Withdrawal of Care - Case Study Example

? A Case Study on Withdrawal of Care of A Case Study on Withdrawal of Care Introduction Recent studies have revealed that more than 20% of global deaths occur in Intensive Care Unit. Among these deaths, more than 65% of them happen as a result of the withdrawal of life-sustaining treatments. The plan to withdraw life support treatment is one of the most intricate decisions that require exhaustive consultation as well as high proficiency level among Clinical Nurse Specialists. The discussion should include the most efficient means of withdrawing the life support services; the needs and significance of withdrawing the life-sustaining treatment are to be realized by those who work in the field. The withdrawal of life-sustaining treatment legal and ethical aspects should as well be put into perspective before embarking on the withdrawal of care process (Gordon, 2008). Nurses have an incredibly decisive role in initiating the plan of withdrawing life support health treatment. In most cases nurses are in charge of taking care of hospitalized patients. Additionally, nurses are as well squarely responsible for executing the withdrawal of life-sustaining treatment plan. In most cases, nurses are blamed for lack of sufficient knowledge and resources to put into practice the withdrawal of life-sustaining plan (Kirchhoff et al., 2010). Different Intensive Care Units have dissimilar and unique ways of managing and controlling deaths. As a result this has complicated the nurses’ practice of managing and implementing the life-sustaining treatment withdrawal initiatives. The case under study concerns a 50 years old drunkard and a smoker male patient. The patient was found in stairwell in his ophthalmologist office and was brought to the emergence department by life squad. On arriving at the emergence department, the patient was diagnosed with severe blood pressure and pulse problem. The X-ray result also discovered that, the patient had symptoms of opacified right hemothorax with mediastinal. CAT scan also confirmed that, the patient had a big multiloculated right pleural effusion that was rectified by fixing a chest tube in his right side interiorly. The ailing man also underwent a normal CAT head scan. By referring to his medical history provided by his sister and sister in law, the patient was at one time diagnosed with epilepsy. The patient had as well undergone brain surgery two years ago to access the possibility of brain tumor. In the recent days, the patient was reported to have be fatigued and having consistent out spells. Additionally, two month prior to the presentation of the case, the patient was also diagnosed with pneumonia. Since pneumonia treatment, the patient has been experiencing choric cough, was very weak and tired. Moreover, the ailing man had over years experienced elevated white blood counts. To address the problem, the patient underwent bone marrow biopsy After the initial physical examination, the patient was admitted in the hospital as a chronically and pale ill white male. The assessment on his neck did not reveal signs of a jugular venous distension. There were signs of diminished breath sounds as well as evidence of bilateral course rhonchi. The heart beat was at a rate of 60-65 bpm. After detailed examination, there were no signs of clubbing, cyanosis, or edema. The patient was as well releasing small amount of urine and the feet were cool. However, after exhaustive assessment, the 50 years old man was revealed to have chronic pneumonia that incorporated massive emphysema. His condition was also complicated by respiratory failure, septic shocks, sepsis, renal complications, respiratory acidosis and leukemia, as well as mixed metabolic problem. There were also indications of poly-microbial complications due to the presence of smelling pus. Owing to his severe and painful heath complications, health practitioners concluded that, his chances of survival were about 25%. As a result, after thorough consultation between health practitioners, and family members, they all agreed to withdrawal life-sustaining treatment. The resolution to select this case was influenced by several factors. Prior to the decision to withdraw life-support treatment, all stakeholders were squarely involved as provided for by the existing ethical and legal requirements. Secondly, withdrawal of life-sustaining treatment in this case was suitable and to some extent inevitable. This is due to the fact that, the patient’s health condition was at its extreme stage and chances of recovery were far much below average. Thirdly, the fact that the patient under study was an ophthalmologist has as well motivation the decision to deal with this case. Case Presentation Critical Aspects Presented The case under study has presented exceptionally critical aspects of the significance of human health as well as the competency of Clinical Nurse Specialists. After the presentation of the ailing man into the emergence department, Clinical Nurse Specialist conducted a thorough assessment to examine the likely health problem. Heath practitioners also offered the required first aid assistance that demonstrated their high level of proficiency. , the skills and competency in offering the end-of-life care is especially a challenging and vital constituent of a qualified Clinical Nurse Specialist. Therefore, there is dire need for Clinical Nurse Specialist to recognize the prevailing clinical practice