Sample Answer for NRS 434 Topic 5 DQ 2\u00a0 Included After Question<\/strong><\/h2>\nNRS 434 Topic 5 DQ 2<\/p>\n
End-of-life care <\/span><\/a>becomes<\/span> 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 <\/span>regarding<\/span> end-of-life care <\/span>in accordance with<\/span> their wishes. Support your response with evidence-based literature.<\/span><\/span>\u00a0<\/span><\/p>\nA Sample Answer For the Assignment: NRS 434 Topic 5 DQ 2\u00a0<\/strong><\/h2>\nTitle: NRS 434 Topic 5 DQ 2\u00a0<\/strong><\/h2>\nNRS 434 Topic 5 DQ 2\u00a0<\/a><\/em><\/span><\/h2>\n\u00a0<\/span>A majority of older adults do not die in their homes despite it being their preference, and they prefer home care<\/a>. 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\u202f<\/span>et al<\/span><\/i>., 2013). In a case where a patient\u2019s relatives would experience burdens and risks by providing home care, the choice of dying at home is usually inappropriate (Loh\u202fet 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.<\/span>\u00a0<\/span><\/p>\nThe 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\u202fet al., 2016). I would respect patients\u2019 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.<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>References<\/span> ![\"NRS](\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2023\/09\/Downloader.la-649b1d35b7dc4-300x204.webp\")
<\/span><\/h3>\nGrand Canyon University. (Ed.). (2018). <\/span>Health assessment: Foundations for effective practice<\/span><\/i>. Retrieved from <\/span>https:\/\/www.gcumedia.com\/digital-resources\/grand-canyon-university\/2018\/health-assessment_foundations-for-effective-practice_1e.php<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nMorris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study.\u202f<\/span>BMC health services research<\/span><\/i>,\u202f<\/span>13<\/span><\/i>(1), 89.<\/span>\u00a0<\/span><\/p>\nPrice, J. (2016). Informed shared decision-making in planning for the end of life.\u202f<\/span>British Journal of Nursing<\/span><\/i>,\u202f<\/span>25<\/span><\/i>(7), 378-383.<\/span>\u00a0<\/span><\/p>\nWheatley, 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.\u202f<\/span>Postgraduate medical journal<\/span><\/i>,\u202f<\/span>83<\/span><\/i>(984), 643\u2013648. doi:10.1136\/pgmj.2007.058487<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>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\u202f<\/span>et al<\/span><\/i>., 2015). More than half of the patients die in hospitals, about 20% in long-term care institutions, and 4% in specialized palliative care units.\u202f<\/span>\u00a0<\/span><\/p>\n![\"Sample](\"http:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2023\/10\/Sample-Answer-for-NRS-434-Topic-5-DQ-2-Included-After-Question-300x144.png\")
Sample Answer for NRS 434 Topic 5 DQ 2\u00a0 Included After Question<\/figcaption><\/figure>\nClick here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NRS 434 Topic 5 DQ 2\u00a0\u00a0<\/strong><\/a><\/em><\/span><\/span><\/p>\nThe 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\u202f<\/span>et al<\/span><\/i>., 2015). Emergency admission mostly occurs when the patient\u2019s condition drastically deteriorates, and the patient then dies after admission (Loh\u202f<\/span>et al<\/span><\/i>., 2016). Furthermore, despite the patient\u2019s 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.<\/span>\u00a0<\/span><\/p>\nThe nurse has the role of supporting patients\u2019 decisions regarding end-of-life care and preferred place of death. I would support my patients\u2019 wishes by first inquiring from terminally patients on how they would wish to spend their last days (Loh\u202f<\/span>et al<\/span><\/i>., 2016). For patients who wish to be cared for at home, I would discuss the wishes with the patients\u2019 relatives with the patient. In addition, I would educate the caregiver and patient\u2019s family on the signs of impending death that the patient is likely to have to avoid panic and unnecessary emergency admissions (Hoare\u202f<\/span>et al<\/span><\/i>., 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.<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h3>\nHoare, 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.\u202f<\/span>PLoS One<\/span><\/i>,\u202f<\/span>10<\/span><\/i>(11).<\/span> https:\/\/doi.org\/10.1371\/journal.pone.0142723<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nTopic 5 DQ 2<\/span><\/b>\u00a0<\/span><\/h3>\nA 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\u2019s health condition deteriorates considerably, and the patient dies when in the emergency department or after being admitted.\u00a0<\/span>\u00a0<\/span><\/p>\nFamily-dominated decision making about a patient\u2019s care in their last days result in a patient\u2019s wishes on their preferred place of death failing to be fulfilled (Lai, Wong, & Ching, 2018).\u00a0 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\u2019s condition may worsen at home and thus prefer the patient to stay as an inpatient for some time to be monitored by health providers.\u00a0<\/span>\u00a0<\/span><\/p>\n
