Why Every APRN Needs to Embrace the Goals of Care Framework

Goals of Care: A Clinical-Ethical Framework to Enhance APRN Practice

The Goals of Care: A Clinical-Ethical Framework provides an essential tool for Advanced Practice Registered Nurses (APRNs) to guide their ethical decision-making and deliver patient-centered care. Rooted in the ethic of care model, this framework helps APRNs focus on the values, beliefs, and preferences of patients, allowing them to explore the holistic dimensions of patient care. Using this approach ensures that APRNs fully understand who the patient is, both as an individual and within their broader context, enhancing the quality of care provided.

In this framework, curiosity is a guiding principle. APRNs are encouraged to ask critical questions about the patient’s values, their definition of quality of life, and the relationships that matter to them. This comprehensive approach ensures that care is aligned with the patient’s preferences, beliefs, and needs, contributing to better outcomes and improved patient satisfaction.

Table: Key Aspects of Goals of Care Framework for APRNs (Insertable in WordPress)

For more detailed information, please refer to Jones & Bartlett Publishers’ Manual of Nursing Diagnoses.

The Importance of Exploring Values, Beliefs, and Preferences in APRN Practice

Ethical decision-making is central to the Goals of Care Framework. One key aspect is understanding the patient’s values, beliefs, and preferences, which require a deep and empathetic exploration. This allows APRNs to align care decisions with what the patient deems most important in life. Asking questions like “What does quality of life mean for this patient?” or “What religious or cultural beliefs are significant in their care decisions?” can help build a clear profile of the patient.

According to Noddings’ (2010) Ethic of Care, APRNs must develop a curiosity about who the patient is. Understanding the patient’s values guides the overall care strategy and ensures that interventions respect the patient’s dignity and preferences.

Context: Understanding the Full Picture

A patient’s context plays an essential role in shaping their healthcare decisions. APRNs must assess not only the medical aspects but also the social, financial, and emotional circumstances surrounding the patient’s condition. Questions such as “What led the patient to their current situation?” or “What external factors are influencing their decision-making process?” can help APRNs develop more holistic care plans.

By considering context, APRNs can deliver care that is more personalized and meaningful to the patient, ensuring that care aligns with the patient’s real-life circumstances.

Relationships: Balancing Autonomy and Relational Ethics

While Western healthcare often prioritizes autonomy, the Goals of Care Framework recognizes that relationships significantly impact patient decision-making, especially during critical illnesses. Patients rely on their networks of family, friends, and caregivers when making life-changing medical decisions. APRNs must navigate these relationships to identify supportive networks and manage potentially harmful dynamics.

In Exemplar 11.3, a woman named A.L., facing terminal illness, revealed her desire to remain a full code because of her husband’s emotional dependency on her. Through guided discussions, the APRN helped A.L. and her family arrive at decisions that reflected her values, balancing her husband’s emotional needs while focusing on her own goals.

Ethical Approaches in the Goals of Care Framework

Various ethical models provide additional guidance to APRNs. These models include casuistry, which focuses on analyzing specific cases, and narrative ethics, which emphasizes the importance of understanding the patient’s full context. Other approaches, like virtue-based ethics, highlight the moral integrity of the care provider, while feminist ethics focus on the perspective of marginalized groups and power imbalances. Care-based ethics centers on building and sustaining meaningful relationships between the APRN and patient.

Each of these ethical approaches serves to strengthen the patient-centered focus of the Goals of Care Framework.

Addressing Practical Concerns and Surrogate Decision Makers

Often, patients may lack the capacity to make decisions about their care, especially during critical phases of illness. The Goals of Care Framework advises APRNs to seek input from legally appointed surrogates or family members. When patients are unable to express their wishes, it becomes essential to engage surrogates who are well-informed about the patient’s values and preferences.

APRNs must navigate complex family dynamics, balancing the ethical principles of autonomy, beneficence, and non-maleficence, while ensuring that the patient’s voice is honored through surrogates.

FAQs on Goals of Care: A Clinical-Ethical Framework to Enhance APRN Practice

Q1: How does the Goals of Care framework enhance APRN practice?
A1: The framework provides ethical guidance, enabling APRNs to deliver patient-centered care by focusing on the patient’s values, preferences, and context. It enhances decision-making and aligns medical interventions with the patient’s overall life goals.

Q2: What ethical approaches are integrated into the Goals of Care framework?
A2: The framework incorporates casuistry, narrative ethics, virtue-based ethics, feminist ethics, and care-based ethics, ensuring that care is both ethically sound and patient-centered.

Q3: How do APRNs use relationships in ethical decision-making?
A3: Relationships play a crucial role in patient care, especially during critical illnesses. APRNs must balance autonomy with relational ethics, ensuring that important relationships are considered in decision-making processes.

Q4: What is the role of surrogate decision-makers in the Goals of Care framework?
A4: Surrogate decision-makers are often involved when a patient lacks capacity to make decisions. APRNs work closely with surrogates to ensure that care aligns with the patient’s values and preferences.

Q5: What questions should APRNs ask when exploring a patient’s values and preferences?
A5: APRNs should ask questions such as “What does quality of life mean for you?” and “What religious or cultural beliefs influence your decisions?” to develop a comprehensive understanding of the patient’s values.

By focusing on these core elements, the Goals of Care Framework empowers APRNs to provide ethical, compassionate, and effective care that honors the individuality and dignity of every patient.