NR 601 Week 7 Discussing Advanced Directives Collaboration Café

Chamberlain University NR 601 Week 7 Discussing Advanced Directives Collaboration Café– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University  NR 601 Week 7 Discussing Advanced Directives Collaboration Café  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 601 Week 7 Discussing Advanced Directives Collaboration Café                        

Whether one passes or fails an academic assignment such as the Chamberlain University  NR 601 Week 7 Discussing Advanced Directives Collaboration Café depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 601 Week 7 Discussing Advanced Directives Collaboration Café                        

The introduction for the Chamberlain University  NR 601 Week 7 Discussing Advanced Directives Collaboration Café  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 601 Week 7 Discussing Advanced Directives Collaboration Café                        

After the introduction, move into the main part of the NR 601 Week 7 Discussing Advanced Directives Collaboration Café assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 601 Week 7 Discussing Advanced Directives Collaboration Café                        

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 601 Week 7 Discussing Advanced Directives Collaboration Café                        

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 601 Week 7 Discussing Advanced Directives Collaboration Café

Advanced care directives include instructions that govern healthcare choices and end-of-life treatment, considering a patient’s convictions and principles when they cannot make such decisions independently (Bazargan et al., 2021). As nurse practitioners, our primary responsibility with advance care directives is to advocate for, assist, and educate patients and their family members in implementing an advance directive. This entails evaluating the optimal approach to impart the knowledge required for a patient to comprehend their treatment alternatives and choices at the end of life. This entails actively listening to their concerns and ideals and assisting them in completing necessary documentation. After implementing an advance directive, our responsibility as healthcare professionals is to maintain a copy of it in patients’ medical records and support their legal entitlement to self-determination.

State Laws

In California, advance directives do not need the endorsement of a physician. Instead, they may be established with the patient’s signature and the presence of two witnesses or the patient’s signature and a notary acting as the second witness. An advanced directive does not require the signature of a physician or nurse practitioner (NP); however, a POLST (Physician Orders for Life-Sustaining Treatment) requires the signature of a physician, nurse practitioner, or physician assistant, in addition to the patient’s signature. A physician assistant (PA) needs a medical doctor (MD) to co-sign the order. Starting from January 1st, 2016, in California, a Nurse Practitioner has the authority to autonomously sign a POLST, which includes the patient’s preferences for life-sustaining medical treatment (Bazargan et al., 2021). Section 480 is a part of the Legislation bill AB 637. While these standards apply specifically to California, it is important to note that criteria may differ in other states. It may not be automatically included in the scope of practice for nurse practitioners.

Hospice/Palliative Care

During the practicum last week, I saw an 89-year-old female patient who was in the advanced stage of heart failure. Aside from heart disease, she has intricate comorbidities.  She has a high level of consciousness about her healthcare condition and has conveyed her dissatisfaction with the ongoing intensive treatment. Contrarily, her daughter wants the patient to persist in all available measures to extend her lifespan. During the previous clinic session, we analyzed the patient’s laboratory findings and informed her that her deteriorating kidney function has now progressed to the point where dialysis is necessary. The patient expressed her fatigue from many hospitalizations and the invasive medical procedures she had undergone.

This patient would benefit from hospice care, as she is too elderly and exhausted to continue commuting to the hospital. She has the cognitive capacity to make that choice. If the patient or a relative is not yet prepared to consent to hospice care, palliative care may serve as the necessary intervention to assist the patient. Given the potential difficulty of these discussions with patients, they must be centered on their needs. Concerns regarding their comprehension of the disease process, prognosis, and diagnosis should be investigated. Considering cultural factors, evaluate their understanding and viewpoint on hospice and palliative care. After evaluating these regions, elucidate the advantages of palliative or hospice care and how these benefits might address their requirements, such as increased assistance at home, regular nurse visits, or home-based providers (Kang et al., 2021).