guidelines. Additionally, the study has as well raised an incredibly serious issue of the significance of quality treatment intervention. Initially, the 50 years ailing men underwent a lot of preventable treatment that could be avoided if appropriate examination was done. Teamwork between Clinical Nurse Specialists and family members therefore played an extremely critical role in identifying the main health complication in the ailing man. The cases also presented the need and imperative of an intensive consultation before coming up with a decision to withdraw life-sustaining treatment. In this case, Clinical Nurses Specialists held an in depth consultation before deciding collectively on the need to withdraw health care to the ailing man. Identification of Unknown Reasonable consultation between health practitioners and family members as well as comprehensive health examination helped significantly in identification of the unknown issues that surrounded the 50 years old man’s health. To start with, by interviewing the patient’s sister and sister in law, Clinical Nurse Specialists were in a position to note that, the patient was a consistent smoker and a regular drunkard. Secondly, through consultation, health experts also revealed the fact that, the patient under study has over year’s undergone continuous treatment on various health complications. Thirdly, through systematic examination, Clinical Nurse Specialists also revealed several disorders in the patient’s health that diminished his survival chances. , health assessment also failed to identify probable signs and symptoms of cardiogenic shock. Clinical Question Reflect APN Perspectives Sufficient knowledge among Advanced Practice Nurses as well as the application of the prevailing policies and procedure that govern the withdrawal of life-sustaining treatment was clearly reflected in the case under study. Appropriate execution of the learnt skills therefore reinforced Advanced Practice Nurses role in the incorporation ethical issues into critical care environment. To necessitate valuable performance, all Clinical Nurses Specialists are trained on the most effective ways of utilizing their knowledge and skills since their main roles are directly linked to patient’s life. As reflected in the cases under study, healing can be effectively achieved through developing a valuable life prevention plan as well as creating meaning to the frustrations and despair brought about severe illness. Advanced Practiced Nurses are as well expected to establish practical means of facilitating continuity of effective and valuable quality care. In the cases under study, Clinical Nurse Specialist ensured quality patient’s care by undertaking all the required examination to assess the unidentified health complication as well the most successful and helpful action to minimize the severe suffering and pain. Spheres of Influence Clinical Nurse Specialists intervenes on patients’ health problem through three main spheres of influences, systems, nurse-nurse, and patent-family. In the cases under study, the patient-family sphere of influence played an incredibly critical role in synthesizing and in making of decision on the most useful means of withdrawing health support to the patient. This was achieved through effective collaboration between family members, medical practitioners, and nursing staffs in the development of an effective means of withdrawing life support. Secondly, nurse-nurse sphere of influence was revealed through effective collaboration of all health practitioners in trying to identifying the patient’s health problem. Thirdly, the system sphere of influence provided qualified health experts as well as resources and equipments that were relevant in the examination of patient’s health complications. Review of Literature and Evidence Synthesis of Evidence Provided Relevant to the Case Evidence synthesis entails the full process of coming up with practical healthcare treatment plan that is based on evidence (Curley, 2008). The most effective synthesis of evidence model relevant in this case is qualitative evidence synthesis. The qualitative evidence synthesis of evidence helped in the establishment of effective evidence based synthesis program on the patient’s health complication. Qualitative synthesis of evidence also helped in the development of necessary health intervention policy based on the available evidence. Qualitative Synthesis of evidence as well played an exceedingly valuable role in the execution of helpful services aimed at improving patient health (Pawson, 2006). In coming up with the most effective evidence synthesis, Clinical Nurse Specialists appreciated the value of evidence synthesis in the patient health. Discussion Application of the Evidence to the Cases Clinical Nurse Specialists relied directly on the available evidence in coming up with a long term solution to the 50 years old patients health predicament. In their examination process, Clinical Nurse Specialists interviewed the patient’s sisters and sister in law to understand the patient’s health problem. From the interview, Clinical Nurses Specialists learnt that, the patient has in the past undergone various treatments on various health complications in different health centers. Clinical Health Specialists undertook an intensive health examination to identify the patient’s main health problem. The examination was also aimed at looking for evidence necessary in the treatment of