NRS 434 Topic 5 DQ 2
Sample Answer for NRS 434 Topic 5 DQ 2 Included After Question
NRS 434 Topic 5 DQ 2
End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.
A Sample Answer For the Assignment: NRS 434 Topic 5 DQ 2
Title: NRS 434 Topic 5 DQ 2
NRS 434 Topic 5 DQ 2
A majority of older adults do not die in their homes despite it being their preference, and they prefer home care. However, about 25% of patients having terminal illnesses have a home death, while 50% die in hospitals, 20% in nursing homes, and 4% in palliative care facilities (Wheatley & Baker, 2007). A majority of patients, even those who are discharged following admission, are not able to stay at home and instead die in inpatient units. Besides, a large percentage of patients get an emergency admission before their death due to a change in their health condition in which discharge at this point is usually impossible (Morris et al., 2013). In a case where a patient’s relatives would experience burdens and risks by providing home care, the choice of dying at home is usually inappropriate (Loh et al., 2016). Furthermore, in situations where there are limited resources and community providers cannot provide care at the household level, home care is often impossible, and patients end up dying at nursing homes.
The duty of a nurse should be to uphold the four ethical principles of respect for autonomy, beneficence, non-maleficence, and justice. The four principles provide a framework when facing ethical dilemmas that enables effective decision-making on the emotional issues involved and ensures that crucial factors are not disregarded (Wheatley & Baker, 2007). Decisions on the place of care in patients with terminal illnesses are usually ethically challenging. Ethical considerations of non-maleficence and beneficence should be balanced against the respect to autonomy and justice (Grand Canyon University, 2018). As a nurse, I would support my clients regarding end-of-life care per their wishes by upholding the moral principle of respect for autonomy (Loh et al., 2016). I would respect patients’ choices on their lives and bodies and allow them to exercise the freedom to make decisions that concern them. Besides, I would enable clients to have adequate time and experience to make decisions regarding end-of-life care to promote better patient outcomes and decrease the occurrence of adverse events (Price, 2016). I will empower patients and caregivers to make healthcare decisions that avoid hospitalizations at the very end of life.
References 
Grand Canyon University. (Ed.). (2018). Health assessment: Foundations for effective practice. Retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php
Loh, A. Z. H., Tan, J. S. Y., Jinxuan, T., Lyn, T. Y., Krishna, L. K. R., & Goh, C. R. (2016). Place of care at end of life: what factors are associated with patients’ and their family members’ preferences? American Journal of Hospice and Palliative Medicine®, 33(7), 669-677.
Morris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study. BMC health services research, 13(1), 89.
Price, J. (2016). Informed shared decision-making in planning for the end of life. British Journal of Nursing, 25(7), 378-383.
Wheatley, V. J., & Baker, J. I. (2007). “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Postgraduate medical journal, 83(984), 643–648. doi:10.1136/pgmj.2007.058487
Most palliative care patients prefer to receive care, and to die, at home. Nevertheless, a majority die in institutions. A survey conducted in the UK revealed that even though 50-70% of elderly patient s with a terminal illness prefer to be cared for and die at home, only approximately 25% have a home death (Hoare et al., 2015). More than half of the patients die in hospitals, about 20% in long-term care institutions, and 4% in specialized palliative care units.
The high prevalence of death in institutions is related to the fact that most patients, including those that get discharged, are not able to stay at home and die in the inpatient units. Additionally, a significant number of patients have an emergency admission at home, after which a discharge is usually impossible (Hoare et al., 2015). Emergency admission mostly occurs when the patient’s condition drastically deteriorates, and the patient then dies after admission (Loh et al., 2016). Furthermore, despite the patient’s health condition becoming stable after an emergency admission, the informal caregivers at home may prefer the patient to stay as an inpatient for some days for further management.
The nurse has the role of supporting patients’ decisions regarding end-of-life care and preferred place of death. I would support my patients’ wishes by first inquiring from terminally patients on how they would wish to spend their last days (Loh et al., 2016). For patients who wish to be cared for at home, I would discuss the wishes with the patients’ relatives with the patient. In addition, I would educate the caregiver and patient’s family on the signs of impending death that the patient is likely to have to avoid panic and unnecessary emergency admissions (Hoare et al., 2015). I would inform of signs such as a decreased level of awareness, dyspnea with erratic breathing patterns, abnormal breathing sounds, cold extremities with blue toes, and refusal to feed.
References
Hoare, S., Morris, Z. S., Kelly, M. P., Kuhn, I., & Barclay, S. (2015). Do patients want to die at home? A systematic review of the UK literature, focused on missing preferences for place of death. PLoS One, 10(11). https://doi.org/10.1371/journal.pone.0142723
Loh, A. Z. H., Tan, J. S. Y., Jinxuan, T., Lyn, T. Y., Krishna, L. K. R., & Goh, C. R. (2016). Place of care at end of life: what factors are associated with patients’ and their family members’ preferences? American Journal of Hospice and Palliative Medicine®, 33(7), 669-677.
Topic 5 DQ 2
A majority of geriatric patients on palliative and hospice care prefer to spend their last days and die at their homes surrounded by their loved ones. However, most of these patients die in healthcare institutions against their advanced care plans. Besides, many patients, including those discharged, do not manage to stay at home and instead die as inpatients (Lai, Wong, & Ching, 2018). The trend of dying in healthcare facilities is because a significant proportion of palliative care patients have an emergency admission from home, after which it becomes possible to arrange a discharge (Carr & Luth, 2017). Emergency admissions occur when a patient’s health condition deteriorates considerably, and the patient dies when in the emergency department or after being admitted.
Family-dominated decision making about a patient’s care in their last days result in a patient’s wishes on their preferred place of death failing to be fulfilled (Lai, Wong, & Ching, 2018). For instance, the caregivers often prefer that the patient remains hospitalized even after stabilizing in the emergency department. This is because the caregivers worry that the patient’s condition may worsen at home and thus prefer the patient to stay as an inpatient for some time to be monitored by health providers.
A nurse has an ethical duty to respect and support a patient’s decisions on their end-of-life care and place of death. I would support palliative care patients by informing them about advance care planning, which involves having a written document that state one wishes on their end of life care (Carr & Luth, 2017). For patients with advanced care planning documents, I would inform their families of the patient’s wishes. Besides, I would probe from the patients on their end-of-life care and where they would want to spend their last days. I would then advocate for the patient’s wishes to be fulfilled by their families.
References
Carr, D., & Luth, E. A. (2017). Advance care planning: contemporary issues and future directions. Innovation in Aging, 1(1).
Lai, X. B., Wong, F. K. Y., & Ching, S. S. Y. (2018). The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study. BMC palliative care, 17(1), 1-11. https://doi.org/10.1186/s12904-018-0372-7
See Also: NRS 434 Topic 2 DQ 1