NR 341 Week 2 Client Comfort and End of Life Care

Student Name

Chamberlain University

NR-341 Complex Adult Health

Prof. Name

Date

Reflective Journal

During the hospice care simulation, I drew upon my prior clinical experiences, particularly in the Neurological Unit at St. Joseph’s University Medical Center in Paterson. In my role, I often care for patients experiencing initial or recurrent strokes, many of whom present with multiple comorbidities that complicate treatment. Over time, I have witnessed the emotional toll of such conditions not only on patients but also on their families.

In one instance during the simulation, the patient expressed a wish to discontinue treatment due to fatigue and emotional exhaustion. However, her daughter rejected these wishes, reflecting a common yet emotionally charged family response. Such situations can cause patients to experience feelings of guilt, making them continue treatments they no longer desire.

To enhance my professional practice, I would focus on prioritizing transparent communication with patients and their families. This is particularly critical in end-of-life care, where emotions often overwhelm rational decision-making. Direct conversations with patients create a safe environment for them to express their preferences openly. I also believe that meeting with patients privately before involving family members allows them to share their authentic wishes without external influence. By addressing their concerns in a supportive manner, nurses can uphold patient autonomy while also providing emotional support to families.

Question One

What responsibilities do nurses have regarding pain management, particularly in patients with a history of substance use?

According to the New Jersey Board of Nursing, registered nurses are legally and ethically responsible for ensuring that patients’ pain is assessed and managed effectively. Similarly, the American Nurses Association (ANA) emphasizes that alleviating pain and suffering is a core ethical obligation for all nurses.

To fulfill this responsibility, nurses must complete a thorough medical history, which includes identifying the nature, frequency, and severity of pain, as well as exploring any history of substance use or dependency. A well-documented assessment enables accurate nursing diagnoses and tailored pain management strategies.

When substance use history is present, nurses should apply additional caution. They may need to evaluate non-opioid medications, employ alternative therapies (e.g., relaxation techniques, physical therapy, or integrative modalities), and collaborate with interdisciplinary teams to balance effective pain relief with patient safety.

Responsibility	Description
Ethical duty (ANA)	Nurses must relieve suffering and promote patient dignity.
Legal duty (NJ BON)	Pain management is a regulated responsibility requiring safe and effective interventions.
Pain assessment	Includes history-taking (nature, frequency, severity, prior interventions).
Substance use consideration	Careful planning to avoid dependency risks, with exploration of alternative pain control.

Question Two

Who is legally authorized to make medical decisions in New Jersey when a patient lacks a medical power of attorney?

In New Jersey, if a patient does not have an appointed medical power of attorney, state law outlines a hierarchy of decision-makers. This ensures that medical decisions are made in the patient’s best interest by those closest to them.

Authorized Decision-Makers	Examples of Responsibilities
Court-appointed guardian/conservator	Can approve or decline treatments, hospital admission/discharge.
Spouse/domestic partner	May consent to or refuse treatment, medications, and care plans.
Adult child	Holds authority to make care-related choices, including access to records.

These individuals are empowered to make critical decisions such as initiating or discontinuing treatment, approving hospital admissions, or granting access to medical information (Durable Powers of Attorney for Health Care, 2016).

Question Three

How is patient incapacity defined under New Jersey law?

New Jersey law defines incapacity as a condition where a patient is unable to make informed medical decisions, confirmed by the attending physician with a reasonable degree of medical certainty. This assessment includes the underlying cause, extent of impairment, and the likelihood of recovery.

An incapacitated patient is typically one who, due to mental illness, cognitive decline, or intellectual deficiency, cannot manage personal or medical affairs effectively (Assembly Health and Senior Services Committee, 2011). Physicians must document their assessment clearly, ensuring that legal standards are upheld and that surrogate decision-makers are appropriately identified.

Criteria for Incapacity	Explanation
Physician determination	Must be confirmed with reasonable medical certainty.
Assessment elements	Cause, extent, and potential for recovery are evaluated.
Legal definition	Inability to manage personal or medical affairs due to mental illness or deficiency.

References

American Nurses Association. (2018). Code of ethics for nurses with interpretive statements. ANA.

Assembly Health and Senior Services Committee Statement to Assembly, No. 4098 State of New Jersey. (2011). Retrieved from https://www.njleg.state.nj.us/2010/Bills/A4500/4098_S1.PDF

NR 341 Week 2 Client Comfort and End of Life Care

Durable Powers of Attorney for Health Care. (2016). LawHelp.org. Retrieved from https://www.lawhelp.org/dc/resource/frequently-asked-questions-about-durable-power

New Jersey Board of Nursing: Law and Public Safety. (2020). Retrieved from https://www.njconsumeraffairs.gov/regulations/Chapter-37-New-Jersey-Board-ofNursing.pdf