Nurse Life Care Planning

Debilitating and tragic accidents, painful, chronic illnesses that leave one dependent and unable to do many simple activities of daily life – who would you want to help plan the highly important details of care to maintain the rest of yours or a loved one’s life? Nurse Life Care Planners play a significant role in combining the assessment and diagnoses of a patient to develop a long-term plan with individualized interventions for that patient based on environmental conditions that will lead to optimal outcomes. (Lance, 2007). Nurse Life Care Planners extend beyond the biomedical aspect of an individual and approach care from a holistic perspective that includes managing symptoms, improving quality of life, promoting health, wellness, and managing disease. The American Association of Nurse Life Care Planners (AANLCP) defines a Nurse Life Care Planner duties as “employ[ing] the nursing process, or critical thinking methodology when developing a life care plan through the diagnosis and treatment of the human response to alleviate suffering, prevent future illness and injury while promoting and optimizing health and abilities, and advocating for care of the individual and their family. The Nurse Life Care Planner may delegate the implementation and ongoing evaluation of the life care plan to a registered nurse case manager, or other nurse life care planners”(citation) . To develop the understanding of the important role Nurse Life Care Planners in healthcare provide, this paper will cover the educational requirements, training, salary, field history, demand, legal aspects, and applicable nursing theories related to a career as a Nurse Life Care Planner.

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Educational Requirements

Much debate surrounds the level of degree required for Nurse Life Care Planners, specifically if Registered Nurses should have a minimum education of a bachelor’s degree level in Nursing and still remains a point of discrepancy, yet to be defined today. Currently, Registered Nurses with experience caring for critically injured or ill patients primarily in critical care settings are most-qualified to become Life Care Planners, for example Certified Registered Nurse Anesthetists (CRNA’s) with experience in critical care and a master’s degree level specialized in Anesthesia. Additionally, other professionals, such as counselors, case managers, social workers, psychologists, rehabilitation healthcare professionals and etc. with degrees and background in life care planning are eligible to become Life Care Planners (Van Wieren & Reid, 2007). A certification in Life Care Planning is required once minimal education requirements are achieved for Registered Nurses, and at least two years of experience in critical care are completed. Nurse Life Care Planners must acquire knowledge in all aspects of disability – medical, vocational, psychological, and behavioral – among additional knowledge of facility placement/referrals if long-term facilities are needed for an individual’s plan of care, and methods and skills for preventative care (Van Wieren & Reid, 2007). Several Life Care Planning certification programs exist today and offer classes that focus on medical disability and case management, and life care development (“Becoming a Certified Life Care Planner,” n.d.).

Salary

The typical wage for nurse Life Care Planners ranges from eighty to one-hundred and fifty dollars per hour and continues to increase due to a great demand for Nurse Life Care Planners (“Life Care Planning Career”, n.d.).

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Job Description

Patients who have survived critical illnesses or trauma and remain disabled with long term limitations from illness and/or injury, often require well-planned, coordinated long-term care. Through exercising the nursing process (Assess, Diagnose, Plan, Implement, and Evaluate), Life Care Planners develop the most effective and individualized plan of care for their patient to achieve optimal wellness for their condition. Life Care Planning involves everything from basic and critical care nursing skills to evaluating costs and care providers that patients can afford. In term, Nurse Life Care Planners combine multiple aspects, experiences, and healthcare departments like, “Case Management, Rehabilitation, Home Health, and Discharge Planning” to provide care for dependent patients (Lance, 2007). Essentially, a complete, practicing knowledge of the nursing process helps define the goals and purpose of Nurse Life Care Planning. For example, consider a burn victim, a Nurse Life Care Planner will fully assess the patient and gather a database and effects of the burns holistically; then, the Nurse Life Care Planner will form a nursing diagnosis, coupled with a medical diagnosis based on the evidence gathered from an initial and on-going assessment to identify realistic concerns and risks the patient may face. Following the formed diagnoses, the Nurse Life Care Planner will develop a multidisciplinary-approached care plan for the patient’s diagnoses, including detailed thought and attention to the patient’s individual needs such as finances, environment, esteem, and other personal aspects that are crucial in quality long-term care. Finally, implementing the well-thought, highly detailed plan in a timely action (i.e. before scar maturation) for the patient begins, involving all aspects of healthcare before finally being evaluated and adjusted for the patient when necessary (Weed & Berens, 2005). The Nursing Process’ role is a conceptual framework or model that guides the work of Nurse Life Care Planners and facilitates achievement of individualized care and best outcomes for the patient.

