Comprehensive Care And End-of-Life Essay For Patients With Serious Illnesses.

What is Comprehensive Care?

Comprehensive care can be referred to as the care provided to a patient that is well planned around the physical, mental, Social, And Emotional Well-Being of the concerned patient. This is usually provided to a patient at the end of their life and is a part of palliative care. Palliative care is provided to patients who suffer from long-term serious diseases. It focuses on alleviating the symptoms and improving the quality of patient’s life by enhancing their comfort (Radbruch et al., 2020). This care plan involves a multidisciplinary team (MDT) that is formed on the basis of care and management required for a patient. An MDT consists of a team of specialized healthcare professionals who focus on providing person-centered care.

 Mr. Jagger’s comprehensive care plan must include plans and methods to reduce his back pain and increase his food intake. At first, the causes of these problems have to be understood and then methods have to be advocated to Mr. Jaggers and his wife that will help them to reduce the impact of these problems. The back pain in Mr. Jagger’s case is most probably because of bowel obstruction that prevents the normal passage of the bowel through the intestines. This has probably also caused the lack of appetite in Mr. Jaggers which led to his malnutrition.

The MDT in Mr. Jagger’s case should comprise specialists who can help ease his condition. Therefore, a team consisting of a surgeon who specializes in bowel cancer, an oncologist, a nurse who can deliver information about and tend to the stoma, an additional nurse for support and care, a pathologist, a radiologist, a dietician, a physiotherapist, and a counselor. Such a diverse MDT can help manage Mr. Jagger’s physical as well as mental and emotional well-being. 

As Mr. Jagger has opted for managing his symptoms without further treatment, his comprehensive palliative care plan should incorporate methods to reduce his back pain. Relieving pain is an integral part of providing palliative care (Sholjakova et al., 2018). The MDT can prescribe pain relievers like aspirin and ibuprofen, weak opioids like codeine, or even steroids to relieve his pain. Other home remedies may include the application of ice or heat packs. However, if the pain continues an ostomy can be performed that will help relieve stored wastes from the intestines thereby reducing pain. They can also design specific diet plans and exercise routines that may help increase appetite and reduce back pain. Providing balanced nutritional diets that will include lower levels of fiber-containing food, increased amounts of vegetables, fruits, and whole grains will help in bowel cancer. The patient should also be advised to avoid alcohol and fizzy drinks. He should also be encouraged to consume smaller portions of meals throughout the day rather than three larger meals. Apart from these, he can also be provided with light exercise routines. Exercise will not only improve his physical strength but also provide energy to do other activities of his liking. One simple yet effective technique is distracting the patient. Encouraging the patient to engage in activities like reading and listening to music helps him not concentrate on the pain he is experiencing. 

Mr. Jagger's Comprehensive Care Plan

End-of-life care refers to the medical care and support that is provided to a person during their last days. It is a part of the palliative care approach and thus, it incorporates the patient as well as their family and other caregivers. Thus, it is very important for the families and carers to have effective strategies to deal with and provide patients with end-of-life care. End-of-life care usually incorporates methods that improve the chances of dying peacefully by following their end-of-life wishes and maintaining their dignity while dying.

One strategy for providing such care may be proper communication between the MDT team, the family members, and the patient about the patient’s needs and wishes. Clear communication helps develop plans according to everybody’s convenience and helps incorporate steps for overall emotional and mental health improvement in order to provide comfort to the dying patient (Jóhannesdóttir & Hjörleifsdóttir, 2018). Through adequate communication important decisions like do not resuscitate (DNR) and wishes of where to live during the last days can be made correctly. Communicating with the patient also improves their mental health as they feel a part of the process. Talking about good memories with the patient comforts them. Friends or relatives who cannot be present physically may send videos of themselves. Apart from that, provide the patient with a safe and secure environment where they can share their feelings and experiences with their caregivers and family members. Body language is also an important part of effective communication (Farabelli et al., 2020). The caregivers should always behave in a way that makes the patient feel that they are receptive to them. Also, physical touch like holding hands can be reassuring for some patients. Sometimes just listening to the patients can help the patients share their feelings about the end-of-life and find solace.

