Plan Of Care: Communication And Care Of Patient With Multisystem Failure Sample College Essay


It is apparent that nursing care for a patient in multisystem failure requires more than physiological care tools. That is, it involves working with the family of the patient, particularly when it is evident that the patient is in an end-of-life situation. In such a scenario, communication becomes the fundamental tool of care. This plan discusses fundamental communication issues of palliative care, advanced directives and organ donation, provision of a humane and healing environment, ethical issues related to end-of-life situations, the interdisciplinary team for such care, and other important healthcare issues from the perspective of the patient’s family. Realistically, issues are not experienced or occur in a linear fashion but are likely to happen concurrently. However, for orderliness and simplicity, I have discussed them separately.

Palliative care for the patient

Effective communication is vital for a patient with an uncertain future. A terminally ill patient needs an honest disclosure, to pursue realistic hopes as well as reorganize his or her priorities and make adaptations in coping with the process (Siminoff, 2001). According to the American Nurses Association (2003), nurses have a duty to educate patients and families about end-of-life issues, to encourage the discussion of life preferences, to communicate relevant information for any decision, and to advocate for the patient. To achieve this, I’ll be initiating optimal interaction with a patient. Pierce (1999) specifically states that a nurse fulfills three critical communication tasks in end-of-life care: (a) they create an environment conducive to communication, (b) they ease the interaction between physician and patient, and (3) they facilitate interaction between family and patient.

Communicating advanced directives and organ donation

Dealing with the administration of advance directives has a possibility of causing a conflict between the advanced instructions and the contemporaneous patient and family interests. Practically, the judicial resolution is seldom used to solve such cases. It, therefore, means that it is the responsibility of the nurse to interpret an advanced directive to accord with the contemporaneous interest of the patient. In other words, as the nurse in charge, I am legitimately allowed to examine whether the issuer of the directive really contemplated and intended to encompass the situation confronted at present. When the assessment reveals that implementing such a directive will obviously cause harm to the incapacitated patient, it is necessary that such a directive be given a second thought or ignored completely to allow for an action that complies with the present situation. According to Cantor (1993), even if the advanced directive is misinterpreted by the nurse or implementers, it is common that decisions to favor the perceptible, contemporaneous interests of a now incompetent patient will seldom be challenged or overturned- Medical staff, surrounding family, and courts are likely to acquiesce in decisions to maintain an ostensibly happy patient or allow a severely anguished patient to die, regardless of the apparent intention of the directive (Cantor, 1993, p.112).

However, commentators have varied responses as concerns this controversial issue. A few have argued that prior directives must prevail, no matter the outcome. But Professor Dresser cited in Cantor (1993), argues that an advanced directive should not be followed if the incompetent patient has any significant interest in the continued life-meaning a capacity to interact with the environment (p. 113). Cantor (1993) agrees that in some situations where a directive calls for withholding life-preserving medical intervention from an apparently content, though demented patient, it should not precede other decisions to continue preserving such a life. In such a scenario, the nurse should discuss the issue with the family and the decision reached should precede all the previous directives (Cantor, 1993).

Passing information that will involve advanced action on the patient such as organ transplant and a donation can be complex because information alone is never sufficient (Pierce, 1999). For instance, it would involve getting informed consent from the family members (Siminoff, 2001, p. 72). One study established that in the United States, about 25% of family members are not in favor of donation (Siminoff et al., 2001, p. 74). In this case, information must be given the inappropriate context of educational, developmental level (patient’s age), stress level, and time constraints (Siminoff, 2001). Pierce (1999) says the process should start with the nurse listening to the patient’s concerns without interrupting, explaining the technical medical terms involved, conveying empathy through acknowledgment of the family and patient’s concerns, and offering encouragement to the patient to continue expressing the concerns.

Provision of a humane and healing environment

A conducive environment for end-of-life care is that which has a humane nature. According to Coyle & Sculco (2003), an effective environment is essential and should take place in a comfortable, private area and not at the patient’s bedside (p.206). It’s my duty to ensure the environment is comprised of people who have been accepted by the family members. Then the focus would be on the patient, where he or she will disclose the people to be entrusted with the medical information.

