Advance Care Planning and End of Life Care in Elderly Patients

Advance Care Planning, and End of Life Care in Elderly Patients
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 Ethical issue in health care
Advance Care planning and end of life is an ethical issue in health care. For many years, patients who reach the end of life receive medical care that does not match what they would have desired due to a medical situation that causes them to lose the ability to make decisions. Physicians or family members are forced to make decisions for the patient in regards to how they will be treated which sometimes is not the way a patient would have desired. Advance care planning is essential since it allows patients to make their decisions in regards to how they would want physicians to handle their future health care issues in case they are incapable of participating directly in their care. A written document known as advance directives gives an opportunity to a competent patient a chance to express their value and preferences to guide future health care decisions in case they are unable to make medical decisions at that time. Advance care planning enables and enlightens patients that they can have a say in their present and future treatment. Advance care planning has helped in improving end of life care.
Advance care planning for the elderly patients is complicated when they are seriously sick or when the length of stay in hospitals is short. It is therefore essential for people to be encouraged to understand and support advance care planning when they are well since it is helpful when one is not capable of deciding on what they would want for their lives in regards to treatment (Boot, & Wilson, 2014).

Advance care planning (ACP) is essential since it identifies expectations, wishes, and preferences. ACP helps to advance end of life care since it allows patients to deliberate and record their imminent health and care wishes. The process is essential to the society since it enables individuals to have a sense of control since it allows individuals the opportunity to prepare for the future. It also allows them not to burden others when they are disabled. Advance care planning is a chance for people to make decisions and promote person-centered care. There are various benefits of the ACP to the society. The program is person-centered, meaning that it is flexible, voluntary, done individually and recognized as helpful. Scientific evidence also supports ACP. Additionally, people can visit a healthcare organization’s all over the country and be guided on how to it since it is a well-coordinated process. The process helps to give dignity to the elderly, provide autonomy to them and their families. It also respects their will while ensuring that compassion is applied at the end of life plans are made (Baughman, Aultman, Ludwick, & O’Neill, 2014).
 Evidence-based Position as a Nurse
As a nurse, I believe Advance Care Planning, and End of Life Care in Elderly Patients is essential since it allows nurses and physicians to be aware of the wishes of the incapacitated patient and therefore knows what they would want regarding treatment. Even though data from clinical trials in regards to ACP intervention as are limited, preliminary evidence shows strong support of ACP due to its high value in allowing patients to prepare for their death. Research also indicates that ACP also helps in strengthening relationships with loved ones. Patients achieve a sense of control with ACP and also relieve their loved ones and physicians of coming up with the best treatment method that matches their wish. ACP has also been shown to strengthen the relationships between patients and physicians. A better understanding and relationship is formed between the surrogates and the patients. The patient also gets high satisfaction since there are fewer conflicts regarding the end of life decisions. Even though there is little data precisely to end of life, but it indicates that ACP has a positive outcome for patients who have used it. It leads to increased hospice length of stay, ensure that limited time is spent in hospitals and also ensure that increased patients die at the locations of the preference.
Personal, Professional, and institutional values underpinning my position
I support people to plan early regarding their end of life by visiting healthcare institutions and talking to physicians on how they can have their advance care directives. I believe in respect for other people’s decisions, and that is why I will be delighted to see that the patient’s wishes are fulfilled when they face a health crisis. Personally, my position is driven by my love for other people. I have a passion for seeing people doing well, especially health wise. I am delighted to help people have a right plan for their lives so that they do not become a burden to others when they are disabled. I believe in giving people hope that they will live according to how they want if they make the right decisions today. I also think in changing situations around me. I trust that it is my responsibility to pass knowledge and information to others so that they can make their lives better.
In regards to my professional values, I believe in accountability, competency, service, integrity, compassion, and excellence. As a nurse, I would want to acquire the best education to maximize my potential in the caring career. I also believe in being ready to account for time, resources and other responsibilities allocated to me. I believe in delivering services to patients and being compassionate and excellent in my work. All these values can only be effective when I work closely with patients and ensure that their wishes are fulfilled through having the advance care planning (Daaleman, Williams, Preisser, Sloane, Biola, & Zimmerman, 2009).
