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Holistic Assessment for Comprehensive Care

Holistic assessment is basically an important aspect that provides high-quality care which is focused on meeting the health of the patient and also the needs of the individual. The holistic assessment also takes the overall health (Hui, 2018). This also includes the psychological, social, social physical, and spiritual well-being of the patient. Holistic Assessment is important as it can help in addressing the cause of the problem instead of just the symptoms. It also takes into account for encouraging individuals to take charge of their well-being and health. It can also prevent illness and can help in finding long terms solutions for the same (Grant et al, 2021).

The choices that people have when they are completing the advanced care plan are the willingness of living, power of attorney, and also health care proxy. Advanced care planning also is important as it identifies the palliative needs of the patients and also recognizes the end of life. it also can help in preparing the families for the death of a loved one and resolving the conflicts between the families and also coping with the bereavement (Dalberg, 2018).

Who makes the decision if there is no advance care plan?

Three major signs of the respiratory distress are –

  • Breathing rate
  • Nose flaring
  • Wheezing

For the palliative patient breathing exercises for the long and slow breaths can be managed by appropriate positioning which is upright and also relaxation training also can be helpful for the palliative patient (Berntsen et al, 2019). Other things which are helpful are Opioids as they are effective in the treatment of dyspnoea, also this might not have any effect on the respiratory rate, oxygenation, and effort like pC02 (Troost et al, 2019).

Signs and symptoms which is associated with the dysphagia or swallowing difficulties include –

  • Pain while swallowing
  • Inability to swallow

These can be improved and managed by taking small mouthfuls of the foods, and also taking sips of the fluid in between the mouth. It also can be improved by sitting upright while having meals and also later staying upright for 30 mins after finishing the meal. Other than frequent meals should be taken (Bucsea, 2019).

Two methods other than the 1-10 scale that can be beneficial in terms of assessing the pain of Judy are –

  • Pain Quality Assessment Scale
  • Brief Pain Inventory

For Judy, doctors can use a pain quality assessment scale as it is a valid tool that can measure the quality of the pain which is being perceived by the patient, it also can measure the depth of the neuropathic pain. Likewise, a brief pain inventory can be used for assessing the pain of Judy as it measures the clinical pain and also is considered to be one of the most widely used tools of measurement of pain (Geziry, 2018). The Brief Pain Inventory allows patients to rate the severity of the pain.

Three examples of Non – pharmacological pain management strategies which can be used in the case of Judy are –

  • Patient psycho-education- as this can help them in verbally giving the therapy session which can be in the form of psychological tools handouts, chapter sessions, and Guides, this can be helpful in the case of Judy as these sessions can encourage her in discovering he information which is necessarily important for her (Kia, 2021).
  • Supportive psychotherapy– It is in form of psychotherapy, this can be beneficial for bringing improvement in the case of Judy as this therapy mainly relies upon the therapeutic alliance which also can alleviate symptoms, and also which can improve their self-esteem, it also can restore the relationship which is to reality, it also can regulate the impulses and can stop the negative thinking (Harrington, 2021).
  • Behavioral interventions– Adapting strategies of Behavioral interventions can help Judy with Anxiety, concerns about the image of the body, problems with the family, and also with the fear of the reoccurrence. It also can improve Judy’s mood and can also decrease the disturbance (Elli,et al, 2020).  

Syringe Drivers are put in a syringe, which goes into a small plastic tube into the body of a point. The tube also is interested in the body using a thin needle, which also then Is removed. It usually also is inserted under the skin on the arm, abdomen, and leg. The main point which needs to be remembered is that a syringe driver is an alternative route for the delivery of drugs and also is not only a method of pain relief (Robinson, 2019).

Advanced Care Planning for End-of-Life Considerations

Contradiction for using the Syringe driver is when the patient is unable to take the medicine by their mouth, mainly because of nausea and vomiting, or oral lesions. It also is used when there is poor absorption of oral medicines (Cherny, 2018).

The main goal is to manage the symptoms of the patient as they are followed by the wound management and also by the treatment of the tumor of the grant which is underlying if the doctor finds it appropriate and possible. The main two areas which should be focused on are progression and quality of the loge which is for alleviating physical symptoms. Including malodor pain, risk of hemorrhage, etc (Van , 2019). The main motive is to ease the suffering and to help the palliative patients in maintaining a good quality of the life. This also can be focused more on the pain odor, exudate, and bleeding of Judy’s health.