Setting

Life Care Planning is not exclusive to working in hospital settings, many work for insurance companies, settlement companies, long-term health facilities like nursing homes, legally as attorneys consultants, and even self-employed within personal practices (Lance, 2007).

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Field History

As a fairly recent practice, Dr. Paul Deutsch publicly described Nurse Life Care Planning thirty years ago to be a specialty of rehabilitation and “developed the basic tenets, methodologies and processes of Life Care Planning…as a fundamental tool of case management in his 1981 text, Damages in Tort Actions” (“Congratulations, Dr. Paul Deutsch,” 2007, p.). Over the last thirty years, Dr. Deutsch, among others, has continued developing Nurse Life Care Planning and has since begun to involve multiple healthcare fields “including rehabilitation counseling, rehabilitation nursing, rehabilitation psychology, physiatry, case management, and other areas” (Van Wieren & Reid, 2007, p. 25).

Demand

The need for such an ever-evolving career is very large for the small supply that is currently available today; there are approximately 560 Nurse Life Care Planners in the United States today, thus a hard demand to fulfill (Life Care Planning Career, n.d.). According to the U.S. Department of Health and Human Service’s website, LongTermCare.gov, sixty-nine percent of the US population requires long-term care for at least three years and eight percent of the US population who are between ages forty and fifty have disabilities that require long-term care services; with these statistics alone, the number of Nurse Life Care Planners compared to population in need of long-term care is easily outweighed.

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Legal Issues Surrounding Nurse Life Care Planning

More legal and ethical issues, typical to healthcare, surround Life Care Planning, especially when care plans consult end-of-life care. “End-of-Life Care” is loosely defined, varies among different theories, and has not been scientifically proved to be consistent with a precise period in time; ultimately, it can be defined by policy, procedures, and guidelines of different facilities and is specific to the illnesses and injuries a patient is diagnosed with (Izumi, Nagae, Sakurai, & Imamura 2012, p. 613). Guaranteeing a high standard of care, relief from symptoms and preserving dignity by letting patients have control of their end-of-life care plans regardless of their medical and financial situations are key goals for end-of-life care planning. Two ways terminally-ill patients can preserve and form resources to sustain their best interests when not able to for themselves are by referring to previous Advanced Directives for refusals and outlines of treatments or referring to an individual who has been given detailed directions by the patient themselves as a Power of Attorney (Brown & Vaughan, 2013). Incorporating Advanced Directives and respecting Power of Attorneys into the patient’s life care plan is critical among being the most useful resources, yet can create potential ethical dilemmas or conflicts of interest amongst patients, family members, and providers that Nurse Life Care Planners might face during end-of-life care planning if not followed completely.

In the 2014 study, “Narrative analysis of the ethics in providing advance care planning,” a group of researchers asked sixty-two care managers (RN’s or Social Workers) the ethical themes and values that they faced as care managers and when dealing with end-of-life care planning. Those themes were identified as humility, respect, responsibility, setting boundaries, client empowerment, courage, and veracity. The ethical theme and value of humility for understanding the diverse beliefs of clients, along with the respect for a client’s beliefs, similar to humility, regardless of the care manager’s beliefs were identified by the participants. Additionally, responsibility and setting boundaries were identified as ethical themes and values to educate clients on their options for end-of-life care planning and fulfilling their duties to their agencies and professions both legally and morally, while setting boundaries between social and professional obligations, which, in turn, can become legal boundaries. Empowering clients with information and choice needed to develop their end-of-life care plans, but not influencing the client’s decisions as well as courage to advocate for client’s faced with family-influenced decisions, were two other identified ethical themes and values for Nurse Life Care Planners. Finally, veracity, as an ethical theme and value from establishing rapport with clients and their families enough to be trusted with care-planning and the imperative information regarding care-planning (Baughman, Aultman, Ludwick, & O’Neill, 2014).

Guaranteeing a patient that their best interest and wishes will be maintained and used is not only a duty of the Nurse Life Care Planner, but a basis to providing quality care and allows clients to make critical decisions about their health in times when they do not have such capacity. Subsequently, identifying and maintaining ethical themes and values for quality patient care is an added duty during end-of-life and life care planning.

