Patient Centered Care 1125

Patient Centered Care occurs

when the nurse recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs.

We are intermediaries between family and patient.

Ex. the spouse can no longer care for the sick spouse. We try to come up with solutions. Such a hospice, hospice, home health, social workers financial help

Negative Outcomes

Never Events• Near Miss• Sentinel Events• Discomfort: Psychological & Physiological

Exemplars

Advocacy, prioritizing individualized care

The nurse is caring for a client with diabetes. Which of the following is a characteristic of chronic illness?

Chronic illness affects the entire family.Chronic illness affects the entire family to the extent that family life can be dramatically altered. Managing chronic conditions must be a collaborative process. One chronic disease can lead to the development of other chronic conditions. Chronic conditions usually involve many different phases over the course of a person's lifetime.

Caring in Nursing questions

Is caring teachable??? Why do you think so? • Why is it necessary? • How are caring and patient-centered care similar? • How does caring affect patient-centered care?

Professional Reponsibilities

• Nurses provide care & comfort in all health care settings • Nurse's concern: Meeting the patient's needs no matter the focus • Health Promotion/Illness Prevention • Disease/Symptom Management • Family Support • End of Life Care

Prioritzing Individual Care pt.2

EXPERIENCE AND EXPETISE OF NURSE PATIENT ACUITY AVAILABILITY OF RESOURCES INTERRUPTIONS FROM CARE PROVIDORS Nurse-patient relationship Priority setting strategies and framework Philosophies and models of care

Key Points 1-3

Patient-centered care is an essential part of nursing care requiring the nurse to become fully engaged in partnership with the patient to achieve positive outcomes. Health literacy, empowerment, and an optimal healing environment are essential to achieving patient-centered care and assisting the patient to progress from illness to wellness. The nurse's professional responsibilities assist her in helping the patient to move across the continuum of illness to maximal health.

Patient Centered Care

Patient-centered care is present when the nurse recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values and needs.(QSEN)

We make sure problems are taken to higher ups or _______________ to resolve the issues for their patients.

chain of command

Positive Outcomes

• Quality Care/Continuity of Care• Treatment Compliance• Cost Containment• Comfort: Psychological & Physiological

The Six C's of Caring in Nursing

•Compassion •Competence •Confidence •Conscience •Commitment •Comportment

Caring in Nursing

•Providing Presence •Touch •Listening •Knowing the Patient •Spiritual Caring •Relieving Pain and Suffering •Family Care

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply.

Allow family members to express feelings. Educate the family about medications and side effects. Suggest support for household maintenance. Family members benefit from increased education on what to expect. Allowing family members to express their feelings has also been shown to relieve stress. Supporting the caregiver and family with help in household duties will also help the overburdened family. Antianxiety medications and church attendance have not been shown to reduce caregiver stress.

The nurse reviews the physician's emergency department progress notes for the client who sustained a head injury and sees that the physician observed the Battle sign. The nurse knows that the physician observed which clinical manifestation?

An area of bruising over the mastoid bone. Battle sign may indicate a skull fracture. A bloodstain surrounded by a yellowish stain on the head dressing is referred to as a halo sign and is highly suggestive of a cerebrospinal fluid (CSF) leak. Escape of CSF from the client's ear is termed otorrhea. Escape of CSF from the client's nose is termed rhinorrhea.

Prioritizing Individual Care

Assess patient, Identify problems, Prioritize problems, Identify nursing outcomes, Identify interventions for achieving outcomes, Prioritize interventions, Deliver patient care, Evaluate interventions

A nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take?

Immediately stop the nurse. The nurse should interrupt the nurse and remind him or her that it is important not to impose personal values onto the client.

Which is a cause related to the increasing number of people with chronic conditions?

Improved screening and diagnostic procedure. The increasing number of people with chronic conditions is related to improved screening and diagnostic procedures. Mortality from infectious disease has been decreasing. Chronic conditions tend to develop in the elderly population. People are living longer for various reasons.

The adolescent client has become bored with the video game system, which had been the positive reward for cleaning one's room. Which intervention would be most effective intervention at this time?

Let the adolescent choose another reward that would be more fun. Positive rewards need to be viewed as desirable to motivate desired behavior changes. One method of rewards/punishment is the token system. The child is rewarded for good behavior with a token and the token is taken away for inappropriate behavior. When the child has collected a specified amount of tokens or a specific time has occurred the token can be exchanged for a reward. If the adolescent is bored or distracted with the video game then it is not serving the purpose for which it was intended. The nurse should allow the adolescent to select another reward as a result of good behavior and as specified by the parents in the rules for the adolescent. Making the adolescent continue to use the gaming system only increases anger, frustration and aggression.

