Week 2: Palliative Care Flashcards
Exam 1
Palliative and End-of-Life Care:
What is needed?
The need for quality at end of life
Palliative and End-of-Life Care:
What exists now? What are examples?
Improved ability to care for the critically ill
Meds, technology
Palliative and End-of-Life Care:
What is often lost in healthcare?
Loss of sensitivity for human suffering in an effort to aggressively save lives
Palliative and End-of-Life Care:
What must be understood?
Understanding Human Death
Palliative and End-of-Life Care:
Understanding Human Death
Increased education for health care providers education
Improve EOL decision making
Reduce frequency of mechanically supported, painful and prolonged death.
Palliative and End-of-Life Care:
Opportunity for improvement
Respecting decision to avoid CPR
The need for quality end of life care
40 % of ICU deaths were among patients who
who were in ICU 10 days or more
The need for quality end of life care
40 % of ICU deaths were among patients who were in ICU 10 days or more
What is this preceded by?
Preceded by aggressive support
The need for quality end of life care
40 % of ICU deaths were among patients who were in ICU 10 days or more
Preceded by aggressive support like:
Outcomes of decisions often not understood
Highly stressful environment
The need for quality end of life care
What is the role of the nurse?
Nurse’s role to explain the choices to patients and family
The need for quality end of life care
When does palliative care begin and end?
Palliative care can begin at admission and continue to end of life.
Elements of Palliative Care
Alleviation of distressing symptoms (palliation)
Advanced Care Planning
Family centered care
Emotional and psychological care of the patient and family
Facilitating communication
Effects of End-of-Life Issues on Nurses and Health Care Teams
What should you do to lessen stress?
Know when you need a break
Discuss experience with colleagues, friends and leaders
Be in touch with your feelings
Physical exercise, mediation, humor, music, eating properly, getting rest
Recognize burnout-
Effects of End-of-Life Issues on Nurses and Health Care Teams
Recognize burnout- what are signs?
Increased sick days,
difficulty solving problems,
isolation,
withdrawal,
change in behavior,
diminished capacity for experiencing pleasure
Flashbacks
Common Symptoms at End of Life
Pain
Anxiety
Hunger
Thirst
Dyspnea
Diarrhea
Nausea
Confusion
Agitation
Sleep disturbance
Communication and Conflict Resolution:
What should you provide and allow to family?
Provide clear, ongoing, honest communication
Allow time for family members to express themselves
Communication and Conflict Resolution:
What should you agree on? What should you emphasize? What should you facilitate?
Agree on a treatment plan
Emphasize that patient will not be abandoned
Facilitate continuity of care
What is the most common withdrawal intervention?
Ventilator Withdrawal
What “terminal weaning”?
Ventilator Withdrawal
During Ventilator Withdrawal, what should be done?
Titrate pain medications and sedation during this process
Ventilator Withdrawal: Titrate pain medications and sedation during this process
What does this do?
Relieves tachypnea, dyspnea, and use of accessory muscles
Ethical Principles Related to Withdrawal and Withholding of Treatment:
Death is a product of what?
Death is a product of the underlying disease
Ethical Principles Related to Withdrawal and Withholding of Treatment:
What is the goal of withdrawal and withholding of treatment?
Goal is to relieve suffering, not hasten death
Ethical Principles Related to Withdrawal and Withholding of Treatment:
Withholding life-sustaining treatment is similar to what?
Withholding life-sustaining treatment is moral equivalent of withdrawing treatment
Ethical Principles Related to Withdrawal and Withholding of Treatment
When can treatment be withheld or withdrawn?
Any treatment may be withheld or withdrawn with patient and family consent
Nursing Interventions During Withdrawal or Withholding of Treatment
include?
Provide
Anticipate
Titrate
Nursing Interventions During Withdrawal or Withholding of Treatment
What should you provide?
Provide anticipatory guidance to patient and family
Nursing Interventions During Withdrawal or Withholding of Treatment
What should you anticipate?
Anticipate distressing symptoms and medicate to relieve symptoms
Nursing Interventions During Withdrawal or Withholding of Treatment
What should you Titrate?
Titrate therapy to relieve emotional and physical distress
Hospice Care
What does it comfort?
Emphasizes comfort rather than cure
Hospice Care
How does it view dying?
Views dying as a normal process
Hospice Care
Philosophy?
Philosophy of care, not a location
Hospice Care
Where is it common?
Common in oncology
Hospice Care
When is it appropriate?
Appropriate when aggressive interventions are withdrawn
Hospice Care
What is it considered?
Quality end-of-life care
Hospice Referral:
Hospice is what kind of care?
Hospice is a model of care based on comfort measures
Hospice Referral:
When is a referral made?
After decision to withdraw or withhold therapy
Hospice Referral:
How does care occur?
Smooth transition of care
Hospice Referral:
What occurs?
Family and patient involvement
Communication
Cultural Competence in End of Life
How do most clinicians feel?
Most clinicians feel ill-prepared
Cultural Competence in End of Life
Cultural differences?
Cultures differ in death practices
Cultures differ in end-of-life options selection
Cultural Competence in End of Life
What should providers do?
