 2015). Mrs. Sloan’s family has to be informed about the patient’s decision on the DNR order and encouraged to discuss Mrs. Sloan’s other needs openly.
End-of-life care has to be discussed with both the patients and their families to avoid misunderstandings and help patients pass with dignity. The nurse must assist patients and respect their choices. Thus, conversations with the family are based on the concepts of nonmaleficence and beneficence. Steps taken to treat patients should not harm them or come into conflict with their views. Nonetheless, the nurse also has to provide all the necessary education to patients and relatives to make sure that their decisions are well-informed.
Garrido, M. M., Balboni, T. A., Maciejewski, P. K., Bao, Y., & Prigerson, H. G. (2015). Quality of life and cost of care at the end of life: The role of advance directives. Journal of Pain and Symptom Management, 49(5), 828-835.
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.
Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. (2015). Communicating with patients and their families about palliative and end-of-life care: Comfort and educational needs of nurses. International Journal of Palliative Nursing, 21(3), 109-112.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.