Decision making in end -of-life situations is often a complicated experience where difficult decisions must be made. Deciding whether to continue or stop life support, initiating a cardiopulmonary resuscitation, or placing a feeding tube comes with a fair share of difficulty. When the patients are acutely ill, their decision-making capacity is often impaired and hence transferring the role of to family members. Prognostic uncertainty and the determination of when to begin EOL discussions have been described as the biggest challenges towards decision making. Besides, the emotional difficulties for the patients, families and the practitioners are real concerns in making the discussions (Cherry & Jacob, 2016).
Role of Nurses
The nurses in scenarios of EOL play a fundamental role of being information brokers. They facilitate communication between members of the family and the care collaboration. Nurses pass on information regarding the sick people and their families to the doctors. The information transferred includes the clinical status, psychological and emotional states of the patients and families. Further, they broke information concerning wishes of the patients to the health team. Nurses also play a vital role in giving the information relating to equipment, the condition of the patient and diagnosis to family members (Cherry & Jacob, 2016). Other roles include being supporters by the building of gullible relations with the affected members and by extending empathy, listening to the wishes and wants of the patients and members of their family. Advocacy is another key role of the nurses whose enactment takes the form of verbal communication to health care group on behalf of the affected person and communicating to family on behalf of the patient (Adams, Bailey, Anderson, & Docherty, 2011).
Primary Policies that define Healthcare in EOL Decisions
The current policies that address the healthcare in EOL focus on the provision of quality of care to the patients which may include aspects like management of pain and distressing symptoms, building strong relationships between the physicians, nurses, and patients and their family. The policy also addresses the importance of effective communication among the various stakeholders. Early and regular initiation of communication helps in sharing of information helps the patients and other decision makers comprehend the shared information. Other issues that are touched in the policies include consent to treatment, advance care planning, interventions and management of care, safety especially for the dying at home, desires, and requests to accelerate death, conflict management, and documentation among others (Rosen & Imperato, 2015).
Effect of End-of-Life Regulations and Controls on Patient Outcomes
The controls instituted towards the EOL care ensure that a holistic nursing care and support is afforded to the patients and families. The gains of such an approach are anchored in providing for stability of the affected individuals physically, emotionally, spiritually and psychologically. Because the patients may be confused, lost and sometimes uncomfortable discussing their issues with the healthcare providers, it is the responsibility of the various individuals that the regulations give authority to act in a particular way to ensure the quality of care and a dignified death (Cherry & Jacob, 2016). However, in the western culture, it is imperative to let the person remain in control of their wishes and the person they want to share those issues with. The regulations also enable the avoidance of possible conflicts that may arise among the family members and even the healthcare partnership. The approaches that nurses use during the provision of care and support do affect the capacity of the next of kin to recognize that the patient may not survive. Indeed, this does influence the general process of decision making (Rosen & Imperato, 2015).
The Legislation that Generated End-of-Life Health Care Policies
The policies regarding the end-of-life health care were generated from amendments to the Public Health Service Act which was enacted in 1944. The law is defined in Title 42 of the United States Code. The various policies are derived from amendments to this law. One such amendment is the HIPAA which seeks to ensure that the privacy of the information of the deceased persons is protected for a minimum of 50 years after their death (Adams et al., 2011). However, the more substantive law, the Affordable Care Act of 2010 gives guidelines on various aspects of end-of –life care (Cherry & Jacob, 2016). Regrettably, though, is the fact that some provision of the EOL were stripped off from the ACA because of the death panel myth. With the considered introduction of an amendment to the Health law of 1944, the house is considering the introduction of the Palliative Care and Hospice Education Training Act which will regulate the advanced care planning in the country (Rosen & Imperato, 2015).
Ethical Considerations that have Influenced Policy Decisions in Regard to End-of-Life Decisions
Ethical concerns continue to complicate decision-making of the nurses in palliative care settings. The nurses are required to balance their decisions based on the dictates of evidence-based practice, what the law requires and the dilemmas of ethics (Cherry & Jacob, 2016). For, example, while the law requires that the patient is given the right to be in control of their care, a dilemma may arise when the patient did not wish to be administered with nutrition but lacked express advance directive to that end. It is difficult without such a document for any of the stakeholders to advocate for what the patient really wanted. The nurses should be guided by the American Nurses Association code of ethics during their decision making (Butts & Rich, 2012).
This paper sheds some light on the critical role the nurse play in end-of-life by acting as advocates and brokers of information to the various parties involved in the healthcare of the patients. Besides, the policies that guide the EOL decision making were discussed in addition to the importance of regulations and controls to the outcomes of healthcare to the patient and families. However, more research is required if the aging American population is to receive the quality of care during the EOL. The current law under consideration by the house should be quickly worked on and enacted into law to improve the palliative care.
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