Many have agreed that even though having a well-designed physical facility fit for healing is important for end-of-life care, the programs designed for the period of care are equally important. Flesner & Rantz (2004) say that the cornerstone of any long-term care facility is its activities program, which becomes the healing program. Such programs may entail artwork and theatre performances such as dancing, singing, playing a musical instrument, storytelling, and other visual arts like painting and knitting (Flesner & Rantz, 2004). Coyle & Sculco (2003) further notes that such programs can be made successful through a partnership between staff members with such talents and the family members.

Sensitivity to cultural, religious, spiritual, racial, gender, and language are ethically critical in the communication process. According to Pierce (1999), not only is it important to appreciate verbal cues, but also nonverbal cues (p.12). Common knowledge informs us that communication varies in different cultures. In such a case, it’ll be ethically right to focus communication towards beneficence. Any form of disclosure must be viewed in the context of the patient and the family, with an understanding of and respect for their values and beliefs (Pierce, 1999).

It thus follows that good care provision for a dying patient needs a lot of background knowledge of the patient’s ethical issues related to end-of-life or death (Cavalieri, 2001). This is to ensure that the patient’s autonomy is observed despite all the drawbacks such inability to make a decision or talk. Some of the issues that are likely to emerge are the use of artificial nutrition in a case where the patient’s ethical belief does not allow such intervention, a request for nurse-assisted suicide, and a patient’s demand for particular traditional methods of treatment to be carried out in conjunction with the contemporary medicine (Cavalieri, 2001). According to Cavalieri (2001), the nurse should be ready to incorporate spiritual issues in such scenarios to maintain his or her integrity as a moral agent.

The interdisciplinary team for care

It’s my role as the nurse in charge to coordinate the whole team and be the link between the team and the family members. Other members of the team would include physicians, social workers, and other clinicians. This diverse group requires proper coordination to effectively support the patient and the family. Scheduling a meeting between the team and the patient and his or her family is important in that it helps in information sharing (Pierce, 1999). Such information includes medical facts, prognosis, treatment options, and source of support and guidance (Pierce, 1999, p.13). Such meetings promote collaborative care by allowing the team to review the information in order to provide a unified and consistent message to the patient and family. I’ll ensure proper scheduling to allow the patient and the family to prepare emotionally and psychologically (Pierce, 1999). But the first important thing is to assess the patient’s physical, emotional, and psychological concerns so as to help the team plan the points for discussion during the meeting (Coyle & Sculco, 2003).

Other healthcare issues

Other than the issues highlighted above, the timing of the communication is critically important. The following ‘urgent’ issues as defined by Quill, cited in Coyle & Sculco (2003) will initiate immediate communication: (1) the patient is facing imminent death; (2) the patient is talking about wanting to die; (3) the patient or family is enquiring about hospice; (4) the patient has recently been hospitalized for severe progressive illness; and (5) the patient is experiencing severe suffering and poor prognosis (p.209). Coyle & Sculco (2003) thus note that end-of-life communication is more ‘routine’ circumstances; when stability or recovery is predicted, it normalizes the discussion of advanced care planning. To ensure effective communication, I will have to be sensitive, simple, straightforward, and understanding in terms of language.

Reference List

American Nurses Association. (2003). Position Statement on Nursing Care and Do-Not Resuscitate (DNR) Decisions. Washington, DC: ANA.

Cantor, N. (1993). Advanced Directives and the Pursuit of Death with Dignity. Indiana: Indiana University Press.

Cavalieri, T. (2001). Ethical issues at the end of life. JAOA. Vol 101, No.10. 616-624.

Coyle, N. & Sculco L. (2003). Communication and patient/ physician relationship: Phenomenological inquiry. J Support Oncol., 1:206-215.

Flesner, M., & Rantz M. (2004). Mutual empowerment and respect: Effect on nursing home quality of care. Journal of Nursing Care Quality, 19:193-6.

Pierce, S. F. (1999). Improving end-of-life care: Gathering questions from family members. Nurs. Forum, 34:5-14.

Siminoff, L. A. (2001). Gordon N, Hewlett J, Arnold RM. Factors influencing families’ consent for donation of solid organs for transplantation. JAMA, 286:71-7.

