Advanced Directives
A person authorized by a witnessed legal document to make medical decisions for you when you are unable to make your own decisions.
What is a Health Care Surrogate?
The most important non-verbal ways to demonstrate active listening...
What is: Make eye contact, lean forward, sit or kneel to be on same level?
This aggressive treatment is typically used for patients with a diagnosis of cancer.
What is Chemotherapy and Radiation?
As health declines and patients and families become more ill, care becomes more demanding. It is very helpful to...
What is partner with the hospice team to assist? The team includes (RN, SW, Chaplain, HHA, APRN, Physician, Respiratory Therapist, and Volunteers)
Ethical principle commonly known as "do no harm."
Nonmaleficence
A legal document that names one person the health care agent of another person. The agent has the ability to make health care decisions and the responsibility to make sure doctors and other medical personnel provide necessary and appropriate care according to the patient's wishes.
What is a Health Care Power of Attorney?
This verbal question type is recommended when having goals of care conversations.
What are open-ended questions?
This treatment for End Stage Renal Failure, usually believed to be aggressive, is allowed with VITAS, on a case-by-case basis.
What is dialysis?
In healthcare, we manage the physical needs of our patients as well as the reality and (even more difficult) the ___________ of the patient and family.
What is the perception?
Ethical principal which supports a patients individual right to make a rational, uninfluenced decision.
What is Autonomy?
A written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent.
What is a Living Will?
Despite all interventions, Mr. Smith is declining more each day. Mr. Smith states, "I am just so sick and tired, of being sick and tired." This response would not be appropriate...
What is: maybe tomorrow will be better?
IV therapies such as fluids and antibiotics are sometimes considered aggressive treatments. These therapies are often included with this type of service based of a patients goals of care and symptom burden.
What is VITAS Hospice services?
During difficult conversations the family members want to feel...
What is heard, included, validated?
This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient.
What is Beneficence?
Ms. Fisher has 4 sons, 2 daughters, 2 siblings and 18 grandchildren. They have all been active in her care. Ms. Fisher has no advanced directive in place and now can no longer make her healthcare decisions. Several family members have stated that they should be the primary decision maker. However, in Florida you know that.
What is the Florida State Hierarchy must be followed? 1. Spouse, 2. Majority of adult children in agreement, 3. Parent, 4. Majority of siblings, 5. Adult Relative, 6. Close Friend, 7. Court Appointed Guardian or Licensed Clinical Social Worker.
Mrs. Jessup is declining rapidly and James, husband of 62 years states, "I just don't think I can make it without her." You would want to avoid statements like this.
What is: "I know how you feel."
Mr. Coe would like to continue chemotherapy for his Stage IV Prostate Cancer, however, his doctor states he needs a "chemo break" due to his labs. Mr. Coe and his family are distraught. This is a good option for Mr. Coe at this time.
What is a hospice consult? This will allow Mr. Coe to give his body time to rest and heal and he can always revoke services and resume chemo if/when his strength returns and he will have additional support for himself and his family either way.
Ms. Jules has no advanced directives, and is now unresponsive. Ms. Jules has 5 children, her oldest daughter, Sylvia, is at the bedside and states, "let's just keep mom comfortable." You response to Sylvia is based on your knowledge that Florida law requires.
What is: the majority of adult children in agreement with the plan of care?
Ms. Jones, 98 yo, has always wanted to remain at home, and has made it clear that she doesn't want to be hospitalized. Due to her elderly status and new onset, intermittent confusion, her wishes should be...
What is honored and upheld?
Ms. Plum has no advanced directives in place, no family on record and no longer has capacity to make her healthcare decisions. Ms. Plum's neighbor would like to offer her assistance, as they shared many long talks and she knows how Ms. Plum "would've wanted to live." Your next step should be.
What is document all attempts to reach any other next-of-kin and if unable allow Ms. Plum's neighbor to assist?
Ms. Crawford, 89-year-old, Alzheimer’s patient, is no longer able to make her needs known and is non-verbal. She has been hospitalized three times in 6 months for urosepsis and has just returned to your facility post-hospitalization. Ms. Crawford is more confused than ever and crying out, suffering from delirium and having difficulty eating and drinking. Her daughter states, “I just can’t believe Mama is having to go through all of this.” You respond.
What is: I know this is a lot right now, please tell me more about everything you are feeling?
Ms. Lively has end-stage CHF, EF 10%. Her cardiologist has ordered her a Dobutamine drip for hospital discharge. Most facilities are unable to manage this drip and her discharge plan is becoming increasingly more difficult. These additional services could manage and provider Ms. Lively's drip and support the facility staff in her care.
What is VITAS Hospice services. Milrinone and Dobutamine provide comfort and decrease hospitalization for end-stage heart failure patients. VITAS covers the medication and provides nurses to administer and manage each infusion.
Mr. Jones daughter, Olivia, just flew in from Chicago and would like a "higher level of care" for her father. Mr. Jones has capacity and states, "I don't want to go anywhere. I am staying here. This is my home." Your best response is...
What is: Olivia please tell me more about your concerns regarding your father's care?
Mr. Stone, 79 yo, CHF, lives at home in the ALF. He has had 3 falls in the past week and it is clear he is declining rapidly. Mr. Stone is adamant that he wants to remain in his ALF and not move to a higher level of care or return to the hospital. Regulatory requirement which supports Mr. Stone's wishes...
What is 'aging in place?'