My position in encouraging Advance care planning is based on the values of the institution that I work for. The institution is dedicated to ensuring that the patient receives the best care. Every individual who comes to this health care institution is treated with respect and dignity that they deserve. ACP is about respecting and preserving the dignity of the vulnerable group through ensuring that they receive the treatment and care they had chosen before the medical crisis. The institution is there to listen compassionately to the health needs of patients and help address them. Advance care planning assists the patient to express their issues to physicians who listen to them attentively and help resolve their fears by encouraging them to plan their life using advance care directives. The company is patient-centered and therefore has many employees who role is to be polite and friendly in understanding a patient’s culture, needs, medical history and others to help a patient. The company keeps up with innovative methods to address patients’ needs and health care. ACP is an innovative method that allows the elderly and other sick persons nearing the end of life choose how they want their life to be without involving other persons to make decisions for their life. The company seeks direction from patients and therefore Advance care planning is a way for patients to give physician’s direction regarding their life (Chiu, Feuz, McMahan, Miao, & Sudore, 2016).
Position to End-of-Life Care
Putting the elderly in nursing care may prompt anger and a feeling that they are unwanted by the family members the end. Advanced care planning in end-of-life can at times cause the elderly to feel that they were left on their own by the family members who should be trying to show them love and care in the last days of their lives. However, what these elderly individuals tend to forget is that most of the family members have some other activities to take care of rather than just staying at home to look after them. Understanding the reason as to why they were taken to such facilities away from home to live with other elderly at times confuses them. However, some of these decisions are undertaken (Dempsey, 2013).
The Advance Care Planning, and End of Life care for the elderly major disadvantage which brings about an ethical dilemma. For instance, during the care planning, it is difficult to get an assurance that the agreement you make during the planning will be honored. Studies have revealed over 70 percent of the physicians attending these individuals are not aware of the wishes that were made by the elderly individual (Boot & Wilson, 2014). Therefore, the likelihood of the agreement and his or her wishes being honored is high. The agreement is expected to be respected regardless of the circumstances that an individual finds himself or herself in provided there was an agreement to respect their will. Opposing this position has presented an ethical dilemma, especially for the caregivers. The end-of-life care means a lot to the individuals who have applied for the program. It is the wish of every individual applying for the Advanced Care Planning will get all the benefits as agreed. The health system does not have a structured way on how to address this particular issue. The healthcare should consider involving the practitioner involved in the signing of the agreement to conduct a frequent assessment on to whether the level of care advanced to the elderly individual is conducted as they had agreed. The type of care also advanced to the elderly should be patient-centered (Chiu et al., 2016).
Do Not Resuscitate (DNR) order is one of the many agreements that are mostly ignored by most of the healthcare practitioners. Most of the healthcare facilities need to take this issue seriously to avoid lying to the people who are in their sunset day. It is good to ensure that all of their wishes have been granted early in advance. The elderly in the Advance Care planning, from their values, feel betrayed by the leadership of these facilities for failing to honor their wishes during these end days. It is a sense of betrayal on their side. At this time of their life, most of their health decisions are carried out by the medical practitioners. The practitioner (not all), tend to think that the wishes of them client do not matter. In so doing, they bring about an ethical dilemma and affecting or going against the decisions of the elderly individual. It is unethical to fail to adhere to the terms that are acceptable in accordance with the agreements that have been made by the elderly (Daaleman et al., 2009).
Professionally, is important to honor and respect the consumers of the given form of care and making sure that the agreement that had been made are followed. It is a common code of ethics to respect the wishes of the patients and especially in their end days. Professionals should never at any time attempt to make decisions that have not been validated by the consumer of those services. Respecting the wishes and the decisions of the consumer is crucial for the care managers. The decision made by the consumer of such services should be respected and deviating from the wishes of the consumers can lead to litigation filed against the institution or the care manager by the family members (Boot & Wilson, 2014).
