Clinical Decision Making in Palliative Care and End of Life Care.
Summary of "Clinical Decision Making in Palliative Care and End of Life Care."
Clinical decision making involves a consideration of multiple factors; clinical options are constructed based on the objective clinical data and evidence-based standards. Technologic advances have led not only to life saving interventions, but also to the use of these technologies when benefit to the patient was unclear or unexamined. The cases of Karen Quinlan, Nancy Cruzan, and Terri Schiavo provide a framework for examining the evolution of clinical decision making, including when to use or not to use technologies such as ventilators and artificial nutrition and hydration, and the role of specific questions in the process. Advance directives are a means to convey patient preferences, however, in the absence of advance directives, skilled questioning can elicit patient preferences. Nurses' roles in clinical decision making are often nebulous but can be enhanced by understanding these interrelated processes, as well as by knowing the policies and procedures of their institutions.
Affiliation
Palliative Care and Ethics, School of Nursing, George Mason University, 4400 University Drive, Mail Stop 3C4, Fairfax, VA 22030, USA.
Journal Details
This article was published in the following journal.
Name: The Nursing clinics of North America
ISSN: 1558-1357
Pages: 345-362
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20804882
- DOI: http://dx.doi.org/10.1016/j.cnur.2010.03.002
Medical and Biotech [MESH] Definitions
Decision Support Systems, Clinical
Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.
Patient Self-determination Act
The purpose of this 1990 federal act is to assure that individuals receiving health care services will be given an opportunity to participate in and direct health care decisions affecting themselves. Under this act, hospitals, health care agencies, and health maintenance organizations are responsible for developing patient information for distribution. The information must include patients' rights, advance directives, living wills, ethics committees' consultation and education functions, limited medical treatment (support/comfort care only), mental health treatment, resuscitation, restraints, surrogate decision making and transfer of care. (from JCAHO, Lexicon, 1994)
Progressive Patient Care
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
Decision Support Techniques
Mathematical or statistical procedures used as aids in making a decision. They are frequently used in medical decision-making.
Palliative Care
Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed)
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