End of Life Care for COPD and Alzheimer’s patient

Care provided to individuals who are close to the end of life and have no more receiving management to cure or manage their illness is called the end of life care. Ethical and legal issues can take place when providing end of life care.

Running Head: COPD
0
COPD and Alzheimer’s
student
5/27/2019

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Table of Contents
End of life care.............................................................................................................................................2
Ethical and legal issues............................................................................................................................2
Decision making for Mac’s end of life care.............................................................................................3
Creating a Holistic care plan for Mac......................................................................................................4
Recommended Self-care Strategies.........................................................................................................4
Reflecting on my Experience.......................................................................................................................6
References...................................................................................................................................................9

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End of Life Care for COPD and Alzheimer’s patient
End of life care
Care provided to individuals who are close to the end of life and have no more receiving
management to cure or manage their illness is called the end of life care. End-of-life upkeep
comprises bodily, emotional, societal, and mystical support for the diseased person and their
relatives. The objective of end-of-life maintenance is to manage pain and other indications so the
individual can be as relaxed as conceivable. End-of-life care might comprise palliative care,
helpful care, and hospice upkeep (Aldridge, & Kelley, 2015).
Ethical and legal issues
Ethical and legal issues can take place when providing end of life care. The ethical issue
of medicinal futility is a medical situation in clinical ethics that might pose encounters in
delivering care at the end of life of the person. Ethical dilemmas at the end of life care commonly
rotate around choices to withhold or withdraw intercessions or management (Flo, Husebo,
Bruusgaard, Gjerberg, Thoresen, Lillemoen, & Pedersen, 2016). When the diseased person and
doctor decided that there is no advantage in carrying on or initiate a new intercession the right
accomplishment is clear, however, skill is obligatory on the nurses’ part to handle these
discussions perceptively. Respecting and concerning about the autonomy of a diseased person
who is essential to continue or start treatment requirements to be confronted when it would
outcome in irresistible harm, and may lead to legal issues. Ethical issues might take place when
the four different ethical values of end of life care are conceded; such as autonomy, the non-
maleficence, patient’s beneficence, and justice to patient. Legal issues might ascend when the
diseased person rejects to obtain any kind of health facilities and nurses attempt to pressurize
them to the treatment or service (Stuart, & Thielke, 2018).

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Therapeutic lying can be a reason for legal issues (Boland, 2018). As deliberated in the
mac’s case study his wife is unhappy and she considers that her spouse will expire in upcoming
days, here giving fake expectations to her, might source legal questions (Flo et al., 2016).
Beforehand giving any kind of facilities related to the end of life care, the agreement form
(consent) should be taken from their relatives. In any case, the nurses do not take consent; it may
lead to legal issues later. Mac had to dissimilar wellbeing matters that require consistent
assessment and managing, consequently nurses must meet Mac and identify if he is not
comfortable and facing additional issues. Ethical and legal matters may ascend if the health care
professionals try to accomplish their duty, and breach of privacy might arise. Mac is an old
person who must be addressed empathetically and respectfully, in order to build a therapeutic
association with him and Dorothy; ethical complications come up when the person is
disrespected by any health care providers or nurse (Karnik, & Kanekar, 2016).
Decision making for Mac’s end of life care
Decision making is the most crucial process at the end of life care which must include
patient, their families, and health care professional. Every individual admitted to the hospitals or
getting any health facilities to have specific right to sort choice about their disease management
and other facilities, it can be associated with the with pain management an advanced care
directives (Dzeng, Colaianni, Roland, Chander, Smith, Kelly, & Levine, 2015). When a diseased
person and his family are not capable to make a choice themselves, they have the right to allow
substitute decision-makers to make a decision on their behalf this process is termed power of
attorney. In case of Mac, this must be implemented and his wide must also be included in the
process. Before using any type of care plan nurses or other healthcare workers must provide the
patient and their family with advanced care directive form which allows the patient to write their

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actual wishes and selections about upcoming facilities (Wooster, et al., 2018). As stated in Mac’s
case study he is not cooperative and abused when I entered inside the room, thus her wife should
be included in this decision-making process. A statement of wishes and preferences is not
legitimately binding. However, it does have legalized standing and would be comprised when
making a judgment in a person’s best benefits (Dzeng et al., 2015).
Creating a Holistic care plan for Mac
Holistic care is the term or idea of receiving growing consideration crossways the
concerned health care workers (Head, Schapmire, Earnshaw, Chenault, Pfeifer, Sawning, S&
Shaw, 2016). Advance Care Planning should similarly be applied in Mac’s case which comprises
the discussion of the investigation, prognosis, the probable course of the illness and the possible
treatment substitutes, their dangers and interests and should be engaged in the viewpoint of the
patient's purposes, projections, fears, ethics and beliefs. The Holistic care planning the patient
must instigate with a detailed and comprehensive valuation of his routine and necessities of the
carefulness being received by him (Wilson, 2017). During the HCP It is a regular effort to create
a framework for wellbeing workers and family caregivers to follow the everyday delivery of
health services, and an evaluating the tool and equipment that are implemented to provide
support for the patient ((Head et al., 2016). In Mac’s Holistic care planning should be dynamic
including the latest approaches repeatedly being conceived and existing plans evaluated. Holistic
care plan for Mac must involve all the health care team assigned for him.
Recommended Self-care Strategies
Self-care is the concept which is difficult to describe; the term is commonly applied
interchangeably with other different terms like self-management, self-help, and self-monitoring.

