Question

What options are available to families and health care workers if the patient cannot execute an advance directive?

2. If the patient has no living will or durable power of attorney for health care, how is the decision made for a do not resuscitate order?

3. What is dysfunctional grieving and what type interventions are appropriate

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Answer 1

Ans) 1) When a patient who lacks decision-making capacity has no advance directive and there is no surrogate available and willing to make treatment decisions on the patient’s behalf, or no surrogate can be identified, the attending physician should seek assistance from an ethics committee or other appropriate resource in ascertaining the patient’s best interest.

2) If you cannot express your wishes, other people such as your legal guardian, a person you named in a health care power of attorney or a family member can speak for you. You should make sure these people know your desires about CPR. If your doctor writes a DNR order at your request, no one can override it.

3) Dysfunctional grieving represents a failure to follow the predictable course of normal grieving to resolution.

- When the process deviates from the norm, the individual becomes overwhelmed and resorts to maladaptive coping. The process implies movement toward assimilation to or accommodation of the loss, resulting in progression toward social, psychological, and medical morbidity. Nurses will better assess the needs of the client with adequate information about the client's recent losses and perception of those losses. Such an assessment, in conjunction with an understanding of the signs, symptoms, and predisposing factors of complicated bereavement, will enable the nurse to develop a plan of effective intervention. Both case examples illustrate unresolved grief.

Intervention:

- Evaluate the long-term support system of the bereaved client. Encourage client to interact with the support system at defined intervals. Regular contact with support systems allows for regular expression of feelings and grief resolution.