Assignment: Clinical Resolution

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Assignment: Clinical Resolution

I need a power point presentation

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

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

To help ease the altercation, the physician noted that the patient was still capable of making decisions and asked the patient in front of his daughters what he wanted to do. The patient stated clearly that he could not breathe and that he wanted his pain relieved and his shortness of breath better managed. The patient also verbally acknowledged that, “I am dying, help me.” The physician expressed to the daughters that her obligation and duty as a medical professional was to treat their father, and that she therefore would be doing so. When the daughters left the room, the physician also cautioned them against having such disagreements in front of their father; rather, they should make every effort to ensure their father’s final memories would not be of family dysfunction or conflict.

Both nonpharmacologic and pharmacologic options were presented for the relief of his severe shortness of breath and congestion. As part of the patient’s management strategy and after having discussed his alternatives, the patient with the support of his proxy verbally consented to start scheduled opioids and anticholinergics. Once again, the non proxy daughter challenged the use of medication. At this point, the attending physician reminded the daughter that her father’s death was imminent “with or without the use of medications for symptom control” and described what she could expect over the ensuing hours in either scenario. It was made clear that the degree of suffering her father would experience in the last period of his life would be very much dependent upon the decision to use appropriate analgesics and other therapies. The concept of accepting some risk for appropriate symptom control at the end of life was further discussed, as well as methods for selecting and titrating medication sin order to minimize that risk as much as possible. The patient was able to direct his care and felt relief within a short time after the appropriate combination of medications was initiated.

The doctor struggled to provide the care necessary to ameliorate the patient’s suffering, which she succeeded to do. But the majority of the time the non proxy daughter hovered over, sometimes taking an adversarial stance towards the physician and the PCU staff.

She arrived with a range of complaints about her father’s final hours and a subliminal threat that she would sue the organization 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

Assignment: Clinical Resolution

Assignment: Clinical Resolution

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