Sample Nursing Case Study on Advance Care Planning Essay

Communication is important in ensuring that patients diagnosed with critical illnesses receive proper healthcare services and are comfortable during their treatment processes. The case study used for this essay addresses the processes taken in preparation for advanced care planning among patients with chronic diseases or those that have a high risk of dying. The case study is based on Dorothy, a 79-year-old, who has a history of heart attack, COPD related to smoking, and type II diabetes. She was recently diagnosed with ovarian cancer, which has metastasized to other organs. She is also prone to chest infections and recently had a clot in her leg. Her husband recently died after battling cancer and her sister succumbed to ovarian cancer after years of treatment. The case addresses advanced plans for palliative care that will be applied to Dorothy’s case, her preferences in terms of treatment, her decisions regarding the indications and contraindications that should be considered by healthcare practitioners before resuscitating her, and the need to ensure that her “do-not-resuscitate” decision will be adhered to, and her concerns about dying. Effective communication in advance care planning is critical in promoting the well-being and comfort of patients.

Communication Barriers

Communication barriers are common between nurses and their patients and often relate to the medical treatment that the patient is supposed to undergo or receive, treatment preferences, presence of comorbid conditions, among other factors. When considering a patient’s medical treatment in advance care planning, communication barriers can arise when healthcare practitioners and patients fail to discuss the extent of care that should be offered to the patient in palliative care or in cases where the patients’ symptoms worsen (Carduff, Kendall, & Murray, 2017). During treatment, such barriers can also be observed in cases where patients require advanced treatment or healthcare procedures like surgery but face the challenge of deciding whether they should go ahead with the treatment due to a lack of information regarding whether the medical treatment would be beneficial to them (Buiar & Goldim, 2019). For instance, in the case study, Dorothy was unsure whether a surgical procedure would be beneficial to her because of her history of comorbid conditions like COPD and diabetes, which might have affected the treatment’s effectiveness in managing her cancer. Difficulty in estimating patients’ prognosis and inability to provide patients with adequate information about their health can affect communication about advance care planning.

Communication between patients and their healthcare practitioners is also affected by discomfort surrounding discussion about advanced care plans and death. Most patients and family members assume that talking about death often results in death, which makes them reluctant to plan for approaches that might be implemented in cases where treatment plans fail or the patient’s condition worsens (Pino, Parry, Land, Faull, & Seymour, 2016). Emotional distress caused by end-of-life decision-making and history of the loss of another family member to the same illness can also affect family members’ ability to participate in discussions about advance care planning and death (Jeong, et al., 2019; Zwakman, et al., 2018). Additionally, not having access to healthcare practitioners that are comfortable with talking about advance care planning and end-of-life decisions also affects communication between patients and their healthcare practitioners (Laryionava, et al., 2018). In the case study, Dorothy pointed out the discomfort her family, especially her son, experienced while discussing with her nurse and family members about her advanced care plan and end-of-life decision. Most patients diagnosed with severe forms of cancer or other illnesses experience the same discomfort when talking to their healthcare practitioners about advanced care.

Patient’s unawareness about the role of nurses and other healthcare practitioners in the advanced care plan is an additional factor that introduces communication barriers between patients and their care providers when developing the advance care directive. Patients often do not understand the roles different healthcare providers are supposed to play during the advanced stage of their treatment. The lack of understanding about the roles played by nurses, physicians, and other healthcare practitioners can promote overlooking of some of the healthcare services that should be considered during advanced care planning (Miller, et al., 2020; Wune, Ayalew, Hailu, & Gebretensaye, 2020). Factors like shortage of workers in healthcare settings and excess workload can also affect healthcare practitioners’ ability to consider all the preparations that should be considered when planning for advanced care and the need to inform patients about the healthcare services that they should be given (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 2016). In the case of Dorothy’s case study, she stated that although her family was not informed about the need for advanced care planning and the services that would be included in the plan while her husband was undergoing treatment but was advised about advanced care planning while she was going through her treatment.

Communication Skills for Effective Conversation

Proper communication skills that promote effective conversations during advanced care planning entails involving the patients’ family members in conversations regarding the advanced care that could be offered to the patient and selecting a medical treatment decision-maker. In the case study, Dorothy had identified her daughter and her neighbor, who was also a nurse as potential medical treatment decision-makers who could help her out because she trusted them. She also ensured that her daughter was comfortable with the inclusion of their neighbor in the decision-making role. Patients should be informed about the need to identify a trusted individual who will make decisions for them during emergencies or in cases where they are unable to decide for themselves (Dionne-Odom, et al., 2019). It is essential to ensure that a healthcare practitioner, legal documents such as advanced legal directives or power of attorney, or a recorded conversation is made to ensure that the medical treatment decision-maker is properly identified and can be contacted during emergencies (Al-Bahri, Al-Moundhri, & Al-Azri, 2018). Proper identification of a medical treatment decision-maker can relieve that patient with stress related to their advance case plans.

