Peer Response – Florida Laws on Nurse Practitioners and Advanced Directives

Peer Response – Florida Laws on Nurse Practitioners and Advanced Directives

Responding to Jacqueline

Hello Jacqueline,

This is a great post. It is interesting to read about the legislation in Florida governing nurse practitioners’ participation in developing and signing advanced directives. The fact that NPs in your state can independently fill AD documentation is an essential aspect that indicates the growing awareness of their competence in providing holistic patient care. Your focus on the need for NPs to educate patients and families on the subtleties of these agreements and acting as facilitators during treatment preference discussions is critical in ensuring that patients make educated decisions about their future healthcare.

Your depiction of a situation from your prior work on the cancer step-down unit emphasizes the real-world scenarios in which palliative or hospice care can be useful. It is critical to handle such discussions with sensitivity and empathy, especially when dealing with younger patients who may find it emotionally difficult. As an NP, your suggested method reflects the patient-centered approach by consulting the patient’s family and offering clear explanations about the differences between palliative care and end-of-life care.

Your suggestions for enhancing vulnerable groups’ access to palliative and hospice care are also extremely useful. Educating policymakers, providers, and the general public about the role and significance of palliative care can help eliminate stigma and access hurdles (Siddiqui et al., 2023). Telehealth and mobile palliative care teams can be useful in expanding care to remote or underserved areas, ensuring that those in need receive the care they deserve (Rogers, 2023). These recommendations are in line with the changing healthcare landscape, particularly in light of improvements in telehealth services.

In conclusion, your discussion gives useful information about the legal framework for nurse practitioners in Florida, as well as the practical aspects of approaching patients in need of palliative or hospice care. Your proposals for enhancing access to these programs show a proactive approach to better serving marginalized people. Great job!

References

Rogers, T. (2023). A call away: Investigating a solution to healthcare access barriers in remote communities. Honors Theses. https://digitalcommons.colby.edu/honorstheses/1421/

Siddiqui, M. F., Nohra, L., Saleh, M., Thakkar, K., Trivedi, R., Moujally, S. N., Deeb, H., Nicolas, G., & Emmanuel, N. (2023). Pediatric oncology, palliative care and low- or middle-income countries: a call for action. Global Pediatric Health, 10. https://doi.org/10.1177/2333794×231188591

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Respond to Jacqueline

Discuss the laws in your state 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.

Advanced directives are legal documents in which an individual identifies a healthcare proxy and future care preferences when unable to make decisions for oneself (Auriemmaet al., 2022). As in many states, Nurse practitioners are often part of this process. In the state of Florida, NPs are permitted to create and sign advanced directives independently, without need for a physician to sign or cosign. Although NPs can do so independently there is a responsibility for the NP to educate patients and their families about the differences in documents such as living wills, durable power of attorney for healthcare and DNR. The NP should also serve as a facilitator when discussing treatment preferences, ensure the document is properly completed and signed, and regularly review and update the documents according to the patients’ preferences and needs.

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.

In the practicum setting I have yet to encounter a client who would benefit from a hospice or palliative care referral. My first job as a nurse was in an oncology stepdown unit and there, I was exposed to quite a few patients that would have benefited from that referral. One case the I can think of specifically was a young female in her mid 20’s who was diagnosed with stage 3 colon cancer. The patient had intractable pain, nausea, and vomiting and was no longer able to tolerate anything by mouth. As an NP the conversation with the patient could be difficult due to her age and nature of the conversation but it is important to approach the conversation with empathy, patience, privacy, and of course with the outmost respect for the patient’s autonomy. I would encourage the patient to have the family part of the conversation given palliative care is family centered. I would start by educating the patient and the family on the difference between palliative care and hospice care since the two are often confused and reiterate to the patient that speaking of palliative care does not mean end of life care. I would explain that a palliative care specialist is there to help manage symptoms, enhance quality of life, allow an opportunity to receive care outside of the hospital, and inform the benefit of palliative care includes providing emotional and psychological support for both patient and family. I would of course end the conversation by making myself available to the patient and family to answer any questions and address any concerns.

Discuss at least TWO recommendations you have for improving palliative and hospice care access to vulnerable and underserved populations in your community.

Two recommendations to improve palliative and hospice care to underserved populations in my community is to educate policymakers, providers, and the public about the role and value of palliative care and improve access to palliative care with technology like telehealth and mobile palliative care teams.

Through education to policymakers, providers, and the public you decrease the evident lack of familiarity, discomfort with the topic, and stigma (Purington,2019). Removing the stigma prevents providers, patients, and families from requesting services, or asking questions about palliative care. States can use public health to promote understanding and acceptance of palliative care, and resources to educate the public as they do with other community outreach efforts such as vaccinations and STD screens.

Improving access to palliative care with efforts such as telehealth would be my second recommendation to improve access to the underserved public in my community. Telehealth services are not limited to telephone or video calls but may also include mobile palliative care services. Telehealth allows people who live in remote areas, have issues with mobility, no means of transportation, or limited family support to receive consultation for symptom management and emotional support. Something like this has proven itself successful in South Carolina with a statewide program directed by an APRN (Watts et al., 2021), and I believe could be a benefit for patients requiring palliative and hospice care nationwide.

References

Allen Watts, K., Malone, E., Dionne‐Odom, J. N., McCammon, S., Currie, E., Hicks, J., Tucker, R. O., Wallace, E., Elk, R., & Bakitas, M. (2021). Can you hear me now?: Improving palliative care access through Telehealth. Research in Nursing & Health, 44(1), 226-237. https://doi.org/10.1002/nur.22105Links to an external site.

Auriemma, C. L., O’Donnell, H., Klaiman, T., Jones, J., Barbati, Z., Akpek, E., & Halpern, S. D. (2022). How traditional advance directives undermine advance care planning. JAMA Internal Medicine, 182(6), 682. https://doi.org/10.1001/jamainternmed.2022.1180Links to an external site.

Purington, K. (2019). States take up palliative care: NASHP’s work with the John A. Hartford Foundation. Forefront Group. https://doi.org/10.1377/forefront.20191119.500135Links to an external site.