How would you approach a situation where a patient's family disagrees on end-of-life care decisions?

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When a patient's family disagrees on end-of-life care, it's a challenging situation for everyone involved. As a nurse, your role is to provide compassionate care while respecting the patient's wishes and the family's perspective. It's essential to navigate these situations with sensitivity, ensuring that all parties feel heard and supported. This involves a combination of clear communication, understanding the legal aspects, and providing emotional support, all while adhering to professional ethics and standards of care.

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1 Understanding Ethics

Ethical considerations are paramount when dealing with end-of-life care decisions. You should familiarize yourself with the principles of autonomy, beneficence, non-maleficence, and justice . Autonomy respects the patient's right to make decisions about their own care. Beneficence involves acting in the best interest of the patient, while non-maleficence means doing no harm. Justice refers to fairness in medical decisions. Balancing these ethical principles can be complex, especially when family members have conflicting views.

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2 Legal Aspects

Legally, it's important to determine who has the authority to make decisions on behalf of the patient if they are unable to do so themselves. This may be outlined in an advance directive or a power of attorney for healthcare . Understanding these documents and ensuring they are up to date can prevent confusion and conflict. If there is no legal directive, the healthcare team must work with the family to reach a consensus that considers the patient's best interests and previously expressed wishes.

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PATRICIA NEWTON DNP, RN, APN, FNP-BC, RNC-OB, CDP

Empathy in Healthcare Educator | Assistant Professor | Public Speaker | Empowering Healthcare Providers to Lead with Compassion
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In my experience, the terms "POA" and "Living Will" are unclear to many. Some family members claim they're the POA, but no legal document has been signed. In this case, if the patient is able to verbalize his/her wishes, I encourage a healthcare proxy form to be completed asap. Others have thought when I ask about a living will, I want to find out who the assets will be left to. I often utilize "The Five Wishes" booklet (fivewishes.org) to guide a conversation about end of life wishes. Most patients I've shared this with have found this document to be helpful, even if it's only for the individual to prioritize what's most important to him/her at this time. This, of course, is easier to do while the patient can still express his/her wishes.

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3 Communication Skills

Effective communication is crucial in resolving disagreements about end-of-life care. You should listen actively to each family member's concerns and ensure they understand the patient's condition, prognosis, and the implications of different care options. Use clear, empathetic language to facilitate discussions and help the family navigate complex medical information. Mediating a conversation between family members can help them find common ground or a compromise that honors the patient's values.

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Fatima Abidemi Adam

Oncology Nurse||Vice President Oncology Nursing Society of Nigeria (ONS-N)||Patient Navigator ll Cancer Advocate|| Resume/CV writer (RN, ROncN, BLS, CPR, BNSc. in view)
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Most patients at this stage need their loved ones around and it'll hurt their pride (relatives) when their decision doesn't matter at the most difficult part of the journey. Addressing the situation systematically and thoughtfully can help the family make a more informed and compassionate decision about the end of life care.

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4 Emotional Support

Providing emotional support to both the patient and their family is an integral part of your role. End-of-life decisions can be emotionally charged, and families often need guidance to process their feelings. Be present, offer a listening ear, and acknowledge their emotions without judgment. Connecting them with additional resources such as counseling or support groups can also be beneficial in helping them cope with the situation.

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PATRICIA NEWTON DNP, RN, APN, FNP-BC, RNC-OB, CDP

Empathy in Healthcare Educator | Assistant Professor | Public Speaker | Empowering Healthcare Providers to Lead with Compassion
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I've discovered that as much as possible, the family needs to lead these conversations, not the provider. That being said, there are times where we need concise answers quickly. However, when there's time for discussion, we need to understand sometimes we move in "baby steps." Set a short goal, have a brief discussion, and walk away with a clear understanding of when we will meet again. Allow the family to contemplate and discuss, then follow-up as planned. Vital Talk (vitaltalk.org) has helpful resources for these types of conversations. This is a time for patient-centered care; we have goals, but the patient and family lead the journey in getting us there.

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5 Professional Boundaries

Maintaining professional boundaries is essential when dealing with family disagreements. While empathizing with the family's situation, you must remain neutral and avoid taking sides. Your focus should be on advocating for what is in the best interest of the patient while supporting the family as a whole. Upholding these boundaries ensures that you can provide objective and effective care without becoming personally entangled in the family dynamics.

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6 Collaborative Approach

Taking a collaborative approach with the healthcare team can provide a united front in managing family disagreements on end-of-life care. Work closely with physicians, social workers, and other professionals to present consistent information and support to the family. This team approach can help reinforce the rationale behind care recommendations and ensure that the patient's needs remain at the center of all discussions.

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How would you approach a situation where a patient's family disagrees on end-of-life care decisions?

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1 Understanding Ethics

2 Legal Aspects

3 Communication Skills

4 Emotional Support

5 Professional Boundaries

6 Collaborative Approach

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