In terms of the patient’s medical condition, nurses and other healthcare practitioners should also possess the skill of knowledge sharing through the use of simple terms, in a manner that ensures patients understand their medical conditions. It is particularly important to educate patients about the pathophysiology of their conditions, the risks of metastasis in cases of cancer, the effects of comorbid conditions on the patient’s future care and their health, and the possible effects that the disease will have on their health in case the symptoms worsen. Proper information sharing techniques are essential in helping patients understand what they should expect (Johnson, Butow, Kerridge, & Tattersall, 2015). For instance, in the case of Dorothy, when considering whether she would ever opt for surgery as part of her advanced care, she was informed about the possibility that surgery could not offer her the ultimate solution for her problem because of the existence of other conditions like COPD and type 2 diabetes, which had been diagnosed earlier. While she initially believed that surgery might have caused her sister’s cancer to spread faster, being informed about the effects of comorbid conditions helped her understand their effects on her overall health.

Being willing to address the topic of death with patients is also another conversation skill that healthcare providers caring for patients with chronic illnesses who need advanced care planning, should possess. It is important to prepare patients and their family members for death and ensure that they understand that medical treatment approaches used can fail to treat the patient effectively especially in cases where the patient was severely ill (Carr & Luth, 2017; Miller, et al., 2020). In the case study, Dorothy was informed about her cancer’s metastasis and had access to a nurse who talked to her and her family about death and her decisions regarding whether she wanted to continue being treated in cases where her condition worsened. The nurse also called her son and had a long conversation with him about Dorothy’s condition, death, and Dorothy’s decision about death. The professor in the audio also points out that the decision about death should be based on Dorothy’s preferences and values regarding how she would like to spend the time she had before dying. As such, healthcare practitioners need to address topics related to death and dying as part of advanced care planning.

Responding to patients’ and family members’ concerns by preparing for the worst-case scenario is also an important skill in managing patients with chronic illnesses who have a high risk of dying. In advance care planning, reassuring patients that they will receive expert services as part of end-of-life care is essential in helping family members and the patient cope with the impending death. Planning for such care allows people to live comfortably despite the impact of the disease on their health (Clark, 2017). Attention to patient’s and family members’ concerns about death also prepares them for the emotional impact that losing a loved one would have on their lives. It also addresses concerns such as those held by Dorothy about her son’s difficulty in coping with the death of his father due to cancer and the imminent loss of his mother. Healthcare practitioners should respond to patients’ concerns regarding the extent of care that would be offered in the palliative management

Managing uncertainty is also important in promoting proper communication during advance care planning. Patients and family members are often unsure about the components of advanced care and its alignment with their care preferences. For instance, while some patients might opt for pain management and palliative care, they would still want to receive proper treatment in cases where they get an infection (Chan, Sim, ZImmermann, & Krzyzanowska, 2016). In the case study, while Dorothy did not want aggressive treatment aimed at curing her cancer and wanted to be comfortable in preparation for her death, she still wanted to be assured that if she caught a chest infection, she would be given proper treatment to treat the infection. Discussing with patients about concerns related to changes that patients might wish to include in their advance care planning is also important in ensuring care-specific decisions are solely based on patient’s preferences over time (Heins, et al., 2018; Rhee, et al., 2020; Hall, Rowland, & Grande, 2019). Addressing uncertainties regarding the intervention that will be included in advanced planning, while at the same time respecting patient’s autonomy is important in advance care planning.

Effective communication in advance care planning should also entail utilizing an advance directive document that details the patient’s preferences during the caregiving processes. The practice of patient-centered care is based on offering patients services that align with their values and preferences (Buiar & Goldim, 2019). Advance directive documents contain information about the patient’s preferences regarding medical treatment and end-of-life care, details on the quality of death and measures that should be taken in ensuring that the patient is comfortable during the care process, and contacts of individuals who will make decisions about the patient during emergencies. Other details considered in preparing an advance care directive include DNR orders record, whether or not to intubate the patient, use of feeding tubes, management of falls and infections, and any additional information (Freitas, Rocha, & Nunes, 2018; Alfayyad, Al-Tannir, AlEssa, Heena, & Abu-Shaheen, 2019). It is also important to inform the patient that they can change their advance directives in cases where the condition continues to affects their health. In the case study, Dorothy had included a DNR and specification on treatments that could be used as part of her palliative care in her advance directive.

Conclusion

Advance care planning is critical in ensuring that the needs of a patient are addressed during care provision and in eliminating the risks of misunderstandings during end-of-life care. Some of the barriers of communication that affect effective conversations between patients and their healthcare providers during advance care planning include patients’ unawareness about the services that should be offered to them, limited knowledge about their health condition and its implication on their overall well-being, and discomfort surrounding discussions about death and advance directives. Healthcare practitioners can work with patients in ensuring all their concerns are addressed during advance care planning. Effective strategies that can be implemented to improve communication in advance care planning include sharing knowledge with patients about their conditions, responding to their concerns, managing uncertainties through continued discussions, and utilizing a medical treatment decision-maker. Collaboration between healthcare practitioners, patients, and their family members is essential in planning patients’ advance care.

 

 

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