This paper presents an analysis of the role of advanced practice nurses in the management of end-of-life care. It discusses the aspects associated with end-of-life care and the decision-making process. The paper suggests the approach that can be used while communicating with the patient’s family and addresses the appropriateness of hospice services. It also discusses a case study that involves an unresponsive patient and inconsistency in his relatives’ opinion regarding care. The paper concludes that the advanced practice nurse’s role in end-of-life care may be vital.
The Aspects of End-of-Life Care
The role of advanced practice nurses in the management of end-of-life care and the establishment of communication with patients and their families is crucial. For a caregiver, assisting patients and their relatives in health-related decisions is an opportunity to practice compassion, patience and enhance their communication skills. Moreover, advanced practice nurses are patients’ advocates in end-of-life care. According to the studies by Gjerberg, Lillemoen, Førde, and Pedersen (2015) and Alsop (2010), it is vital to assure a shared decision-making process between the hospital’s staff, individuals, and their families through the establishment of productive communication.
When approaching a family that wants “everything” done for a patient, I would consider their concerns about their relative’s health and do all in my power to follow their request. However, if a patient is able to make decisions, his or her preferences are my priority. It is necessary for advanced practice nurses to develop a strategy that can be used when individuals’ and his family’ opinions differ. For example, if a patient does not want life-saving interventions, but the family does not agree with this decision, a caregiver should analyze the reasons for the individual’s choice and suggest a possible change.
As for hospice, I believe that it is appropriate to involve its services only if it is the patient’s decision. In my opinion, it is crucial for caregivers to avoid placing pressure on families or individuals that refuse hospice. It is vital to understand relatives’ desire to spend as much time with their family members as possible while they have this opportunity.
The selected case study presents a challenging situation both for the patient’s family and for the advanced practice nurse. According to Gallagher et al. (2015), end-of-life decisions are often associated with a high level of uncertainty. Gjerberg et al. (2015) note that individuals’ relatives may have a wrong or unclear perception of patients’ values and preferences. The case study reflects this point of view as it shows that Mr. Marley’s children have opposite opinions on his desire to live. The primary challenge in this situation is that there are no existing advance directives, which are significant aspects of end-of-life decisions (Levy & Kutner, 2012).
To facilitate the discussion with the patient’s family, I would ask them to elaborate on the factors that have influenced their opinion regarding Mr. Marley’s preferences. I would explain to them that the potential patient outcome, in this case, is his death, which means that it is crucial to consider all relevant aspects before making a decision. Although my opinion is not a determining factor in the family’s decision, I would insist that if there is a chance that Mr. Marley has a desire to live, it is vital to perform life-preserving interventions.
End-of-life care can be challenging even for an experienced advanced practice nurse. Caregivers play a significant role in helping individuals and their family members to make vital decisions. It is crucial to address patients’ and their relatives’ concerns and the reasons for their preferences considering care. Moreover, an advanced practice nurse should advocate for individuals’ safety and ensure that the planned action corresponds to their will.
Alsop, A. (2010). Collaborative working in end-of-life care: Developing a guide for health and social care professionals. International Journal of Palliative Nursing, 16(3), 120–125.
Gallagher, A., Bousso, R. S., McCarthy, J., Kohlen, H., Andrews, T., Paganini, M. C.,… & Padilha, K. G. (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.
Gjerberg, E., Lillemoen, L., Førde, R., & Pedersen, R. (2015). End-of-life care communications and shared decision-making in Norwegian nursing homes-experiences and perspectives of patients and relatives. BMC Geriatrics, 15. Web.
Levy, C. & Kutner, J. S. (2012). A good death: Appropriate end-of-life care. In J. M. Holroyd-Leduc & M. Reddy (Eds.), Evidence-based geriatric medicine: A practical clinical guide (pp. 175-186). Hoboken, NJ: Blackwell Publishing.