NR 341 Week 2 Client Comfort and End of Life Care

Student Name

Chamberlain University

NR-341 Complex Adult Health

Prof. Name:

Date

Reflective Journal

During the hospice care simulation, I drew upon past experiences from my nursing role in the Neurological Unit at St. Joseph’s University Medical Center in Paterson. In my work, I frequently care for patients who are experiencing their first or recurrent strokes, often accompanied by complex medical conditions. These experiences have provided me with valuable insights into the dynamics of patient and family interactions, especially when patients express a desire to discontinue treatment due to fatigue or emotional strain. In the simulation, the patient’s daughter disregarded her mother’s wishes, an emotional response that, while understandable, may lead to feelings of guilt for the patient. This guilt could compel patients to continue treatment against their preferences.

To enhance my clinical practice, I aim to foster open communication with both patients and their families. This approach is crucial in end-of-life situations, where emotions often run high, and information may be overwhelming. Providing the patient with a safe space to articulate their needs through direct dialogue is essential. Additionally, I advocate for speaking privately with the patient before involving family members. This allows the patient to express their wishes without external pressures and ensures their concerns and questions are addressed thoroughly.

Table: Legal and Ethical Nursing Considerations

Heading	Key Details	References
Pain Management Responsibility	Registered nurses in New Jersey must manage patient pain effectively, guided by the American Nurses Association’s ethical principles. A comprehensive pain assessment should include the nature, frequency, and severity of the pain and consider the patient’s substance use history. Alternative pain management methods should be explored if necessary.	New Jersey Board of Nursing: Law and Public Safety (2020).
Decision-Making Without a Power of Attorney	When patients lack a medical power of attorney, New Jersey law designates a sequence of individuals authorized to make decisions. These include court-appointed guardians, spouses, domestic partners, or adult children. Decisions include treatment plans, hospital admissions, and access to medical records.	Durable Powers of Attorney for Health Care (2016).
Definition of Patient Incapacity	In New Jersey, patient incapacity is determined by the attending physician based on a reasonable medical certainty. The physician evaluates the cause, extent, and potential for recovery. Incapacity refers to a mental impairment that limits personal decision-making abilities.	Assembly Health and Senior Services Committee Statement to Assembly, No. 4098 State of New Jersey (2011).

References

Assembly Health and Senior Services Committee Statement to Assembly, No. 4098 State of New Jersey. Njleg.state.nj.us. (2011). Retrieved from https://www.njleg.state.nj.us/2010/Bills/A4500/4098_S1.PDF.

Durable Powers of Attorney for Health Care. Lawhelp.org. (2016). Retrieved from https://www.lawhelp.org/dc/resource/frequently-asked-questions-about-durable-power.