DELIVERY AND NURSES
1a) Provide and discuss credible rationales for appropriate circumstances to cease oral hydration and nutrition when delivering(EOLC)
During the end of life, care, quality measures are required to manage symptoms to ensure survival increases and improve the quality of life for the patient and preventing suffering in all stages of the disease. Therefore, physical, psychological, and emotional support is vital even at this stage. Palliative care, feeding, or nutrition support is a significant concern because the patient needs to replace lost water through sweating and urinating. The nurse can stop oral hydration and nutrition for Jo if she finds it unnecessary due to an inadequate amount of water and food Jo takes in or if Jo refuses to feed or if his son decides to use an alternative method to feed him.
For instance, now that Jo is still trying to take in some little water and food, it means he still requires them so, artificial hydration and nutrition will work better for him rather than forcing him to feed more. Artificial hydration and nutrition are given in different ways. One, hypodermoclysis whereby the fluid is put under the skin, and the other one is intravenous, where the liquid is put into the vein and nasogastric through the plastic tube. The plastic tube method may not work well with Jo because it results in aspiration complications due to the entry of fluid to the lungs. This because he could be a risk because of suffering a chronic pulmonary disease. Therefore, hypodermoclsis would be the preferred method because it is associated with fewer complications that would endanger Jo’s life, compared to other methods.
1b) Explain how the registered nurse would effectively communicate information about ceasing oral hydration and nutrition as part EOLC to his family and other concerned parties
Since there is no formal way of communicating the information, the nurse uses her understanding and knowledge of communication skills to pass the information about stopping oral hydration and nutrition to Jo’s family. For instance, the nurse may choose to engage them in a general conversation about Jo’s progress, and then on the process of discussion, including the decision of withdrawing oral hydration and nutrition. After that, the nurse begins to explain to the family members the factors that influenced her decision to withdraw oral hydration and nutrition. For example, it evidences that Jo was straining to feed, and there was a need to seek a comfortable way of feeding. Secondly, the amount of food and water he was taking was not enough to sustain him, therefore, creating a need for an effective way to ensure he receives adequate nutrients and water that the body requires. And how it would help him at this stage. Explain the reasons for choosing a specific type of method over other methods of feeding comparing, the level of risk associated with each of them. That is by explaining how important it is to Jo and the family and why it is necessary at this stage. Also, discuss them complications they may experience and how to manage the situation in case of any indication of danger. The nurse should give family members time to ask any question or seek clarity of any information she had explained and also give their suggestion of any support they think is essential for the family and Jo.
PART 2
Introduction
Nurses always play a significant role when it comes to our health. Still, a competent nurse should be able to manage other issues that arise related to sickness. For example psychological and spiritual needs of the patient, therefore, don’t only give care and medication to the patient but also moral support and any other intervention that may be necessary to the patient and family. At this time, the hospice nurse is there to offer emotional support to the family that is in panic mood as they struggle to couple with the reality and trying as much as they can to provide the best care to the patient during the last days of their life. The primary role of a hospice nurse is to ensure the wishes of the patient are honored exclusively without the influence of the family or any external source.
Roles of a hospice nurse
During the end of life process, nurses are supposed to prepare a policy to be followed during the procedure to avoid improper medical interventions and therapies. This aims at improving the quality of care being offered by professional or family members. The policy is developed based on medical practitioner goals and objective evaluation during the process. The following are involved in the plan. Consistency should be maintained while delivering service to ensure every caregiver follows the set procedure. Decision making based on medical preferences and appropriateness by the patient or family is documented for accountability during the process.It also involves decisions to withdraw life support and after death care.
It is the role of a nurse to ensure the patient’s interests are met without considering the interest of the family. The needs involve cultural practices and health decisions. They advocate for the patient by providing proper follow in information to the right person. They ensure the right medication is given to the patient and at the right time to avoid overdose or underdose, which could limit them from achieving quality improved life for the patient.
Nurses develop assessment tools to be used in evaluating the condition of the patient. The tools include a report from the patient and caregiver about mental health and physical symptoms, for example, pain. Difficulties caregivers may have experienced during the exercise and general progress of the patient and the family in terms of what they feel about the situation, have they accepted the reality that would receive reports of death any time soon, and how far they are in terms of planning.
