SOCW 6204 WU Medical Social Work End of Life Care Case Study
End-of-Life Care: Case 2 Margaret is a 72-year-old female with severe cardiovascular disease. She is admitted to the hospital after a stroke. There is no indication that she will recover and, if so, to what level of functioning. The doctors have informed her family that she is experiencing cardiac issues that might lead to heart failure. Should this happen, the doctors will have to take efforts to resuscitate her. The medical social worker and the doctor meet with the family to discuss a do not resuscitate order. The family is completely overwhelmed. They do not fully understand what the doctor is saying and they are in disagreement about what to do. Respond by Day 5 to at least two different colleagues’ postings in one or more of the following ways: Comment and elaborate on the scope of practice of a medical social worker that your colleague shared. Critique your colleague’s post and/or share additional conclusions or insights about the legal ramifications of living wills, medical power of attorney, and advance directives. Recommend an additional advocacy role of the medical social worker in the case your colleague selected. Be sure to USE REFERENCE!! DB 1 Logan-- An explanation of how you as a medical social worker would handle the case you selected. I have chosen case 2, working with Margaret and her family. As a medical social worker, I would work with Margaret and her family to help explain what a DNR is and the process of how to obtain one. According to the NASW Code of ethics (2017), states that social workers should advocate for the needs, decisions, and rights of clients in palliative and end of life care. According to Gehlert &Browne (2019), advance directive are written documents completed by an individual that specify treatment preference for healthcare decision making. Advance directives often include DNR’s that have been signed off by a physician. Explain the services you might offer to the family within the applicable laws and your scope of practice. According to Gehlert & Browne (2019), some services a social worker may offer are; counseling, validate, normalize, and encourage expression of feelings, facilitate support groups, facilitate family care plan meetings, encourage effective communication, provide case management and discharge planning, and client advocacy. When working with Margaret’s family, I would encourage, validate, normalize, and encourage expression of feelings, make referrals to support groups, help to facilitate care plan meetings, encourage effective communication, provide case management and discharge planning, and client advocacy. Explain the methods and practices you might employ to educate this family regarding the legal issues surrounding the case. The methods and practices that I might employ to educate this family regarding the legal issues surrounding the case, would be to facilitate a family care plan meeting with the doctor present, in order to answer their questions about DNR, and to encourage communication between her family members in order to come a solution with all members present for the best interest of the patient. The legal issues will be resolved once, the family understands a what a DNR is and the process of obtaining one. Then, explain the purpose, benefits, and legal ramifications of living wills, medical power of attorney, and advance directives. The purpose, benefits, and legal ramifications of living wills, medical power of attorney, and advance directives, are to help, determine end of life decisions for the patient. According to Gehlert & Browne (2019), advance directive are written documents completed by an individual that specify treatment preference for healthcare decision making. According to Gehlert & Browne (2019), a durable power of attorney for health care involves the legal appointment of an individual to speak for a person should that person no longer be able to make decisions for himself or herself. According to Gehlert & Browne (2019), a living will is a directive to a physician and healthcare that states a persons wishes about life-prolonging treatment should be provided or withheld should they lose the ability to communicate those wishes. Finally, explain the advocacy role you might play on behalf of the patient and patient’s family in this case. The advocacy role that I might play on behalf of the patient and patients’ family in this case, is too encourage communication within the family and with the patient in order to determine if they would like a DNR order, or a living will, advance directive or power of attorney to be put in place in the case of end of life care. Reference: Gehlert, S., & Browne, T. (Eds.). (2019). End-of-life care. In Handbook of health social work (3rd., pp. 569-584). Wiley. https://doi.org/10.1002/9781119420743 National Association of Social Workers. (2004). NASW standards of social work practice in palliative & end of life care. Retrieved from https://www.socailworkers.org/LinkClick.aspx?flieticket=xBMd58VwEhk%3d&portaql-id=0 DB 2 Nicole, An explanation of how you as a social worker would handle the case you selected. Margaret is a 72-year-old female with severe cardiovascular disease. She is admitted to the hospital after a stroke. There is no indication that she will recover and, if so, to what level of functioning. The doctors have informed her family that she is experiencing cardiac issues that might lead to heart failure. Should this happen, the doctors will have to take efforts to resuscitate her. The medical social worker and the doctor meet with the family to