A Sample Answer For the Assignment: NRS 434 Topic 5 DQ 2\u00a0<\/strong><\/h2>\nTitle: NRS 434 Topic 5 DQ 2\u00a0<\/strong><\/h2>\nNRS 434 Topic 5 DQ 2\u00a0<\/a><\/em><\/span><\/h2>\n\u00a0<\/span>A majority of older adults do not die in their homes despite it being their preference, and they prefer home care<\/a>. 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\u202f<\/span>et al<\/span><\/i>., 2013). In a case where a patient\u2019s relatives would experience burdens and risks by providing home care, the choice of dying at home is usually inappropriate (Loh\u202fet 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.<\/span>\u00a0<\/span><\/p>\nThe 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\u202fet al., 2016). I would respect patients\u2019 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.<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>References<\/span> <\/span><\/h3>\nGrand Canyon University. (Ed.). (2018). <\/span>Health assessment: Foundations for effective practice<\/span><\/i>. Retrieved from <\/span>https:\/\/www.gcumedia.com\/digital-resources\/grand-canyon-university\/2018\/health-assessment_foundations-for-effective-practice_1e.php<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nMorris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study.\u202f<\/span>BMC health services research<\/span><\/i>,\u202f<\/span>13<\/span><\/i>(1), 89.<\/span>\u00a0<\/span><\/p>\nPrice, J. (2016). Informed shared decision-making in planning for the end of life.\u202f<\/span>British Journal of Nursing<\/span><\/i>,\u202f<\/span>25<\/span><\/i>(7), 378-383.<\/span>\u00a0<\/span><\/p>\nWheatley, 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.\u202f<\/span>Postgraduate medical journal<\/span><\/i>,\u202f<\/span>83<\/span><\/i>(984), 643\u2013648. doi:10.1136\/pgmj.2007.058487<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>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\u202f<\/span>et al<\/span><\/i>., 2015). More than half of the patients die in hospitals, about 20% in long-term care institutions, and 4% in specialized palliative care units.\u202f<\/span>\u00a0<\/span><\/p>\nSample Answer for NRS 434 Topic 5 DQ 2\u00a0 Included After Question<\/figcaption><\/figure>\nClick here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NRS 434 Topic 5 DQ 2\u00a0\u00a0<\/strong><\/a><\/em><\/span><\/span><\/p>\nThe 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\u202f<\/span>et al<\/span><\/i>., 2015). Emergency admission mostly occurs when the patient\u2019s condition drastically deteriorates, and the patient then dies after admission (Loh\u202f<\/span>et al<\/span><\/i>., 2016). Furthermore, despite the patient\u2019s 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.<\/span>\u00a0<\/span><\/p>\nThe nurse has the role of supporting patients\u2019 decisions regarding end-of-life care and preferred place of death. I would support my patients\u2019 wishes by first inquiring from terminally patients on how they would wish to spend their last days (Loh\u202f<\/span>et al<\/span><\/i>., 2016). For patients who wish to be cared for at home, I would discuss the wishes with the patients\u2019 relatives with the patient. In addition, I would educate the caregiver and patient\u2019s family on the signs of impending death that the patient is likely to have to avoid panic and unnecessary emergency admissions (Hoare\u202f<\/span>et al<\/span><\/i>., 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.<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h3>\nHoare, 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.\u202f<\/span>PLoS One<\/span><\/i>,\u202f<\/span>10<\/span><\/i>(11).<\/span> https:\/\/doi.org\/10.1371\/journal.pone.0142723<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nTopic 5 DQ 2<\/span><\/b>\u00a0<\/span><\/h3>\nA 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\u2019s health condition deteriorates considerably, and the patient dies when in the emergency department or after being admitted.\u00a0<\/span>\u00a0<\/span><\/p>\nFamily-dominated decision making about a patient\u2019s care in their last days result in a patient\u2019s wishes on their preferred place of death failing to be fulfilled (Lai, Wong, & Ching, 2018).\u00a0 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\u2019s condition may worsen at home and thus prefer the patient to stay as an inpatient for some time to be monitored by health providers.\u00a0<\/span>\u00a0<\/span><\/p>\n