They offer emotional support and care to the patient and family; this helps to relieve or control a feeling of uncertainty. This is done through open communication whereby the nurse discusses the progress openly of the patient with them and family, that is, if the patient can talk. But if the patient cannot speak like in Jo’s case, the family is engaged in a talk to help them accept the reality and make plans of how they will move on with life after the death of the patient. And if the patient can engage in conversation, the idea of drafting a will may be raised if the patient is willing to do so. The nurse assists the patient to complete the ambitious task; for example, expectations of visiting a specific place or of participating in a particular event, the caregiver can help the patient do so if he or she has the ability. They also help the family make tough decisions in matters involving the society; they make sure the decision made will not result to regret and stress. A patient may wish to resolve personal and social issues before death. For example, thanking caregivers, seeking forgiveness for wrong things he committed, showing love by gifting specific people or person, say goodbye to these people he may regard as special to him and completing a spiritual task
(For example, buying something for the church).
It is the responsibility of a registered nurse to relieve family members from the task of caring for the dying patient. It helps to prevent fatigue, depression and helps to restore energy to the caregiver due to continuous stressing exercise .it advantage to the person receiving the care because the medical practitioner is likely to give more advanced care due to knowledge and experience of palliative care.
During the end of the life care process, nurses play the role of mediator between the rest of the caregivers’ team, family, and patient by enabling them to exchange information. Nurses arrange for family meetings where they act as the third party and suggest involving external parties, for example, chaplains to moderate EOL discussion. Nurses guide a family member on the questions to ask the physician and help to clarify any information that might be confusing the team. They also ensure proper flow of information among family members and the health care team to ease communication about EOL decision making and updating family members about their person’s progress.
Nurses offer support to family members by developing a healthy relationship bond and trust to facilitate talks. Nurses build trust by introducing themselves to the family and introducing incoming shift nurses to show confidence. They engage family members to be part of the activities and set them free to perform their rituals if they want to. Nurses help the family to remain energetic and hopeful that their life will not be doomed even after the death of the patient. They help family members to accept the decisions of the patient to avoid crises during palliative care based on economic, social, and personal issues.
End of Life nurse should have the following qualities
communication and listening skills
A palliative care nurse should have excellent communication and listening skills because communication is the most crucial competencies in nursing. Nurses play the role of mediator during the EOL process, and for information to flow efficiently, the nurse must be a good listener and good at communication. This process entails a lot of discussions, thus making communication vital.
Empathy and flexibility
hospice nurse should be in an excellent position to understand the feelings of the sick person and the family. The nurse should show family kindness, encourage them to be reliable. End -of –life nurse should be flexible enough to meet the needs of the dying person because this process aims to improve the quality of life of the person.
Emotionally strong
in this process, family and caregivers are most likely to be faced by situations that influence emotions. Therefore, the nurse should be strong enough to intervene as the mediator in a difficult situation to act in favor of the patient and create an atmosphere that will aid the rest of caregivers to overcome the challenges.
Problem-solving skills
End-of-life nurses should have excellent problem-solving skills because one of the significant roles of a nurse is to solve problems of the patient by reducing pain and suffering to improve the quality of life. Nurses help in controlling crises that occur during the process due to different decision-makers who can end up with differing opinions, thus leading to disaster.
Attention to detail and physical endurance
All details are vital in the medical field because an error in one step is an error to the whole process, so a good nurse pays attention to capture all details carefully without making errors. In the medical field, no information that is useless, including reading a patient’s chart. Nurse take part in some problematic tasks, for example, lifting heavy objects, standing for long periods, and a lot of movement.so eating well and practicing a healthy lifestyle is important because they need to regain energy to remain strong for the next day’s excise.
Interpersonal skills
A good nurse should have excellent interpersonal skills to work with different people in a different situation. They should be friendly and have a good working relationship with everyone because they bring the hospital together by liaising with various departments and connect patients with doctors. Therefore, nurses are a reflection of the hospital.
Conclusions
Various factors indicate a possibility that EOL decision making continues to be difficult for family members, patients, and hospice nurse due to uncertainty of the situation. During the end-of-life process, all the wishes of the patient are respected, including personal and social issues that the patient may wish to address. He is assisted in doing so by the caregivers. The excise aims to improve the quality of life of the patient and to make it comfortable for the remaining period before he dies. In EOL, nurses advocate for their patients to ensure all their wishes are met, including performing of rituals. Nurses make decisions on behave of the patient, conduct family meetings in presences of other mediators that she suggested, and intervene in case of a crisis to ensure the very problem is solved. Nurses offer support to the family members by encouraging them to remain hopeful and assist them in making tough decisions and even after death plans.