NR 341 The Communicator 2.0 Video Interaction Client Comfort and End-of-Life Care

11 July 2024

The Communicator 2.0 Video Interaction: Client Comfort and End-of-Life Care

Reflective Paragraph

A change I will implement in my clinical practice is enhancing my communication with patients. It is essential to understand and respect my patient’s wishes. Ensuring that patients make informed decisions about their care is a priority. Particularly in situations involving multiple family members, it can be challenging to navigate their concerns while focusing on the patient’s desires. I will prioritize one-on-one communication with patients to confirm that their choices reflect their true desires, free from external pressures.

Registered Nurse’s Responsibility in Treating a Patient’s Pain

According to the American Nurses Association (ANA)-Illinois, registered nurses have a responsibility to advocate for patients’ rights to quality pain management for acute, chronic, and end-of-life pain. This advocacy aims to minimize suffering and improve the quality of life and functionality, regardless of diagnosis, age, or culture (ANA-Illinois, n.d.). Nurses must involve patients in managing their pain, ensuring they understand their options and are part of the decision-making process. Nurses should advocate for effective pain management while minimizing adverse effects. This involves comprehensive assessments, proper administration of medications, and monitoring the patient’s response to treatments.

Hierarchy of Decision-Makers

In Illinois, if a patient does not have a medical power of attorney, the next individuals authorized to make medical decisions on their behalf are determined by a specific legal hierarchy. According to IllinoisLegalAid.org (n.d.), the order of decision-makers is as follows:

  1. Guardian: A legally appointed guardian has the primary authority to make decisions for the patient.
  2. Spouse: If there is no guardian, the patient’s spouse is next in line.
  3. Adult Children: If there is no spouse, the patient’s adult children can make decisions.
  4. Parents: If none of the above are available, the patient’s parents assume the role.
  5. Siblings: Following parents, siblings are next in line.
  6. Grandchildren: In the absence of siblings, the patient’s grandchildren are considered.
  7. Close Family Friends: Trusted friends may be given the responsibility if no family members are available.
  8. Guardian of the Estate: Lastly, a guardian of the estate can make decisions if other options are exhausted.

Understanding this hierarchy is crucial for nurses to ensure that the patient’s rights and preferences are upheld when they cannot make decisions themselves.

Definition of Incapacitation by State Law

According to the Illinois General Assembly (n.d.), a person is considered incapacitated if they are under legal disability. This legal status can be determined if a licensed physician examines the person and concludes that they lack decision-making capacity. The physician must document this determination in a written and signed record within 90 days of the examination, and this record must be delivered to the patient’s agent. This legal definition is vital for nurses to understand so they can recognize and respond appropriately when patients are deemed incapacitated.

Enhancing Communication Strategies in End-of-Life Care

Therapeutic Communication

Effective therapeutic communication is essential in end-of-life care. It involves active listening, empathy, and providing emotional support to both patients and their families. Nurses must ensure that patients feel heard and understood, which helps in building trust and facilitating open dialogue. This approach is crucial for discussing sensitive topics such as prognosis, treatment options, and patient preferences.

Family Involvement and Education

Involving family members in the decision-making process is often necessary, but it can be complex due to differing opinions and emotional stress. Nurses should provide clear, compassionate explanations about the patient’s condition and care options. This includes organizing family meetings where everyone can express their views and concerns, thereby ensuring that decisions reflect the patient’s best interests.

Ethical and Cultural Considerations

Cultural Competence

Cultural competence is integral to providing holistic and respectful end-of-life care. Nurses must be aware of and sensitive to the cultural beliefs and practices that influence patients' and families' views on death and dying. This understanding helps in delivering care that respects patients' values and traditions, whether related to religious rituals, dietary restrictions, or communication styles.

Ethical Decision-Making

Ethical decision-making involves balancing the principles of autonomy, beneficence, non-maleficence, and justice. Nurses must ensure that the care provided aligns with these principles while considering the patient’s values, family dynamics, and medical realities. Interdisciplinary collaboration and ethical consultations are often necessary to navigate these complex decisions.

References

By comprehensively addressing these multifaceted aspects of end-of-life care, nurses can better support patients and their families during some of the most challenging times. Advocacy, communication, and legal knowledge are key components in providing compassionate and ethical care. This holistic approach ensures that patients receive the highest quality of care tailored to their unique needs and circumstances, thereby upholding the dignity and integrity of the nursing profession.