A client has been prescribed diuretic therapy for hypertension. It has been causing frequent urination at night and now the client is refusing to take the morning dose of furosemide. What would be the best response by the nurse?

Reinforce the reason for the medication. Respect the decision if the client still refuses the medication, and chart the refusal.The client needs to understand the importance of extra fluid removal and how it helps control blood pressure. The nurse needs to be respectful that the client still has a choice in whether to take the medication.

A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness:

The client stops taking some medications due to side effects that are disturbing to the client. Clients who experience a chronic illness may stop taking medications or alter dosages of medications due to side effects that they consider more disturbing or disruptive than the chronic illness. Many clients and their families have the chronic illness become the focal point of their life. For many clients, the effects of the chronic illness threaten identity and body image. Clients have difficulty adhering to a therapeutic regimen due to the realities of daily life and culture, values, and socioeconomic factors.

A client who's paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis?

The client uses a mirror to inspect the skin. The client demonstrates understanding of safety measures related to paralysis when he uses a mirror to inspect his skin. The mirror enables the client to inspect all areas of the skin for signs of breakdown without the help of staff or family members. The client should keep the side rails up to help with repositioning and to prevent falls. The paralyzed client should take responsibility for repositioning or for reminding the staff to assist with it, if needed. A client with left-side paralysis may not realize that the left arm is hanging over the side of the wheelchair. However, the nurse should call this position to the client's attention because the arm can get caught in the wheel spokes or develop impaired circulation from being in a dependent position for too long.

Advocacy

The protection and support of another's rights. Promotes dignity and well being - Planning care in partnership with the patient - The right to self determination - May entail becoming politically active - Advocacy does not entail supporting patients in all their preferences (smoking) - We help facilitate the patient's own decision making. We don't tell them what to do but give them options and education to make the tight decision for them. This may include helping the patient set up advance directives. - Make sure their loyalty to their employer does not compromise primary commitment to patient - Carefully evaluate the competing claims of the patient's autonomy and the patient's well being

When there is a breach in the nurse & patient/family relationship, negative consequences (outcomes) can result.

These include never events; near miss; sentinel events; and psychological and physiological discomfort.

When patient-centered care occurs, positive consequences (outcomes) are experienced as a result of the nurse & patient/family relationship.

These include quality care; continuity of care; treatment compliance; cost containment; and psychological and physiological patient comfort.

A client was hit in the head with a ball and knocked unconscious. Upon arrival at the emergency department and subsequent diagnostic tests, it was determined that the client suffered a subdural hematoma. The client is becoming increasingly symptomatic. How would the nurse expect this subdural hematoma to be classified?

acute, Subdural hematomas are classified as acute, subacute, and chronic according to the rate of neurologic changes. Symptoms progressively worsen in a client with an acute subdural hematoma within the first 24 hours of the head injury.

The nurse is preparing a client for a neurological examination by the physician and explains tests the physician will be doing, including the Romberg test. The client asks the purpose of this particular test. The correct reply by the nurse is which of the following?

"It is a test for balance." The Romberg test screens for balance. The client stands with feet together and arms at the side, first with eyes open and then with both eyes closed for 20 to 30 seconds. Slight swaying is normal, but a loss of balance is abnormal and is considered a positive Romberg test.

A client from a nursing home arrives at an acute care facility for treatment related to complications of chronic obstructive pulmonary disease. A nurse performing the admission assessment notes the presence of a large stage III pressure ulcer. The client's child asks if the hospital can "treat the sore." What is the nurse's best initial response?

"We will collaborate with the physician to obtain an order for the wound care nurse to see the client." After the client's admission to the acute care facility, the physician must provide orders for referrals and consultations with the services the client needs. Therefore, the nurse will need a physician's order to establish contact between the client and the wound care nurse. As a member of the health care team, the nurse should initiate collaboration among other team members, and the nurse should respond to the client's child in a therapeutic way that conveys a commitment to helping the client through a collaborative effort from all members of the health care team. It would not be appropriate to assume that the client will need debridement, nor should the nurse imply that only the nurse will take care of the wound.

Objectives

1. Explain the concept of patient-centered care (definition, antecedents, attributes) 2. Discuss exemplars of Advocacy and Prioritizing Individual Care 3. Analyze conditions which place a patient at risk for negative consequences (outcomes). 4. Identify when a negative consequence (outcome) is developing or has developed. 5. Apply the nursing process (including collaborative interventions) for individuals experiencing negative consequences related to patient-centered care.

