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Part 1

1.What are your thoughts on the 5 question framework?


2.Do you agree that it could be useful in decision making in unanticipated scenarios?  Give a rationale for your thinking / use the literature to explain.


3.Do you agree that it is ethically appropriate to override advance directives in situations like this? Give a rationale for your thinking / use the literature to explain.

Part 2

1.How did this make you feel? How do you think that Anne and the RN felt after this conversation?

Consider yourself in the position of the RN alone on night duty:

  • What would you do now?
  • What factors will often contribute to moving residents (or patients if they are at home) to hospital (eg, staffing skill mix, family choice)
  • How can strategies be put in place to avoid this?

The Five Question Framework for Emergency Decisions in Patient Care

1.The five question framework is quite significant as it is helpful for the physicians and the surrogates during the decision making process of the patients who are rendered in capable of taking decisions on their own. The five question framework involves questions which help the decision makers to investigate the prevailing situation and to determine if the situation requires emergency actions to be taken. If it is seen that it is an emergency situation, then the decision makers need to make decision for the patient like wise and must put into action immediately. The question also helps the decision makers to understand in the view of the values and goals of the patient, that how the decision taken by them for implementation of the interventions will be able to outweigh the burdens. Additionally the questions included in the framework allow the decision makers to evaluate the need of advance directive in the prevailing condition of the concerned patient. Once this has been understood, the process of the decision making also becomes easier. Similarly for better decision making it is also required to know and understand much leeway does the patient provide the surrogate for overriding the advance directive. In case of the physicians while helping the surrogate to make the decision, the framework helps them to assess that well does the surrogate represent the patient’s best interests. Once this can be made sure, then the decision can be taken according to it (Halpern et al., 2013).

2.Advance directive is essential especially in unanticipated situations because these advance directives will be able to give voice to the decisions of the patients especially regarding their medical care even when they are severely ill or unconscious and are not able to communicate (Bischoff et al., 2013). While we are healthy and capable of communicating properly, it can accept of refuse any treatment that is presented however there are chances that we might fall ill seriously and might become incapable of participating in decision regarding treatment therefore in such conditions advance directives come into play. According to research, 80 percent of individuals face death in some kind of medical facility such as a hospital or nursing home, where extending life is possible through medical technology. However the quality of that life might get highly reduced. Therefore, most of the patients and their families along with caregivers have to face critical questions regarding the amount of technology that are used when the patient fail to get better, but dying can be prolonged (Brinkman-Stoppelenburg, Rietjens & van der Heide, 2014). From this it can be understood that a decision has to be faced regarding the usage of medical treatments for sustaining life during the end period of lives. However at that point most of the time, other people will have to make that decision for the concerned individual. Making decisions might end up in a patient's death which is hard to deal as well as painful for their loved ones including family, friends and caregivers. In cases the loved ones don't know the values and wishes then decision making becomes harder by them. Without information about the wishes of the patients, chances of disputes might arise between their family and healthcare professionals or within the family itself (Ni et al., 2014).

The Significance of Advance Directives in End-of-Life Care

3.The process of autonomy of patient is most of time seen as a dominant principle in terms of medical ethics and medicine. It is also argued that by following the advance directives the provision of the best means in order to respect the wishes of the patient along with preservation of autonomy in case the patient no longer has the capacity to make a decision. Most of the time about 76.5 percent of the patient as seen in one survey, want their wishes to be carried out during an event when they are no more capable of making any decision for themselves. Therefore some people who disagree regarding the fact that the advance directives possess a strong prima facie weight which overlooks the serious justification (Sudore et al., 2017). In cases where all the parties agree on using the advance directives in order to respect the autonomy of the patient, most of the decision makers continue to face difficulties regarding what intervention and situations are covered by the directive (Health and Food Ethics, 2018).

1.In the absence of any other staff during the night shift when the patient was suffering from end-of-life situation, I being the RN present in the situation had several responsibilities. Observing, discussing and recording any changes in conditions is included in the process and offering compassion and support to the patient Greta. In such a situation I need to project a number of skills which will include treating the patient with compassion, listening properly and communicating clearly. I need to acknowledge the distress and pain of the patient that she is suffering from. I need to consider every person when someone is experiencing the last few days and hours of life and additionally try to involve the patient’s family in the decision regarding the care and try to respect the wishes of the patient as well. As the only staff present in the situation, it is my duty to inform the people who are important to the person experiencing the last few hours of life regarding the changes or difference happening in the condition. Here this person is the daughter of the patient, Anne. I also need to document the summary of the conversions and the decisions regarding the patient. Although the job is challenging as well as emotionally demanding, while supporting the patient therefore I need to have the appropiate skills, knowledge and attitude, end of life care which has the potential of being very rewarding (ANA Enterprise | American Nurses Association, 2018).

