NURS 6521 Week 1 Assignment Case Study - Case Study Analysis for Advanced Directives

Case Study Analysis for Advanced Directives This paper discusses the dilemma of a ventilated 72-year-old male who did not prepare any advanced directives. His wife and daughter were at odds with what they "thought" he would be and the provider's responsibility to the surrogate. Advanced Directives Advance directives are legal documents that offer patients a way to avoid unwanted care in the event of severe illness or incapacity (Yadav et al., 2017). While this document may not capture all situations one might face near the end of life, it protects patients loved ones from decision-making burdens if their family member becomes incapacitated. Ethical Consideration and Risk Factors Yadav et al. (2017) suggest that approximately one in three United States adults has completed any advance directive. Even with provider influence, many adults continue to decline the completion of advanced directives. They leave many families in turmoil about medical treatment choices in critical or end-of-life care. If no advanced directives are in force, the next of kin is responsible for medical decisions. A surrogate hierarchy in Georgia requires court interventions for challenges (DeMartino et al., 2017). In this scenario, the daughter must file legal action challenging the mother's decisions if there is a conflict. As determined by the hierarchy, the wife is the next of kin and makes medical decisions per the Georgia Supreme Court ("Georgia code title 31. Health § 31-9-2," 2021). Case Assessment 3 The wife and the daughter are at odds with their beliefs about what treatment AC would want. The NP can assist with easing conflict by showing support, being empathetic, and providing accurate information that is easily understood. Clinicians should adopt a mindset that providing information to surrogates is necessary for support. Many surrogates may also need emotional and psychological support to navigate the complexities of decision-making dilemmas. Providers should tailor support strategies on a case-by-case basis by leveraging the entire interprofessional team, including nurses, social workers, chaplains, and palliative care clinicians, for the best results (Dionne-Odom, & White, 2021). The Nurse Practitioner (NP) is a provider for the medical decisions, medication, and treatment plans that require greater responsibility and accountability, abiding by the American Nurses Association (ANA) code of conduct. Fowler (2015) discusses the ANA code of conduct expected from nurses in Provision 4, The Expectation of Expertise. This provision is about authority, accountability, responsibility, and delegation. Accountability refers to being held accountable for choices or decisions by a professional standards panel or board. Responsibility is the liability for one's actions. The challenges of determining an appropriate plan of care based on evidence prove difficult in critical situations. The NP's responsibility is to provide accurate and credible information to all involved in decision-making capacities, regardless of the provider's personal beliefs. Every provider's moral compass can undoubtedly be challenged, creating moral distress. Moral distress is "knowing what to do in an ethical situation, but not being permitted to do it." (Rundio, 2019). There is an ethical dilemma the providers may face, withdrawing and withholding interventions. The discussion with the surrogate should be without the provider's persuasion because of their personal beliefs. Patient autonomy is the primary ethical principle that providers try to follow if it is ethical and legal (Rundio, 2019).