NR 341 Week 2 Client Comfort and End of Life Care
Student Name
Chamberlain University
NR-341 Complex Adult Health
Prof. Name
Date
Reflective Journal
During the hospice care simulation, I was reminded of several real-life experiences from my role as a nurse on the Neurological Unit at St. Joseph’s University Medical Center in Paterson. My unit frequently receives patients who are either experiencing their first stroke or are readmitted due to recurrent strokes and coexisting medical conditions. These situations often bring patients and their families to the difficult crossroads of end-of-life care.
In one particularly resonant scenario from the simulation, the patient expressed a desire to discontinue treatment due to emotional and physical exhaustion. However, their family—especially the daughter—dismissed these wishes, reflecting a response I have seen multiple times in clinical practice. Family members often react emotionally and, in doing so, may unintentionally guilt the patient into continuing treatment that no longer aligns with their desires or values. As nurses, it is essential that we recognize this as a natural, though problematic, emotional response.
Reflecting on how I can improve my own practice, one key change would be to prioritize clear, empathetic communication with both patients and their families. Open dialogue is vital when a patient is transitioning to end-of-life care, as emotions can overwhelm understanding. It’s important to foster a safe space where patients feel empowered to voice their true preferences.
Moreover, I would begin the conversation with the patient before family members are involved. This private time would not only allow me to clarify the patient’s wishes and support autonomy but also serve as an opportunity to answer questions, provide education, and assess understanding. This proactive approach could alleviate miscommunication and reduce conflict between patients and families during such a vulnerable time.
Question One: According to the State Board of Nursing in your state, what is the Registered Nurse’s responsibility in treating a patient’s pain?
In the state of New Jersey, registered nurses carry both a legal and ethical responsibility to manage and alleviate a patient’s pain. According to the New Jersey Board of Nursing and the American Nurses Association (ANA), nurses are ethically obligated to prevent and relieve suffering. This includes conducting a thorough pain assessment that examines not only the severity and frequency of the pain but also evaluates prior pain management strategies and any history of substance misuse (New Jersey Board of Nursing, 2020).
NR 341 Week 2 Client Comfort and End of Life Care
A nurse’s responsibilities include the following:
| Responsibility | Description |
|---|---|
| Pain Assessment | Collecting data on pain intensity, frequency, duration, and impact on function. |
| Medical History | Reviewing past treatments, drug use, and alternative pain management attempts. |
| Substance Use Evaluation | Identifying any history of substance use to guide safe and effective care. |
| Treatment Planning | Developing an individualized care plan based on assessment findings. |
When patients have a history of substance use disorder, nurses must exercise caution with opioid prescriptions and may need to coordinate with providers to explore alternative pain control strategies such as non-opioid medications or non-pharmacologic interventions (e.g., physical therapy, cognitive-behavioral therapy).
Question Two: Based on the laws of your state, if a patient does not have a medical power of attorney, who are the next three people responsible to make medical decisions for the patient?
If a patient in New Jersey is incapacitated and has not designated a medical power of attorney, the state’s laws outline a legal hierarchy of surrogate decision-makers. The three individuals next in line to make healthcare decisions are:
| Legal Decision-Maker | Authority and Responsibilities |
|---|---|
| Court-Appointed Guardian/Conservator | Legally assigned by the court to act on the patient’s behalf, including decisions on hospitalization or discharge. |
| Spouse or Domestic Partner | Entitled to make decisions about treatment, access to medical records, and end-of-life care. |
| Adult Child | Can participate in determining care plans, treatment refusals, and access permissions if no spouse is present. |
These individuals are empowered to make decisions about treatments, medications, and patient placement in medical facilities. They also control access to the patient’s personal health information, ensuring decisions are aligned with what they believe the patient would want (LawHelp.org, 2016).
Question Three: What is defined by state law as a patient being incapacitated?
In New Jersey, a patient is considered incapacitated when their attending physician determines, with medical certainty, that the individual lacks the capacity to make informed healthcare decisions. This assessment includes evaluating the extent, cause, and potential reversibility of the patient’s impaired mental state (Assembly Health and Senior Services Committee, 2011).
The state further defines an incapacitated person as someone whose decision-making is significantly impaired due to mental illness, cognitive disorders, or intellectual disabilities, making them unable to effectively manage their personal or healthcare matters.
This legal definition ensures that patients are protected when they can no longer speak for themselves, but it also places a strong responsibility on physicians to assess carefully and document the nature and permanence of the incapacity.
References
Assembly Health and Senior Services Committee Statement to Assembly, No. 4098 State of New Jersey. (2011). Njleg.state.nj.us. Retrieved from https://www.njleg.state.nj.us/2010/Bills/A4500/4098_S1.PDF
Durable Powers of Attorney for Health Care. (2016). Lawhelp.org. Retrieved from https://www.lawhelp.org/dc/resource/frequently-asked-questions-about-durable-power
NR 341 Week 2 Client Comfort and End of Life Care
New Jersey Board of Nursing: Law and Public Safety. (2020). Njconsumeraffairs.gov. Retrieved from https://www.njconsumeraffairs.gov/regulations/Chapter-37-New-Jersey-Board-ofNursing.pdf