How would you approach a family conflict regarding end-of-life care decisions for a patient?

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When faced with the delicate situation of end-of-life care decisions, it's paramount for nurses to navigate family conflicts with sensitivity and professionalism. The role of a nurse extends beyond patient care; it often involves being a mediator, an educator, and a compassionate presence during these trying times. Understanding the ethical principles of autonomy, beneficence, non-maleficence, and justice is crucial. These principles guide decision-making to ensure that the patient's wishes and well-being are at the forefront, balanced against the family's concerns and the practicalities of care.

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1 Understand Needs

To begin addressing a family conflict over end-of-life care, you must first understand the needs and perspectives of all parties involved. This means actively listening to the patient's wishes, if they can communicate, and recognizing the family's emotions and concerns. It's essential to provide a supportive environment where each voice can be heard without judgment. The goal is to find common ground, acknowledging that each person's input is valuable in forming a care plan that respects the patient's autonomy and the family's role in their loved one's life.

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Jason Lesandrini, PhD, FACHE, LPEC, HEC-C
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These situations are ripe for ethics consultation. Well trained ethics consultants have the necessary knowledge and skills to elucidate the patient/family values, the clinical team’s values and map out a path forward. While most ethicist are employed by their organization, they can stand in a non-care provider role and assist all parties in coming to a resolution.

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RON ORDONA, DNP, FNP-BC, GS-C, WCC

US Navy Veteran, Certified Gerontological Specialist (GS-C), Doctoral NP (DNP) in Independent Practice, Wound Care Certified (WCC), Volunteer Clinical/Doctoral Faculty, CANP Health Policy & Practice Chairperson
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Patient (family) centered care is a great way to use as blueprint in any goals of care discussions especially at the end of life continuum. As healthcare professionals, our role is mainly to provide scientific and evidence-based information from which patient (family) can refer to for their decisions. At the end of the day, we respect their decisions about their life and care goals.

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Aparna Gupta, DNP, EMBA, FACHE, CPHQ, ANP-BC

Design Thinker. Lifelong Learner. Bringing tomorrow's solutions to solve today's problems
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Earlier this year, I had the good fortune of hearing Dr. Bob Arnold of VitalTalks talk about the three pivotal questions to consider when addressing this kind of family challenge - 1. What happened? 2. How does it make me feel? 3. What is my identity? Addressing these three questions at the core brings to a deep understanding of needs of the patient and each family member involved and the emotions underlying family dynamics. True patient cantered care requires patience, perspective and the ability to facilitate difficult family conversations.

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Sandra Hertkorn

Underserved Community Outreach
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If appropriate I would recommend a meeting with all parties led by a neutral healthcare representative. Conflict might be resolved through impartial representation by a patient advocate involved in the process.

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Daphne Chakurian

PhD(c), RN, PHN, CCM
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First, identify the legal decision maker. second, meet with the attending to find out the recommended medical plan. Third, find out what the patient wants and their goal, if they can speak and communicate this. Last, find out what the family wants. Then, schedule a meeting to get everyone’s questions answered. The medical team must be on the same page to prevent confusion. After these steps, it’s the art of listening, establishing rapport among the parties, and respecting decisions we may not agree with.

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2 Educate Calmly

Education is a powerful tool in resolving conflicts. As a nurse, calmly providing clear and concise information about the patient's condition, prognosis, and potential care options can help families make informed decisions. Avoid medical jargon and explain terms like "palliative care" or "advance directives" in layman's terms. Encourage questions and take the time to answer them thoroughly. This approach not only empowers families but also fosters trust in the healthcare team's recommendations.

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3 Mediate Fairly

Mediation is a critical skill in these situations. Strive to be an impartial facilitator who encourages open dialogue between family members. Acknowledge differing opinions and validate emotions while steering the conversation towards a focus on the patient's needs and wishes. It's important to avoid taking sides or allowing personal beliefs to influence the process. Instead, aim to guide the family towards a consensus that honors the patient's end-of-life care preferences.

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4 Advocate Wisely

Advocacy is an integral part of nursing, especially when a patient's ability to speak for themselves is compromised. You should advocate for the patient's wishes as expressed in advance directives or previous conversations. If these are not available, advocate for what you believe, based on your professional judgment, is in the patient's best interest. It's vital to balance this advocacy with respect for the family's emotional journey and cultural values.

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5 Plan Together

Developing a care plan is a collaborative effort that should include input from the patient, family, and healthcare team. Create an atmosphere where everyone feels their opinions are valued and respected. This shared decision-making process can help alleviate tensions by giving each party a sense of ownership over the chosen path. Documenting the plan and agreed-upon decisions is crucial to ensure clarity and provide a reference for future discussions.

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Mohammad Reza karkhaneh Yousefi

Multifaceted Healthcare Professional & Creative || ICU & ER Nurse || Videographer & Video Editor || Food-Truck Manager | Animation Enthusiast | Death Advocate on Instagram ????????????
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An effective plan is a multi-dimensional plan, that collaborate all aspects of any side of the health and include any circle of member nursing. Some other aspects are so hidden like cultural materials and financial issues. When you are planing for a patient, you should consider all of this.

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6 Follow Up

Following up is key in maintaining the peace and ensuring that the care plan is implemented as agreed. Regularly check in with the family to address any new concerns or questions that arise. This ongoing support demonstrates your commitment to their loved one's care and helps prevent misunderstandings or resentments from resurfacing. It also provides an opportunity to adjust the care plan as needed in response to changes in the patient's condition or family dynamics.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How would you approach a family conflict regarding end-of-life care decisions for a patient?

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1 Understand Needs

2 Educate Calmly

3 Mediate Fairly

4 Advocate Wisely

5 Plan Together

6 Follow Up

7 Here’s what else to consider

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