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1.Explain and outline the philosophy of palliative care. 

2. For each of the following give a short explanation of how palliative care can be involved with individuals in these environments. 

•  Home based care

•  Hospice based care

•  Residential aged care

• Acute/hospital based care 


3. Australia is a multi-cultural society today, identify a cultural group which is different to your own and discuss the family relationship structures that may impact on the nature of palliative care , and discuss how you would raise matters surrounding the beliefs about death and dying that would need to be considered during the palliative care period.(400 words)

4. Nurses are governed by a Code of Ethics - a code of four principles. 

• Autonomy - respecting the rights of others and their need to make choices .

• Beneficence - doing good and promoting well being .

• Non-malefience - not doing harm .

• Justice - acting without prejudice Consider each of these principles and explain how they influence your nursing practice with terminally ill clients (300 words)

5. Explain what nursing care of the body after death involves and discuss what care of the breaved needs to be considered. (250 words) 

Types of Palliative Care Interventions

According to Wilson, Avalos, & Dowling, (2016) palliative care refers to the care that is given to patients who suffer from terminal illnesses and life threatening conditions. This care may include several intervention but it is largely meant to improve the quality of life for such people. therefore, there are several operations done as part of palliative care which aims at resolving physical and emotional pain, relieving the patient from some of the symptoms of diseases, helping patients who are dying to die a natural and normal death and also improving the social life of patients by collaborating with family and friends to provide holistic care to the patient in what is perceived as end of life care.

Palliative care begins with the identification and diagnosis of a terminal illness in a patient. The patient is assigned palliative care at home, in the hospital or in a hospice. At this early stage, most of the interventions that the patient goes through are meant to prolong life and make life more enjoyable by the patient. Such intervention include chemotherapy for patients with cancerous conditions. Palliative care is also geared to ensuring that patients live as actively as possible to ensure that they make the best out of their life. Palliative care therefore does not only involve the hospital based medications but also psychosocial support and counselling.

Palliative care is provided to patients with terminal illnesses because they are perceived to be experiencing pain from all aspects of their life ranging from social spheres where they experience neglect Connor, (2017). Physical pain from the illnesses, cultural pain that may emanate from stigma and other related misconceptions about their health. Lastly, they experience spiritual and emotional pain as they approach dying and they are worried about the next phase of life. Palliative care therefore requires a team oriented care that is well coordinated, continuous throughout a patient’s life and comprehensive enough to cure all sorts of pain.  

Home based palliative care simply refers to offering palliative care at home. There are several advantages of home based care which includes unconditional support. The patient is able to benefit from unconditional love and care from their family members who understands them more and who are likely to give the best physical and emotional support. Home based care improves the quality of life as it shifts the attention of the patient from their illnesses to the love and warmth of being at home. In addition, it is a cost effective option as opposed to receiving care at the hospital. However, it may have several challenges as family members and members of the society who fail to understand the patient may add unto them emotional stress and stigma which may worsen the condition of the patient.

Advantages and Challenges of Home-based Care

A hospice refers to a specialized home that offers palliative and end of life care to patients with terminal illnesses. The hospice is best suited to offer palliative care as it shields patients from harsh environments such as in the hospital or at home where they are likely to be discriminated against, stigmatized and being treated with judgmental attitude Fitch, Fliedner, & O’Connor, (2015). One major advantage of the hospice care is that patients are able to identify with people who are facing life threatening conditions as them which gives them solace and hope. The concept of a hospice care is one that is still developing but it has not encountered serious challenges yet.

Residential aged care refers to the care given to very old people who can no longer comfortably stay at their homes Sjögren, Lindkvist, Sandman, Zingmark, & Edvardsson, (2015). Some of the main reasons that disadvantage them from staying at their homes include sickness, disability or having no one to take care of them when they can no longer manage to take care of themselves. Centers where such care is provided are known as residential aged care facilities. These are specialized facilities that cater for old people by giving them a quality life that makes them feel appreciated and productive in life.

Acute/hospital based care refers to intensive secondary support that is given in the hospital for a short while. This refers to attention to patients who are recovering from a severe sickness or injury. Acute/hospital based palliative care refers to palliative care being offered in a hospital setting. One advantage of the hospital based palliative care is that patients are able to interact with doctors and nurses around the clock which enables them to benefit from the best quality of care. However a great disadvantage about the hospital setting is that patients are likely to develop other illnesses from the hospital or suffer neglect where they feel cut off from the society.

The Chinese population is the biggest population in the world and also among the societies with the highest life expectancy. It is therefore interesting to find out how the Chinese people believe and practice in regard to palliative care and end of life care. One interesting fact about the Chinese, Wu, Li, Su, Yao, & Wen, (2016) is that they esteem moral values such as bravely, resilience, enduring pain and dignity. With these it is almost possible to imagine how the Chinese view terminal illnesses and end of life care.

