Question: E. L. is an 88-year-old widow who has advanced dementia. She is a retired secretary and is cared for in the home of

End-of-life care is an essential aspect of healthcare that requires careful consideration and thoughtful decision-making. Patients with advanced dementia like E. L. require unique care that takes into account their specific needs and preferences. The purpose of this paper is to provide guidance on artificial nutrition and hydration for E. L.’s daughter, who is seeking advice on her mother's end-of-life care. The paper will present five discussion points that reflect best practices in end-of-life care, guided by relevant literature.

Discussion Points

1. Goals of care and treatment options The first discussion point is to clarify E. L.’s goals of care and treatment options. End-of-life care decisions must align with the patient's wishes, values, and beliefs. Therefore, it is essential to establish E. L.’s end-of-life goals, which could be comfort care, life-prolonging care, or a combination of both. Once the goals are clear, the next step is to discuss the available treatment options, including artificial nutrition and hydration. Research has shown that providing artificial nutrition and hydration to patients with advanced dementia does not improve outcomes or quality of life (Givens, Selby, & Staley, 2012). Therefore, it is crucial to weigh the benefits and risks of this intervention and consider E. L.'s overall health status, including her underlying conditions and life expectancy.

2. Informed consent and decision-making The second discussion point is informed consent and decision-making. E. L.’s daughter is her power of attorney for health affairs, which means she has the legal authority to make decisions on her behalf. However, the decision-making process should be collaborative and involve E. L.’s healthcare providers, family members, and other relevant parties. The nurse has a critical role in obtaining informed consent for treatment, explaining the benefits and risks of artificial nutrition and hydration, and ensuring that E. L.’s daughter understands the implications of her decision (CNA, 2017).

3. Advance care planning and documentation The third discussion point is advance care planning and documentation. Advance care planning involves discussing and documenting end-of-life wishes and preferences while the patient is still capable of making decisions. E. L.’s advanced dementia makes it impossible for her to participate in such discussions actively. However, her daughter can provide guidance on her mother’s values, beliefs, and preferences, which can inform end-of-life care decisions. The nurse can facilitate this process by providing education on advance care planning, initiating discussions with E. L.’s daughter, and documenting the outcomes in E. L.’s medical record (CNA, 2017).

4. Palliative and comfort care The fourth discussion point is palliative and comfort care. Palliative care is an approach that focuses on improving the quality of life of patients with advanced illnesses, including dementia, by managing their symptoms, alleviating pain, and addressing their psychosocial and spiritual needs (ANA, 2015). Comfort care is an integral part of palliative care and involves ensuring that patients are comfortable and free from pain and distress. The nurse can work with E. L.’s healthcare team to develop a palliative care plan that addresses her specific needs and preferences and ensures that she receives compassionate and competent care (Miller, 2015).

5. Communication and family support The fifth discussion point is communication and family support. End-of-life care decisions can be emotionally challenging and stressful for families. Therefore, it is crucial to provide emotional support and open communication channels to E. L.’s daughter and family members. The nurse can facilitate family meetings, provide education on end-of-life care, and offer emotional support to E. L.’s daughter and family members. Effective communication can help alleviate anxiety, improve decision-making, and ensure that E.

   End-of-life care is an essential aspect of healthcare that requires careful consideration and thoughtful decision-making. Patients with advanced dementia like E. L. require unique care that takes into account their specific needs and preferences. The purpose of this paper is to provide guidance on artificial nutrition and hydration for E. L.’s daughter, who is seeking advice on her mother's end-of-life care. The paper will present five discussion points that reflect best practices in end-of-life care, guided by relevant literature.

   Discussion Points

6. Goals of care and treatment options The first discussion point is to clarify E. L.’s goals of care and treatment options. End-of-life care decisions must align with the patient's wishes, values, and beliefs. Therefore, it is essential to establish E. L.’s end-of-life goals, which could be comfort care, life-prolonging care, or a combination of both. Once the goals are clear, the next step is to discuss the available treatment options, including artificial nutrition and hydration. Research has shown that providing artificial nutrition and hydration to patients with advanced dementia does not improve outcomes or quality of life (Givens, Selby, & Staley, 2012). Therefore, it is crucial to weigh the benefits and risks of this intervention and consider E. L.'s overall health status, including her underlying conditions and life expectancy.

7. Informed consent and decision-making The second discussion point is informed consent and decision-making. E. L.’s daughter is her power of attorney for health affairs, which means she has the legal authority to make decisions on her behalf. However, the decision-making process should be collaborative and involve E. L.’s healthcare providers, family members, and other relevant parties. The nurse has a critical role in obtaining informed consent for treatment, explaining the benefits and risks of artificial nutrition and hydration, and ensuring that E. L.’s daughter understands the implications of her decision (CNA, 2017).

8. Advance care planning and documentation The third discussion point is advance care planning and documentation. Advance care planning involves discussing and documenting end-of-life wishes and preferences while the patient is still capable of making decisions. E. L.’s advanced dementia makes it impossible for her to participate in such discussions actively. However, her daughter can provide guidance on her mother’s values, beliefs, and preferences, which can inform end-of-life care decisions. The nurse can facilitate this process by providing education on advance care planning, initiating discussions with E. L.’s daughter, and documenting the outcomes in E. L.’s medical record (CNA, 2017).

9. Palliative and comfort care The fourth discussion point is palliative and comfort care. Palliative care is an approach that focuses on improving the quality of life of patients with advanced illnesses, including dementia, by managing their symptoms, alleviating pain, and addressing their psychosocial and spiritual needs (ANA, 2015). Comfort care is an integral part of palliative care and involves ensuring that patients are comfortable and free from pain and distress. The nurse can work with E. L.’s healthcare team to develop a palliative care plan that addresses her specific needs and preferences and ensures that she receives compassionate and competent care (Miller, 2015).

10. Communication and family support The fifth discussion point is communication and family support. End-of-life care decisions can be emotionally challenging and stressful for families. Therefore, it is crucial to provide emotional support and open communication channels to E. L.’s daughter and family members. The nurse can facilitate family meetings, provide education on end-of-life care, and offer emotional support to E. L.’s daughter and family members. Effective communication can help alleviate anxiety, improve decision-making, and ensure that E.