Palliative Care

Palliative Care

Nurses often encounter the challenge of choosing who should be involved in decision-making regarding patient care. This has been a serious issue whenever patients do not have the capacity to make decisions concerning their management. Even though patient caregivers can make good decisions regarding patient care, they sometimes make decisions that do not impress patients. This paper analyses the ideal individuals who should participate in decision-making regarding Mrs Thomas’s care.

In Mrs Thomas’ case, the family and friends were angered by the fact that only immediate family members could take part in decision-making. The reaction from the family and friends was not appropriate since they had not been given the right to take part in decision-making by Mrs Thomas. The immediate family members would be blamed by the other family members and friends in case they make a decision leading to poor health outcomes. This would lead to conflicts between them. It would be appropriate to handle the situation by asking the immediate family members to discuss the need for all of them to be involved in decision-making with the other family members and friends. They would also be required to discuss the possible courses of action regarding the care plan for Mrs Thomas before deciding who should be part of the meeting. If they decide on only immediate family members attending the meeting with the oncology and ICU team, they would be given another opportunity to meet before final decisions are made. This would mean both friends and all family members are involved in decision-making. Friends and family members can make decisions that improve the plan of care for cancer patients (Dionne-Odom et al., 2019). This is because they have stayed with the patient for a long and understand the patient’s needs.

If I were the patient, it would be my immediate family members making the decisions. I would prefer to be cared for in a nursing home immediately after my symptoms improve in the ICU. This is because patients transferred from ICUs to nursing homes have a significant improvement in their symptoms (Zadeh et al., 2018). My father would know that I want this since I have told him several times about it. Even though some of my family members would be against such a decision, it would be the most appropriate since it would save them a large amount of money, and I would still recover.

Overall, decisions regarding the plan of care for patients in an ICU are difficult to make since patients do not have the capacity to make decisions. Involving family members and friends could lead to decisions that improve the health outcomes of patients. In case of a conflict between family members and friends, there should be a peaceful discussion for them to decide on who should be involved regarding a patient’s care.

References

Dionne-odom, N., Ejem, D., Wells, R., Barnato, A. E., Taylor, R. A., Rocque, G. B., Turkman, Y. E., Kenny, M., Ivankova, V., Bakitas, M. A., & Martin, M. Y. (2019). How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making : A qualitative study. PLoS ONE, 1–15.

Zadeh, R. S., Eshelman, P., Setla, J., Kennedy, L., Hon, E., & Basara, A. (2018). Environmental Design for End-of-Life Care : An Integrative Review on Improving the Quality of Life and Managing Symptoms for Patients in Institutional Settings. Journal of Pain and Symptom Management, 55(3), 1018–1034. https://doi.org/10.1016/j.jpainsymman.2017.09.0

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Palliative Care

Scenario
Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment. She is an active member of her church community and friends, comments that she had so much energy that she exhausted all of them just being around her. At age 51, she was diagnosed with non-Hodgkin’s lymphoma. Busy with raising her grandchildren, a little more than 3 years went by before she sought attention for her symptoms and was diagnosed. Despite aggressive treatments with chemotherapy and radiation, her diseased progressed and she was considering undergoing a bone marrow transplant. Climbing the stairs to the apartment one afternoon she became very short of breath and collapsed. Her twelve, year old granddaughter called 911. At the hospital she was minimally responsive and in severe respiratory distress. She was intubated and transferred to the ICU. A family meeting with the oncology and ICU team was called to discuss Mrs. Thomas’s advanced condition, the fact that she would probably not survive further treatment for the lymphoma and to develop a plan of care. Fifteen family members arrived, including her daughter, pre-teen granddaughters and grandson, three nieces, four nephews, several friends from her church and the minister. On being asked that only the immediate family participate in the meeting, the family and friends became angry and insisted that all of them be involved in this discussion.

Guidelines

 Support your discussion with a professional nursing journal that is no more than 5 years old.
 Incorporate topic discussion into clinical judgment and decision making within practice setting.
 The students should focus their thoughts on the dynamics of this family meeting. If you were the nurse in this situation, how would you address meeting? Here are some questions that may help your thinking.
Questions

1. What is your impression regarding this scenario? What are some concerns you have with this case? What do you anticipate would happen? How would you handle all the family members and friends wanting to be included in the discussion? There is not a right or wrong answer. But remember you need a professional journal to support the discussion.

2. Now think about you being the patient. How would the situation be handle within your family? Have you thought about what kind of care you would want? Does someone know what you would want if you had a catastrophic event? Would family members support the decision maker's decision for for you?