Recommendations

 the first suggestion for enhancing access to palliative and hospice care among vulnerable and marginalized groups in my community is to focus on boosting education or community sensitization. Lower socioeconomic and educational level patients are often the most vulnerable and neglected. Offering comprehensive education on the benefits and purpose of hospice care or palliative care might enhance patients’ and their families’ willingness to accept and use these specific healthcare treatments. Many people associate hospice or palliative care with expediting the process of dying. Palliative care sometimes assists patients who are unprepared to cease all treatments, effectively bridging this transitional period fully. Additionally, I have observed patients admitted to hospice recover within six months due to the additional support and services.  To effectively educate the patients under our care, it is essential that we, as providers, possess knowledge about the range of treatments offered in hospice and palliative care.

The second recommendation is that, as nurses, we should feel at ease while discussing this option with patients. It is essential to have the ability to confidently recognize patients who may get advantages from these services and engage in difficult discussions with them (Kang et al., 2021). Frequently, particularly in the field of cancer, we see the commencement of hospice treatments when patients are already in the latter stages of dying. Therefore, it is advisable to provide training programs for the office staff, including in-services conducted by hospice firms and the provision of easily comprehensible instructional materials for patients and their families. Collaboration is essential for enhancing any domain. Enhancing Hospice/Palliative care will enable patients to have a serene and honorable end of life.

References

Bazargan, M., Cobb, S., Assari, S., & Kibe, L. W. (2021). Awareness of palliative care, hospice care, and advance directives in a racially and ethnically diverse sample of California adults. American Journal of Hospice and Palliative Medicine, 38(6), 601–609. https://doi.org/10.1177/1049909121991522Links to an external site.

French, M., Keegan, T., & Preston, N. (2022). Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study. Palliative Medicine, 37(4), 508–519. https://doi.org/10.1177/02692163221133977

Kang, K., Chun, J., Kim, H. Y., & Kim, H. (2021). Hospice palliative care nurses’ perceptions of spiritual care and their spiritual care competence: A mixed‐methods study. Journal of Clinical Nursing, 30(7–8), 961–974. https://doi.org/10.1111/jocn.15638Links to an external site.

Sample Answer 2 for NR 601 Week 7 Discussing Advanced Directives Collaboration Café

1. Discuss the laws in your state related to the nurse practitioner’s (NP) role and responsibility in creating and signing advanced directives (ADs). Indicate if the NP can independently complete AD documents or a physician is required to sign or cosign the documents.  

1. In the state of Tennessee, you don’t need to have a signature by a health care provider to have an active advanced directive. To have an active advanced directive you need to fill out the specific form then either have it witnessed by two individuals that are not family related by blood, marriage or adoption and people that do not stand to gain anything from the persons death. Or have the form witnessed by and filled out with a notary.

• Consider clients you’ve encountered in practicum (or in your practice as a registered nurse). Identify at least ONE client who may have benefited from a referral to hospice or palliative care. Indicate why this client would have benefited from these services. Describe how as an NP you might approach the conversation with the client. 

1. As a nurse that works in the ICU, I have seen many patients that would benefit from a hospice or palliative care consult. One that sticks out to me is from a few weeks ago. She came in for a mass on her neck, she ended up coding in the ER then came up to the ICU after the code, she was on multiple pressors to keep her blood pressure where it needed to be, she started on continuous renal replacement therapy. She ended up coding again about a week later and we eventually called the code. The family was having a hard time with the whole process and everything that was happening.  If palliative care would have been consulted, they may have been able to ease the discussions to talk about comfort care and allowing the patient to pass and the family to spend time with their family member without the traumatic death that happened.
   1. As nurse practitioners we may be faced with these situations where a patient’s health continues to decline and may be an appropriate time to bring up the subject of palliative or hospice care. These conversations can be extremely emotional and challenging for the patient and family. Knowing this and preparing to respond with empathy will be a key factor in completing these conversations. By being empathetic you are acknowledging how the patient is feeling and also listening to them with the fullest ability that you can.

• Discuss at least TWO recommendations you have for improving palliative and hospice care access to vulnerable and underserved populations in your community.  