A primigravid client gave birth vaginally 2 hours ago with no complications. As the nurse plans care for this postpartum client, which postpartum goal would have the highest priority

The client will demonstrate self-care and infant care by the end of the shift. Educating the client about caring for herself and her infant are the two highest priority goals. Following birth, all mothers, especially the primigravida, require instructions regarding self-care and infant care. Learning needs should be assessed in order to meet the specific needs of each client. Bonding is significant, but it is only one aspect of the needs of this client and the bonding process would have been implemented immediately postpartum, rather than waiting 2 hours. Planning the discharge occurs after the initial education has taken place for mother and infant and the nurse is aware of any need for referrals. Safety is an aspect of education taught continuously by the nurse and should include maternal as well as newborn safety.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?

To avoid inflammation of the pancreas, Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

Which ethical principle is related to the idea of self-determination?

autonomy, Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make healthcare decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm.

The nurse recognizes the patient's participation in patient-centered care occurs when they desire/exhibit behaviors for self-management;

engage in partnership with the nurse; and becomes an active partner in cultural competence to facilitate their care. The nurse responds to the patient by exhibiting a respect for diversity, disparities, and self-expression; advocates for the patient/family's desires, wishes, and needs; engages in cultural competence; becomes an empowerment coach; and acts as coordinator of care to meet the patient where they are and help them to progress towards an optimal level of wellness.

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client's prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?

international normalized ratio (INR), The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.

The nurse teaches the client that osteoarthritis

is the most common and frequently disabling of joint disorders.The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues and is usually diagnosed in the second or third decade of life.

Other concepts that can affect patient-centered care

nclude quality improvement; diversity; ethical and legal precepts; safety; health information technology; communication; collaboration and teamwork; evidence-based practice and health care organizations. If the patient's attributes of these concepts are optimal then the concepts contribute toward positive consequences related to patient-centered care. In the absence of optimum attributes these concepts may contribute to a breach in patient-centered care leading to negative consequences and requiring nursing interventions.

After receiving the morning report, the nurse prioritizes care needed by several clients. Which is not a factor that the nurse would keep in mind when creating this priority list?

• A) Client condition • B) Safety • C) Time available • D) Client preferences • E) Time of day

• The nurse is caring for a terminally ill pediatric client. The parents have decided to remove their child from life support. This decision was met with much opposition from other nurses on the unit. Which action by the nurse displays the role of client advocate?

• A) Respecting the parents' decision • B) Telling the parents they are making the right decision • C) Asking to be assigned to a different client • D) Referring the parents to social services

Professional Responsibilities cont.

• Autonomy & Accountability - • Essential element of the Nursing Profession - • Involves high levels of responsibility and accountability • Caregiver - • Meet all health care needs of the patient/family in a holistic manner • Advocate - • Protect the patient's human & legal rights - • Provide assistance in asserting those rights • Educator - • Formal and Informal Teaching • Communicator - • Central to the nurse-patient relationship - • Essential for all nursing roles and activities

Interrelated Concepts

• Quality Improvement• Diversity• Ethical/Legal Precepts• Safety• Health Information Technology• Communication• Collaboration & Teamwork• Evidence-Based Practice• Health Care Organizations Based on the definitions of these concepts, Explain how they could impact Patient-Centered Care?

Nursing Diagnosis

• Readiness for Enhanced Communication• Readiness for Enhanced Self Health management• Readiness for Enhanced Knowledge• Readiness for Enhanced Comfort• Risk-Prone Health Behavior• Impaired Verbal Communication• Ineffective Self Health management• Deficient Knowledge• Ineffective Health Maintenance• Ineffective Family Therapeutic Regimen Management• Impaired Comfort

Antecedents- Nurse Focus

• Respect for Diversity, Disparities, and Self-Expression• Advocate for Patient/Family Desires/Wishes/Needs• Cultural Competence• Empowerment Coach• Coordinator of Care

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. The client asks, "Why am I practicing breathing when I'm having hernia surgery." What is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications." Deep breathing after surgery reduces the risk for development of postoperative respiratory complications. It does not help with pain control, facilitate quicker healing, or reduce the risk for blood clots.

A client diagnosed with thyroid cancer signed a living will that states the client doesn't want ventilatory support if the condition deteriorates. As the client's condition worsens, the client states, "I changed my mind. I want everything done for me." Which response by the nurse is best?

