NR 341 Week 2 Client Comfort and End of Life Care

Name

Chamberlain University

NR-341 Complex Adult Health

Prof. Name

Date

Reflective Journal

In the hospice care simulation, I reflected on past experiences caring for patients with similar needs. As a nurse working in the Neurological Unit at St. Joseph’s University Medical Center in Paterson, I often encounter patients experiencing their first or recurring strokes. These patients frequently present with complex underlying conditions. I have observed family dynamics and reactions firsthand 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, which reflected an emotional response that, while understandable, can lead to patient guilt. This guilt might cause patients to feel pressured into continuing treatment they no longer desire. To improve my clinical practice, I would prioritize open communication with both patients and families. This approach is essential when emotions are heightened, as is often the case in end-of-life situations, where information may be overwhelming. Engaging in direct dialogue with the patient can offer them a safe space to voice their needs. Additionally, I would advocate for speaking with the patient privately before family involvement, allowing them to discuss their wishes without external pressure and addressing any questions they might have.

Question One

According to the State Board of Nursing in New Jersey, registered nurses bear a responsibility for managing patient pain effectively. The American Nurses Association (ANA) highlights an ethical duty for nurses to alleviate pain and suffering. Nurses are responsible for conducting a comprehensive medical history, including the pain’s nature, frequency, and severity, and assessing any history of substance abuse. Such an assessment ensures appropriate nursing diagnoses and effective pain management planning. If a patient has a history of substance use, the nurse must exercise caution in medication administration, exploring alternative pain management options when necessary (New Jersey Board of Nursing: Law and Public Safety, 2020).

Question Two

In New Jersey, when a patient lacks a medical power of attorney, the state designates a sequence of individuals to make medical decisions on the patient’s behalf. These include a court-appointed guardian or conservator, the patient’s spouse or domestic partner, and an adult child. Each of these parties has legal authority to make decisions such as hospital admission or discharge, determining treatment and medication plans, and authorizing access to medical records (Durable Powers of Attorney for Health Care, 2016).

Question Three

State law in New Jersey defines patient incapacity as a condition determined by the attending physician, who must confirm, to a reasonable degree of medical certainty, that the patient lacks decision-making capacity. This determination includes an assessment of the cause and extent of incapacity, along with the potential for recovery. Under state law, an incapacitated person is someone who is impaired due to mental illness or deficiency and is unable to effectively manage their personal affairs (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.