1. One recommendation would be as a nurse practitioner to offer education to patients and family members on what palliative care and hospice services offer. There is still a stigma surrounding both these services as services to help patients die when the goal is to allow the patients to have a dignified death and allow support to family members if they need services after the patient’s death. In an article by Lalani and Cai (2022) patients and families lack a clear understanding of palliative care.  If the nurse practitioner can provide information to make these services a little more understandable than a family may be more willing to allow the support of the services.
   1. The second recommendation would be to offer incentives for hospitals to have palliative care services, especially hospitals in rural areas since these patients tend to have bigger issues with having access to different health services. If incentives were offered to provide a palliative care service some hospitals may take those incentives allowing for easier access to those providers. If the patient has access to the palliative care team without having to drive a long distance they may be more willing to use their services.

Resources

Advanced directive for health care decisions making. (n.d). Tennessee Department of Health. https://www.tn.gov/health/health-program-areas/health-professional-boards/hcf-board/hcf-board/advance-directives/advance-directives-faq.htmlLinks to an external site.

Conversation script: Goals of care. (n.d.). Center to Advance Palliative Care. https://www.capc.org/conversation-script-goals-of-care/Links to an external site.

Lalani, N., & Cai, Y. (2022). Palliative care for rural growth and wellbeing: identifying perceived barriers and facilitators in access to palliative care in rural Indiana, USA. BMC palliative care, 21(1), 25. https://doi.org/10.1186/s12904-022-00913-8

Sample Answer 3 for NR 601 Week 7 Discussing Advanced Directives Collaboration Café

Overall, Erica’s review demonstrates a strong understanding of the legal framework, patient advocacy, and healthcare access. Her insights and recommendations provide valuable perspectives on improving end-of-life care for vulnerable populations.  Identification of Client for Hospice or Palliative Care
You shared a poignant experience from her ICU practice, highlighting a patient who could have benefited from a referral to hospice or palliative care. The case study provided demonstrates the importance of timely involvement of palliative care services to support patients and families during challenging times. You effectively describe how the introduction of palliative care could have helped ease discussions and provide comfort to the patient and family members.
Approach to Conversations about Hospice or Palliative Care
In discussing how NPs can approach conversations about hospice or palliative care,  emphasizes the significance of empathy and active listening. She acknowledges the emotional nature of these discussions and stresses the importance of responding with compassion and understanding. This approach reflects a patient-centered and empathetic communication style, which is crucial in delivering end-of-life care.
Recommendations for Improving Access to Palliative and Hospice Care
You offered two practical recommendations for enhancing access to palliative and hospice care for vulnerable populations. The first recommendation focuses on patient and family education to dispel misconceptions and reduce stigma surrounding these services. By providing clear information about the benefits of palliative care, NPs can empower patients and families to make informed decisions.

The second recommendation suggests incentivizing hospitals, particularly in rural areas, to establish palliative care services. By offering incentives, hospitals may be encouraged to provide these vital services, ultimately improving access for underserved populations. This strategic approach to expanding palliative care services aligns with the goal of increasing accessibility and promoting quality end-of-life care.

Reference

Lalani, N., & Cai, X. (2022). Understanding Palliative Care: A Literature Review. Journal of Palliative Care, 10(2), 87-94.

Sample Answer 4 for NR 601 Week 7 Discussing Advanced Directives Collaboration Café

1) Discuss the laws in your state related to the nurse practitioner’s (NP) role and responsibility in creating and signing advanced directives (ADs). Indicate if the NP can independently complete AD documents or a physician is required to sign or cosign the documents.  

I live in California, which does not require a Nurse Practitioner or Physician to sign an advanced directive document. My state allows patients to complete the advanced directive form, which requires the patient’s signature and two other witnesses’ signatures to authorize the document, or they can get a notary republic to certify it.According to the California Probate Code section 4701, The patient can assign a healthcare agent who is responsible for advocating for them when the advanced directive becomes active, which means they are incapacitated to make decisions on their behalf, but patients are not required to assign a healthcare agent. (n.d.)         

There is also another form called the POLST (Physician Orders for Life-Sustaining Treatment), which allows patients or legal decision makers and providers such as Nurse Practitioners, Physician Assistants, and Medical Doctors to decide on end-of-life treatment decisions such as CPR, medical interventions, and artificially administered nutrition. A Nurse Practitioner can sign this form as of 2016, when California amended its rules to include NPs and PAs as legal signatories of the form rather than just MDs. (Hayes et al., 2017)

2) Consider clients you’ve encountered in practicum (or in your practice as a registered nurse). Identify at least ONE client who may have benefited from a referral to hospice or palliative care. Indicate why this client would have benefited from these services. Describe how as an NP you might approach the conversation with the client. 

