You must respond to two students who have chosen the other question. Always construct your responses in a word processing program like Word. Check for grammar, spelling, and mechanical errors. Make t

Bell,

2- Do you feel hospice care is appropriate? Why or why not?

                 Hospice care is a practical and the most appropriate option for Mr. Shoemaker given his advanced age, the chronic and progressive nature of his kidney disease, and his wishes. Hospice care focuses on providing comfort and quality of life rather than curative treatments, which aligns with Mr. Shoemaker's desire to stop dialysis and avoid feeling awful after treatments. According to the National Hospice and Palliative Care Organization, hospice care is intended for patients who have a prognosis of six months or less to live if the disease follows its usual course (NHPCO, 2020). Based on that and given Mr. Shoemaker's condition, I believe hospice care will be appropriate.

                Also, hospice care can offer several benefits for Mr. Shoemaker. It provides a multidisciplinary approach to manage symptoms such as pain, breathlessness, and fatigue, which are common in end-stage renal disease (ESRD) patients (Brown et al., 2018). Additionally, hospice care can deliver psychological and emotional support, which is crucial considering Mr. Shoemaker's feelings of isolation and grief after his wife's passing. This is a more holistic approach to ensure that Mr. Shoemaker can spend his remaining time with dignity and comfort, which is a fundamental principle of hospice care (Ritchie et al., 2020). Still, by opting for hospice care, Mr. Shoemaker will avoid unnecessary hospital admissions and aggressive treatments that may not significantly improve his quality of life. This decision respects Mr. Shoemaker's autonomy and aligns with the ethical principle of beneficence, prioritizing his comfort and overall well-being (American Nurses Association, 2015).

Katherine,

Do you feel hospice care is appropriate?  Why or why not?

I feel Hospice is an appropriate decision for Mr. Shoemaker in his current state. I would like to consider the patients baseline status for ADLs and emotional state. and determine how much of this current presentation is related to anemia and weigh that with how easily correctable this is before discussing this option with the patient. There is a chance that in this moment, he is feeling an emotional low and may feel less inclined to accept treatment compared to when he is feeling better. In addition I want to consider the cause of his anemia prior to correcting it with a blood transfusion. Is the patient anemic due to malnourishment which can be corrected by diet? Or, is he anemic due to the CKD and his body not generating Erythropoietin? Or, is he anemic due to blood loss from hemodialysis? These questions are important to answer prior to making the decision on hospice because this will provide us with more information on the need for continued transfusions and may impact the decision. 

Mr. Shoemaker expresses ideas such as “he has lived a good life” and how now he only “has one or two days a week where he feels okay” which indicate he has reached acceptance with the ideas of end of life and he might be happier with more supportive treatment and a higher quality of life as he lives out his remaining days. These two things are a primary focus at a hospice facility.

Due to the extent of Mr. Shoemaker’s condition he requires heavy assistance with ADLs and is high risk for self-care deficits. In addition, he requires aggressive treatment including hemodialysis three times a week, strict I/Os, blood transfusions ect. All of these interventions leave Mr. Shoemaker lacking in autonomy and heavily dependent. In addition, Mr. Shoemakers advanced age leaves him more susceptible to complications such as infection during prolonged hospitalization, skin breakdown and ulcers ect.

Hospice Care has a primary focus on palliative care which includes medical care with a focus on symptom management and stress management. (Keister, 2023) Mr. Shoemaker is not cognitively impaired and demonstrates appropriate orientation and based on his assessment documentation, I do believe he is capable of making a rational decision regarding this if he is presented with an adequate explanation of what hospice is and what he can expect.