NRS-434VN Topic 5 Discussion Question 2

NRS-434VN Topic 5 Discussion Question 2 End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires. Support your response with evidence-based literature.

Although many elderly individuals prefer to die at home, various factors can hinder those wishes turning into fruition. The term Advance Care Planning (ACP) is unknown to many individuals, especially the elderly. ACP refers to planning for the unforeseen circumstances in the one’s life.The lack of awareness, denial of death, confusion, and cultural differences contribute to the elderly not preparing advance care plan directives (Aldrich & Benson, 2012).Some elderly are not aware of what an ACP is and might not have a proper directive for the family and physician on what to do if he or she gets ills suddenly. The lack of awareness of the existence of the elderly patient’s ACP is one of the reasons that the patient’s wishes go unnoticed. Although the elderly patient might have an ACP, the patient might not have discussed his or her wishes with the physician (Aldrich & Benson, 2012). Hence, the physician might not be aware of the existence of the ACP and cannot proceed with the patient’s wishes. Likewise, the family of the elderly patient might not be aware of their parent having an ACP. Hence, more elderly clients need to not only prepare an ACP but also inform and discuss the directive with their family and physician.Although elderly clients are aware of the decline in their health conditions, some remain in denial that they are or might be in the last phase of their lives (Aldrich & Benson, 2012). This denial also contributes to the inadequate planning from the elderly client on what to do if he or she falls ill and relying wishes to die at home instead of the hospital or a nursing home. In addition, the elderly individual might also be confused in deciding to opt for palliative care programs because it might interfere with the possibility of extending one’s life (Aldrich & Benson, 2012). Some elderly might feel that they are opting or discussing palliative care plans too early when he or she is diagnosed with terminal illness. If the palliative care plans are discussed earlier on during treatment, the physician and the family can be aware of the patient’s preferences to spend his or her last phase of life.Moreover, cultural differences contribute to the trend. Although many express desire for high quality of life at the last phase of life, most prefer to use life extending or sustaining options to palliative care options. African-American and Hispanic elderly clients chose to use life extending care options even with the possibility of side effects compared to their white counterparts (Aldrich & Benson, 2012). Some ethnic minorities might be hesitant to discuss death with their family and might avoid life shortening options. This might hinder the elderly from adequately planning and utilizing palliative care options.

According to Henry (2010, para. 11), a “health or social care professional needs to take responsibility for initiating discussion with the individual and their family about end of life care, conduct a comprehensive assessment and start the process of advance care planning.” As a nurse, I would listen to the elderly client’s desires and preferences for his or her care for the last phase of life. It is important to not only listen but also suggest to the elderly patient to discuss this with the family. I would provide more information and resources regarding palliative care options.Likewise, I would also discuss the financial aspect for long term care. This way the client is aware of all the aspects involved in the end of life care and can make informed choices.References Aldrich, N., & Benson, W. (2012). Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf Henry, C. (2010, August 11). Too many people are dying in hospital against their wishes.

Retrieved from The Guardian:

http://www.theguardian.com/society/joepublic/2010/aug/11/dying-end-of-life-choices-home- hospital