NU475-Chronic Disease Essay

Introduction

It is now 6 months later. Despite palliative interventions to help George maintain a good quality of life, Georges condition has deteriorated. Interventions have not been sufficient to maintain the stability of Georges blood sugar. His neuropathy has progressed. Foot ulcers have not healed and George has required the amputation of several toes. His uncontrolled hypertension and congestive heart failure have resulted in limited mobility and dependence on oxygen therapy. Georges resting oxygen saturation is 90%; with exertion it drops to the low 80s. George becomes short of breath after even short activity.

Curative interventions are no longer effective. New referrals were made. George has been admitted to hospice services.

Wt 196 lbs

BP 174/96

George and Martha were visibly shaken when they heard that George was given a hospice referral. Martha was in tears. They both agree that they want George to stay at home to care for him there. They are not entirely on board with this decision regarding hospice services because they do not feel that George is at the point of needing these services yet. George and Martha do not really know anything about hospice care except that it is a place to go at the end of life. They have read on the internet about miracle treatments in Mexico and might consider trying those treatments first.

George and Martha have many thoughts and questions such as:

• Isnt there another medication you can try?
• Why now? We really are getting along pretty well.
• Can we wait just a little longer for the change to hospice?
• How much longer does George have to live?
• How will Martha care for George at home?

Write a 34-page expository paper that conveys the communication strategies that you would use to support George and Martha as they receive this difficult news. Your paper should include the elements listed below.

1. Introduction to End-of-Life Communication
2. Hospice and Palliative Care Knowledge

• It is important to listen to George and Martha and understand their perspective on Georges diagnosis and to discover what they know about hospice and palliative care.
• Provide three (3) questions that you would ask to assess understanding. Provide rationale for the questions you would ask.

1. Common Emotions

• Identify three (3) emotions that patients or family members might commonly experience at the time of a terminal diagnosis.
• Provide evidence-based strategies the nurse can use in response to the emotions.

1. Negotiation and Problem Solving

• Identify three (3) strategies to negotiate and problem solve George and Marthas hesitancy and reluctance to accept hospice services. Give examples.

1. Decision Making

• Describe how you would assist George and Martha in their ability to make decisions. Give examples.
• How does ethical decision making on the part of the nurse apply to this scenario? Discuss two (2) possible ethical considerations and your responses.
• Provide at least 3 current references (within the last 5 years).