Scenario number 7
Information need to be obtained about the patient through health
assessments and diagnostic tests
Patient wishing for hospice care experienced less emergency visit, less
invasive procedures and have gained compatibility to select location of death
as per his wish.
Patient’s medical history: It is important to assess patient’s present and
past medical history, medications, allergies, lifestyle and habits. Hospice
care provide great option to relieve burdensome medication and intervention
for medical condition.
Patient’s current health status and diagnostic result: It is ideal to
examine patient’s current condition, severity of disease progress, pain
management and quality of life. Recent lab and diagnostic test result can
guide to understand patient’s health status.
Prognosis: Prognosis of myositis should be understood and explained in
detail. The possible complications, ill effects and life expectancy should be
discussed with patient and wife. Prognosis for homebound patient having
cognitive impairment, neurogenerative disorder, comorbid condition or high
symptoms is very limited (Roberts et al, 2021).
Patient’s value: In given case, patient desire to stay home with hospice
care. His health condition is rapidly declining. His decision is respected.
However, he should be discussed about wife’s concern. Often continuity of
care gets difficult to achieve at home on long run and seeing wife worried
about his health may arise destress that can get involve with intimate
aspects of care (Shepperd et al, 2021).
Family’s value: In the given case, wife desire patient to get inpatient care.
Explaining her that effect of home care hospice has shown higher patients’
satisfaction and lower health service cost compared to inpatient services
(Shepperd et al, 2021) can guide her in decision making.
Response as an advanced practice nurse based on evidence-based
practice guidelines and ethical considerations
There should be a balance between medical recommendations, patient’s
wishes, potential benefits, disadvantage of each option and the need and
resources of the family. In the given case study, there is an ethical conflict is
between the patient’s wish to stay home with hospice care and the wife’s
wish to admit him to inpatient care. As an advanced practice nurse, I would
practice open communication, consult with the other healthcare team, and
advocate the patients and counseling.
Open Communication: Open communication with patient could unfold the
most crucial barriers during patient centered care (Roodbeen et al, 2020).
Communicate openly with patient, and wife about the current health status,
progress of the disease, explain pros and cons of both hospice care at home
and in patient can be beneficial to resolve the clash.
Patient’s Autonomy: Autonomy act 2019, the law fully protects patient’s
right allowing patient in self advance care planning and make advance
decision. Hospice care improves patient’s right in decision making and
decreases polypharmacy and extreme life sustaining treatments (Wang et al,
2022). Also, patient centered home care services reduce unnecessary
emergency visit and hospitalization (Wang et al, 2022).
Advocate patient: As APN, I would admire patient’s wishes, on other hand I
would discuss concern of his wife. Counseling them can guide towards
mutual understanding and agreement. Educating patient about inpatient
hospice care with specialist can be advantageous and minimize useless
interventions.
Shared decision making: Discuss framework regarding advocacy, and
restrictions and provide guidance about patient’s health status and
autonomy. Shared decision making is effective for patient receiving hospital
care which is highly complex and preference sensitive (Roodbeen et al,
2020).
Consult other healthcare team: Consulting other teammates like social
workers, healthcare providers, case manager and ethicist for their viewpoint
and valuable guidance can assist in settlement. Interactive teamwork
between health care, social care, community services, pain management
team and 24hr services can upgrade patient’s quality of care (Shepperd et
al, 2021)
Documentation: Each and every step of discussions, decisions, plan and
intervention
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