HLT54115 Diploma Of Nursing

1. Palliative care is a care provided to a person suffering from life threatening diseases. The basic principle of palliative care can simply be explained as a good clinical practice provided to the patient irrespective of a social status, culture, education, disease(Kam, n.d.). These includes:

• It respects the choices of dying person and even his family members and loved ones. It takes care of person preferences, his likes, dislikes etc.
• It focuses on the social, spiritual, emotional needs of the patients.
• It is family oriented service and offers help to patient’s family in various ways like finds ways to pay for the medical expenses, supports family during grieve etc.
• It provides best trained medical team to care for the dying patients in every way possible.
• It helps patient to relieve pain and helps to reduce any mental or physical stresses.

Ramesh who is admitted in this ward with life threatening disease needs holistic care, I will ensure his daily activities like eating, dressing, walking etc.

I will also provide his daily medications like daily analgesics intake along with his other medicines according to the medication management plan, daily dressing for his wound. I will provide him comfort by helping him ease his pain and by relieving emotional stress and trauma of him and his family as well.

2. Gastric carcinoma is a disease in which the cancerous cells form the lining of the stomach. In other words, the formation of mucus secreting glands all over the body. It can develop in different parts of the body and is common in lung cancer, prostate cancer, pancreatic cancer, oesophageal cancer, colorectal cancer(Dicken, Bigam, & Cass, 2008).  

In this scenario, chemotherapy is one of the way to control growth of cancer cells. It helps to shrink the cancer cells and reduce some symptoms which might help the patient live longer. The other need are the ways to relieve pain of the patient and here Ramesh was on daily analgesic to supress the pain.

3. A) We can assess the pain by examining the areas affected with cancer and melanoma. As he did not had defecation. It was also discovered that he had pain in the upper quadrant. He was given regular medicine on daily basis to manage pain.  
4. The first is to identify the pain and giving specific medicine.

The second is to ask the patient or following his action if there is any uneasiness or pain due to the medication.

1. Ramesh had codeine induced constipation due to the side affects of analgesics which he was taking on regular basis. He was having oxycodone which not only blocks pain but also increases constipation(Camilleri, 2011).

4. A) lifestyle choices- As an EN, I would make sure if he had vegetarian food. His daily activities like bathing, dressing, toileting, walking or transferring is taken care of.

1. B) Social context – The social needs include his culture or environment where he wants to

live. He social needs should be considered by keeping in mind that his care is at most priority.

C)Emotional- This includes consoling the family and the patient to cope up with the situation. palliative care team provides emotional support to give them lot of courage to deal with the situation.

1. D) Spiritual-This includes the need like prayers that the family members wanted to do during his end time to calm the situation.

5. My role as an EN in this scenario would be to take care of all the needs of Ramesh right then from daily activities, medication, plan to assess him at regular interval so that he is not at any physical and mental discomfort. I also need to make sure his family is provided the required information about his health condition so that they know their beloved is taken care in right way. It is important to work within the roles and responsibilities of interdisciplinary team to ensure everybody knows their roles and responsibilities.

6. As the family is going through such hard time, they are emotionally unstable Family in such hard time of losing a beloved are going through many emotional and physical trauma. As palliative care is a family oriented care, it takes care of the factors like stress, anxiety, depression, job control, hopelessness etc that are considered as the psychosocial factors which family are going through(ML, L, & I, 2007). The psychosocial impacts of palliative care on Ramesh’s wife and family are: Information about the patient health should be shared with the family. Financial issues are also one of the main issue so in this case palliative care help patient’s family to solve these problems by referring them about the financial help programs.

7. I would have allowed his daughter to do the spiritual prayer as it would have calmed the situation and as it is a cultural belief in Hinduism which is to be followed by them and palliative care supports patients culture and traditions as well. So, it is important to allow them to follow their norms and traditions in their own way during such emotional situation. However, I would have allowed the prayers in a controlled way that patient is not being affected by it in a wrong way.

8. The two best communication techniques in this scenario would be: Using silence: It is said that it is not necessary to speak every time, silence can act as a means of communication. In palliative care, nurses should always allow patient time and space they require to open up.

Acceptance: Sometimes it is necessary to understand what patient have to say and let them know that they have been heard (Engard, 2017). It forms the bond between the patient and nurse and eventually patient becomes more receptive to care.

While the two support services would be general and specialist care which would take care of both the patient and the family.

9. In this scenario, Ramesh was growing weak with each passing day as he started avoiding to eat. He did not have bowel movement from four days. Further, he became less responsive and made unusual sound while breathing, moving limbs and inconsistence of both face and urine were some signs of dying.

It is important to share all these information to his family in a way so that they may not feel that the facts are kept hidden from them and it also shows the transparency of the system.

10. The physiology of dying includes several stages that patient experiences before dying are:

Loss of appetite and thirst: the patient appetite and thirst decrease and they have less desire to eat or drink.

 Sleep and alertness: Further, the patient may sleep for longer duration and it becomes difficult to wake them (The Dying Process, 2015).

Temperature: The temperature of body changes from being cold at one time to hot at other time.

Incontinence: The incontinence in face and urine. The secretion of urine decreases due less intake of water.

The other stages include drawling of saliva, irregular breathing patterns and restlessness. It is not necessary to share all the accurate details of dying process as it may cause panic to the family member.

11. When the health of Ramesh further started to deteriorate he started making noises while breathings, saliva started to droll, hiccupping and coughing even while sipping water were some of the signs of respiratory and swallowing difficulties.