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Applicable Nursing Theory

One’s response to chronic illness varies based upon individuals, but ultimately depends on their ability to cope as well as resources available to the patient to manage alterations in their health. In Carrie Jo Braden’s 1990 nursing theory, “A test of the Self-Help Model: Learned Response to Chronic Illness Experience” the theorist identifies that individuals subjected to chronic illnesses needing assistance with the strategies of managing and coping with the illness may depend more on the individual’s perception of their own ability to help themselves or remain helpless. The perception of learned-helplessness is, ultimately, lacking knowledge to remain in control of the common and manageable, yet irrepressible difficulties associated with chronic illnesses. Comparatively, the learned self-help response incorporates these irrepressible difficulties into a cultivated response, not necessarily as a treatment of the chronic illness, but as coping and management of the illness (Braden, 1990, p. 42).

Braden (1990) conclusively states that the variables influencing self-help as a learned response to chronic illness are the illness severity, uncertainty, dependency, enabling skill, self-help and life quality. Both the severity of the illness and monitoring the illness remain the preexisting variables contributing to the learned response process, keeping in mind that adversities vary from illness-to-illness and person-to-person. The ability to monitor the complicated adversities of the illness are immediately linked with the severity of the illness and therefore the ability of the individual to find the resources to manage and cope with the severity; this also remains an issue of self-help and desire to access educational and supportive resources. Braden determined that the study’s participants who attended self-help classes were more likely to have gained monitoring and self-enabled care skills. Additionally, those with greater incomes had greater self-help ability to afford measures that maximize coping and management of chronic illness. Further discovery into background topics like predispositions of illness (gender, race, age), class, and income were variables not fully examined but identified as possible and actual contributors to self-help responses (Braden, 1990, p. 46-7).

Nurse Life Care Planners connect the learned response to chronic illness and life care planning to resourcefully design individualized care plans that incorporates aspects and perceptions of self-help to cope and manage chronic illnesses. Additionally, Nurse Life Care Planners eliminate factors like financial disposition of the self-help response by examining and identifying life care plans that are affordable and patient-centered. Nurse Life Care Planners also provide critical patient education and support focused on the individual’s condition and outlined in the patient’s life care plan. By combining the Learned Response to Chronic Illness theory and the specialized skill and knowledge of the Nurse Life Care Planner, it is possible to provide the best options and plans for patient coping and management of chronic illnesses.

Conclusion

Examining the educational requirements/training, salary, history, demand, legal aspects, and nursing theories applicable to Nurse Life Care planning gives great insight into the importance and benefits of becoming a Nurse Life Care Planner. Nurse Life Care Planners are responsible for and play the critical role in alleviating the frustrations patients may encounter when faced with chronic illnesses. Individualizing care plans, remaining sensitive to patient preference and hardships, and providing a high standard of care is the prime objective of Nurse Life Planners.

References

Baughman, K., Aultman, J., Ludwick, R., & O’Neill, A. (2014). Narrative analysis of the ethics in providing advance care planning. Nursing Ethics, 21(1), 53-63. doi:10.1177/0969733013486795

Becoming a Certified Life Care Planner. (n.d.). Nurse Without Borders. Retrieved February 9, 2014, from http://nursewithoutborders.org/becoming-a-certified-life-care-planner/

Braden, C. J. (1990). A test of the Self-Help Model: Learned Response to Chronic Illness Experience. Nursing Research, 39(1), 42-47.

Brown, M., & Vaughan, C. (2013). Care at the end of life: how policy and the law support practice. British Journal Of Nursing, 22(10), 580-583

Congratulations, Dr. Paul Deutsch. (2007).Journal of Life Care Planning,6(1-2), 53-54.

Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012). Defining end-of-life care from perspectives of nursing ethics.Nursing Ethics,19(5), 608-618. doi:10.1177/0969733011436205

Lance, K. (2007). Nurse life care planning. Virginia Nurses Today, 15(3), 11

Life Care Planning Career. (n.d.). Becoming a Life Care Planner. Retrieved February 9, 2014, from http://www.healthcarepathway.com/Health-Care-Careers/Life-Care-Planner.html#forms2

Van Wieren, T., & Reid, C. (2007). Nursing educational requirements: relevance to life care planning credentialing policy.Journal Of Life Care Planning,6(1-2), 25-45.

Weed, R., Berens, D. (2005). Basics of Burn Injury: Implications for Case Management and Life Care Planning. Lippincott’s Case Management, 10(1), 22-29.

U.S. Department of Health and Human Services. Who Needs Care?. (n.d.). LongTermCare.gov. Retrieved February 9, 2014, from http://longtermcare.gov/the-basics/who-needs-care/