N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide (DPOA) for healthcare is similar to a living will; however, it takes effect any time unconsciousness or inability to make informed medical decisions is present. A family member or friend is stipulated in the DPOA to make medical decisionson behalf of the patient. While both living wills and DPOAs are legal in most states, there are some states that do not officially recognize these documents. However, they may still be used to guide families and doctors in treatment wishes. Do-not-resuscitate (DNR) orders can be incorporated into an advance directive or by informing hospital staff. Unless instructions for a DNR are in effect, hospital staff must make every effort to help patients whose hearts have stopped or who have stopped breathing. DNR orders are recognized in all states and will be incorporated into a patient’s medical chart if requested. Patients who benefit from a DNR order are those whohave terminal or other debilitating illnesses. The nurse caring for a patient must be aware of any legal documents that may impact end of life decisions. 4.6 Hospice and Palliative Care End of life care may include hospice and or palliative care. Hospice care is based on the idea that death is inevitable and accepted. In hospice care, pain and other symptoms are managed and care is provided to the family unit as well as the patient. Hospice care is generally provided outside of the hospital environment and is typically provided very close to the end of life. In many cases, a terminal diagnosis and prognosis of less than six months to live is required to qualify for hospice care. With this type of care, life-prolonging treatments will be discontinued. Palliative care is more holistic than hospice care and may begin much earlier in the dying process. The emphasis in palliative care is on the social, psychological, and spiritual issues, in addition to pain and other physical symptoms that are managed in hospice care. Palliative care will also typically include emphasis on the patient in the context of the family, including advance care planning. While hospice and palliative care may be desired by the patient and their family, there are several barriers to its use in the United States. Medicine has a traditional focus on cure and prolonging life. In addition, insurance companies may not pay for hospice or palliative care. There is also a need for training more health professionals in these areas. 4.7 Post-Mortem Care The care of the body after death is guided by state regulation, facility policy, and the family’s culture and religion. The nurse must understand all laws and policies governing post-mortem care and be aware of any rituals required by the family. In all cases, the nurse must handle the body with care, dignity, and sensitivity. A decision that must often be made before the actual death of an individual is whether or not organs and tissues will be donated. If the patient has signed a donor card or otherwise made it known to the family that they desire to be a donor, the nurse may be required to talk to the family to explain what will be done. Rules for organ donation vary by state; the nurse should be aware of any laws or regulations governing organ donation. In many large cities, organ donation teams may be available to assist with preparation of the patient and family for the process of organ donation. A durable power of attorney

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