APNs have reported feeling greatly distressed when it comes to having to make end-of-life decisions because of a lack of support in this area. In conclusion, more effort needs to be put into making the lines less blurry for APNs so that they can make end-of-life decisions with more confidence and support.
eferences:

Ahrens, T., & Kolleff, M. (2003). Improving family communications at the end of life:

implications for length of stay in the intensive care unit and resource use. Am J. Crit

Care,12(4): 317-324.

Beckstrand, .L., & Kirchhoff, K.T. (2005). Providing end-of-life care to patients: critical care nurses' perceived obstacles and supportive behaviors. Am J. Crit Care,14: 395-403.

Daly, B.J. (2006a). End-of life decision making, organ donation, and critical care nurses. Crit Care Nurse,26(2): 78-86.

Daly, B.J. (2006b). The ethics of end of life care. Pgs. 16-17. The Frances Payne Bolton School

of Nursing. Case Western eserve University. Accessed on February 13, 2011:

http://fpb.cwru.edu/alumni/magazines/Spring06/Ethics.pdf

Hansen, L., Goodell, T.T.,….

End-of-life care provided by nurses in palliative settings necessitates conscious awareness of several factors that contribute to the effectiveness of care. Factors that are significantly important components of nursing in end-of-life care include communication skills, advance care planning, sensitivity to contextual and cultural factors, support from the healthcare team, and continuing education.
Communication skills

The importance of communication skills in end-of-life care was acknowledged by Clayton et al. (2007), who developed a set of communication guidelines that nurses could adhere to in the deliverance of end-of-life care. These guidelines were represented by the acronym PEPAED, and they included: to prepare for discussion, relate to patients and their families, elicit preferences held by patients and families, present information, acknowledgement of emotions and concerns, realistic hope, encourage questions, and documentation of information and documents (Clayton et al., 2007). Specific factors regarding the details of information communicated to patients are important in discussions in end-of-life….

End-of-Life Health Care
Imagine this scenario: a patient has end stage heart failure, coronary artery disease, peripheral artery disease, chronic obstructive pulmonary disease and sleep apnea. She has refused any invasive treatments for many years, ignoring potential consequences, and has opted for medical management. She has an advance directive stating her preference for no cardiopulmonary resuscitation, no artificial hydration or nutrition, and only desires comfort measures to allow for a pain-free and natural death. This patient has developed shortness of breath, leg edema, and chest pain, and is rushed to the emergency room. Upon admission, she is diagnosed with pulmonary edema and renal failure. Medications are administered to treat pulmonary edema, but she is not responding to the medications and starts to decompensate. The patient mentions that she does not want to have dialysis or a respirator. Her family is informed of the critical status of the patient and that….

Grief is not something that goes away on its own. If grief is not dealt with properly it can result in psychological problems for the sufferer as well as for the patient. A "positive coping style may be characterized by a spirit of inner strength. A negative coping style may be identified by helplessness or hopelessness, which may lead to more negative outcomes in dealing with life circumstances" (Guido 2010: 138). Grief that is not appropriately channeled can assert itself in unexpected ways: a husband may take out his anger at the loss of his mother on his wife, for example. Positive grief resolution can help the survivors have a more realistic and resilient outlook when confronted with future life events. Ideally, they can learn to honor the person who has passed without being overly regretful about what they cannot change. Grief that is dealt with in an unproductive fashion….

End-of-Life Case StudyAbstractThe ethical issues that arise in decision-making process to end-of-life care will be addressed. Patients autonomy and preferences about treatment and end-of-life care should be respected by all parties which are inclusive of, but are not limited to; health professionals and family members. A patient may be incapacitated and may, thus, be unable to make decisions. In such a case, the values and preferences of the patient should be respected through an advanced directive. The said document comprises of the treatment preferences of the patient and an attorney who is allowed to make decisions when the patient is not able to do so. The case study below will come in handy in efforts to discuss the end-of-life care for a patient, who should make decisions in a case when there is no advance directive.In North America, the adoption rate of advanced directives in low. When the rate is….

Life Dilemmas in Nursing
End of life

End of Life Dilemmas in Nursing: Issues with Euthanasia and How to Approach Them

A friend of mine had the unfortunate experience of having to make a decision about withdrawing health care from his terminally ill wife. Even without revealing too much detail about the case the description of this incident is rather disturbing. His wife had been treated for breast cancer, but several months later it was found that the cancer had spread to her lungs and brain. Upon returning from treatment one evening she began to experience hallucinations and became very confused. He took her to a local E, where she was combative, confused, and delirious. He was immediately asked by the E physician if he wanted her put on life support as her condition was terminal, and he asked that she be put on life support until he could discuss his options….

ethical hospice care is that it must be founded upon honesty. "Frank discussions about death and dying, clarifying knowledge of the underlying illness and knowledge of the dying process" is essential (Guido 2010: 35). However, this must be balanced with the patient's desire for confidentiality and his right to die in a way which honors his wishes. In this instance, a private and confidential discussion with Mr. West is essential. The nurse should explain why candor is preferable when dealing with his wife. By communicating the message that it will be less upsetting if Mrs. West is kept aware of his medical condition, Mr. West will be more willing to allow his wife to understand the likely trajectory of his condition. Then, the nurse should have a meeting with the couple and discuss what will occur. However, the hospice principles of honesty vs. autonomy would be in conflict if….

