The healthcare system has undergone significant transformations in recent years. Care coordination has particularly received attention by hospitals, insurers, and other healthcare systems as a vital tool that can be employed to improve the health of patients and control of healthcare costs (Naylor and Kurtzman, 2010, P. 893-899). Registered nurses have a primary role in care coordination; this has been a crucial competency and standard for healthcare systems. Their task involves educating patients as well as their families at the time of discharge, creating care plans for development, and facilitating continuity of patient care among providers and across various settings. With the ever-increasing attention to patient care, it is important for registered nurses to step up and focus on elevating the quality of patient care, satisfaction, efficient and effective use of resources (Naylor and Kurtzman, 2010, P. 893-894). The PLO took place in gastroenteritis wards of the National Health Service (NHS); an organization that is funded primarily by taxation. The assigned patient was a 72-year-old woman with advanced liver cancer, and the care episode was the management of patients syringe driver (for pain management) by the nurse. This episode was chosen because it involves the care of an elderly patient, something that is in harmony with adult nursing and one that puts attitudes and values such as dignity and compassion into perspective. In this context, the nurse was expected to implement, assess, coordinate, and monitor various aspects of patient care including emotional support and treatment plans.

Assumptions have developed concerning the ethical, professional, and legal principles in patient care for adults. It is common for registered nurses to find themselves in an ethical and legal tightrope when overseeing an adult patient suffering a terminal disease. This is the same feeling that the nurse in the gastroenteritis ward had; admittedly, she found it very easy to deviate from good patient care to serious wrongdoing (Allmark and Tod, 2009, p.35). From the nurses experience, the most difficult legal, ethical, and professional challenges she has encountered in her career involve withdrawal or withholding a particular life-prolonging treatment. For instance, an elderly patient on ventilation, antibiotics, or artificial nutrition as a result of advanced cancer might present a problem for the care team on whether or not to withdraw one of the life support treatment. In such as a scenario, a patient has a higher probability of dying earlier than expected. The nurse was involved with pain medication; this included methods such as sedation and strong analgesia. Reportedly, the nurse had to decide on terminal sedation in cases where the patient manifested uncontrollable symptoms requiring high-level sedation to the state of unconsciousness.

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