Responsibilities of a Nurse on Night Duty in End-of-Life Situations

2.Transitional consideration aims to incorporate a wide possibility of administrations and conditions intended to advance the sheltered and convenient section of patients between levels of human services and crosswise over consideration settings. High caliber transitional consideration is particularly imperative for older adults with various endless conditions including complex regimens and in addition for their family parental figures. These patients regularly get care from numerous suppliers and move often inside social insurance settings. There are many factors that contribute during the transition of the patients from the care home setting to the different care settings such as hospitals (Verhaegh et al., 2014). Poor correspondence, fragmented exchange of data, deficient instruction of more established grown-ups and their family guardians constrained access to fundamental administrations, and the nonappearance of a solitary go-to person to guarantee coherence of contemplation all contribute to the change. Dialect and wellbeing proficiency issues and social contrasts strengthen the subject. Family parental figures play a noteworthy and maybe the most critical job in supporting more seasoned grown-ups amid hospitalization and particularly after release (Australian Institute of Health and Welfare, 2018). Up to this point, in any case, little consideration was paid to family parental figures' unmistakable needs amid advances in consideration. Providing care can be fulfilling, yet it can likewise force troubles on family parental figures. The tension of provision of care is most of the time going to be exacerbated amongst the scenes of intense ailment. The nurses and social specialists are required to take care of the enthusiastic needs of parental figures amid transitional consideration to help limit their adverse encounters and to improve their capability to help their friends and family.

3.The systems that can be executed to maintain a strategic distance from this include a few interdisciplinary intercessions will help to reliably enhanced nature of human services administrations. These include care advances instructing alongside APN transitional consideration display. A propelled hone nurture (APN) filled in as the "advances mentor," instructing the patient and guardian abilities expected to advance cross-site progression of consideration. Instructing started in the doctor's facility and proceeded for 30 days after release (rcnendoflife, 2018). A randomized, controlled preliminary found that patients who got this mediation had bring down all-cause re-hospitalization rates through 90 days after release contrasted and control patients. At a half year, mean clinic costs were roughly $500 less for patients in the mediation amass contrasted and controls (Allen et al., 2014). Patients offered this kind of consideration are high-hazard, intellectually unblemished more established grown-ups with an assortment of therapeutic and careful conditions who are progressing from doctor's facility to home. In a joint effort with each more seasoned grown-up, family guardian, doctor, and other wellbeing colleagues and guided by proof based conventions, the APN accepts essential accountability for advancing every patient's wellbeing amid hospitalization and for planning the arrangement for follow-up consideration. A similar medical caretaker actualizes this arrangement after release by giving customary visiting attendant administrations, making home visits and being accessible seven days seven days by phone. Three randomized, controlled preliminaries financed by the National Institutes of Health (NIH) reliably showed that this model of consideration enhances more established grown-ups' fulfillment, lessens rehospitalizations, and declines medicinal services costs (Rennke et al., 2013).

References

Allen, J., Hutchinson, A. M., Brown, R., & Livingston, P. M. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC health services research, 14(1), 346.

ANA Enterprise | American Nurses Association. (2018). Retrieved from https://www.nursingworld.org/

Australian Institute of Health and Welfare (2018). Retrieved from https://www.aihw.gov.au/getmedia/ba6a7e49-6939-499e-af79 f72acc5bff56/13755.pdf.aspx?inline=true

Bischoff, K. E., Sudore, R., Miao, Y., Boscardin, W. J., & Smith, A. K. (2013). Advance care planning and the quality of end?of?life care in older adults. Journal of the American Geriatrics Society, 61(2), 209-214.

Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), 1000-1025.

Halpern, S. D., Loewenstein, G., Volpp, K. G., Cooney, E., Vranas, K., Quill, C. M., ... & Arnold, R. (2013). Default options in advance directives influence how patients set goals for end-of-life care. Health Affairs, 32(2), 408-417.

Health and Food Ethics. (2018). Retrieved from https://journalofethics.ama-assn.org

Ni, P., Zhou, J., Wang, Z. X., Nie, R., Phillips, J., & Mao, J. (2014). Advance directive and end-of-life care preferences among nursing home residents in Wuhan, China: a cross-sectional study. Journal of the American Medical Directors Association, 15(10), 751-756.

rcnendoflife (2018). Retrieved from https://rcnendoflife.org.uk

Rennke, S., Nguyen, O. K., Shoeb, M. H., Magan, Y., Wachter, R. M., & Ranji, S. R. (2013). Hospital-initiated transitional care interventions as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5_Part_2), 433-440.

Sudore, R. L., Boscardin, J., Feuz, M. A., McMahan, R. D., Katen, M. T., & Barnes, D. E. (2017). Effect of the prepare website vs an easy-to-read advance directive on advance care planning documentation and engagement among veterans: a randomized clinical trial. JAMA internal medicine, 177(8), 1102-1109.

Verhaegh, K. J., MacNeil-Vroomen, J. L., Eslami, S., Geerlings, S. E., de Rooij, S. E., & Buurman, B. M. (2014). Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health affairs, 33(9), 1531-1539

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