Phyllis Young Only

Response #1

Rochelle, you have a great post. Mrs. Sloan is a sound mind and cognitively intact. She has the right to refuse and right to choose her treatment. She is a competent adult that can make decisions for herself and determine what shall be done with own body. As an advance practical nurse, we should have an excellent communication skills necessary to engender trust and draw patients into a partnership of care (Flaherty & Resnick, 2014). We have to ensure that Mrs. Sloan has a clear understanding about the advance directives and know the pros and cons of her decisions. Although all patients who require CPR have acute illness by virtue of needing CPR, there may be differences in the type or severity of the acute illness leading to CPR that could influence outcomes. I will emphasize to her the benefits or pros and cons that she might get from CPR. There are some patients that get terrified when we talk about advance directives or end-of-life care, so we have to make sure that we explained it right and not sound to be morbid. The value of the APN role extends beyond specialized and expanded knowledge, critical thinking, and evidence-based practice to enhanced communication skills that facilitate direct patient care through informed decision-making, patient and family education, and psychosocial-spiritual care (Yeager, 2014). Great post.

References:

Flaherty, E., & Resnick, B. (Eds.). (2014). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (4th ed.). New York, NY: American Geriatrics Society.

Yeager, K. (2014). The Role of Advanced Practice Nursing in Palliative Care. Retrieved from http://nursing.onclive.com/publications/oncology-nurse/2014/March-2014/The-Role-of-Advanced-Practice-Nursing-in-Palliative-Care#sthash.1eA6sARh.dpuf

Response #2

Lisa, you have a very informative post. I certainly agree with you to encourage Ms. Strearn to elaborate on what other needs she would like to have fulfilled and who she would like to involve in the decision making. In case study #2, Ms. Stearn was already 81 years old and disoriented at times. She even performed poorly on a standardized mental state exam. Even though, she appropriately answered questions, her cognitive status is mildly cognitively impaired. As her nurse practitioner, we should establish a good patient-relationship so that she will be more comfortable in expressing her concerns why she is refusing bladder catheterization. We should have the ability to listen which is the most valuable skill that can be used and allow her the opportunity to tell her story. We have to have open communication and show to her that we are willing to take care of her and address her concerns (Knox, 2010). We should show empathy and be with the patient so she will feel her importance as a person and a human being. We should also explain well to the patient the complications that she might get if she refuse the treatments. Also, we have to find out the reason why she is refusing bladder catheterization, it may be because she was very conservative and ashamed to examine her private area since she had no sexual intercourse ever since. As a nurse practitioner, we should always remember to promote excellent communication with the patient and family, encourage appropriate advance care planning and decision making, and demonstrate empathy for patient and family emotions (Rabow, 2004). If the patient still refuse despite of all the explanations that we did, I will talk to the family and consult a psychologist to evaluate her capability in decision-making. Great post.

References:

Knox, P. (2010). Palliative Care Nurse Practitioners. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/features/articles/palliative-care-nurse-practitioners.aspx

Rabow, M. W., Hauser, J. M., & Adams, J. (2004). Supporting family caregivers at the end of life: "they don't know what they don't know". Jama, 291(4), 483-491.