the ailing man. Therefore, the Clinical Nurse Specialists decision to withdraw life-sustaining treatment was purely based on the available and reliable evidence. The evidence revealed very limited chances of survival for the ailing 50 years man. Knowledge Gained The study has offered an incredibly valuable platform for advancing new health practitioners competency. For a starter, the study is especially vital in necessitating the understanding of the needs for the utilization of the available evidence before coming up with a treatment intervention plan. Secondly, the study has offered an insight on the significance of interaction and collaboration among all players in the entire treatment process. Thirdly, adherence to the existing ethical and legal requirements prior to the withdrawal life-sustaining treatment to a severely ailing patient is significant and inevitable. , undertaking exhaustive and sufficient examination on patient’s health problem has also proved to be very essential and worth in the entire treatment plan. How the APN/CNS Perspective Can Offer a Unique Contribution to the Care of this Patient-core Competency Initially, Clinical Nurse Specialist or Advanced Practice Nurses roles were to provide an expertise research, education and consultation as well as treatment services in hospital settings. However, with contemporary growth, Clinical Nurse Specialist or Advanced Practice Nurses has a supplementary responsibility of utilizing the three spheres of influence that is; patient-family, nurse-nurse, and system to come up with the most effective healing plan. Therefore, to effectively advance the patient-core competency of the patient under study, Clinical Nurse Specialist or Advanced Practice Nurses can utilize the APN/CNS perspective of collaboration to create a workable intervention plan appropriate to the intricacy of the patient’s problem and system resources. Clinical Nurse Specialists should therefore work closely with other healthcare team to fulfill the patients, health providers, and family members needs (Kirchhoff et al., 2008). Clinical Nurse Specialists should as well create an environment that will facilitate clinical enquiry to advance the patient’s clinical service outcome. Moreover, as a facilitator, Clinical Nurse Specialists should as well develop an education program aimed at improving patient’s health. Application of the Spheres of Influence and the Synergy Model In the cases under study, Clinical Nurse Specialists intensively utilized the three spheres of influence. First, Clinical Nurse Specialists and other health experts worked collaboratively in the identification of the probable health complication. Secondly, clinical nurse used hospital equipments in examining the 50 years old health condition. Finally, decision to withdraw life-sustaining treatment was as a result of thorough consultation between family members and health practitioners. Synergy model is used to examine and explicate the nurse-patient and family relationship (Barnett-Page & Thomas, 2009). The model also helps in the analyses of the role of Advanced Practice Nurses in the entire treatment intervention. In the cases under study, the synergy model was adequately employed in examining the patient health history. Clinical Nurse Specialist also consulted with family members before making their decision to withdrawal life-sustaining treatment to the patient under study. Recommendation In the light of the above analyses, it is clear that, the issue of withdrawal of life-sustaining treatment is one of the most lawfully and ethically challenging decision. Primarily, Clinical Nurse Specialist and other health practitioners’ core obligations is to improve patients’ health condition. Therefore, failure to follow the ethical and legal procedure in withdrawal life-sustaining treatment is likely to be unethical and unlawful. As a result, I would recommend to the Clinical Nurse Specialists to consider withdrawal of life-sustaining treatment to patients as a thing of the last resort after all the other intervention has failed. The study has proved to be incredibly relevant especially among new nurses as it offers a platform for accessing their learnt knowledge on withdrawal of health care to an ailing person. Effective application of synergy model has as well proved to be extremely essential in the health intervention plan as it offers an avenue where all players are involved in the planning and in the execution of a health plan. References Barnett-Page, E., & Thomas J. (2009). Methods for the synthesis of qualitative research: A critical review. BMC Mededical Research Methodology, 6 (9), 59. Curley, M. (2008). Patient-nurse synergy: Optimizing patients' outcomes. American Journal of Critical Care, 7(1), 64-72. Gordon, D. (2008). Principles and practice of withdrawing life-sustaining treatments. Harborview Medical Center. Division of Pulmonary and Critical Care Medicine, University of Washington, 3 (25), 435-451. Kirchhoff, K., T., Palzkill, J., P., Kowalkowsi J., Mork, A., & Gretarsdotir, E. (2008). Preparing families of intensive care patients for withdrawal of life support: A pilot study. American Association of Critical-Care Nurses, 3 (17), 113-121. Kirchhoff, K., T., & Kowalkowsi J. (2010). Current practices for withdrawal of life support in intensive care unit. American Journal of Critical Care 19 (6), 532-541. Pawson, R. (2006). Evidence-Based Policy: A Realist Perspective. London: Sage. Read More