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Self-care approaches are composed of some following sub terms like acceptance, being positive,
selection, control, belief, and provision from people with the disease (Sansó, et al., 2015). Two
dissimilar circumstances might take place in this Mac’s that may harm Dorothy adversely; Mac
may become violent as he is facing the situation, and Dorothy is undergoing the emotional issues
as her spouse will die soon. She should also retain herself harmless as the patient might become
violent. I would her recommend for being positive and compliant the fact that expiry is certain
and he cannot be cured, therefore she should spend most of her time with him. Other self-care
strategies like Distraction are the most helpful approach that can be applied by Dorothy. I will
similarly suggest her for not discussing the time of his death.

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Reflecting on my Experience
Gibbs reflection Cycle
The Gibbs Reflective Cycle initiates with Description and then endures clockwise
to other steps such as Feelings, Evaluation, Analysis, Conclusion and finishes at Action plan, to
lastly return to first step Description and Here the cycle is finished (Husebø, O'Regan, & Nestel,
2015).
When I entered inside the patient’s room, he was speaking to her partner and due to my
interruption, he became aggressive. His wife regrets his actions and specified that she wanted
that he should die rather than facing such issues. When I asked her for any help, she displayed
her interest in speaking to deal with the current situation, as Dorothy is undergoing an emotional
crisis. This specific condition specifies that her husband is no longer attentive in the management
and just needs his privacy with her wife. Here I can support Dorothy to deal with the condition
by applying my effective communications abilities and educating her about self-care strategies. I
will also try to speak with Mac in order to make therapeutic communication with him so that he
will respond in the further end of life care services. About this specific situation, my view is that
it is serious and both Mac and Dorothy are worried about each other. Dorothy knows that her
husband will die soon; therefore she is feeling unhappy for him and his behaviour. After I have
arrived in patient’s room he became violent and mistreated me for disturbing them, though I
think that I have controlled the situation effectively, but it was difficult for me to admit that he
abused me. I decided for an instant that I should talk to the doctor for the patient's abusive
behavior. But I also realized that both mac and Dorothy experiencing sorrow and grief as the
patient will die soon, therefore it is usual that somebody behaves negatively. After Dorothy

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revealed how disease changed Mac's behavior to me and regrets for Mac’s conducts, I realized
that I should help her as it is my duty to provide her emotional support.
Patient’s wife knows the situations and realized that talking can help her, therefore she
asked me to speak to cope with the adverse situation. She realizes that death is certain in Mac's
case, thus she is not able to do anything in this scenario. As an experienced RN, here I can
support her and inspire her to converse with her husband and support him to admit the condition.
She stated that she wanted he could just expire, he is not her real husband, He is prepared to
decease and following time he acquires chest contamination, he will possibly die. I must make
her comprehend that it is usual and people frequently do that as it is difficult for them to admit
that they will die soon and they have no other option than leaving their loved ones. I have also
questioned Dorothy to speak with me whenever she wants me, and also expressed her that I must
assess her husband as it is essential for further interventions. From this specific situation, I have
learned many things that can be used in my career. Throughout my professional career, I have
been an effective registered nurse, and I continually believed that I have every skill needed for
dealing with different adverse situations. However, this specific scenario makes me ruralized that
there are many things I have to add in my skills in order to provide supportive services to the
people receiving an end of life car and their relatives. After speaking the matters with Dorothy, I
realized how it senses to let your family member expire in front of your eyes. Though I could
have been additional proficient during the circumstances, I must have knocked the patient’s door
before entering inside the room, I should have given them privacy as most of the patient requires
privacy during this time. Is should have assumed or recognized that they were conversing
something actually essential for them and spending quality time with each other. In future, I will
apply this experience to deal with other individuals who are receiving an end of life care. I will

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acquire additional skills for example self-care approaches and self-management methods that can
be trained to the diseased person and their relatives (Abel, Kellehear, & Karapliagou, 2018).
In the end, I recognize that only giving medicinal facility at the end of life condition is
not sufficient, you must become more sympathetic, and deal with the diseased person and their
relatives with respect and must provide them with their space and privacy. I recognize that self-
care method is also important to manage patient’s violent behavior (Price, et al., 2017). I
similarly apprehend that as greatly the diseased person requires an emotional provision in such
conditions; their relatives similarly need the provision if they are feeling sad, depressed, and
alone (Schreibeis-Baum et al., 2016). I will educate new nurses or midwives and other team
associates how to respond in such situations. I will make further efforts in delivering a well,
peaceful and environment which is patient-friendly and allow my team member to learn new
skills that can be beneficial at the end of life care situations. As indicated in Mac’s cases study he
is no more interested in speaking with anybody except his wife, thus, her Dorothy must be
included to gather Patient’s information in upcoming days. Allied healthcare specialists,
clinicians, social workforces and other wellbeing care worker will similarly be included in the
holistic care arrangement for the patient. Additionally, the choice must be made on counting
shareholder in the facilities of the end of life carefulness to the individual wants to be cured in
their household and wants to receive residential aged upkeep (Schellinger, Anderson, Frazer, &
Cain, 2018).

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References
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Aldridge, M. D., & Kelley, A. S. (2015). The myth regarding the high cost of end-of-life
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Boland, B. (2018). Key concerns with lying as therapy. Australian Ageing Agenda, (Sep/Oct
2018), 50.
Dzeng, E., Colaianni, A., Roland, M., Chander, G., Smith, T. J., Kelly, M. P., & Levine, D.
(2015). Influence of institutional culture and policies on do-not-resuscitate decision
making at the end of life. JAMA internal medicine, 175(5), 812-819.
Flo, E., Husebo, B. S., Bruusgaard, P., Gjerberg, E., Thoresen, L., Lillemoen, L., & Pedersen, R.
(2016). A review of the implementation and research strategies of advance care planning
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Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: a narrative review.
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Price, D. M., Strodtman, L., Montagnini, M., Smith, H. M., Miller, J., Zybert, J., & Ghosh, B.
(2017). Palliative and end-of-life care education needs of nurses across inpatient care
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