Become familiar with religious groups and beliefs about end of life rituals and practices
Attend Ethics committee meetings
Attend ethics rounds
Legal issues in Critical Care
Medical futility:
Situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient’s health condition, or a lack of attainable goals of care
Legal issues in Critical Care
HIPAA: What must nurses do to decide who has patient information accessible to them?
Nurses need to verify who can have access to patient information
Legal issues in Critical Care
HIPAA: Who decides who has access to patient information?
Patient has right to make this decision
Legal issues in Critical Care
HIPAA: What must be communicated to the patient?
Must communicate HIPAA to the patient
Legal issues in Critical Care
HIPAA:
Keep patient information confidential
Criminal Law:
What kind of law?
Public Law
Criminal Law:
Conviction of public law means what?
= penalty can include loss of liberty
Criminal Law
Conviction = penalty can include loss of liberty
For nurses these cases include:
Intentional assault and battery
Fraud
Theft
Negligent homicide
Civil Law:
What kind if law is it?
Private law
Civil Law:
What does it involve?
Individual conflicts
Civil Law:
What does it include?
Includes tort law: trespass, assault, battery and negligence
Nursing malpractice
Malpractice law:
What does it require?
Requires a causal relationship between the nurse’s breach of standard of care and injury to the patient.
Malpractice law:
What must is show?
Must show that injury is result of nurses’ action or inaction
Malpractice law:
What is the award most often?
Most often award is monetary
Malpractice law:
What are noneconomic damages? What do many states have limits on?
Noneconomic damages: pain suffering..
Many states have limits on monetary awards
Nursing Malpractice Case:
How does it start?
Distressed patient and or family file lawsuit against nurse in civil court
Nursing Malpractice Case:
What is the nurse in these situations?
Nurse becomes a defendant w legal representation
Nursing Malpractice Case:
Discovery phase: What is it? What else occurs?
Discovery phase- written answers to written questions
Depositions /oral testimony
Elements of malpractice
Duty: What is there a legal relationship between?
legal relationship between two or more parties
Elements of malpractice
Duty: What is there a contractual relationship between?
Contractual relationship between patient and HC facility
Elements of malpractice
Duty: Nurses name is where?
Duty of Nurse’s name in patient records
Elements of malpractice
Duty: What is the duty of the nurse?
Duty to provide reasonable care within established standard of care
Elements of malpractice
Include:
Breach of duty
Causation
Damages/Harm
Breach of Duty:
What must be shown for malpractice?
Must show breach
Breach of Duty:
How is negligence detemined?
Negligence is determined by comparing the nurse’s conduct with the established standard of care (SOC)
Breach of Duty:
Negligence is determined by comparing the nurse’s conduct with the established standard of care (SOC)
If nurse fails to meet SOC…
If nurse fails to meet SOC, violation has occurred in duty to patient
Breach of Duty:
Negligence can be ____or ____.
Negligence can be ordinary or gross
Breach of Duty
Negligence can be ordinary or gross
What is gross negligence?
Gross negligence indicates the nurse willfully and consciously ignored a known risk of harm for the patient
Vicarious liability
Holding someone responsible for the actions of another
Vicarious liability
Includes:
respondent superior (employer responsible for actions of employee)
Corporate liability
Negligent supervision
Rule of personal liability
Vicarious liability
Includes: respondent superior
(employer responsible for actions of employee)
Vicarious liability
Under respondent superior, who is held liable for negligent behavior?
Under this legal theory, hospitals are held liable for the negligence of their employees.
It is a legal doctrine based on public policy that notes that because a hospital profits from the patients seeking care, the hospital should pauy for some of the damages caused by the hospital personeel if ngligence occurs.
Vicarious liability
Includes: Corporate liability
Is a vicarious liability that occurs when a hospital is found liable for its own unreasonable conduct.
Vicarious liability
What is an example of corporate liability?
if it is found that a unit is chronically understaffed and a patient suffers an injury as a result of short staffing, the hospital can be held accountable.
Vicarious liability
Negligent supervision: What is it?
When a supervisor fails to reasonably supervise people under their direction.
Vicarious liability
Negligent supervision: What is an example?
If a nurse rotates to an unfamiliar unit and informs the charge nurse that they have never worked in critical care, it would be unreasonable. for the charge to ask the floating nurse to perform invasive monitoring.
If the charge did assign such responsibilities, to the floater and patient injury occurs, the charge nurse could be held accountable to the patient for negligent supervision.
Vicarious liability
Rule of personal liability
Nurses are responsible for making sound decisions by virtue of their own specialized education, training and experience.
Corporate liability: Who is liable?
When hospital is liable for unreasonable conduct
Nurse responsibility
Nurses are responsible for making sound decisions by virtue of their own specialized education training and experience.
Nurse responsibility: What kind of orders should nurses not follow?
Do not follow orders that the nurse deems unsafe.
Nurse responsibility:
Orders that are deemed unsafe- what should nurses do?
Seek clarification or follow the chain of command
Nurse responsibility:
There is a problem with devices, what is it called?
Safe medical devices act: report malfunctions of medical devices
Nurse responsibility:
What should not be done with defective equipment?
Do not use defective equipment
