Advanced Directives in California- Nurse Practitioner’s Role and Legal Responsibilities
In the shifting world of medical services, the role of Family Nurse Practitioners (FNPs) is very important as they deal with the multifaceted needs of older adults and their respective families. FNPs are essential in providing patient-centered care by assessing, diagnosing, and managing the health challenges that accompany aging taking into consideration cultural preferences and values (Kwame & Petrucka, 2021). This collaborative café becomes a place where FNPs can discuss other crucial areas of their job, such as the signing and creating advance directives (ADs), proper referral to hospice and palliative care, and suggestions on improving access to these services for the less privileged. By way of significant dialogues, FNPs can have the competency to offer competent and comprehensive care and eventually be among those who can lead the nursing profession to greater heights.
Laws Related to NP’s Role in Creating and Signing Advanced Directives (ADs) in California
In California, Nurse Practitioners (NPs) enjoy a great degree of freedom in making medical decisions, including the creation and signing of advance directives (ADs), as stipulated under the California Nursing Practice Act (NPA) (California Board of Registered Nursing, 2023). California Nursing Practice Act specifies the range of functions that can be performed by NPs, letting them independently complete ADs and not necessarily involving medical doctors and their signatures. This legislation emphasizes the trust given to NPs in performing holistic care, particularly towards the end of life, or in advanced care planning. The new law giving NPs a central role to play in the long-standing advance directives process in California is in line with the evolving scope of practice for APRNs which recognizes nurses’ expertise in respecting patient autonomy and facilitating patient-centered care. This legislative support is not only for access to essential healthcare services but also for the indication of professional care toward the total well-being of their patients, which is an indication of their role as advocates.
Identification of a Client Who May Have Benefited from a Referral to Hospice or Palliative Care
In my practice, I met a 78-year-old patient who was in an advanced stage of pancreatic cancer. She responded to the aggressive therapy, but in the end, her condition continued to worsen, affecting her severely both physically and emotionally. She mentioned that she would like to spend the rest of it in the peace of her home with her near and dear ones. While her condition was alleviated, inadequate treatment made her condition worse and lack of emotional support reduced her quality of life.
This client could have been referred to hospice or palliative care services, which would have highly benefited her. Hospice would have covered all aspects of symptom management, such as pain and nausea, with special attention to psychological and soul-searching issues. Aside from the comfort and dignity provided by palliative care, it could have also helped her in the decision-making concerning the treatments as she needed to maximize comfort and respect for her preferences.
To start with, as an NP addressing the client will require empathy, compassion, and truthfulness (Molina-Mula & Gallo-Estrada, 2020). I would begin by emphasizing that she had all the right to feel as she did. Next, I would bring up the idea of hospice and palliative care as other options that can make things at this time less difficult for her. I would put the accent on the fact that these services are for improving her quality of life and for providing individualized care that matches her needs and preferences. Besides, I would arrange the referral procedure and pay attention to the patient’s transitions and family’s support.
Recommendations for Improving Palliative and Hospice Care Access to Vulnerable and Underserved Populations
Increase Community Outreach and Education
Developing ties with community organizations, local centers, and religious groups, to shape public opinion about palliative and hospice care would be helpful (Rego et al., 2020). Further, providing culturally sensitive educational materials in multiple languages to cater to different people. Lastly, organizing workshops and informational sessions to explain the main misconceptions and fears that people have about end-of-life care would be helpful
Enhance Interdisciplinary Collaboration
Collaborations should be established between healthcare professionals, social workers, clergy, and community leaders to reduce any barriers that would prevent underserved populations from obtaining palliative and hospice care. Secondly, referral networks and mechanisms of care coordination should be established to allow for prompt and equitable access to the services required.
References
California Board of Registered Nursing. (2023). Nursing Practice Act. Ca.gov. https://www.rn.ca.gov/practice/npa.shtml
Kwame, A., & Petrucka, P. M. (2021). A literature-based Study of patient-centered Care and Communication in nurse-patient interactions: Barriers, facilitators, and the Way Forward. BMC Nursing, 20(158), 1–10. BMC Nursing. https://doi.org/10.1186/s12912-021-00684-2
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835
Rego, F., Gonçalves, F., Moutinho, S., Castro, L., & Nunes, R. (2020). The influence of spirituality on decision-making in palliative care outpatients: A cross-sectional study. BMC Palliative Care, 19(1), 1–14. https://doi.org/10.1186/s12904-020-0525-3
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Question 
Preparing the Assignment
Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.
Family nurse practitioners often care for older adults as they experience changes in functional health. Assessments may reveal that clients are unsafe in their current environment or that they may require additional assistance to remain at home. Carefully read the questions below and address each in your initial post.
Advanced Directives in California- Nurse Practitioner’s Role and Legal Responsibilities
Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
Discuss the laws in your state (CALIFORNIA) related to the nurse practitioner’s (NP) role and responsibility in creating and signing advanced directives (ADs). Indicate if the NP can independently complete AD documents or if a physician is required to sign or cosign the documents.
Consider clients you’ve encountered in practicum (or in your practice as a registered nurse). Identify at least ONE client who may have benefited from a referral to hospice or palliative care. Indicate why this client would have benefited from these services. Describe how as an NP you might approach the conversation with the client.
Discuss at least TWO recommendations you have for improving palliative and hospice care access to vulnerable and underserved populations in your community.