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Program Outcome #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. (Extraordinary Nursing) I was able to achieve this program outcome in the palliative setting when we refer our patients with progressive chronic conditions to home health with outpatient palliative by collaborating with the patient’s providers, discharge planner, and all other disciplines involved in patient’s care. This also includes having patients and their family present as we establish plan of care. These discharge meetings ensure that patients are transitioned to home safely with appropriate assistance. A priority is also required for those special case patients requiring comprehensive and complicated conditions, with a need for a timely care such as use of medical equipment for antibiotic infusions, feeding tubes, or a wound vac. The key factor of collaboration is to have an organizational trust defined by confidence in cooperative team and individuals. Communication is the essential element of collaboration. It is in communication that we are able to obtain trust and illuminate the roles of each member of the team, which is a powerful asset for a successful collaboration between organizational systems (Lundereng, et al., 2020). Another example of advocating for positive health outcome in my clinical rotation is every morning, we huddle as a team. This is done in our office before we see patients and we go through our list with another nurse practitioner. This gives us the opportunity to discuss about our patients, recognize concerns, and address unresolved issues. It also gives us a dedicated time to familiarize other patients that we are not seeing, which I find crucial when working as a team. Daily healthcare huddles have remarkably revealed an improvement in patient safety by promoting teamwork, producing a standard communication system, and provides a sense of sharing responsibility among the team. The implementation of huddles
assists in improving staff accountability, facilitate a collaboration culture, and promote an enhanced community and empowerment (Rowan, et al., 2022). American Association of Colleges of Nursing (AACN) Essentials Domain 6. Perform effectively in different team roles, using principles and values of team dynamics. I was able to integrate evidence-based strategies and processes to improve team effectiveness and outcomes in this course by participating at several family meetings, along with my preceptor and another provider at a family meeting. I remember the first day of my clinical, when I had my first family meeting. It was a heavy conversation and such an emotional moment, telling the patient’s family about his poor prognosis. It was so hard to watch them lose their loved one, but they knew that it was time to let him go. My preceptor, along with the neurology NP showed great amount of emotional support as they discussed patient-centered, realistic end-of-life goals. The family felt comforted despite of the difficult moment they were experiencing. Palliative care holds a family meeting as a way to have patients and their families engage in a discussion regarding their critical illness which clarifies the patients and caregivers’ values, provide facts, assess for preferences in care, and recognize illness-related distress and burden. It is considered to be the best practice in attaining a patient- and family-centered care. It also helps reduce caregiver distress, investigate unmet needs, provide family members preparation, and bereavement outcomes improvement. This experience reinforces a trusting alliance with families and promote a unified care. It also enhances provider satisfaction as the treatment plan shows an empathetic way of seeing the family’s perspective (Glajchen, et al., 2022). Another advanced-level nursing education competency that I achieved was
extensive knowledge of their scope of practice and be able to explain it in a way that patient and family can comprehend. This meeting generally concludes with a summary reflecting on the medical condition update, the patients and family’s response and answered questions, and the clarifications of treatment options and goals of care (Glajchen, et al., 2022). Competencies from the National Organization of Nurse Practitioner Faculties (NONPF) Ethics Competency I learned on how to integrate ethical principles in decision making when my preceptor and I were consulted for palliative, to aid in goals of care. The patient was a 90-year-old patient, admitted for pneumonia, who also has dysphagia and expressive aphasia, which was complication from Bulbar ALS. My preceptor has explained to the patient and her daughter that
due to her progressive neurological condition, illnesses such as pneumonia can cause a setback and a possibility of not being able to get back to her baseline status. We discussed how palliative is able to assist her in health decisions to have a greater sense of control that align with her values and priorities. As the meeting ended, her daughter pulled us to the side and asked for us not to get her mother involved in this kind of conversation as she does not want her to worry. This is one of the ethical challenges related to the ethical principle of truth-telling, showing whether it is appropriate to discuss a diagnosis and/or prognosis to both the patient and to family members. It also covers whether it may be right to withhold patients from information because of families’ wishes (Schofield, et al., 2021). My preceptor explained that as my patient’s daughter’s concerns are valid, it would not be fair to hide information from her especially that she is in decisional capacity. We further explained that although our goals consist of rehabilitation to get back to baseline, discussing this matter is not necessarily to make her worry but to prepare her if it goes to a different direction. It is best for the provider to support the family by educating them to acknowledge that it is in their loved one’s best interests to know the truth and accept full disclosure of their fears and concerns. Another ethical dilemma we had to face during one of my clinicals was when we had a 95-year-old patient who has severe dementia with cervical fracture. She was in a lot of pain and agitated, was put in restraints for her own safety. She is unable to state her needs due to her dementia. Her family wanted to continue with aggressive treatment including a feeding tube placement despite her poor prognosis. Patient’s autonomy was clearly compromised. A family meeting was held involving the IDT in an empathic atmosphere. The family’s care goals were explored while aligning the reality that is currently happening. Although it was hard for her family, they have accepted that it was best for the patient to be placed in hospice care. They realized that the patient would not want to live with tube
explained in detail. Honoring and respecting for patients’ values is a priority for providers (Tahmasebi, 2023). References Glajchen, M., Goehring, A., Johns, H., & Portenoy, R. K. (2022). Family meetings in palliative care: benefits and barriers. Current Treatment Options in Oncology , 23 (5), 658–667. https://doi.org/10.1007/s11864-022-00957- Lundereng, E. D., Dihle, A., & Steindal, S. A. (2020). Nurses’ experiences and perspectives on collaborative discharge planning when patients receiving palliative care for cancer are discharged home from hospitals. Journal of Clinical Nursing , 29 (17–18), 3382–3391. https://doi.org/10.1111/jocn. Rowan, B. L., Anjara, S., De Brún, A., MacDonald, S., Kearns, E. C., Marnane, M., & McAuliffe, E. (2022). The impact of huddles on a multidisciplinary healthcare teams’ work engagement, teamwork and job satisfaction: A systematic review. Journal of Evaluation in Clinical Practice , 28 (3), 382–393. https://doi.org/10.1111/jep. Schofield, G., Dittborn, M., Huxtable, R., Brangan, E., & Selman, L. E. (2021). Real- world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliative Medicine , 35 (2), 315–334. https://doi.org/10.1177/ Tahmasebi, M. (2023). Ethics and palliative care: a case of patient’s autonomy. Journal of Medical Ethics and History of Medicine , 15 , 16-. https://doi.org/10.18502/jmehm.v15i16.