Medical Records And Health Insurance And Portability Act


Records are very important in every administrative work. In medical services, record plays an important role in health service provision. Medical records entail an orderly documentation of medical information and history of a patient. Medical records comprises of physical and electronic record about individual’s medical information. Medical records are sensitive; information about an individual’s health information ought to be protected. Health Insurance and Portability Act (HIPAA) 1996 was passed with an aim of protecting privacy of medical records. The act provides guideline on how medical health information may be shared. HIPAA allow each state to define laws that give guidelines to health providers and other institutions holding individuals’ medical information on how they can share the information. The case involving Mrs. Anderson and daughter, Sandra is an example of challenges faced in keeping medical records.


Sandra is diagnosed as pregnant. She reveals to the physician that she had been impregnated by her stepfather. Since Sandra is 15 years old, she is regarded by law as a minor. The mother, as a parent has responsibility to her. The act by the stepfather leads to child abuse. The legal and ethical issues raised in the case involves keeping medical record and playing the role of mandated reported in the case.

Mandated Reporter

Mandated reporters are individuals that are mandated by law to report cases of abuse to children or incapacitated adults. Any person with information about abuse of a child qualifies as a mandated reporter. Medical provider, dentist practitioners, and clergy that have information on an abuse qualify as mandated reporters (Roach, W, 2003, p 63). In this case, the physician to whom Sandra reveals the information about her case qualifies as mandated reporter. The mother, Mrs. Anderson also qualifies as a mandated reporter after she received information about the abuse. Mandated reporter have legal obligation to report the information they have to the relevant authorities. Failure to reports the case can result to legal consequences. In this case, Mrs. Anderson have legal obligation to report the case to the necessary authorities regardless of her relation with the perpetrator.

The law offers legal immunity to any mandated reporter who reveals information to the authorities within stipulated time and in good faith. The Abused and Neglected Child Reporting Act requires that a mandated reported reports the case of abuse to the authorities immediately (Roach, W, 2003, p67). Failure to report or conspiracy to hind evidence may lead to legal consequences. Mrs. Anderson has responsibility to report the case to authorities. Failure to report or her conspiracy to hind evidence for family unity may lead to her prosecution.

Access to Sandra’s Medical Records

As parent to Sandra, Mrs Anderson has legal right to medical records of her child. However, her right to access Sandra’s medical record is limited by the fact that the case involved reproductive care information (Health Insurance Portable and Accountability Act, 2006, par 7-8). To receive medical record of her daughter, Mrs Anderson is required by Connecticut to make a formal application for the record within one month. However, the health provider has right to deny Mrs. Anderson access to health records of her daughter. In this case, Sandra has right to access reproductive health care without the consent of her mother. She is also entitled to privacy of information revealed to health provider (Health Insurance Portable and Accountability Act, 2006, par 5-6). However, information revealed to the physicians may be revealed to a third party when the information is necessary for health care provision to her. HPAA also provides that the medial information may be revealed when needed for legal issues.

Mrs. Anderson has no right to change Sandra’s medical records. According to Connecticut law, parents do not always have the right to receive and amend medical records of their children (Pritts, J. Kudszus, N. & Health Policy Institute Georgetown University, 2006, par 7). If the medical service provider belies that a parent is abusing a child or want to access the record for malicious reasons, then access to medical record can be denied.


Cases such as that involving Mrs. Anderson and her daughter can be avoided through a health record policy (Roach, W, 2003, p77). The health institution ought to prepare and implement its health records policy to provide guidance to its health workers on how to deals with health record privacy issues. HPAA and Connecticut law provides framework through which the policy could be prepared. Sandra’s case involves an insider to the health institution. To avoid cases where insiders changes or colludes with other individual to changes records of their relatives, the institution should adopt a distributed electronic health record that provide distributed mechanism for changing records.


Privacy is very important to medical health records. Sensitivity of health information calls for a lot of care when keeping and revealing the records. In Mrs. Anderson and Sandra’s case, the physician qualifies as a mandated reporter to sex abuse against Sandra. The physician has legal obligation to report the case to the authorities; failure to report can lead to legal consequences. Although, Mrs. Anderson, in normal circumstances, has legal right to her daughter’s health records, in this case the health institution can deny her the right. However, Mrs. Anderson has no right to alter the records.

Reference List

Health Insurance Portable and Accountability Act (2006). Health Insurance Portable and Accountability Act. Web.

Pritts, J. Kudszus, N. & Health Policy Institute Georgetown University. (2006). Your Medical Record Rights In Connecticut. The National of Medicine. Web.