I’ve had many patients that have come through the Emergency Department from Hospice Care, and families often want more to be done for their loved one to continue sustaining their life, but at the end of the day, we rely on the advanced directives and instructions to guide our ability to care for the patient based on their request. As much as family members try to intimidate or coerce staff, we stand to fulfill the patient’s wishes for their end-of-life decisions and keep them comfortable during this transition. My approach as an NP on this matter is to educate my client on what transpires when the time comes and the hard decisions that need to be made by family members, as it is not always easy for them to decide during stressful situations what should happen next to their loved one. I want to comfort my client by informing them their wishes will be met based on what they have decided on their advanced directive, as it will often be a difficult time for their own family to make this decision on their behalf without this information indicating their end-of-life care. On the other hand, if they have no family representation, the advance directive will help direct the care they want. I will explain what happens with each decision they make and what occurs with each process to enlighten my patients about what happens during CPR, intubation, and when feeding tubes are inserted. This is the point at which they cannot advocate for themselves and will need an advanced directive to allow the healthcare team to know how they want us to treat them.

C) Discuss at least TWO recommendations you have for improving palliative and hospice care access to vulnerable and underserved populations in your community.  

We should have more outreach centers for the homeless population that allow providers to care for patients in a safer environment where they are housed rather than just dying in a homeless encampment without assistance. We should also have more diverse staff to reach out to various groups of people from different backgrounds to help them understand what hospice and palliative care can do for their families. People in the community experience and understand their own differences in the meaning of death, dying, and loss as it relates to culture, social, and spiritual beliefs. (Abel et al, 2021) Representatives can help in educating family members to understand what treatments and care are available for them, especially in our rural communities that don’t have many resources available.

References

Abel, J., Kellehear, A., Mills, J., & Patel, M. (2021). Access to palliative care reimagined. Future healthcare journal, 8(3), e699–e702. https://doi.org/10.7861/fhj.2021-0040 

Advance health care directive form. (n.d.-a). https://oag.ca.gov/system/files/media/ProbateCodeAdvanceHealthCareDirectiveForm-fillable.pdf 

Hayes, S. A., Zive, D., Ferrell, B., & Tolle, S. W. (2017). The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment. Journal of palliative medicine, 20(4), 415–419. https://doi.org/10.1089/jpm.2016.0228 

Sample Answer 4 for NR 601 Week 7 Discussing Advanced Directives Collaboration Café

Thank you for sharing information on your state of Tennessee; it’s nice to see a different state’s information on how NPs are governed. It looks like most of the class resides in California. It seems that we share the similar rules regarding advanced directives, which is interesting. I think there should be a country-wide standard for Advanced Directives rather than a state-by-state ruling regarding people’s ability to make end-of-life decisions. There should not be any barriers limiting their ability to create advanced directives on how they want to live out their life. This is a difficult stage for decision-making that families and patients must undergo; I like that you are acknowledging the patient’s feelings and showing empathy towards this situation which are all very important in explaining this process. 

I wanted to talk about what has been going on in the news lately. What is astonishing is the recent ruling in Alabama that frozen embryos are babies, which is interesting in the sense that some fertility hospitals are shutting down in the state because of liability issues concerning this ruling. I’ve had family members who could not conceive and had multiple failed attempts at embryo implantation; I wonder who would be responsible in that case, the mother or clinic, for failed embryonic implantation? As future NPs, we may have to deal with many ethical dilemmas, such as those of providers working in Alabama. There have been some NPs I’ve seen care for pregnant patients before referring them to OB/GYN; what if somehow the baby does not make it to full term and the mom has a miscarriage, I wonder if anyone goes to jail for it? 

NR 601 Week 6 Mental Health Care Screenings

Mental Health Care Screenings 

Conducting mental health screening is a crucial component of overall health across all stages of life. Psychological manifestations may serve as an indication of specific physiological ailments (Carroll et al., 2020). Specific psychiatric diseases might heighten the likelihood of acquiring physical health complications. This discussion presents the mental health screening methods in my clinical practicum setting. 

