Nokea
One of the functions of nursing care of the terminally ill is to support the patient and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support patients and their families during this process? Select all that apply.
- A. Describe their personal experiences in dealing with end-of-life issues.
- B. Encourage the patient and family to keep fighting as a cure may come.
- C. Try to appreciate and understand the illness from the patients perspective.
- D. Assist patients with performing a life review.
- E. Provide interventions that facilitate end-of-life closure.
Correct Answer: C,D,E
Rationale: Nurses are responsible for educating patients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist patients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the patients perspective. The nurses personal experiences should not normally be included and a cure is often not a realistic hope.
You may also like to solve these questions
A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patients care in this setting be based?
- A. Meaningful living during terminal illness requires technologic interventions.
- B. Meaningful living during terminal illness is best supported in designated facilities.
- C. Meaningful living during terminal illness is best supported in the home.
- D. Meaningful living during terminal illness is best achieved by prolonging physiologic dying.
Correct Answer: C
Rationale: The hospice movement in the United States is based on the belief that meaningful living is achievable during terminal illness and that it is best supported in the home, free from technologic interventions to prolong physiologic dying.
A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.
- A. Financial pressures on health care providers
- B. Patient reluctance to accept this type of care
- C. Strong association of hospice care with prolonging death
- D. Advances in curative treatment in late-stage illness
- E. Ease of making a terminal diagnosis
Correct Answer: A,B,D
Rationale: Physicians are reluctant to refer patients to hospice, and patients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those patients with noncancer diagnoses), the strong association of hospice with death, advances in curative treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible patients.
A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patients daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?
- A. Lack of an American education of the patient and her family
- B. A language barrier to hospice care for this patient
- C. A barrier to hospice care for this patient
- D. Inability to grasp American concepts of health care
Correct Answer: C
Rationale: Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. The scenario does not indicate whether the patients family has an American education, whether they are unable to grasp American concepts of health care, or whether they can speak or understand English.
Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?
- A. Unwillingness to overmedicate the dying patient
- B. Rules concerning completion of all cure-focused medical treatment
- C. Unwillingness of patients and families to acknowledge the patient is terminal
- D. Lack of knowledge of patients and families regarding availability of care
Correct Answer: B
Rationale: Because of Medicare rules concerning completion of all cure-focused medical treatment before the Medicare hospice benefit may be accessed, many patients delay enrollment in hospice programs until very close to the end of life. Hospice care does not include an unwillingness to medicate the patient to keep him or her from suffering. Patients must accept that they are terminal before being admitted to hospice care. Lack of knowledge is common; however, this is not why some Medicare patients do not receive adequate attention for the symptoms of their underlying illness.
The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patients strategy?
- A. The patient may be trying to protect loved ones from the emotional effects of the illness.
- B. The patient is being noncompliant in order to assert power over caregivers.
- C. The patient may be skeptical of the benefits of the Western biomedical model of health.
- D. The patient thinks that treatment does not provide him comfort.
Correct Answer: A
Rationale: Patients who are characterized as being in denial may be using this strategy to preserve important interpersonal relationships, to protect others from the emotional effects of their illness, and to protect themselves because of fears of abandonment. Each of the other listed options is plausible, but less likely.