Applying Orlando's deliberative nursing process to end-of-life care

¶ … End-of-Life Care: Scholarly Nursing Practice Choice

I am an advanced practice registered nurse (APRN) board-certified to practice in adult care (ANP-BC). Currently, I am employed as a nurse practitioner (NP) in palliative care within a hospice setting. Accordingly, my scholarly nursing practice is focused on the care of individual patients in need of palliative care, many of whom are in need of end-of-life care.

The phenomenon of interest that I have chosen is end-of-life care. Compared to palliative care, end-of-life care is not provided for patients receiving curative treatments or undergoing a disease process that is life-altering (Petersen, Breakwell, & Callahan, 2014). End-of-life care encompasses the principles of palliative medicine, including a focus on the patient's and family's quality of life, optimal functioning, individual growth, and care planning; however, end-of-life care will also emphasize a patient's dignity during the dying process, comfort through effective pain management, and care of family members as they transition through the loss of a loved one.

Managing the care for a dying patient will often raise a number of difficult ethical issues, which patients and family members may be ill-equipped to handle (Petersen et al., 2014). Nursing professionals are ideally positioned in the care team to empower patients and family members to make difficult decisions, such whether to forego life-sustaining treatments. Providing guidance, however, requires a good understanding of the four moral principles of justice, respect, nonmaleficence, and beneficence. Navigating the sometimes complex ethical, moral, and medical decisions that patients and loved ones must face during end-of-life care will require caring and highly trained nursing professionals. These are the reasons why I have chosen to focus on end-of-life care for my scholarly nursing practice.

The nursing model I have chosen as the lens through which end-of-life care will be viewed is Deliberative Nursing Process theory developed by Ida J. Orlando in 1961 (Faust, 2002). This theory emerged from years observing nurse-patient interactions and how these interactions influenced patient outcomes. According to Orlando, nurses are responsible for determining the needs of patients and whether these needs are being met; therefore, nurses are autonomous professionals distinct from physicians. The needs of patients can be determined by directly interacting with the patient or through indirect means, although Orlando emphasized the use of direct observations, perceptions, and feelings triggered during a nurse-patient interaction.