clinical resolution - Genius Papers

I need a power point presentation

Conflict resolution scenario is to follow. FOLLOW the assignment INSTRUCTIONS and RUBRICS given.

It was understoodthat in a consultation before the patients transfer the nature of palliativecare had been explained to the patient, who was still quite capable ofexpressing his wishes, and to his two devoted daughters, one of whom had theofficial proxy designation. The patient was diagnosed with metastatic sarcomawith pulmonary metastasis and severe infiltration of his pulmonary cavity. Hehad experienced a rapid physical decline over the previous few days andnumerous symptoms had escalated. Most distressing to the patient was hisshortness of breath and chest congestion, which he rated as 10/10 and 9/10,respectively, on the Edmonton Symptom Assessment Score scale.1 The patientsPalliative Performance Scale score on admission was 20% and based on thatscore, his recent rate of decline, and his current physical state, theattending physician felt that his likelihood of survival was measured at mostin days.2 After reviewing the goals of palliative symptom management with thepatient and his daughters, the physician was taken aback when one of thedaughters (the daughter without official substitute decision-maker [or proxy]status) began to challenge the physicians choice of medication and indicatedthat she did not want any potent opiates given because she did not want herfather to lose his ability to communicate.

To help ease the altercation, the physician noted that thepatient was still capable of making decisions and asked the patient in front ofhis daughters what he wanted to do. The patient stated clearly that he couldnot breathe and that he wanted his pain relieved and his shortness of breathbetter managed. The patient also verbally acknowledged that, I am dying, helpme. The physician expressed to the daughters that her obligation and duty as amedical professional was to treat their father, and that she therefore would bedoing so. When the daughters left the room, the physician also cautioned themagainst having such disagreements in front of their father; rather, they shouldmake every effort to ensure their fathers final memories would not be offamily dysfunction or conflict.

Both nonpharmacologic and pharmacologic options were presented for therelief of his severe shortness of breath and congestion. As part of thepatients management strategy and after having discussed his alternatives, thepatient with the support of his proxy verbally consented to start scheduledopioids and anticholinergics. Once again, the nonproxy daughter challenged theuse of medication. At this point, the attending physician reminded the daughterthat her fathers death was imminent with or without the use of medicationsfor symptom control and described what she could expect over the ensuing hoursin either scenario. It was made clear that the degree of suffering her fatherwould experience in the last period of his life would be very much dependentupon the decision to use appropriate analgesics and other therapies. Theconcept of accepting some risk for appropriate symptom control at the end oflife was further discussed, as well as methods for selecting and titrating medicationsin order to minimize that risk as much as possible. The patient was able todirect his care and felt relief within a short time after the appropriatecombination of medications was initiated.

The doctor struggled to provide the care necessary to ameliorate thepatients suffering, which she succeeded to do. But the majority of the timethe nonproxy daughter hovered over, sometimes taking an adversarial stancetowards the physician and the PCU staff.

She arrived with a range of complaintsabout her fathers final hours and a subliminal threat that she would sue theorganization for deficiencies in their care and processes.

Refer to:

managedhealthcareconnect.com/article/conflicting-demands-family-end-life-and-challenges-palliative-care-team

RUBRIC

you must assess and implement an action plan for management, discuss how to initiate a plan of action in resolving the clinical issue and present a PowerPoint presentation. No more than 10 slides