Palliative Care: Advanced Care Planning and Reflection | NUR341 Assessment 3 | Desklib

Case study and Reflection assessment
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NUR341 Assessment 3
2
Part 1: Case Study
Introduction
Patient McGregor is having a previous history of Chronic Obstructive
Pulmonary Disease and Alzheimer's. Due to his age, the patient is experiencing
difficulties on daily activities signifying the need for advanced care at this critical
point in time. As people get older and death approaches, body changes encountered
often progress to the advanced care state. End of life care for the patient is essential.
End of life is critical and requires a range of clinical decisions on palliative care, self-
determination of the patient, medical assessment, ethical and efficacy management
of medication process and ethics underlying continued medical use. End of life care
offers n opportunity for resource allocation and attention to the patient and making
critical decisions based on his state of health. End of life management entails
recognition of introducing advance care planning for the patient at this phase
(Stewart, Goddard, Schiff & Hall, 2011).
Advanced care planning for the patient entails the process of enabling the
individual to make plans with regards to his future health with respect to his medical
history state. Advanced care planning is essential for allowing adequate planning
during the end of life window. Advanced care planning entails critical ethical and
legal issues with regard to the consent of patient process such as patient autonomy
(Ferrell et al., 2018).
Advanced care is essential in helping to alleviate and limit life-threatening
diseases. The ultimate focus is to enable manage symptoms and provide crucial
assistance and comfort. Key aspects entail providing emotional, mental, social and
spiritual comfort. End of life is essential in providing practical help with the daily
duties and tasks. The goal often is to improve quality of life and that of the immediate
family. However, despite these key benefits, legal and ethical issues often arise in its
implementation on patient care (Cherry & Jacob, 2016).
Advanced care often requires the health care practitioners especially the
concerned doctor to develop appropriate skills to manage the decision-making
process. Choice of process needs to be a popular approach and be distinguished
from autonomous decision making (Radbruch et al., 2016). More often decisions
need to be applicable to the concerned patient. Mrs. Dorothy is trying to make the
decision for the patient contrary to fundamental approaches which guide decision
making for the end of life entail persons or patient rights to self-determination, truth-
telling, and respect for autonomy and choice (Druml et al., 2016).
Advance care directives
Advanced care directive is an essential aspect to McGregor state. Detailing
his health care preferences is essential for care planning. This will entail personal
values and goals at this end of life stages and define the circumstances which are
not acceptable to the patient and identifying preferences relating to the specific
medical intervention (Allen et al., 2015). Advance care directive will entail a written
document for taking the patient statement and a further doctors letter in completing
the letter directive which ensures that McGregor wishes are clearly documented in a

NUR341 Assessment 3
3
manner that portrays his decision and substitution for advance care directive. This
will aid in substitution of decision making in the future which documents the needed
assistance for the patient.
In case there is no clear advance care directive for the patient, substitute
decision making can take place. Substitute decision making is essential when the
patient does not have the capacity or communicate the care decisions on himself.
Substitute decision making can take place in various forms. A statutory form can be
undertaken for the patient. In case of absence f statutory method, a substitute
decision-maker can be any responsible persons in place. In this Mrs. Dorothy can
take the place of the substitute decision maker for the patients; however, the
patient's wishes must be talent into account. This process to inform the choice of
decision maker entails the proper and relevant compilation of proper paperwork
submission for the patient. Substitute decision-making process entails making
decisions based on substituted judgments or best interest process.
Substitute judgments entail arriving of decisions based on bests
approximation of time the patient wishes to have. This should arrive on known
patient interests and preferences. Best's interest process of decision making is
essential in substituting decision making to focus on the interests of the patient
(Booth & Lehna, 2016). Thus Mrs. Dorothy will have a crucial role to play in this
process in advising on the best interest of the patients based on his preferences and
not her own wishes.
Creating a holistic care plan
Patients at the end of life often experience extreme symptoms which entail
physical, spiritual and psychosocial issues; these prevent overall management of the
patients and limited optimization of the quality of care for the patient (Connor, 2017).
There are crucial factors which are essential for managing the patient state such as
achieving self-control.
Assessment of the patient state needs to take interest in physical needs d
signs which reflect the progression of the disease state. The assessment will reflect
on Macs psychological, emotional spiritual and socio-cultural needs so as to
establish the willingness of the patient in addressing these concerns. Assessing
psychological and emotional needs is vital towards recognizing the overall
psychological and emotional needs of the patient so as to identify appropriate
processes and decision to take in the future. Reflecting on socio-cultural needs is
essential. Values and beliefs on death are essential for the patient. Understanding
these aspects is vital for assessing patient preferences.
Self-care process
Self-care processes entailed the caring actions and behaviors which promote
well being and health. Self-care has been viewed as self-initiated action and
behavior to promote good health and overall well being. As the caregiver, Dorothy's
role is essential in health care practices and is fundamental in ensuring the patient
receives appropriate care. To enhance these techniques, there is a need for Dorothy
to incorporate the following key fundamental strategies in the care process (Sanso et
al., 2015).