Question

How you would advocate for your patient in end of life care? If you have a patient who is not cognitive, and is actively dying, but the family wants everything done to try to save the patient's life, how do you advocate for the best outcome for the patient? And would this change if the patient was a child?

Answer 1

A physician is the one who breaks a terminal illness to the patient and his relative.Most of the time they tend to be fast and a poor personal relationship is existing. A nurse is the one who comes into the role of advocacy most of the time to support the patient and relative.

If a patient is of sound mind the prognosis can be explained and made understood, accepted in end of life care but if the patient is mentally unsound like with cognitive impairment cannot understand what others explain. At this time the advocacy has to be done to the patient relative in the following way

• Explain the prognosis (Positive or negative )
• Pain experience of patient which cannot be explained or realised by the sick
• Support the relatives psychologically to understand what the patient condition is
• Assess for tgeir coping mechanism, or try explaining the most responsible and decision maker of the family
• If it's child it is highly sensitive make the parents understand and accept the status ofvthe child to get a better result
• Inform relative if any procedures will cause a physical injury (intubation,intravenous, centralvenous port insertion, incision ,surgery )
• Explain the metabolism of patient in accepting the drugs administered and its effects.