"What exactly do you mean by wanting 'everything' done for you?" Asking the client what they mean is the best response. The nurse should clarify the client's request and get as much information as possible before notifying the physician of the client's wishes. Asking the physician to revoke the client's do-not-resuscitate (DNR) order makes an assumption about the client's wishes without obtaining clarification of their statement. The client might want aggressive treatment without reversing the DNR order. Asking the client if they understand that they'll be placed on a ventilator places the client on the defensive. Telling the client to talk with family is an inappropriate response; the client has the right to change their treatment plan without input from their family.

A client has been admitted to the unit for chest pain. A nurse told the family that they could not be with the client. The family became very upset, and now the client wants to leave. What is the most culturally appropriate response by the charge nurse?

"Would you feel more comfortable with your family with you?" Some cultures are very family oriented; others may have members who are skeptical of modern health care. The request for the client's family to leave most likely frightened the client. Asking the client how to make the client more comfortable is the best option. Asking the client why the client wants to leave is judgmental, implying there is no real reason to leave. Citing the hospital's policy regarding clients who leave against medical advice is not culturally sensitive and does not address the client's concerns. Clearly in this client's case, having the family present reduces, not causes, stress, so the comment about maintaining a stress-free environment is not valid.

While providing palliative care to a client in the home setting, the client's family expresses concern that the client is receiving "too much narcotic medication." Which statement is the most therapeutic response by the nurse?

"You are concerned that the client is receiving too much narcotic medication?" Using a reflective statement without judgment allows the family to elaborate so the nurse can answer the specific concerns. The other options are not correct because they do not promote more conversation to help the family gain a better perspective on the treatment.

The nurse is preparing to triage victims of a train derailment who are being transported to the emergency department. Which victim would need immediate care?

A) Holding broken arm, sitting in a chair • B) Respiratory rate of 8 and irregular • C) Bleeding from superficial facial wounds and talking to family • D) Walking with a slight limp, asking for something to drink

The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client?

Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification. Distractions to learning, such as the television being on or the client being at meal time, diminish the effectiveness of any education plan. An authoritarian style of teaching does not honor the client as a partner in the learning process. Age does not necessarily determine developmental stage. Assessing the client's developmental stage and understanding of the health problem, clarifying information that is difficult for the client to understand, and ensuring that the client is physically able to perform the task are all aspects of a well-planned education session for all clients.

Key points 4-7

Communication is an essential component of patient-centered care and fosters the nurse-patient relationship. Caring principles assist the nurse in focusing on the patient using critical thinking and clinical judgment to support the decision-making process. Prioritizing individual care allows the nurse to deliver safe, effective, quality care that leads to positive outcomes for the patients. Acting as a patient advocate requires the nurse to be knowledgeable of the patient so that the patient's rights and preferences are preserved at all times.

Antecedents- Patient Focus

Desire/Exhibit Behaviors for Self-Management • Engage in Partnership • Active Partner in Cultural Competence

A client is admitted with an infectious wound. Contact precautions are initiated. To help the client cope with staff using isolation procedures, which nursing action is most helpful?

Discuss the rationale for contact precautions. When assisting the client cope with contact precautions, it is most helpful to understand the client's perspective of how the use of the precautions feels. When discussing, the nurse can explain the importance of the measures and the concerns of the client. Speaking from the door violates confidentiality. Putting stickers on the mask does not help the client cope. Although it is necessary to wear gloves, it does not assist in client coping.

Review the Nursing Diagnosis

Readiness for Enhanced Communication Readiness for Enhanced Self Health management Readiness for Enhanced Knowledge Risk-Prone Health Behavior Impaired Verbal Communication Ineffective Self Health management Deficient Knowledge Ineffective Health Maintenance Ineffective Family Therapeutic Regimen Management

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?

Respect the client's and family members' choices .In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

When developing a labor plan with the client, which outcome is the priority?

The client will direct her pain management techniques.Clients who have their pain managed report higher satisfaction with the birth experience. By working with the nurse in determining the labor plan, the health care provider, nurse, and client can work together to obtain a plan to manage labor pain. This puts the client in control of her care. Neither the client nor the nurse is able to determine if a vaginal birth is feasible. It is rarely realistic to have pain-free labor. Some discomfort is felt at some time within the labor process. It is strongly encouraged to have attended prenatal classes but not the priority.

Which method is used to help reduce intracranial pressure?

