Challenges of Advance Planning in Care-Giving - Assignment Example

Advance Planning in Care-Giving Every adult has the right and the potential to have an advanced health care plan or directive. These may include things such as living will or health care power of attorney; these enable him to make preparations for his health care preferences clearly and legally binding[Bum06]. This is important because during the final stage of many terminal diseases, care priorities tend to change and take a new direction, from curative measures to palliative care which focuses on the relief of pain, symptoms and psychological attention. Anticipating these demands is very important to almost all individuals who would like to have easy journey and eventually “good death”[Lav10]. However, these anticipations and advance planning faces a lot of challenges. Part 1: Challenges of Advanced Planning One of the most basic challenges in advanced planning is the misconception that it requires a complex legal documentation process. These make patients reluctant in engaging in the process. In such a situation, a patient may require some time to go and rethink the issue over and prepare for a discussion over the matter. It is necessary at this point to demonstrate the benefits of the plan to their lives and to family members[Lav10]. Initiating this program only requires patients to be thoughtful and engage the family in their discussions. Lack of awareness, State laws support advance directives in care giving for all individuals. Nevertheless, there is still no clear process and procedures to allow individual wishes to be known and be fulfilled at the appropriate time. Support studies sponsored by various organizations such as Robert Johnson Foundation in America reported that almost 75% of terminally ill patients do not like cardiopulmonary resuscitation but less than 50% of their care givers know about this. Even if the patient had documented his preference, less than 42% of the cases are discussed by the actual care giver[Bum06]. These bring lack of awareness as a strong challenge to the process of advanced planning. Denial is also a key problem in advance care planning. The society’s denial of death and dying puts patients in a situation where they cannot make decisions for themselves. These make them unable to heed waning of life just as we acknowledge the waning of birth. Denial about death makes people not to review life. Live in fear and uncertainty when these happens, the patient is unable to make clear directives of his health care preference. Confusion this is also a big challenge that affects advance plans in health care giving. Despite a strong desire for quality life and “good death”, many people worry about conflicting feelings within them. These conflicts arise from palliative care and doing whatever it takes to extent patient’s life. Research carried out by Regence Foundation shows that almost 50% of the respondent ascertained that emphasizing on palliative and end of life care options can interfere with the processes put in place to extent the patient’s life as long as possible[Bum06]. This creates a misunderstanding of what to take as the best alternative. Majority of patients, who benefit from Medicare of all racial and ethnic groups, argue that in the event of a terminal illness with less than months to live, they would rather stay at home and die. They would not like to use life prolonging drugs that have uncomfortable side effects to prolong their lives for a week or month hindering advance planning. However, various researchers like Amber Barnato, MD and colleges have discovered different distribution of end life preferences in different races ethnic groups. For example a research done between the whites and the blacks shows that more blacks are likely to die in the hospital compared to white. Blacks also spend a lot of time in intensive care units and life sustaining treatments such as mechanical ventilation and feeding through tubes. They also incur a lot of medical expenses in their last 12 months of survival compared to the whites. Some of these differences are also due to the distribution of higher end-of –life treatment costs; marginalization may also be a factor making access to such services difficult. These challenges of advance planning can be addressed in a variety of ways. The health care giver should put into consideration the fact that people vary greatly in what they want at the end of their life. Some patients would like to have intensive medical care up to the end of their time. Others are willing to endure side effects of medication and hospitalization in the hope of gaining extra time in their lives. While others prefer to focus on the quality of their lives however short it may be. Some choose to concentrate on closure of their conditions or even comfort care in a familiar environment. These should be highly regarded to avoid ignorance and lack of personal touch between the patient and the care giver. To address denial, patients who need advanced health care plan such the elderly and terminally ill people, should be respected and told the truth. The patient and his family should be given emotional support. The feelings and the fears are supposed to be discussed openly and not denied these can help greatly in planning the appropriate care that is best for the victim. End of life career need to be planned though it’s not practically possible to make funeral arrangement it should be anticipated and not over looked. Legal and financial issues should be addressed before the death in case of terminal illness. These enable denial to be at its minimum level and pave way for reality and sober decision making. Default surrogate should also be put in place. Many states around the world are adopting policies in which decisions can be made in the absence of any kind of advance plan or directive. Although these default surrogates vary greatly among states and countries. The laws contained in them provide a wide range of default surrogates in which a family can choose from. Usually they consider the consent of spouse then next of kin in the provided priorities. Many states also allow close family friends to make important health care decisions for a patient who is unable to do so. These helps address almost all challenges of advance planning since the patient is not involved in the decision making process, though these dines them the right of expressing their own preferences. Part 2: Challenges of bereavement and mourning for a deceased patient’s family. Bereavement causes grief and mourning which are natural responses to a loss in relation to palliative care and hospice[Bum06]. This process usually begins with the delivery of bad news. However these may be anticipated as result of palliative care or hospice, the family should prepare for a tragic loss and put in place bereavement plans which are characterized by various challenges. Studies have proven that intervention with palliative or hospice is not only vital for the patients prolonged life and desirable death but also for care givers and loved ones in identifying symptoms of grief and provide bereavement support. Dealing with death and bereavement is often challenging to many families who are attempting to come into terms with the loss of a loved one. In most cases even the supports from people who are in their social circle do not have much help. For example a person with learning disabilities suffers double or long periods of mourning. Such people in most cases are protected from the true impact of death, a caring care giver dose this to minimize their distress. This means that they do not have opportunities to grieve openly or consciously. These causes them much more distress when finally they learn about the loss that they had suffered at a later time. There is also over protectiveness which in many cases leads to disempowerment. This because some individuals find it difficult or not encouraged to say good bye to their loved ones; they may not attend the burial and sometimes not told about the death until a considerable amount of time has passed. Such approaches and attitudes may not help individuals to accommodate their grief. Some care givers may also have limited experience or knowledge when it comes to bereavement cases[Bum06]. This may be as a result of inadequate training and may not be aware of the available resources to help the bereaved. They may also have some in borne fear of the individual’s reaction and response during death and bereavement. These challenges can be addressed from many directions; care givers have an important role to play in offering support to bereaved individuals. They should start by finding out what the individual already knows about bereavement, his needs and identify how such needs can be met. The care givers should employ active listening skills to the individuals in order to identify common responses to loss and anticipated difficulties in grieving. These will help in identification and formulation of a frame work that would help the individual in emotional recovery. Part 3: Challenges in having a “Good Death” “Good death” is mainly associated with comfort care which is a very essential part in medical care at the end of life. Good death is care that helps or soothes a person who is dying. The main objective is to prevent, relieve suffering as much as possible while observing the wishes of the dying person. Various challenges may be met in the attempt to deliver “good death”. For example a patient may be worried about who will take care of things when he is not around. In such a case he is not able to have spiritual or emotional comfort denying him “good death”. These can be solved by people close to him offering reassurance[Lav10]. These will be able to provide a certain measure of peace. The dying person is reminded that his personal interests are in good hands, these brings him comfort. Relatives and close friends may not be specific in what they want to offer. It helps a great deal to make specific requests and offers to the patient or family to avoid tasking them with decisions while they are already distressed. Making specific offers and requests helps the family to give maximum attention to the dying person, hence having a peaceful death. References Bum06: , (Bumagin & Hirn, 2006), Lav10: , (Laverty, Laverty, & Cindy, 2010), Read More