Discussion Board Question 2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.

 Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.

Education

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.

Research

1. Increase the integration of evidence-based care across the dimensions of end-of-life care.

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.

Administration

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.

4. Support the development and integration of palliative care services for all in- and outpatients and their families.

1 postsRe: Topic 3 DQ 1

A group is considered as a “vulnerable population” if it has continuing or more aggravating factors that maintains their poor health status compared to an “at- risk” group. There is a significant disproportionate risk of poor health outcomes for vulnerable populations which would include those living in poverty, homeless, disabled, severe cognitive impairment or extremes of age (Maurer & Smith, 2013, p.527). While at risk groups have a chance of being affected, the vulnerable group has many variables that attribute to the susceptibility of poor health. “A vulnerable population is more likely to develop health-related problems, have more difficulty accessing health care” (Maurer & Smith, 2013, p. 528). Vulnerable groups are “more likely to experience a poor outcome or shorter life span because of those health conditions” (Maurer & Smith, 2013, p. 528).

For example, a person is considered vulnerable if he/she suffers from a disease, but also has an income below the poverty level, no health insurance, and stressors related to their living conditions, such as homeless people (Maurer and Smith, 2013).

One example of vulnerable population group in The United States is the children who lives in poverty or parent has very low income to satisfy their necessities. It is estimated that about 387 million children worldwide live in extreme poverty wherein the household income is estimated to be around less than 2 dollars per day. Worldwide, about 19.5% of children compared to only 9.2% of adults are in extreme poverty (UNICEF, 2013). In the United States, poverty is an increasing problem such as from 2009 to 2010, there is almost a 1 million increase of children living in poverty. Child poverty has many effects on the child such as inadequate nutrition, poor academic performance, lack of health care insurance behavioral, social and emotional problems which also makes them further at risk for abuse and/or neglect (American Psychological Association, 2018).

Nurses may need to help advocate for these very young children who live in poverty by helping provide them knowledge and access to appropriate health care and nutritional services. This entails being familiar with existing laws that helps protect their rights and knowledge of existing services that they are eligible to receive (Maurer & Smith, 2013, p.151). Aside from providing health promotion and education, nurses help further by educating vulnerable families on how to access available resources and referral to social services. According to United States Department of Agriculture Food and Nutrition Service (2018), there are several federal programs which help provide nutrition assistance such as Women, Infants, and Children (WIC).

Children from low-income families are most vulnerable of suffering from consuming empty calories. One ethical issue is the involvement of the government in improving school lunches being provided in schools which is being aimed at combating obesity and malnutrition. In 2010, the Hunger-Free Kids Act mandates improving school lunches to provide nutritious foods as recommended by the federal dietary guidelines. This involves increasing fruits, vegetables, non-fat milk and whole grains while decreasing high fat, salt and sugary foods. This bring about the ethical issue of not allowing children to choose the foods they prefer to consume (Crawford, Gosliner & Kayman, 2011). This appears to be a good initiative from the government to implement healthy school meals to ensure that children, especially those from low-income families, are able to meet the recommended nutritional requirement to prevent malnutrition and the possible long-term health problems associated with it. It may be important that nurses also help educate families on the importance of having a nutritious diet and avoid consuming empty calories which may lead to obesity and health problems.nurses also help to educate families on the importance of having a nutritious diet and avoid consuming empty calories which may lead to obesity and health problems.

“Community health nurses can advocate on the behalf of vulnerable groups by writing and calling government representatives and speaking to professional and community organizations about the problems and needs of high-risk groups” (Maurer and Smith, 2013).