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Offering patients with terminal illnesses advanced care planning options is central to the ethical management of their needs. Due to the possible loss of autonomy that the specified population may face when undergoing a medical crisis, further decision-making must meet their requirements to ensure that they are provided with maximum comfort and support (Koffer et al., 2019). For this reason, an exhaustive discussion of the options associated with advanced care planning and the actions that should be taken by a healthcare team in the situation of a health crisis is vital (Jackson et al., 2019). However, due to multiple barriers standing in the way of creating an advanced care plan, the specified goals are very difficult to meet, which is why additional tools for communication between a nurse and a patient play a critical role. Furthermore, the involvement of family members, or anyone whom a patient deems to be suitable support is vital.
Currently, several barriers toward compiling a thorough and exhausting advanced care plan exist. Dents in patients’ health literacy represent the main obstacle toward creating an accurate and detailed plan. Analyzing the case of Dorothy, one will notice that she used to have no idea either about advanced care planning or the importance that it holds. However, after a conversation with a nurse, who was kind enough to guide Dorothy through the key concepts of advanced care planning and the role that it would play in her life, Dorothy decided to discuss the entirety of her options, which led to important insights. For instance, Dorothy’s unwillingness to receive healthcare support in the care of a crisis was a rather unusual choice that had to be documented; otherwise, she would be resuscitated by a medical team (Lee et al., 2019).
Therefore, the lack of patient education or, as the case of Dorothy shows, even awareness about the issue, represents the key barrier.
In addition to the described barriers, the issue of time management and the opportunity to provide each patient with an appropriate amount of attention and communication often represents significant obstacle to overcome when considering the design of an advanced care plan. As Dorothy’s case has shown, she was very lucky to find a nurse who had the time and patience to help her navigate through the complex path of outlining the decisions for her future care (Hsieh et al., 2019). According to recent research, the levels of workload combined with nurse shortage in most hospitals create the environment that is not conductive to extensive conversations and elaborate planning (Tang et al., 2020). Therefore, further changes must be made to the management of nurses’ workload and tasks, which is likely to create another impediment on the way to effective palliative care.
In addition, Dorothy’s case has indicated that, due to the lack of proper health literacy, patients often fail to embrace the full range of options that they can consider instead of rejecting medical interventions altogether. Namely, discussing every possible option apart from invasive surgery is critical to providing a patient with the entirety of opportunities for decision-making (Radhakrishnan et al., 2017). Therefore, the range of roles that nurses play in the advanced care planning context need to include the one of a nurse educator. Specifically, nurses should introduce patients in need for an advanced care plan to the concept thereof and the key steps for its development (Head et al., 2018). In case a patient expresses further concerns and shows difficulties drafting one themselves, a nurse has to take time to offer adequate guidance and provide enough support and empathy to help the patient to approach the process rationally.
However, the lack of a framework for nurse-patient communication is by far the greatest problem along with the lack of health literacy in regard to the issue of palliative care and advanced care planning. As Dorothy mentioned in her final words to the students, the inability to locate the person to address in a nursing setting is often becomes the main reason for patients with terminal illness to fail to develop an advanced care plan. In Dorothy’s own words, “Sometimes we want a conversation but don’t know who to talk to about it.” The sentiment mentioned above indicates a massive problem in the existing nursing setting, namely, the lack of a clear nurse-patient communication infrastructure (Raftery et al., 2020). Being confused by the seemingly convoluted hospital hierarchy and unaware of how to address experts, people tend to refuse from advanced care planning altogether, which leads to drastic results (Blackwood et al., 2019). Therefore, a proper communication network must be established so that patients could have a proper understanding of whom to reach out to and how in case of need.
The issue of fear is another barrier toward receiving the appropriate level and quality of care, especially for patients in need for advanced care planning. As the case of Dorothy has shown, she was afraid of addressing a healthcare expert partially due to her fear of surgery. In fact, the presence of fear, be it the expectations of unwanted invasive procedures or the failure to be understood, is present throughout Dorothy’s narrative. Therefore, it would be logical to presume that fear also poses a tremendous obstacle to receiving proper care and gaining essential information needed for creating an advanced care plan. Several papers on this problem support the stated assumption, determining fear as one of the major roadblocks on the path to providing patients with adequate care and relevant services (Chan et al., 2020; Gross et al., 2109).
Addressing the barriers outlined above will require the introduction of additional communication skills for nurses to use when conversing with patients. Specifically, patients as the main component of a productive dialogue needs to be mentioned. Since a range of patients suffers from the lack of proper health education and low health literacy levels, it is instrumental to offer the target demographic basic guidance and support (Midtbust et al., 2018). Although the process of guiding a patient through the essential concepts of advanced care planning might seem tedious to nurses, it is central to patients’ ability to understand their options and make the choices that reflect their demands for advanced care.
