NURS 6540 Week 11 discussion Discussion: Discussing End-of-Life Care

Week 11 discussion

Discussion: Discussing End-of-Life Care

There is a human tendency to postpone uncomfortable or
unpleasant tasks.

—Nancy Kummer, geriatric patient

This human tendency to avoid the unpleasant makes
end-of-life care and hospice decisions difficult for many patients to discuss
with their families. Kummer is a former social worker who used to counsel
patients with terminal illnesses, yet she avoided discussing her own
end-of-life wishes with her children. While many Americans, like Kummer, agree
that these discussions need to take place, few have actually had these
conversations with their families (Lazar, 2012). Although initiating
conversations about end-of-life care and hospice might be difficult for
patients, as an advanced practice nurse, facilitating these conversations is an
integral part of your geriatric nursing practice. For this Discussion, consider
how you would facilitate care conversations with the patients and families in
the following case studies:

Case Study 1

Mrs. Sloan, a 69-year-old widow, is about to enter the
hospital for an elective cholecystectomy; she is being medically cleared by her
primary care provider. During the discussion, she requests to be placed on a no
code status during her hospitalization. Mrs. Sloan claims that besides her
gallbladder problem, her general health status is good. She wishes to have the
surgery to avoid any further attacks, which have been very painful. She states,
however, that if during surgery or her postoperative period, she undergoes a
cardiac arrest, she would prefer not to be resuscitated. She has read about the
chances of successful resuscitation, and has determined that the risk of brain
damage is too high. For this reason, she is requesting a no code status.

Case Study 2

Ms. Stearns is an 83-year-old nursing home resident with
hypertension, coronary artery disease, arthritis, renal insufficiency, hearing
impairment, and a previous history of stroke. She also has a foot deformity
from childhood polio. She is disoriented at times. She has lived in the nursing
home for 10 years and rarely leaves the chair beside her bed. She has recently
developed urinary incontinence, but has refused a bladder catheterization to
determine postvoid residual urine or possible bladder infection. She does not
have a diagnosis of dementia; however, current testing reveals that she
performs poorly on a standardized mental status examination. She can, however,
identify all the staff in the nursing home, and she can describe each patient
who has been in the bed next to hers over the past 10 years. When asked to
explain why she does not want bladder catheterization, she gives several
reasons. She states that the incontinence does not bother her, and that she has
always been a very private person. She particularly dislikes and objects to any
examination of her pelvic organs; in fact, she has never had a pelvic
examination nor has she ever had sexual intercourse. She realizes that she has
a number of medical problems and that any one of them could worsen at any time.
She states she is not willing to undergo any treatment for any of her current
problems should they become worse.

Case Study 3

Mr. Marley, age 91, is admitted to the intensive care unit
following a stroke. The stroke progressed from mild hemiparesis and difficulty
speaking to complete unresponsiveness and an inability to swallow. His daughter
feels certain, based on prior explicit conversations with her father, that he
would not want to have any treatment that would prolong his life and leave him
in a severely disabled state. Mr. Marley’s oldest son disagrees with his
sister’s assessment of their father. The son claims that their father still has
a strong desire to live, and that he has been very active in his church until
this stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is
asked about insertion of a feeding tube. It is explained to the family that
without food and fluids, their father will die fairly quickly. There are no
existing advance directives or a designated health care decision maker noted
for Mr. Marley.

To prepare:

Review Chapter 14 of the Holroyd-Leduc and Reddy text.

Reflect on the role of the advanced practice nurse in
facilitating the discussion of end-of-life care with patients and their
families.

Think about how you, as an advanced practice nurse, would
approach a family who wants “everything” done for a patient with only a limited
time to live.

Consider when it is appropriate to involve hospice and how
to approach patients and/or families who refuse hospice services.

Select one of the three provided case studies related to the
end-of-life care of the frail elderly. Reflect on potential patient outcomes
and how you would facilitate the discussion of care with this patient’s family.

By Day 3

Post an explanation of the role of the advanced practice
nurse in facilitating the discussion of end-of-life care with patients and
their families. Explain how you would approach a family who wants “everything”
done for a patient with only a limited time to live. Then, explain when it is
appropriate to involve hospice and how to approach patients and/or families who
refuse hospice services. Finally, explain potential outcomes of the patient in
the case study you selected and how you would facilitate the discussion of
end-of-life care with this patient’s family.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who selected different case studies
than you. Based on the site of care, suggest strategies for establishing the
role of advanced practice nurses in end-of-life discussions with patients.

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NURS 6540 Week 11 discussion Discussion: Discussing End-of-Life Care Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.