End-of-life care becomes an issue at some point for elderly patients. Discuss the difference between palliative care and hospice care programs. Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes. Explain the use of advance directives versus Physician Order for Life Sustaining Treatment (POLST) and their legal implications when providing care for elderly patients.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
example 1 Sharon
Two critical components of end-of-life care are palliative care and hospice care
Palliative care deals with the management of serious illness, supporting the patient emotionally physically, and making sure the plan of care is in alignment with the with the desire of the patient. It consist of the management of symptoms and its gears towards recovery. Hospice care on the other hand is a comprehensive care provided to Patience with terminal illness, especially when prognosis is within six months or less. It consist of emotional support promotion of comfort and educating the patient about what to expect during the end of life curative treatment becomes ineffective and care is focused on comfort measures, and the patient wishes.
The role of the nurse in end-of-life care is very important. The nurse corporate with the family and health team to decide what treatment is best for the patient. According to the patient wishes the nose ensures the patient receives comfort oriented care. The nurse shares information with other interdisciplinary members to make decisions that gives the patient the best care The nurse advocates for the dying patient by defending the rights of the patient. The nurse gives compassionate care to patient and family, ensuring a pain-free, peaceful respected transition and surrounded by loved ones or family.
Advance directives which include durable power of attorney, and living will gives the patient the ability to decide on their treatment preference and gives it designated individual to decide on their behalf. In case they are unable to do so while physician order for life-sustaining treatment are treatment preference of a patient Ordered by a physician. It serves as an agreement between the patient and the healthcare provider. Both have legal implications because they are a guide to healthcare providers on treatment preferences of the patient and must be regarded in line with the patient’s wishes.
American Association of Critical Care Nurses(2024) Paliative Care in Acute & Critical Care Settings.https://www.aacn.org/clinical-resources/palliative-end-of-life
House SA, Schoo C, Ogilvie WA. Advance Directives. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459133/https://www.ncbi.nlm.nih.gov/books/NBK459133/
Nacak, U. A., & Erden, Y. (2022). End-of-Life Care and Nurse’s Roles. The Eurasian journal of medicine, 54(Suppl1), 141–144. https://doi.org/10.5152/eurasianjmed.2022.22324https://pmc.ncbi.nlm.nih.gov/articles/PMC11163333/
example 2 Millicent
Palliative care and hospice care both focus on improving the quality of life for patients with serious or terminal illnesses, but they differ in timing and goals. Palliative care can be provided at any stage of a serious illness, alongside curative treatments, and addresses physical, emotional, and spiritual needs (Tatum & Mills, 2020). In contrast, hospice care is reserved for patients with a life expectancy of six months or less, emphasizing comfort and symptom management rather than curative treatment (Tatum & Mills, 2020). As a nurse, supporting patients in end-of-life care involves active listening, providing emotional and psychological support, and ensuring their wishes are respected. Educating patients and families about care options and facilitating discussions about goals of care are vital. Nurses advocate for patients’ rights and ensure decisions are honored by collaborating with interdisciplinary teams. Emotional support extends to families, helping them cope with grief and decision-making during this difficult time.
Advance directives are legal documents specifying a patient’s wishes regarding future medical care, including living wills and durable powers of attorney for healthcare. These are typically created before a health crisis and may include preferences about resuscitation or life-sustaining treatments (Sedini et al., 2022). Conversely, Physician Orders for Life-Sustaining Treatment (POLST) forms are medical orders used for patients with serious illnesses, translating specific treatment preferences into actionable instructions for healthcare providers (Ly & Block, 2021). POLST forms are more detailed than advance directives and are immediately actionable during emergencies. Legally, nurses must honor advance directives and POLST forms, ensuring treatments align with patient preferences. Violations could result in legal consequences or ethical breaches. Nurses play a key role in educating patients about these documents, verifying their accuracy, and advocating for their implementation during care.
References
Ly, D. T., & Block, A. J. (2021). Physician Orders for Life-Sustaining Treatment: The Clinical Nurse Specialist Can Help With That. Clinical Nurse Specialist, 35(4), 161-163. https://journals.lww.com/cns-journal/citation/2021/07000/physician_orders_for_life_sustaining_treatment_.3.aspx?context=latestarticles
Sedini, C., Biotto, M., Crespi Bel’skij, L. M., Moroni Grandini, R. E., & Cesari, M. (2022). Advance care planning and advance directives: an overview of the main critical issues. Aging Clinical and Experimental Research, 1-6. https://link.springer.com/article/10.1007/s40520-021-02001-y
Tatum, P. E., & Mills, S. S. (2020). Hospice and palliative care: an overview. Medical Clinics, 104(3), 359-373. https://www.medical.theclinics.com/article/S0025-7125(20)30001-8/abstract
Example 3 zipporah
End-of-life care is a crucial aspect of healthcare for elderly patients. Palliative care and hospice care programs, while similar in some respects, differ in their goals and timing. Palliative care is intended for clients with active, serious, or terminal diseases and can be given jointly with other curative therapies (Antonacci et al., 2020). Thus, the hospice care is delivered to the patients with the diagnoses that are fatal, and who have less than six months to live and aims at making the patient as comfortable as possible disregarding the disease’s treatment. As a nurse, promoting end of life care means acknowledging patient self-determination and patient’s preferences. To be able to meet this need, there is need to communicate with them to know what they want, as well as educate them on what is available in the market (Antonacci et al., 2020). Staff nurses can support patient self-determination by making sure they are empowered to in ways like filling out advance directives or talking to family members on the patients’ behalf.
The patient and the families need similar support during this period. This paper explains how advance directives and Physician Orders for Life-Sustaining Treatment (POLST) are important means of recording preferences regarding the end of life (Testoni et al., 2020). Living wills note the patient’s broad preferences of care as well as the use of life prolonging therapies and are generally filled out when the patient is not seriously ill. While, POLST is a medical order to be completed for patients with life-limiting disease providing clear directives to the healthcare givers about certain procedures like resuscitation or intubation. Both are legal requirements and serve to guarantee that care delivery meets the patient’s wishes (Testoni et al., 2020). Through promoting patient centeredness, supporting legal requirements, and encouraging communication the nurses ensure elderly patients receive respect towards their dying moments.
References
Antonacci, R., Barrie, C., Baxter, S., Chaffey, S., Chary, S., Grassau, P., Hammond, C., Mirhosseini, M., Mirza, R. M., Murzin, K., & Klinger, C. A. (2020). Gaps in hospice and Palliative Care Research: A scoping review of the North American literature. Journal of Aging Research, 2020, 1–16. https://doi.org/10.1155/2020/3921245
Testoni, I., Sblano, V. F., Palazzo, L., Pompele, S., & Wieser, M. A. (2020). The Hospice as a Learning Environment: A Follow-Up Study with a Palliative Care Team. International Journal of Environmental Research and Public Health, 17(20), 7460. https://doi.org/10.3390/ijerph17207460
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