The ability to convey critical information to patients in a palatable and detailed way is another essential skill that nurses must develop to ensure that the needs of patients in palliative care are met. The development of the advanced care plan requires a profound understanding of multiple nuances concerning health management and different health conditions and situations (Andersson et al., 2017). Therefore, when provided with the entirety of information concerning the subject matter, a patient may feel confused and at a loss, which, in turn, will lead to a failure in creating a detailed and accurate plan. To avoid the described problem, a nurse must use the language that will be intuitively understandable to a patient of any level of health literacy (Selwood et al., 2017). Specifically, the case of Dorothy has shown that she was largely unaware of a range of scenarios in which she could find herself in a certain situation of a health crisis. Moreover, some of the scenarios that her nurse guided her through did not cross her mind at all.
Dorothy’s case indicates that, had she been provided with unfiltered medical terminology when being given a chance to develop her advanced care plan, she would not have been able to approach the planning process at all. Most likely, she would have scrapped the entire idea and left, which would have had detrimental outcomes on her health prospects (Prater et al., 2019). Therefore, devising a communication strategy that will allow delineating key issues in a clear and accurate way is central to managing the needs of patients in the palliative care context.
Finally, addressing the issue of fear as a tremendous hindrance to providing patients with proper care and assisting them in developing a personalised advanced care plan will require placing the emphasis on the issue of patient education. Reaching out to communities and especially those members of it that lack access to care will allow increasing the levels of health literacy and the awareness of key health management options, including the development of an advanced care plan (Kelly, 2019). Namely, nurses must be trained to talk to target audiences about the issue, opening a discussion and inviting those willing to participate (Brighton & Bristowe, 2016). As a result, people with health issues that imply the need for advanced care planning will be able to obtain the vital data and guidance to make appropriate decisions and compile a personalised advanced care plan.
However, the issue of time management appears to be one of the foundational concerns when it comes to creating an advanced care plan. Due to the rapid increase in the extent of nurse shortage in the U.S. healthcare setting, the opportunity for a person willing to learn about advanced care planning options shrinks immensely (Waller et al., 2019). Moreover, with the increase in workload, which nurses will experience once they have to guide each patient individually through the process of advanced care planning, the quality of nursing services will inevitably drop (Westphal et al., 2016). Therefore, new opportunities for improving the efficacy, speed, ad quality of communication between a nurse and a patient, along with the overall process of patient education, is needed.
The introduction of innovative technology for keeping the contact with patients consistent appears to be the most effective method. However, the case under analysis indicates that a large number of patients may not possess the required level of technological prowess and proficiency to utilise the available digital tools. Therefore, the focus on active patient education should be regarded as an indispensable necessity. Namely, nurse educators will have to encourage patients to develop the much needed health literacy along with the basic skills of interacting with nurses using digital technology (Hutson & Hankins, 2019). Thus, progress can be achieved in advancing the quality of care and providing patients with an opportunity to develop advanced care plans individually, with crucial details being taken into account.
In this context, nurses will require not only extensive communication skills, but also teaching competencies. Namely, nurses will have to develop the frameworks for patients to familiarise themselves with advanced care planning options, as well as the opportunity to list all possible options so that undesirable outcomes could be avoided. As the case of Dorothy has shown, it is critical to take every possibility of health issues development into consideration to avoid unnecessary interventions and reduce the threat of the healthcare personnel misreading the patient’s advanced care plan (Costello, 2017). Therefore, ensuring that patients are aware of the existing ways in which their health issues can be handled is critical. For this reason, the focus on a personalised approach should be the priority. In addition, including communication opportunities where possible should be seen as an absolute necessity (Harwood et al., 2020). Thus, patients will be able to gain the required health literacy and the needed information to create a detailed advanced care plan.
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Advanced care planning is a vital part of managing one’s health prospects, yet the lack of communication between a patient and a nurse, as well as the loss of patient awareness, complicates the process. Therefore, additional measures must be taken to improve communication skills of nurses and encourage them to communicate more effectively. The problem of communication between a nurse and a patient and the opportunity for each individual to receive guidance in advanced care planning is linked directly to nurse shortage and the respective quality of care. Therefore, tools for patient education and their transition to the realm of the digital setting will be needed. Additionally, thorough and exhaustive guidelines for patients in need for support should be provided. Thus, patients will be aware of the key options for advanced care planning and the details that they can include into their plans when detailing their requirements and needs.
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