  • Central Nervous System: is a part of the nervous system which vertebrates the brain and also the spinal cord, to which impulses are transmitted and passed out. This helps in coordinating the activities of the entire nervous system (Boyle et al, 2020).
  • Cardiovascular System: is the System which supplies the organs of the body with oxygen and also nutrients so that the organs can do their job in a good manner. The blood vessel also in this case carries the carbon dioxide and also can dispose of the waste.
  • Respiratory: is the network of the organs and also of the tissues which can help in breathing, it also includes the airways, blood vessels, and also lungs. The muscles also can power the lings which also are a part of the respiratory system (Ridley, 2020).
  • Gastrointestinal Tract: is a series of the organs which are hollowed and also are joined in a long, twisting tube from the mouth to the anus in the human body (Geziry, 2018). These hollow organs also include solid organs of the digestive system.
  • Renal: is a term that is used to describe how well the kidneys can work in removing the waste and also extra waste for the blood which is in the form of urine. It also can help in keeping the necessary chemicals in the body.
  • Integumentary (Skin): is said to be the largest organ of the body and forms the physical barrier which is usually between the external environment and internal environment so that it can serve, maintain and protect. This is the system that includes the epidermis, dermis, hypodermis, hair, nails, and also other associated glands (Berntsen et al, 2019).
  • Immune / Lymphatic: Immunity is the system that protects the body which is against a foreign invader. The lymphatic system also can be a part of the immune system as it also can produce and resolve the white blood cells and other cells of immunity as they can monitor and destroy the bacteria which might come up in the body and also which can create some of the issues in the same (Dalberg, 2018).

The responsibility of the nurse after the death of the patient and to the family who has passed away is to encourage the client and to make them learn about the effective strategies which can help them in coping with the loss of a family member.

After the death in the Chinese heritage culture, friends and relatives pour water over the hand of the deceased which is a part of the bathing ceremony. Afterward, thy put the body in the casket and surround it with candles, flowers, and also sticks of the incense. Three main customs which will happen after the death of Judy are Inhumation, water burial, and sky burial (Grant et al, 2021).

Bereavement is the sorrow that is provided to the family when a close family member or relative dies. The Bereavement support is given by the Bereavement department and also by the advice center. They mainly support and advises the people and family member on what way should they adopt in order to cope with the situation after the death (Dalberg, 2018).

By asking the employee and the coworker how they feel, and also by communicating well with them, some of the strategies which can be useful while supporting the colleagues after a patient passes away are by seeking face to face support from the side of people, creating a supportive environment and also taking care of everyone and yourself physically can be adequate (Boyle et al, 2020).


Berntsen, G. K. R., Dalbakk, M., Hurley, J. S., Bergmo, T., Solbakken, B., Spansvoll, L., ... & Rumpsfeld, M. (2019). Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial. BMC health services research, 19(1), 1-17.

Boyle, F. M., Horey, D., Middleton, P. F., & Flenady, V. (2020). Clinical practice guidelines for perinatal bereavement care—an overview. Women and birth, 33(2), 107-110.

Bucsea, O., & Riddell, R. P. (2019, August). Non-pharmacological pain management in the neonatal intensive care unit: managing neonatal pain without drugs. In Seminars in Fetal and Neonatal Medicine (Vol. 24, No. 4, p. 101017). WB Saunders.

Cherny, N. I., Paluch-Shimon, S., & Berner-Wygoda, Y. (2018). Palliative care: needs of advanced breast cancer patients. Breast Cancer: Targets and Therapy, 10, 231.

Dalberg, T., McNinch, N. L., & Friebert, S. (2018). Perceptions of barriers and facilitators to early integration of pediatric palliative care: a national survey of pediatric oncology providers. Pediatric blood & cancer, 65(6), e26996.

El Geziry, A., Toble, Y., Al Kadhi, F., Pervaiz, M., & Al Nobani, M. (2018). Non-pharmacological pain management. Pain management in special circumstances, 1-14.

Elli, S., Mattiussi, E., Bambi, S., Tupputi, S., San Fratello, S., De Nunzio, A., ... & Lucchini, A. (2020). Changing the syringe pump: a challenging procedure in critically ill patients. The Journal of Vascular Access, 21(6), 868-874.

Grant, M., de Graaf, E., & Teunissen, S. (2021). A systematic review of classifications systems to determine complexity of patient care needs in palliative care. Palliative Medicine, 35(4), 636-650. 


Hui, D., Hannon, B. L., Zimmermann, C., & Bruera, E. (2018). Improving patient and caregiver outcomes in oncology: Team?based, timely, and targeted palliative care. CA: a cancer journal for clinicians, 68(5), 356-376.

Kia, Z., Allahbakhshian, M., Ilkhani, M., Nasiri, M., & Allahbakhshian, A. (2021). Nurses’ use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. Complementary Therapies in Medicine, 58, 102705.

Ridley, A., & Frache, S. (2020). Bereavement care interventions for children under the age of 18 following the death of a sibling: a systematic review. Palliative Medicine, 34(10), 1340-1350.

Robinson, P. J., & Holloway, S. L. (2019). Psychological factors associated with malignant fungating breast wounds. EWMA Journal, 20(2).

Troost, E., Roggen, L., Goossens, E., Moons, P., De Meester, P., Van De Bruaene, A., & Budts, W. (2019). Advanced care planning in adult congenital heart disease: transitioning from repair to palliation and end-of-life care. International journal of cardiology, 279, 57-61.

Van Hilst, J., de Rooij, T., Bosscha, K., Brinkman, D. J., van Dieren, S., Dijkgraaf, M. G., ... & Korrel, M. (2019). Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. The lancet Gastroenterology & hepatology, 4(3), 199-207.

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