The strategies I would implement in this scenario would be a specialist care team to comfort the patient in every possible way in accordance to advanced care directive.

12. The malignant wound can be managed in three stages which shifts from healing to palliative approach. The first being the symptom management, the second is the wound management and the last one is the treatment of the tumour in most accurate way. Also, the assessment of pain is vital as this will help the doctors to understand the pain that the patient is experiencing and hence determine the way to treat them.

13. The signs of deterioration according to the ACP or ACD are:

• Patients become very weak that they are unable to move.
• They look tired and exhausted.
• They have less or no interest to eat.
• They feel trouble in breathing.
• Patient may sleep more and it may be hard to awake them.
• Lips appear to be drooped.
• Unusual movement of limbs.

When the health condition of the patient stats to deteriorate, it should be immediately reported to the Palliative care doctor and doctor refers to the Advanced Care Directive so that comfort care is provided to the patient.

14. To support the dignity of patient, we have to think that the person lying in the bed is not just a patient but a person who may be the only earning member of the family. In other words, we need to see the person’s value from their loved one’s perspective. If we just focus on the patient disease or illness then the dignity is lost at that point of time(Kennedy, 2016). The patient and his family must be treated or respected in away so that they believe the medical person are doing their best which will also help to provide the emotional support to the family need even after the patient dies.
15. The ethical issues in the scenario is involvement of the physicians, nurses, patients and families in decision making. There may arise a situation when family members may force the nurse to act in a way differing from the patient wish. According to autonomy it is the patient wish to make his decision upon his treatment which might be against the nurses or family members which overrides another principle of non-maleficence which is not causing any harm to the patient. This depend upon the situation or scenario to decide who would be best person to discuss about the issue.

16. Nurses are bound by their duties and responsibilities to provide comprehensive and sympathetic care after the end of life. Under this the nurse recognize the cause of the death and conveying the same to the deceased family. The nurses should associate with other members of the health care team to make sure the deceased family is getting all kind of support. The nurses along with other health care providers are responsible to take care of all the patient preferences.

17. Care after death includes:

• To honour the spiritual and cultural wishes of the deceased person and their family by ensuring all the legal obligations are met(Nurses Roles and Responsibilities in Providing Care and Support at the End of Life, 2016).
• To transfer the body to mortuary.
• To support the family and well wisher to participate in the process and helping them to do so.
• To ensure privacy and dignity of the deceased is maintained.
• To ensure the health and safety of the members who comes in contact with the deceased is protected.
• To return all the belongings of the deceased to their relatives.

18. The emotional attachment for caring and living with the one is seriously ill is an ongoing process and it effects on relatives and carers continues when that person dies. The support that the hospital provides to the family, relatives and friends involved with the patient is known as bereavement care(Bereavement Care, n.d.). The family needs include their culture or spiritual values which should be respected and emotional support is required. Those who require bereavement care, it provides counselling to support them emotionally and mentally. Support is provided via mail, phone or in person.
19. Grief is a natural response which comes when someone we love passes away. It varies from person the way they feel over the loss of their loved ones. As a nurse, I would let their family know that, “I am sorry about their loss”. I will console them theta hospital members or the staff did their best to take care of patient interest. I would ensure the privacy and dignity of the deceased in maintained. I will support all the well wishers and relatives to participate in the process.
20. As an EN, my needs of self-care would be taking precautions of all kinds while treating or interacting with the patient so that my own health is not affected. I would not establish any emotional connect neither with the patient nor with his relatives as it will affect my decision-making process. As per the principles of the nursing I would only share the require amount of information to the patient and his family to keep the situation under control. I would try to win the trust of both family the patient so that they can share everything which will help in taking any decisions. As long as my decision are under control, it will help me to keep balance between the social and emotional well-being.

21. The two-ethical implications of advanced care planning and advanced care directives are as follows: what kind of care should be provided to the patients and how long it should be provided to the patients with poor prognosis during their last stage. This is quite difficult for the family and the care providers to decide about these two factors. Advance care planning can be applied to the patient generally who are newly admitted and there in non-pressured situation.

22. As Caroline is the first-year nursing student I will help her learn how to handle the situation like this in future. I will tell her about the breaking down in front of patient family and their relatives would send negative message to both which will further worsen the situation. The patient family might feel insecure if any medical personnel reacts in this manner. The importance of profession debriefing is significant as sometimes all the information needs not to be revealed to everyone other than medical personnel as it will create panic. Lastly, I would also let her know that establishing emotional connect between patient or the family member is important.

Bereavement Care. (n.d.). Retrieved from Hign Peaks Hospice & Palliative care: http://www.highpeakshospice.org/services/bereavement-care

Camilleri, M. (2011). Opioid Induced constipation. The American Journal of Gastroenterology.

Dicken, B. J., Bigam, D. L., & Cass, C. (2008, January). Gastric Adenocarcinoma. Retrieved from ncbi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356843/

Engard, B. (2017, March 29). Therapeutic Communication Techniques. Retrieved from Rivier University: https://online.rivier.edu/therapeutic-communication-techniques/

Kam, K. (n.d.). What Is Palliative Care. Retrieved from WebMD: https://www.webmd.com/palliative-care/what-is-palliative-care#1

Kennedy, G. (2016). The importance of patient dignity in care at the end of life. Ncbi, 45-48.

ML, V., L, K., & I, H. (2007). Psychosocial issues in palliative care: the patient, the family, and the process and outcome of care. PubMed.

Nurses Roles and Responsibilities in Providing Care and Support at the End of Life. (2016). American Nurses Association.

The Dying Process. (2015). Palliative Care Australia.