Description
Please respond to each peer with reflective, insightful and significantly contributing information to on-going discussion:
Question 1: Select a domain & analyze it’s guidelines & criteria. How will the domain influence your practice?
Andrew: The domain, “Psychological and Physical Aspects of Care”, readily influences my current practice in medical ICU, and illustrates the integration of palliative care at end-of-life, in nursing. The guidelines of this domain follow the basic nursing process, which include Global, Screening and Assessment, Treatment, and Ongoing Care, of which are employed by the interdisciplinary team (IDT). The Global criteria sets the stage with the social worker, along with the IDT can recognize the palliative care patient physical and psychological needs, and access to specialty clinicians for specific treatment. This domain influences the role of the RN, who acts as the intermediary to relay observed findings to the physicians and in turn, the specialists. This can include infection disease to evaluate for uncommon infections, and psychologists who can evaluate psychiatric conditions to treat, to alleviate some burden from the patient experience. Screening and Assessment of the patient is developmentally and culturally sensitive with minimum requirements, and the Treatment involves the ongoing assessment with the supportive therapies. These criteria are especially relevant to an ICU setting, in the context of patient advocacy and ethics. “The palliative and hospice nurse incorporates ethical principles and professional standards in the care of patients and families who are experiencing life-limiting illnesses or progressive illness, as well as identifying and advocating for their wishes and preferences” (Matzo & Sherman, 2019, p. 9). Patients at end-of-life will have clinical and personal needs for a good death. It will involve patients, their friends and families, and the IDT. In an example, a terminally-ill patient who is opioid-naïve with a history of anxiety, will need adjusted doses of IV infusions, and therapeutic support for their anxiety. Their assessed social needs knowing what music they loved, to play as they die, and preparing the family for anticipatory grief. The domain of these patients’ needs influences the range of decision-making and on-going care on part of the ICU RN, and intercommunication with the IDT for quality care at end-of-life.
Nicholas: After reading the National Consensus Project Report: Practice Guidelines for Quality Practice I decided to elaborate further on Domain 7 Care of the Patient Nearing End of Life. This domain focuses on all aspects of care related to a patient’s final days of life including assessing the signs and symptoms of approaching death, how to communicate and support the patient’s family at the time of death and after, the process of planning what happens after death and, the legal aspects surrounding death. This domain incorporates the nurse’s responsibilities in the patient’s final days of life and postmortem care. I chose this domain as at my current job I will occasionally care for patients who are in our inpatient hospice program. Although I have an understanding, the topic of death and its signs and symptoms is not one that I am very familiar with, but after reading this domain I have gained some new insight on this topic and can further apply this to my inpatient care. I now understand the importance of the nurse’s role in hospice care, one of the guidelines that I can now implement in my own practice is from guideline 7.3 “The IDT elicits and honestly addresses hopes, fears, and expectations about the dying processes in ongoing communications with the patient and their family in a developmentally appropriate and culturally sensitive manner.” National Coalition for Hospice and Palliative Care (2019). It is important to understand that the nurse is not only caring for the patient, but the patient’s family as well, they will need to discuss the patient’s symptoms with the family in order to help the family gain an understanding of where the patient is in terms of end of life. I can implement this into my own care when I care for patients who are part of our inpatient hospice program, and I can now determine ways to communicate honest information to the family in the most compassionate and supportive way possible.
Question 2: Discuss the similarities & differences between hospice & palliative care. How will the differences affect your practice as an APN? Give at least one specific example.
Nicholas: As an APRN it will be important to understand the differences between hospice and palliative care. The definition of palliative care is “specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness” (U.S. Department of Health and Human Services). Hospice care is defined as “focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life” (U.S. Department of Health and Human Services). Some similarities between the two include both aim to alleviate symptoms caused by the disease the patient is facing and both type of care can be done at home, a hospital, a nursing home, or an assisted living facility. Some differences between Palliative and hospice care include types of patient cared for, curative measures for illness, how it is funded, and how long you will be cared for. Palliative care can occur in any patient with a serious illness, the ability to restart a curative treatment for illness can occur if the patient wishes and, it may be paid for by private insurance. Hospice care can occur in patients with a serious illness who have less than 6 months to live, curative measures will not be restarted and only symptoms will be relieved, it is funded partially by Medicare and, the patient is cared for until they pass away usually within months. There are some very important differences between palliative care and hospice care and as an APRN I will need to be able to understand them. This will allow me to help correctly diagnosis the patient in order to make sure they are given the correct type of care. For a patient who has an incurable disease with less than 6 months to live, hospice would be the correct choice as the relief of symptoms becomes the ultimate goal. While in Palliative care curing the disease is also a possibility along with the reduction of symptoms. This will affect my APRN practice as I will have to help safely guide my patients into a care plan that is the most optimal for them, and with this new information I can create a care plan that is patient centered and focuses on the patient’s goals. An example of this would be a patient who suffers from brain cancer, if this cancer is not cureable and causing the patient to have a life expectency under 6 months they would be a candidate for hospice as palliative care can be given for patients who are still undergoing curative measures in this case a patient would still be open to undergoing radiation therapy and surgery.
Jben: According to Sherman (2019), Palliative Care (PC) is the combination of active and compassionate therapies intended to comfort and support individuals who are living with and dying from life-threatening illness (p. 32). Palliative care addresses the physical, emotional, and cultural needs of the patient, family, and caregivers. “The principles of hospice care embrace holistic patient- and family-centered care, offered by an interprofessional team of practitioners (Sherman, 2019, p.63).” Sherman (2019) states, the difference between hospice care and PC is that PC begins at the time of diagnosis with such illnesses and continues until the death of the patient and into the bereavement period for families, whereas hospice care is provided during the last 6 months of life.
Palliative care is not dependent on prognosis and can be provided to alleviate symptoms caused by the disease or treatments. Both PC and hospice care focus on comfort and supportive interventions to promote quality of life. PC typically begins earlier than hospice care as hospice is catered to the end of life stages.
As an APN it is important to know the differences between palliative care and hospice care. When assessing a patient in a palliative care context, I will need to address the symptoms associated with the illness and cater to physical, emotional, cultural, and psychosocial needs. When caring for a patient in a hospice context, my assessment will focus on maintaining the patient’s quality of life in the final stages of illness and symptom management as compared to aggressive treatments. In my work setting, a palliative care patient may still have aggressive treatments, daily blood draws, and therapeutic interventions. Where as a patient under my hospital’s hospice program, we will stop aggressive treatment and daily blood draws. Instead we will focus on providing the patient with symptom management while maintaining their quality of life during the end of their illness. This may include less interruptions during night time, oral care, and dilaudid drips for comfort and labored breathing.