NRS 434 Topic 5 DQ 2\u00a0<\/a><\/em><\/span><\/h2>\n\u00a0<\/span>A majority of older adults do not die in their homes despite it being their preference, and they prefer home care<\/a>. 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\u202f<\/span>et al<\/span><\/i>., 2013). In a case where a patient\u2019s relatives would experience burdens and risks by providing home care, the choice of dying at home is usually inappropriate (Loh\u202fet 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.<\/span>\u00a0<\/span><\/p>\nThe 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\u202fet al., 2016). I would respect patients\u2019 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.<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>References<\/span> <\/span><\/h3>\nGrand Canyon University. (Ed.). (2018). <\/span>Health assessment: Foundations for effective practice<\/span><\/i>. Retrieved from <\/span>https:\/\/www.gcumedia.com\/digital-resources\/grand-canyon-university\/2018\/health-assessment_foundations-for-effective-practice_1e.php<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nMorris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study.\u202f<\/span>BMC health services research<\/span><\/i>,\u202f<\/span>13<\/span><\/i>(1), 89.<\/span>\u00a0<\/span><\/p>\nPrice, J. (2016). Informed shared decision-making in planning for the end of life.\u202f<\/span>British Journal of Nursing<\/span><\/i>,\u202f<\/span>25<\/span><\/i>(7), 378-383.<\/span>\u00a0<\/span><\/p>\nWheatley, 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.\u202f<\/span>Postgraduate medical journal<\/span><\/i>,\u202f<\/span>83<\/span><\/i>(984), 643\u2013648. doi:10.1136\/pgmj.2007.058487<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>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\u202f<\/span>et al<\/span><\/i>., 2015). More than half of the patients die in hospitals, about 20% in long-term care institutions, and 4% in specialized palliative care units.\u202f<\/span>\u00a0<\/span><\/p>\nSample Answer for NRS 434 Topic 5 DQ 2\u00a0 Included After Question<\/figcaption><\/figure>\nClick here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NRS 434 Topic 5 DQ 2\u00a0\u00a0<\/strong><\/a><\/em><\/span><\/span><\/p>\nThe 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\u202f<\/span>et al<\/span><\/i>., 2015). Emergency admission mostly occurs when the patient\u2019s condition drastically deteriorates, and the patient then dies after admission (Loh\u202f<\/span>et al<\/span><\/i>., 2016). Furthermore, despite the patient\u2019s 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.<\/span>\u00a0<\/span><\/p>\nThe nurse has the role of supporting patients\u2019 decisions regarding end-of-life care and preferred place of death. I would support my patients\u2019 wishes by first inquiring from terminally patients on how they would wish to spend their last days (Loh\u202f<\/span>et al<\/span><\/i>., 2016). For patients who wish to be cared for at home, I would discuss the wishes with the patients\u2019 relatives with the patient. In addition, I would educate the caregiver and patient\u2019s family on the signs of impending death that the patient is likely to have to avoid panic and unnecessary emergency admissions (Hoare\u202f<\/span>et al<\/span><\/i>., 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.<\/span>\u00a0<\/span><\/p>\nReferences<\/span>\u00a0<\/span><\/h3>\nHoare, 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.\u202f<\/span>PLoS One<\/span><\/i>,\u202f<\/span>10<\/span><\/i>(11).<\/span> https:\/\/doi.org\/10.1371\/journal.pone.0142723<\/span><\/a>\u00a0<\/span><\/p>\nLoh, 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\nTopic 5 DQ 2<\/span><\/b>\u00a0<\/span><\/h3>\nA 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\u2019s health condition deteriorates considerably, and the patient dies when in the emergency department or after being admitted.\u00a0<\/span>\u00a0<\/span><\/p>\nFamily-dominated decision making about a patient\u2019s care in their last days result in a patient\u2019s wishes on their preferred place of death failing to be fulfilled (Lai, Wong, & Ching, 2018).\u00a0 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\u2019s condition may worsen at home and thus prefer the patient to stay as an inpatient for some time to be monitored by health providers.\u00a0<\/span>\u00a0<\/span><\/p>\n