Using a cervical collar, Use of a cervical collar promotes venous drainage and prevents jugular vein distortion, which can increase ICP. Slight elevation of the head is maintained to aid in venous drainage unless otherwise prescribed. Extreme rotation of the neck is avoided because compression or distortion of the jugular veins increases ICP. Extreme hip flexion is avoided because this position causes an increase in intra-abdominal pressure and intrathoracic pressure, which can produce a rise in ICP

A home health care nurse develops a client's individualized plan of care during the:

entry phase, Nurses provide home health care interventions during the entry phase, using an individualized plan of care for each client based initially on identifying individualized health care needs. In the entry phase, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes (along with the patient and family), plans and implements prescribed care, and provides teaching. During the pre-entry phase, which includes the referral process, the provider or discharge planner of a hospital contacts the home care facility and provides a brief medical history, along with indications for home health services, and then the referral nurse at the home care facility collects as much information as possible about the patient's diagnoses, surgical experience, socioeconomic status, and treatments ordered. Discharge planning occurs during the pre-entry phase and would be too soon for creating a client's individualized plan of home health care, as the home health nurse still needs to meet and assess the client and family first.

The nurse must possess these attributes in order to successfully participate in patient-centered care:

non-judgmental; empathetic; cultural competence; respect for diversity; empowerment; integrity; self-awareness; adaptive; advocate; be present in caring for the patient/family; and provide an optimal healing environment.

Patient Centered Care definition (Patient's included)

occurs when the nurse recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs.

To successfully achieve patient-centered care,

the nurse must assist the patient in achieving health literacy; empower patients to self-manage their ailments; work in an autonomous manner ensuring that all the patients' needs are met and no harm is done; and provide an optimal healing environment making it easier for patient's to progress from illness to wellness.

Nurse Caring Behavior

• Being honest• Advocating for patient's care preferences• Giving clear explanations• Keeping family members informed• Asking permission before doing something to a patient• Providing comfort (e.g. offering warm blanket, rubbing a patient's back)• Reading patient passages from religious texts, favorite book, cards, or mail• Providing for and maintaining patient privacy• Assuring the patient that nursing services will be available• Helping patients do as much for themselves as possible• Teaching the family how to keep the relative physically comfortable

Sub-Concepts of Patient Centered Care

• Health Literacy • Empowerment of Patients • Autonomy • Optimal Healing Environment

Prioritizing

• It is 0700, you have just received morning report and are preparing to make rounds to see your patients. Which patient do you need to see first? 1. Mr. D, a 52-yr-old admitted yesterday with chest pain. He is scheduled for a cardiac stress test at 0900. 2. Mrs. W, a 60-yr-old transferred out of ICU this morning. She had uncomplicated heart surgery. 3. Mr. W, a 45-yr-old who experienced a heart attack 2 days ago. He is complaining of chest pain as 6 on a scale of 0 to 10. 4. Mrs. H, a 76-yr-old who had a pacemaker inserted yesterday. She is complaining of incision pain as a 5 on a scale of 0 to 10.

Advocacy

• The Important Role of Nurse Patient Advocates• http://www.youtube.com/watch?v=ndAM8h7ASHs • As an advocate, the nurse provides patients with information needed to make informed decisions and supports their right to make their own health care decisions. • Advocacy requires accepting and respecting the patient's right to decide, even if the nurse believes the decision to be wrong .• Being an advocate involves...following through, providing resources, and going above and beyond...

A nurse is preparing to teach a 6-year-old client with a broken arm and the client's mother about caring for the child's cast. Which statement reflects the best education plan for these clients?

Include the child in the education; ask questions of both the mother and the child.School-age children are able to make decisions and provide care for themselves. Focusing mainly or only on the mother fails to validate the child's abilities, and teaching the mother and the child separately does not make good use of time.

A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?

Arrange for a sign language interpreter when discussing treatment. During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter.

A nurse is caring for a client with advanced cancer. Based on the accompanying nursing progress notes, what should be the nurse's next intervention?

Explain the use of an advance directive to express the client's wishes. An advance directive is a legal document used as a guideline for life-sustaining medical care of a client with an advanced disease or disability who can no longer indicate their own wishes. This document can include a living will, which instructs the healthcare provider to administer no life-sustaining treatment, and a durable power of attorney for health care, which names another person to act on the client's behalf for medical decisions if the client cannot act for self. By explaining the use of an advanced directive to the client at this time, the client has the opportunity to document future wishes. The document on client rights does not specifically address the client's wishes regarding future care. Calling the spouse is a breach of the client's right to confidentiality. Stating that only a hospital can provide adequate pain relief in a terminal situation demonstrates inadequate knowledge of the resources available in the community through hospice and home care agencies in collaboration with the client's healthcare provider.