discuss a do not resuscitate order. The family is completely overwhelmed. They do not fully understand what the doctor is saying, and they disagree about what to do. I would help the family facilitate and coordinate a patient focused care plan after discussion with the interdisciplinary team and understanding their process moving forward. Identifying appropriate interventions while educating the family in preparation for end of life treatment (Gehlert & Browne, 2019). Also, validating the family’s feelings and being understanding and remaining calm easing their burden of feeling overwhelmed concerning Margaret’s situation. Explain the services you might offer to the family within the applicable laws and your scope of practice. While validating the families feelings of being overwhelmed and not fully understanding what the doctor is saying, I will effectively communicate coping mechanisms while educating the family (Gehlert & Browne, 2019) on the prognosis Margaret’s stroke, her chance of recovery from it, if she does her possible level of functioning thereafter, ensuring they understand the cardiac issues that may lead to possible heart failure and risks in resuscitation. A provision of counseling will be made available along with community resource of support groups. Engaging the family in navigating the system while continually meeting with them to ensure a level of comfortability and trust as they decide on Margaret’s quality of care. I will make sure the family understands the doctor’s decision-making process and provide them with the information in a manner that they will understand (Gehlert & Browne, 2019). To meet with the family to discuss Margaret’s age related multimorbidity’s is influencing the doctor’s decision to look at withholding cardiopulmonary resuscitation during cardiac arrest (de Decker et al., 2014). Ensuring the family understands this will help in making an informed decision. This information allows the family to understand the end of life journey and to be able to put into perspective and discuss the possible path of dying and death (Cagle & Kovacs, 2009). Explain the methods and practices you might employ to educate this family regarding the legal issues surrounding the case. I will employ the methods and practices by educating the family on the advance directive Margaret filled out, appointing her daughter as power of attorney. I will provide the daughter/family with information on Margaret’s prognosis with an understanding of the possibilities of what to expect concerning Margaret’s medical condition and being there for family support. I will remain calm in doing so and showing empathy towards the family in this time of crisis. I will promote self determination by providing the daughter/family with informational support so she can better understand from her perspective to be able to deal with the prognosis and care options discussed with myself and the doctor (Cagle & Kovacs, 2009). Explain the purpose, benefits, and legal ramifications of living wills, medical power of attorney and advance directives. The purpose of living wills, medical power of attorney and advance directives is to provide the individual with their wishes about end of life treatment. It is a legal appointment of a person to speak for another should they no longer be able to make decisions for themselves. A living will is a guide for physicians/doctors to provide medical care in keeping with the wished of the patient (Gehlert & Browne, 2019). In this case Margaret has an advanced directive in which she specifies her end of life treatment, but it does not specify about cardiopulmonary resuscitation. However, her daughter who is her proxy who now must make that decision due to Margaret’s inability to make the decision for herself and her decline in health status. The daughter has the legal authority to make the decision, but she wants to include the family and agree. Effective communication is necessary in this process to respect everyone’s point of view and understand their position as well understanding the care plan for the patient (ABA, 2006). Explain the advocacy role you might play on behalf of the patient and patient’s family in this case. The advocacy role I might play on behalf of the patient and her family is to assist the family in negotiating the goals of care while navigating through the systems of care. I will address the quality of life issues while meeting with the family and doctor concerning the likely outcome of cardiopulmonary resuscitation for Margaret. I will support the family in their decision of choice and ensuring proper treatment. I will be the link in effectively communicating the concerns and needs of the patient to the doctors and the proxy (NASW, 2004). Cagle J. G. & Kovacs, P. J. (2009). Education: a complex and empowering social work intervention at the end of life. Health and Social Work, 34(1), 17-27. de Decker, L., Annweiler, C., Launay, C., Fantino, B., & Beauchet, O. (2014). Do not resuscitate orders and aging: impact of multimorbidity on the decision-making process. J Nutr Health Aging, 18(3), 330-335. Gehlert, S. & Browne, T. (Eds.). (2019). End-of-life-care. In Handbook of health social work (3rd., pp.569-584. Wiley. [Vital Source e-reader]. National Association of Social Workers (2004). NASW standards for social work practice in palliative & end of life care. Retrieved from https://www.socialworkers.org The American Bar Association Commission on Law and Aging (2006). Making medical decisions for someone else: A Maryland handbook. Retrieved from https://americanbar.org/content/dam/aba/administra...