Roach, W. (2003). Medical records and the law. New York: Jones & Bartlett Publishers.

“Wanderer Above The Sea Of Fog” By Friedrich

Wanderer above the Sea of Fog is an oil painting by a German artist, Caspar David Friedrich, created in 1818. It depicts a young man standing back to the viewer at the precipice, observing mountain ranges that extend in front of him (Friedrich, 1818). He is wearing a long overcoat and holds a walking stick. The landscape has a vertical orientation, probably to emphasize the presence of a man.

This painting is considered a masterpiece of Romanticism – an artistic movement that spread in Europe at the end of the 18th – the beginning of the 19th century. It aimed to challenge the Enlightenment era’s dominating ideas (such as reason and order) by emphasizing the emotional component of human life (Romanticism, n.d.). The artists tried to fully express the possibilities of individual senses, intuition, and imagination in appreciating and exploring the world. Nature – wild and untamed – also became the central topic of many artworks (Cohen, 2018). Thus, Friedrich’s painting with a lonely man facing the beautiful yet overwhelming mountain landscape can be viewed as an illustrative work of the movement.

However, his paintings also have certain distinctive features that make them particularly recognizable. One of these characteristics is the subtle color palette he employs when depicting nature (Caspar David Friedrich, n.d.). Though unlike many of his landscapes, due to human presence, Wanderer does not create an unusual sense of emptiness; the mountain ranges are covered with similar distinctive fog often seen in Friedrich’s paintings.

To understand the artwork better, it might be useful to explore in more depth the influences that shaped the master’s style, in general, and contributed to the creation of the Wanderer, in particular. Friedrich received a formal artistic education at the University of Greifswald and at the Academy of Copenhagen, where he studied under Jens Juel, a well-known Danish portraitist (Cohen, 2018). However, it can be noted that unlike many painters, he took less inspiration in the works of masters before him, but was more invested in defining and sharpening his unique style that, in turn, influenced Romanticism. His personality traits, such as melancholic tendencies, seem to have significantly impacted his works (Cohen, 2018). To find inspiration for his landscapes, he tended to travel a lot (Cohen, 2018). The one in Wanderer does not reflect a real place but comprises different parts of the Elbe Sandstone Mountains (Scott, 2020). The result of multiple sketches he made there is the glorious view seen in the painting.

There are different opinions on the male figure’s identity. Some researchers claim that it can be a self-portrait, while others suggest that it might be an individual known to Friedrich, Colonel Friedrich Gotthard von Brincken, who was killed in action (Scott, 2018). Though the latter idea might give the painting a patriotic outlook, there is no enough evidence to suggest that any of the existing theories are necessarily accurate. What is also interesting is that some suggest that Friedrich applied the standards of the Golden Ratio developed by Luca Pacioli while working on the painting (Jones, 2020). That helped to ensure that the man is standing right in the middle of the whole scene that, in turn, attracts the viewer’s attention to the figure, prompting to concentrate on his experiences.

To better understand a painting, it is essential to research the master’s sources of inspiration and the history of its creation. In the case of the Wanderer, it was incredibly helpful for me to acknowledge the main motives and ideas of the Romantic movement to appreciate the importance of individual experience in front of the vast mountain ranges depicted in the picture. I was able to feel how this lonely figure may symbolize both unity with nature and feeling overwhelmed by it. Moreover, a detailed look into the painter’s characteristics, influences, and inspiration helped analyze the main attributes of this artwork. For instance, different ideas about the man’s identity provided me with an opportunity to consider it from several perspectives.


Friedrich, C. D. (1818). Wanderer above the Sea of Fog [painting]. Kunsthalle Hamburg, Hamburg, Germany.

Caspar David Friedrich (n.d.). The Art History. Web.

Cohen, A. (2018). Unraveling the mysteries behind Caspar David Friedrich’s “Wanderer”. Artsy. Web.

Scott, D. (2020). A closer look at Wanderer Above the Sea of Fog by Caspar David Friedrich. Draw Paint Academy. Web.

Jones, C. P. (2020). How to read paintings: Wanderer above the Sea of Fog by Caspar David Friedrich. Medium. Web.

Romanticism (n.d.). The Art History. Web.


“Wanderer Above the Sea of Fog” by Friedrich

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