Reply 1 and 2 ,150 words each one add references and citations by 08/28/2020

Reply 1This is a time when many difficult treatment decisionsmust be made that will benefit patients over the past few weeks or months, often leading to quality of life issues. According to the American College of Nursing, nurses ask patients and their families to step in, make tough decisions, and help them adjust to the painful reality. Nursesare often the only source of support during this difficult time. At this point, families are often confused, scared and overwhelmed. They get information from doctors about medications, treatments and schedules, but often ask nurses for emotional support when they leave the room.
Therefore, nurses help patientsand their families by trying to adapt to the realities facing patients and their families. The primary responsibility of nurses is to their patients and to ensure that their wishes are met. These wishes do not always coincide with the wishes of the family. This is where the role of the palliative care nurse becomes difficult. We must focus on patient preferences, respect autonomy and support families in managing processes they have never encountered. Palliative care nurses care for end-of-life patients and provide convenient 24/7 care in the patient’s home or home. The Houston Chronicle notes that it not only relieves pain and other symptoms but also supports the dying process with dignity. Since each patient and family has a different perspective on end-of-life needs, it is their job for the palliative care nurse to assess and adjust care accordingly. Reference:
Reference:
Https://journalofethics.ana.assn.org/article/ethical-dimensions-caring-well-dying-patients/2018-08
Https//:bjgp.org/content/69/685/e561
Https://bmcpalliative.biomedcentral.com/articles/110.1186/s/2904-018-0371
Https://journalofethics.ana.assn.org/article/ethical-dimensions-caring-well-dying-patients/2018-08
Https//:bjgp.org/content/69/685/e561
Https://bmcpalliative.biomedcentral.com/articles/110.1186/s/2904-018-0371
Reply  2 
One can receive end of life care at home, or in care home, hospices or hospitals depending on one’s needs and preference. Persons who are approaching end of life are entitled to high quality care, wherever they are being cared for. End of life care is support for persons who are in the last days, months or years of their life. End of life care should help a person to live as well as possible until the person dies and dies with dignity. The reason many elderly patients are not dying at home, against their wishes is because many families are not able to care effectively for the needs of the dying person. There are also multiple physical issues requiring nursing care happening at the time of death (Ward, 2018). Another reason is that most health insurances do not cover totally in-home care during the final days.
Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.
End of life care situations are difficult to navigate for families. The difficulties come when no Advance directives are in place. It helps if patient’s wishes are written down as a personalized care plan. Nurses are essential persons to help support, educate and empathize with families at this difficult situation. As a nurse, and with other health care professionals providing care, should ask about patient’s wishes and preferences, and take these into account as I work with patients and families to plan care. (Every moment Counts, n.d.) I should also support family careers, or other people who are important to the patient and educate them on the process of death and dying. I am there for their support (Green, 2018). If they need spiritual care, I should help in arranging for their faith tradition chaplain or other religious/emotional contacts. Good end of life is tailored to the patient who needs it. The patient and the people close to him should be at the center of decisions about his care and the nurse is at the forefront. 
References:
End of life(n.d.) Retrieved from https://www.nhs.uk/conditions/end-of-life
Every Moment Counts(n.d.) retrieved from https://www.nationalvoices.org.uk/default
Green, (2018) Health Assessment: Foundations for Effective Practice. Retrieved from
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health- assessment_foundations-for-effective-practice_1e.php Aligned To: 0 Learning Objectives
Ward, B. (2018). Next Avenue. Retrieved from https://www.nextavenue.org/how-realistic-is-dying-at-home/
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