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\u202fet al., 2016). I would respect patients\u2019 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.<\/span>\u00a0<\/span><\/p>\n Grand Canyon University. (Ed.). (2018). <\/span>Health assessment: Foundations for effective practice<\/span><\/i>. Retrieved from <\/span>https:\/\/www.gcumedia.com\/digital-resources\/grand-canyon-university\/2018\/health-assessment_foundations-for-effective-practice_1e.php<\/span><\/a>\u00a0<\/span><\/p>\n 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\n Morris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study.\u202f<\/span>BMC health services research<\/span><\/i>,\u202f<\/span>13<\/span><\/i>(1), 89.<\/span>\u00a0<\/span><\/p>\n Price, J. (2016). Informed shared decision-making in planning for the end of life.\u202f<\/span>British Journal of Nursing<\/span><\/i>,\u202f<\/span>25<\/span><\/i>(7), 378-383.<\/span>\u00a0<\/span><\/p>\n 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.\u202f<\/span>Postgraduate medical journal<\/span><\/i>,\u202f<\/span>83<\/span><\/i>(984), 643\u2013648. doi:10.1136\/pgmj.2007.058487<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span>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\u202f<\/span>et al<\/span><\/i>., 2015). More than half of the patients die in hospitals, about 20% in long-term care institutions, and 4% in specialized palliative care units.\u202f<\/span>\u00a0<\/span><\/p>\n Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NRS 434 Topic 5 DQ 2\u00a0\u00a0<\/strong><\/a><\/em><\/span><\/span><\/p>\n 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\u202f<\/span>et al<\/span><\/i>., 2015). Emergency admission mostly occurs when the patient\u2019s condition drastically deteriorates, and the patient then dies after admission (Loh\u202f<\/span>et al<\/span><\/i>., 2016). Furthermore, despite the patient\u2019s 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.<\/span>\u00a0<\/span><\/p>\n The nurse has the role of supporting patients\u2019 decisions regarding end-of-life care and preferred place of death. I would support my patients\u2019 wishes by first inquiring from terminally patients on how they would wish to spend their last days (Loh\u202f<\/span>et al<\/span><\/i>., 2016). For patients who wish to be cared for at home, I would discuss the wishes with the patients\u2019 relatives with the patient. In addition, I would educate the caregiver and patient\u2019s family on the signs of impending death that the patient is likely to have to avoid panic and unnecessary emergency admissions (Hoare\u202f<\/span>et al<\/span><\/i>., 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.<\/span>\u00a0<\/span><\/p>\n 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.\u202f<\/span>PLoS One<\/span><\/i>,\u202f<\/span>10<\/span><\/i>(11).<\/span> https:\/\/doi.org\/10.1371\/journal.pone.0142723<\/span><\/a>\u00a0<\/span><\/p>\n 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\u2019 and their family members\u2019 preferences?\u202f<\/span>American Journal of Hospice and Palliative Medicine\u00ae<\/span><\/i>,\u202f<\/span>33<\/span><\/i>(7), 669-677.<\/span>\u00a0<\/span><\/p>\n 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\u2019s health condition deteriorates considerably, and the patient dies when in the emergency department or after being admitted.\u00a0<\/span>\u00a0<\/span><\/p>\n Family-dominated decision making about a patient\u2019s care in their last days result in a patient\u2019s wishes on their preferred place of death failing to be fulfilled (Lai, Wong, & Ching, 2018).\u00a0 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\u2019s condition may worsen at home and thus prefer the patient to stay as an inpatient for some time to be monitored by health providers.\u00a0<\/span>\u00a0<\/span><\/p>\n\u00a0<\/span>References<\/span>
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