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Assignment: Case Study To Consider
Assignment: Case Study To Consider
Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance.
How would you respond to Michael and serve as advocate for your patient?
Option #2 – Share a Related Experience
Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.
What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?
Taking care of a person’s advance care directives
Tell the doctor in charge as quickly as possible if the person has written documentation as part of an advance care plan, such as a do not resuscitate order.
If end-of-life care is provided at home, you’ll need a special out-of-hospital order signed by a doctor to ensure that emergency medical personnel respect the person’s preferences if they are summoned to the house.
Hospice professionals can assist in determining if a medical problem is part of the natural dying process or something that requires medical intervention.
If a person’s advance care plan does not address a circumstance, or if the person does not have one, you can use alternative decision-making processes to help determine the appropriate strategy for the individual.
Substituted judgment and best interests are two decision-making processes.
When you come across decisions that haven’t been addressed in a person’s advance care plan or in earlier talks with them, you can take one of two ways.
One is to put oneself in the shoes of a dying person and make decisions as they would.
Substituted judgment is the term for this.
When possible, some experts believe that decisions should be made on substituted judgment.
Another option, known as best interests, is to select what you, as the dying person’s agent, believe is best for them.
Substituted judgment is occasionally used in conjunction with this.
The stories below exemplify these two methods.
The story of Joseph and Leilani
Leilani, Joseph’s 90-year-old mother, was in a coma following a massive stroke.
According to the doctor, Leilani’s brain damage was extensive, and she needed to be put on a breathing machine (ventilator) or she would die.
The doctor inquired if Joseph consented to this procedure.
Joseph recalled his mother’s disapproval when an elderly neighbor had a stroke and was placed on a comparable machine.
His mother died quietly a few hours later after he declined.
The substituted judgment approach is used in this case.
The narrative of Ali and Wadi
Wadi, Ali’s father, is 80 years old and suffers from lung cancer as well as advanced Parkinson’s disease.
He’s in a nursing home and doesn’t recognize Ali when she pays him a visit.
Wadi’s doctor recommended that removing a portion of one of Wadi’s lungs would help reduce the cancer’s progression and offer him more time.
“What kind of time?” Ali wondered.
What would that period of time mean for Dad?”
Wadi’s best interests were not served by putting his father through surgery and recovery.
Ali concluded that surgery, which could cause extra agony and discomfort, would not improve his father’s quality of life after speaking with his doctors.
This is an example of a decision-making strategy based on the best interests of the parties involved.
If you’re making decisions for someone towards the end of their life and are considering one of these options, consider the following questions:
Have they ever discussed their wishes for the end of their lives?
Have they ever expressed a viewpoint on someone else’s end-of-life care?
What were their values, and what gave their lives meaning?
It could have something to do with being near to family and creating memories together.
Perhaps they preferred being outside and in nature.
Is it still possible for them to join in these activities?
You’ll need as much information as possible to guide your actions if you’re making decisions without particular advice from the dying individual.
Remember that whether the person is at home, in a care facility, or in a hospital, the decisions you must make and the questions you may ask the person’s medical staff will differ.
You could consult your doctor about the following:
If we stick to our current treatment plan, what can we expect to happen in the next several hours, days, or weeks?
Will treatment allow you to spend more time with your family and friends?
What if we don’t want the treatment that is being provided to us?
So, what happens next?
What is the best time to start hospice care?
Is this care available at home or in the hospital?
Will the person be denied certain treatments if we start hospice?
What medications will be used to aid in the management of pain and other symptoms?
What are the possible negative consequences?
What happens if a member of our family stops eating or drinking?
Is a feeding tube a possibility?
What are the advantages and disadvantages?
What happens if we try to use the ventilator to help with breathing and then decide to stop?
When speaking with medical personnel about these difficulties, it is a good idea to have someone with you.
That person can help you remember things by taking notes.
If you’re not sure about something the doctor or nurse stated, don’t be hesitant to ask them to repeat or restate it.
Continue asking questions until you have all of the data you require to make a conclusion.
If the person is at home, make sure you know how to get in touch with a member of the medical team if you have a question or if the dying person requires assistance.
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