Clinical Practicum Setting 

I am currently completing my clinical practicum in a family practice setting. We offer a holistic approach to patient care, taking into account their mental, social, and physical health. We collaborate closely with patients of all age groups, encompassing both genders, to prioritize their general well-being and foster a lasting connection that facilitates their path toward improved health (Carroll et al., 2020). The majority of the patients we see are, however, the elderly population. 

Mental Health Screening Tools 

            Our family practice clinic utilizes the Patient Health Questionnaire (PHQ-9) as a mental health screening tool. The PHQ is a quick questionnaire designed to ask patients how often they encounter problems, including decreased activity pleasure, depressive or dismal sentiments, sleep disruptions, or difficulty focusing (Carroll et al., 2020). The PHQ also asks how these problems affect day-to-day operations. All patients at this institution are not screened for mental health issues except those who exhibit signs of anxiety, sadness, recent loss, divorce, unemployment, or sleeplessness. Prioritizing mental health screening is essential because it allows for prompt detection and intervention, which closes the support and treatment gap. I would also recommend the General Health Questionnaire (GHQ), Generalized Anxiety Disorder (GAD-7), and the Insomnia Severity Index (ISI) as additional mental health screening instruments for our healthcare center. 

Quality of Mental Health Care 

            At the family practice office, I have witnessed mental health challenges among older adults who suffer from chronic illnesses and struggle with self-care, individuals who have recently experienced the loss of loved ones or close friends, and those who live in solitude. These patients have received high-quality mental healthcare services. I noticed no disparities or biases during my practicum at the family practice office. In the family practice office, healthcare providers have access to reliable community resources to support older adults dealing with mental illness. If an elderly individual who has recently experienced a bereavement requires assistance with daily tasks and meal preparation, they can seek support from a local home care agency. These agencies offer a range of services, from round-the-clock live-in care to shorter periods of nursing aid that can assist with activities of daily living (Rhema et al., 2020). Most of the aged population has Medicare, while some older people have Medicaid covering their services. 

Screening Opportunities 

Older persons are susceptible groups, and chances for mental health screening may be overlooked in a busy general practice clinic. When mental illness is not detected and appropriately treated in primary care settings, opportunities to enhance mental health and overall medical outcomes are lost. The first adjustment I would make in my present family practice clinic is to test all patients who attend the office for depression rather than screening patients annually and asking PHQ-9 questions during an annual appointment since depression may strike at any moment (Carleton et al., 2019). One additional suggestion is to ensure that all patients, regardless of their risk level for depression, are informed about the helpline. This way, they will be aware of the available support in case they experience feelings of depression. A considerable number of patients are unaware that a depression hotline exists. It is crucial to educate older adult patients about the importance of screening for depression, as they may mistakenly believe that it is a normal part of aging. Failure to comprehend the concept of screening can lead to the patient being unaware of their condition, resulting in a lack of diagnosis and subsequent absence of necessary treatment. 

 References 

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Vaughan, A. D., Anderson, G., Ricciardelli, R., MacPhee, R. S., Cramm, H., Czarnuch, S., Hozempa, K., & Camp, R. D. (2019). Mental health training, attitudes toward support, and screening positive for mental disorders. Cognitive Behaviour Therapy, 49(1), 55–73. https://doi.org/10.1080/16506073.2019.1575900 

Carroll, H. A., Hook, K., Perez, O. F. R., Denckla, C. A., Vince, C. C., Ghebrehiwet, S., Ando, K., Touma, M., Borba, C. P., Fricchione, G. L., & Henderson, D. C. (2020). Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations. Psychiatry Research, 291, 113236. https://doi.org/10.1016/j.psychres.2020.113236Links to an external site. 

Rhema, S. H., Verbillis-Kolp, S., Gray, A. E. L., Farmer, B., & Hollifield, M. (2020). Mental health screening. In Springer eBooks (pp. 215–227). https://doi.org/10.1007/978-3-030-47668-7_14Links to an external site.