Hospice Care: A Specialized Home for Palliative and End-of-life Care

The Chinese are a society that have remained conservative over the years being rooted in the Confucianism beliefs. This is the philosophy that attracts importance to values such as bravely, resilience and enduring pain. The Chinese however value a dignified death and try to make possible that members of their families die a dignified death as possible. In addition to this, the Chinese stigmatize certain illnesses such as mental illness and cancer to the extent that they conceal such information within their families or within individuals (Kelley, & Morrison, 2015). Palliative care among the Chinese therefore is not geared towards alleviation of pain but rather fighting with resilience and helping family members to die a dignified death as possible.

Among the Chinese, palliative care lacks the western definition and it might be hard to offer palliative care due to the stigma on certain illnesses that do not escape the individuals or their families. Due to these factors, patients who are terminally ill usually suffer various types of pain due to all these factors put together. It therefore requires serious attention as many people upon realizing that they have a terminal illness may even contemplate suicide.

Some of the ways that these beliefs can be addressed is through health education through forums organized by government and other relevant organizations. Some of the key areas that need to be addressed include the end of life care. The Chinese need to be sensitized to focus more on the interests of the individual as they focus more on the family, loyalty and devotion while undermining individual needs and feelings. The Chinese also need to be empowered to be able to seek solutions to address health and illness, eat healthier diets and improve interpersonal communication. Finally, there is dire need to set up many hospices and residential aged care centers where people who are cut off from the society can find solace and the palliative care they require (McKenzie, Kwok, Tsang, & Moreau, 2015).

The patient has the autonomy to decide the treatment option to take and the autonomy to even decide whether to get treated or not. The nurse therefore only acts as a guide and informs the patient on the outcomes of the care, the health requirements they require, the rights and costs of the treatment. The nurse therefore helps the patient to make informed choices using evidence and knowledge of the clinical practice Grace, & DRN, (2017). The nurse also helps the patients to avoid infringing harm on themselves.

Residential Aged Care for Seniors

Non-maleficence is a principle that guides nurses encountered with dilemmas to consider the option that leads to the least possible harm to the patient. This helps nurses to always operate in the best interests of the patient. It is a principle that guides nurses to avoid harming the patients.

Beneficence as a principle requires the nurse to always consider doing the best good possible for the patient and for others. This ensures that nurses adopt a patient centered and holistic approach towards care that ensures that the quality of service and care is not compromised. Beneficence allows nurses to always make decisions in the best interests of the patient regardless of all other circumstances (Holloway, & Galvin, 2016).

Justice ensures that nurses act in a fair and just manner while dealing with others such as treating others as equals and avoiding any form of discrimination. Justice requires of nursed to always do what is right even in difficult and challenging situations. In other words, it helps nurses to cultivate moral courage and critical thinking to effectively make decisions that do not infringe on the rights of others.

There are several nursing care responsibilities that involve washing, dressing and positioning of the body properly before the body stiffens a condition known as rigor mortis Holland, (2017). There may not be so many nursing interventions after someone dies but nurses are expected to preserve the body and observe cultural and religious requirements of the dead person. The nursing interventions therefore involve giving away the property of the deceased to the next of kin, cleaning and preservation of the body in a funeral home or a hospice. The body is positioned properly in a cold environment. Lastly, it is also a nursing care responsibility to ensure that any person who interacts with the deceased is protected from any illness.

For the bereaved, the nurse takes over the role of consoling them Walker, Sque, & Long-Sutehall, (2017). They also assist in explaining the cause of death, documentation of the deceased and helping the bereaved to be able to get over the death of one of them. The nurses, together with the pathologists may also help in conducting post mortem if the cause of death is not identified. Finally, nurses are responsible in giving verbal or written communication to the family of the deceased and their significant others.

References

Connor, S. R. (2017). Hospice and palliative care: The essential guide. Routledge.

Fitch, M. I., Fliedner, M. C., & O’Connor, M. (2015). Nursing perspectives on palliative care 2015. Annals of palliative medicine, 4(3), 150-155.

Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Graven, V., Woods, S., & Jacobsen-Hviid, M. (2016). Hospitalised Palliative Care-from a Philosophy of Care to Rigid Guidelines for Intervention?. Omsorg. Nordisk Tidskrift for Palliativ Medisin.

Holland, K. (2017). Death and bereavement: A cross-cultural perspective. Cultural Awareness in Nursing and Health Care: An Introductory Text.

Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. John Wiley & Sons.

Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.

McKenzie, H., Kwok, C., Tsang, H., & Moreau, E. (2015). Community nursing care of Chinese-Australian cancer patients: a qualitative study. Cancer nursing, 38(4), E53-E60.

Sjögren, K., Lindkvist, M., Sandman, P. O., Zingmark, K., & Edvardsson, D. (2015). To what extent is the work environment of staff related to person?centred care? A cross?sectional study of residential aged care. Journal of clinical nursing, 24(9-10), 1310-1319.

Walker, W., Sque, M., & Long-Sutehall, T. (2017). Ethical issues in bereavement research: Practical use of a decision-making framework.

Wilson, O., Avalos, G., & Dowling, M. (2016). Knowledge of palliative care and attitudes towards nursing the dying patient. British Journal of Nursing, 25(11), 600-605.

Wu, Y., Li, L., Su, H., Yao, X., & Wen, M. (2016). Hospice and palliative care: Development and challenges in China. Clin J Oncol Nurs, 20(1), E16-E19.

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