Case Study: NURS 6650 Week11 Case Study: NURS 6650 Week11 Case Study:

Case Study: NURS 6650 Week11

Case Study: NURS 6650 Week11

Case Study: NURS 6650 Week11

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Case Study: NURS 6650 Week11

NURS 6650  Week 11 Essay Assignment

End-of-Life-Care

It is a fact that humans are born to die. What was once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be discussed, and the organizational structure, culture, and governance that led to this situation will be reviewed.NURS 6650  Week 11 Essay Assignment

Ms. Smith was a 66 -year -old female with breast cancer that had metastasized to her lungs and liver. She had two adult daughters who lived in her home town and one of them had a young child. Mr. Smith was a 70- year-old retired factory worker.

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Ms. Smith had gone through lengthy chemotherapy and radiation treatments that had left her weak and debilitated. She developed pneumonia and experienced a respiratory arrest. She was placed on a ventilator and was weaned off the ventilator after two weeks. She remained in the Intensive Care Unit (ICU). Her family stayed with her as much as the ICU visiting hours allowed, but she was often alone and told her family that she was in pain and wanted to die.

The nurses were concerned about her pain needs, but were also worried that too much medication could cause another respiratory arrest. Ms. Smith languished in the ICU for two months until she did have another respiratory arrest and died without her family at her side. She and her family had agreed that she would not go back on the ventilator, and the physicians had written a Do Not Resuscitate (DNR) order. They had planned to move her from the ICU, but they hesitated to place her on a regular floor. Everyone involved in the case believed that it was not handled well, and a team was assembled to determine how to improve the care of the dying.

A review of the literature found that this institution was not alone with their concerns that the care of the dying needed to improve. Autonomy is one of the core bio ethical principles that focuses on the right of every individual to make choices regarding health care decisions. Providers and caregivers spend a great deal of time instructing and coaxing patients to take control of their own health. But these providers are often surprised and upset when patients with life-limiting illnesses express a desire to control the timing and circumstances of their end-of-life experience (Volker, Kahn, & Penticuff, 2004). In their study, they found that people with advanced cancer expressed a wide variety of preferences for personal control and comfort, and that many wanted to remain as involved as possible in their daily lives for as long as possible.

Organizations can play a key role in policy changes to support the needs of these individuals. Providers are trained to see death as the enemy, and sometimes forget that death is a natural part of the human experience. Joe Cantlupe’s story in Health Leaders stated that “we don’t always deal with the issues of death and dying very well in our culture” (p. 14, 2013). The Institute of Medicine published a report that concluded that many patients die in pain, are not referred to hospice in a timely manner, and the improvements in care have not led to improvements in care at the end of life. Fortunately, there have been efforts to study the patient’s perspective of death and dying as well as the perspectives of nurses and physicians. These studies are leading to a better understanding of the experience and the methods needed to improve the quality of end of life care (Cantlupe, 2013).

It may seem strange to consider quality about end of life care, but it is recognized as an ethical obligation of health care providers and organizations. Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long-term care facilities, to determine their views on end-of-life issues. Their results identified five domains of quality care at the end-of-life. These were “adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones” (p. 163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital.

Some wanted to be at home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009 interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their end-of-life experiences. These patients stressed that they most wanted to continue what they had been doing for most of their lives for as long as possible. They also wanted to help others when possible and live in a caring environment. They often mentioned the use of humor and a positive attitude in the environment. When they discussed their illnesses, they expressed frustration with their physical limitations, and hopelessness when the disease reoccurred. NURS 6650  Week 11 Essay Assignment

As providers began to understand the gap between their traditional training and the needs of patients, researchers began to evaluate the skills needed to provide a better quality of end-of-life care. Nursing had long considered the choices made about artificial nutrition or hydration, palliative treatment, or symptom control to be in the medical domain, and the nursing role was often unclear. Nursing is involved in the end-of-life care. They are with the inpatient on a 24-hour basis, they use a patient-centered approach to care, and they have experience and expertise in caring for dying patients and their families. Case studies have found that the nurses’ involvement in end-of-life care is not only about the technical decisions in the care process, but also that the daily interactions that nurses have with patient’s vulnerabilities make them ethically sensitive to the needs of the patient and family (Gastman, 2012).NURS 6650  Week 11 Essay Assignment

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The International Council of Nurses (ICN) developed a code of ethics that stated that nurses are responsible to alleviate suffering as well as promoting health and preventing illness. By expanding the scope of end-of-life care beyond the narrow medical definitions, and aligning the code of ethics with a broader definition of end-of-life care to expand beyond the hospital setting, nursing can become more involved in end-of-life care (Shigeko, Nague, Sakuai, & Imamura, 2012). The role of the primary care provider in end-of-life care has also been studied, and these studies have found that despite the continuity and comprehensiveness of primary care, few Americans die under the care of their familiar provider. Many patients have reported feeling abandoned by their primary care provider at the time of death. Care at home by primary care providers benefits many patients and the health care system overburdened by hospitalization cost (Silveira, & Forman, 2012).

On the other side of the care spectrum, the role of the intensive care provider also can be improved. White and Curtis (2005) studied the need and the impact of shared decision- making on critically ill ICU patients. They found that while involving families in end-of-life decisions is a complex task that requires excellent communication skills, the more time spent with families discussing and explain the issues, the higher the family satisfaction. The hospital where Ms. Smith died was the average institution with an organizational structure that included a Chief Medical Officer and Medical Directors of each specialty area. There was a Chief Nursing Officer as well as Nursing Administrators responsible for the care of patients. They had been very focused on treating illness, and considered themselves successful. The review by the improvement team helped them to see that they needed to change their perspective and consider less paternalistic alternatives to caring for patients at the end-of-life. NURS 6650  Week 11 Essay Assignment

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

• Communication is so very important. There are multiple ways to communicate with me:
  • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
  • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.