Life Cae
End-of-life cae may be one of the most difficult aspects of healthcae sevices. Afte all, the goal of most healthcae povides is to heal, and poviding end-of-life equies a shift in pespective. One of the challenges in planning end-of-life cae is that many healthcae povides ae simply not comfotable discussing end-of-life (Deteing et al. 2014). Fotunately, when povides take tageted classes with the goal of impoving thei ability to engage in end-of-life discussions, they self-epot feeling moe comfotable having these convesations (Deteing et al. 2014). As a esult, pio to eve woking with a patient to help plan end of life cae, any pofessional should make sue and take the classes necessay to help them with those decisions, including classes that ae specific to acial, cultual, o social issues that might be linked to a specific goup. This is impotant because diffeent cultues appoach death and dying in….

END OF LIFE End of LifeJane is a 57-year old African-American women who was diagnosed with stage 4 cervical cancer 2 months ago. At this advanced stage, the disease is largely considered terminal. This is more so the case given that following review, doctors indicated that the said disease could not be cured and, thus, there was no need to put the patient on any aggressive or advanced treatment with the end goal being to cure the disease. Towards this end, a decision was made to put Jane on treatment to control her symptoms. More specifically, it was recommended that Jane undergoes radiation therapy with the specific aim of not only controlling her symptoms, but also stopping bleeding and easing pain. Janes family has been very supportive so far. She is married to Jordan, a 64-year-old veteran. Together, they have 3 children who are all adults and married.Over the last….

Ethics and the End of Life
Sometimes, when a human life is coming to an end, the most crucial aspect of providing holistic ethical health care is not maintaining life, but maintaining a semblance of familiarity and routine for the individual in question, and creating an equitable solution that satisfies the broad range of beliefs present amongst the members of all of the dying individual's loved ones. The recent case of Terri Shaivo, one must remember, came to the forefront of the national consciousness not because Terri Shaivo was unique in having her feeding tube removed -- as her husband Michael Shaivo reminded the media and the courts quite frequently, such a medical event transpires every day in hospices and hospitals where critically ill patients are being treated. hat was so unusual about the Shaivo case was the level of disagreement amongst the woman's loved ones, about what the woman would….

C.G.
The history of C.G. is that he is a former smoker, 69-year-old male with cancer in the head and neck (a radical neck dissection was performed in 2012), which has recently metastasized in the liver and lungs, as indicated by PET scan which shows metabolic activity. The patient suffers from moderately-severe depression with a PHQ-9 score of 15 (Kroenke, Spitzer, Williams, 2001) and refuses anymore chemotherapy. He is at a point now where he wants to know his options for what remains of the rest of his life, indicating that he is not willing to undergo any further treatment for the his cancer or its spread.

The results of the physical show that C.G. suffers from hypertension, hyperlipidemia, stomatitis, anemia, and neutropenia. He is currently receiving 12.5 mg of Carvedilol daily plus 40 mg of Furosemide daily. His BP indicates that he has "isolated systolic hypertension" and it is likely that….

Charles A Corr's model highlights individual empowerment and guidelines for caregivers. Debbie Messer Zlatin's theory makes use of what she terms life themes in the dying process (Kubler-oss and other Approaches, n.d.).
8. The hospice approach to terminal care

The hospice approach minimizes the patients suffering and provides a compassionate environment for those in the terminal stages. It promotes comfort and quality of life without use of life extending measures. It centers on close, collaborative working associations between health care team members and family (Hospice Approach to End of Life Dementia Care, 2009).

9. Establishment of Hospice programs in the U.S.

The modern American hospice movement was started in 1974 with the founding of the Connecticut Hospice in New Haven. It was based on the replica of care best identified with Dame Cicely Saunders, MD. This center became the representation for complete whole person and family care at the end of life (Hospice….

Cultural Issues in End of Life Care
In this age of increased social diversity the cultural aspects of end-of-life care have become increasingly important in the nursing profession. This importance is however complicated by technology and the cultural problematics of extended life care through artificial means. In the book Cultural Issues in End-of-Life Decision Making (raun, K, Pietsch, J.H. lanchette, P. 1999) the crucial point is made that "providing cultural and spiritually sensitive care requires that nurses, physicians, social workers and others know and understand the implications of family members' beliefs about life and death, supportive rituals and other activities." (Review: cultural Issues in End-of-Life Decision Making, 2004)

This book underlines the fact that cultural issues in end-of-life care have essential implications for nursing -- especially in that professional nurses should have knowledge or be cognizant of the wider cultural and social context or milieu in which they work. This also implies….

Controversial Cases of End-of-Life Decisions
For this discussion, we consider one the most controversial euthanasia case in the history of America - the case of Terri Schiavo who never regained consciousness after collapsing at her home on February 25, 1990. She died 15 years later at a hospital but her death and the preceding legal battle that the Americans witnessed regarding the removal of her feeding tube created a firestorm of debate around the country about the status of end-of-life decisions (Johnstone, 2011).

There were people, politicians, artists, activists and the medical fraternity who were clearly divided in their opinion about the right to death and right to euthanasia. The debate clearly indicated the deep divide in the America society related to euthanasia and end-of-life care.

The proponents of euthanasia argued that it was needed by terminally ill patients and support their claims by 'the compassion argument'. They claimed that every human being….

nursing research findings into clinical practice.
Nociceptive Pain at the end of life

Conduct a Medline/PubMed & CINAHL search to identify 2 (two) PRIMARY OURCE research articles that were published within the last 5 years that are not cited in the text Oxford Textbook of Palliative Nursing by Ferrell & Coyles chapter 6.

McMillan and mall (2007) conducted research in order to test whether the COPE intervention would help caregivers better manage symptoms and pain that is experienced by patients with incurable cancer. ince the caregiver acts as mediator between the critically ill patient and the hospital staff, the hospital staff, usually, relies on the caregiver for description of the patient's pain and symptoms. Caregivers, however, are frequently unable to adequately describe and recognize the intensity of symptoms as well as the emotional quality of life (QOL) of patient (all of which contributes to the pain). The researchers wondered whether the COPE….