Ethical Framework supporting End-of-Life
The preferences and the perspectives of the patients have to be considered by the healthcare providers in such situations. The care managers must ensure that they have worked against their egoistic theory to make sure that they have acted for the good of the patient. The patient’s best interests should be key not the suggestions and the viewpoints of some of the family members. The virtue theory of ethics is the most appropriate in this situation since it ensures that the activities involved are aimed at achieving the greatest good by the patient, the family, and the care manager (Gilissen, Pivodic, Smets, Gastmans, Vander Stichele, Deliens & Van den Block, 2017). The care managers that are involved in caring for their consumers usually find themselves in situations where they are required to provide the appropriate treatment prognosis for the patients. At times, they are required to make a free choice of treatment that is preferable to the patient. The practitioner may offer an act of beneficence by providing the required treatment to a certain patient without regard to an agreement of the End-of-Life care. The distribution of resources is another factor that may bring about ethical issues on the side of the care managers. Some of the resources used by the patient need to be redistributed to other patients if the care giver finds that the treatment being accorded is futile. Such issues need to be addressed early to avoid unequal distribution of scarce resources technology and other medical resources that are used at times of futile treatment (Grant, Barwich, Rush, & Tayler, 2007).
There are many challenges that the healthcare providers face while dealing with the management of the ethical issues that do surround the end-of-life care. Ensuring that certain policies are adhered to can be the most appropriate way of dealing with these ethical dilemmas. For instance, guiding the patients and their families to make treatment choices that are informed can be of great significance in addressing these issues. Similarly, compiling of policies and guidelines for the decision making in end-of-life can be helpful and can make people make informed choices that would not bring about ethical dilemmas (Waird & Crisp, 2016).
Conclusion
Advanced Care Planning is said to be a process of reflection, communication, and discussion of the preferences of treatment among care providers, family, and dying patient with the intension providing quality care during their end-of-life. Encouraging communication during the advance care planning will ensure that most of the ethical issues faced have been addressed. Trustful communication is likely to eliminate then chances of having to deal with the ethical crisis. Effective advance planning is most effective approaches that can be used assist the patient in making choices that are flexible, and that would accommodate specific changes if required. The implementation of these policies will also safeguard the interest of the patients and the healthcare facilities during end-of-life.
References
Baughman, K. R., Aultman, J. M., Ludwick, R., & O’Neill, A. (2014). Narrative analysis of the ethics in providing advance care planning. Nursing ethics, 21(1), 53-63.
Boot, M., & Wilson, C. (2014). Clinical nurse specialists’ perspectives on advance care planning conversations: a qualitative study. International journal of palliative nursing, 20(1), 9-14.
Chiu, C., Feuz, M. A., McMahan, R. D., Miao, Y., & Sudore, R. L. (2016). “Doctor, make my decisions”: decision control preferences, advance care planning, and satisfaction with communication among diverse older adults. Journal of pain and symptom management, 51(1), 33-40.
Daaleman, T. P., Williams, C. S., Preisser, J. S., Sloane, P. D., Biola, H., & Zimmerman, S. (2009). Advance care planning in nursing homes and assisted living communities. Journal of the American Medical Directors Association, 10(4), 243-251.
Dempsey, D. (2013). Advance care planning for people with dementia: benefits and challenges. International journal of palliative nursing, 19(5), 227-234.
Gilissen, J., Pivodic, L., Smets, T., Gastmans, C., Vander Stichele, R., Deliens, L., & Van den Block, L. (2017). Preconditions for successful advance care planning in nursing homes: A systematic review. International journal of nursing studies, 66, 47-59.
Grant, S., Barwich, D., Rush, J. L., & Tayler, C. (2007). Advance Care Planning: What’s All the Talk About?. Canadian Journal of Medical Radiation Technology, 38(4), 5-10.
Waird, A., & Crisp, E. (2016). The role of advance care planning in end-of-life care for residents of aged care facilities. Australian Journal of Advanced Nursing, The, 33(4), 26.