Guidelines for Risk and End of Life Decision In Health Care and Nursing Education

Health Care and Nursing Education and Guidelines for Risk and End of Life Decision

What Is Concept of Risk,Guidelines for  Risk In Health Care  and Nursing,End of Life Decisions Making In Health Care and Nursing.

What Is Concept of Risk

    Especially when the balance of potential harms and benefits from treatment options is close, patient understanding of numerical expressions of risk is central to health decision making. Yet, many current practices in expressing and communicating risk are not research based. For example, in the field of genetic counseling risk has traditionally been expressed in proportions (1 in 112) rather than in rates (8.9 per 1,000). 

    In two studies, understood rates were significantly better than they did proportions (Grimes & Snively, 1999; van Vliet, Grimes, Popkin, & Smith, 2001). Women with little formal education had difficulty understanding risks framed either way.

Guidelines for  Risk In Health Care  and Nursing

    The European Community guideline descriptions of risk very common, common, uncommon, rare, and very rare-led to significant overestimation of the likelihood of adverse effects (Berry, Raynor, Knapp, & Bersellini, 2003). And although drugs are exhaustively tested before marketing, the wording in the information sheets that accompany them is not tested at all.

    Visual communication of risk is often helpful. Line graphs are excellent for conveying trends, and pie charts help in depicting proportions. Figure 3.1 depicts a visual means of communicating risk. Another helpful approach is to use a common denominator. If risk is expressed as 1 in 25 or 1 in 200, individuals frequently think 1 in 200 is a bigger risk, presumably because the denominator is larger (Paling. 2003). Clearly, much work remains to be done in developing means of expressing risk reliably understandable by various populations. 

End of Life Decisions Making I Health Care and Nursing 

    Two ways in which educational interventions can be of help in making end-of-life decisions include encouraging a higher completion rate of advance directives (ADs) and information in managing end-of-life care. Written materials alone fail to ensure completion of ADs. 

    Supplemented with educational interventions by health care providers, individualized information and counseling sessions, and use of videos and case scenarios result in higher completion rates. 

    Using such interventions, the Let Me Decide AD program showed a 49% completion rate among competent residents and a 78% completion rate among families of incompetent residents. Intervention in nursing homes resulted in fewer hospitalizations per resident and less resource use. As ever, this program did require investment in a full time staff member for 6-8 months (Molloy et al., 2000).

    At end of life, the balance between encouraging use of advanced supportive technology when it is of benefit, but limiting its burdens when it is ineffective, is frequently difficult to achieve. 

    Because it is difficult for patients and families to accept that technology has become ineffective or will not result in a functional outcome that is acceptable to the patient, access to palliative care is often delayed for dying critically ill patients, and they continue to consume a disproportionate amount amount of intensive care resources. 

    One trial (Lilly et al., 2000) educated patients and family about appropriate clinical milestones and held formal family meetings after the provider team had reached consensus that restoration of function or survival were unlikely. Failure to meet these milestones allowed patient and family to know that advanced supportive technology had been ineffective and that it was time to explore alternatives including palliative care. 

    Intensive communication in this intervention accomplished greater concordance among patients, families, and providers and resulted in fewer preterminal days of intensive care for dying patients. Because this trial was neither randomized nor double blinded, additional evidence must be sought.