The role of family members in providing end-of-life care is also very crucial. Thus, the MDT should always explain to the family members, their role in the plan of action. Educating them about basic comforting techniques will help them deal with situations better. If family members and caregivers are better prepared, it will reduce their panic and anxiety as well. Family members of patients who develop breathing difficulties should be taught about raising their heads to a semi-fowler position to increase lung capacity (Alan & Khorshid, 2021). Other such techniques include using a damp cloth to relieve dryness around the mouth, providing blankets or changing bedding as required by the patient, and providing the prescribed medication when required. In the case of Mr. Jagger, Mrs. Jagger should be able to provide support to him and make him comfortable at the end of his life. As he is suffering from metastatic bowel cancer and decided to avail no further treatment, his family must be clearly informed about his medical situation. This will help them to be better prepared for the end-of-life phase. His advanced care plan also states his wishes of dying at home and support from family is vital to achieve that.  

End-of-Life Care and Communication

Palliative care is necessary because it not only cares for the patient but also incorporates the family members. When a close family member dies it creates mental and emotional trauma for other members and thus their health care is also managed through this approach (Sherman, 2019). Mr. Jagger wishes to spend his last days at his home but he does not wish to burden his wife with his responsibility. His wife was not comfortable with managing his deteriorating health. Thus, to fulfill both their wishes a nurse can be appointed from the MDT at their home who will care for Mr. Jagger’s requirements. This will allow Mr. Jagger to spend time at home in the company of his wife and also will not burden his wife with all his responsibilities. Along with that, the members of the MDT like the dietician, physiotherapist, counselor, and the physician should also keep visiting Mr. Jagger regularly to monitor his health and provide support as per his condition.

Palliative care includes improvement of overall quality of life. Along with reducing back pain and improving his diet, Mr. Jagger should be given spiritual care. Spiritual well-being is a key component of palliative care as per the definition of WHO (WHO, 2022). Spirituality helps a person provide hope and courage, especially, during the last phase of their lives (Gijsberts et al., 2019). To provide such care, he must be provided with prayers and other religious activities. Being spiritually well, he will feel at peace with himself. Also distraction techniques, like listening to music, reading, or other hobbies that he likes. Keeping himself busy with these activities will distract his mind from his constant back pain and also give him opportunities to seek pleasure through such simple activities. Teaching him meditation techniques will also help manage his back pain. According to Day et al (2020), mindfulness meditation can help improve the ability to deal with pain. Also, acupuncture therapy may prove effective in providing relief from lower back pain (Wei et al.,2019).  Being non-invasive methods of reducing pain meditation and acupuncture will prove to be excellent methods to provide palliative care.  

Adequate family support and comforting activities can provide a sense of comfort and strength to deal with his condition. Administration of anticipatory medications like opioids such as morphine should be decided in advanced care planning so that when the pain reaches an unbearable stage such decisions are already made. Also, adequate amounts of fluids should be provided to Mr. Jagger so as to maintain his electrolyte balance. Apart from these, palliative care also aims at the well-being of the patient’s family. Thus, Mrs. Jagger may be recommended to facilities that provide bereavement support so as to deal with her trauma after the death of Mr. Jagger. Following all these methods will alleviate the pain of Mr. Jagger and fulfill the wishes of both Mr. and Mrs. Jagger.

References

Alan, N., & Khorshid, L. (2021). The effects of different positions on saturation and vital signs in patients. Nursing in critical care, 26(1), 28-34. https://doi.org/10.1111/nicc.12477

Day, M. A., Ward, L. C., Thorn, B. E., Burns, J., Ehde, D. M., Barnier, A. J., ... & Jensen, M. P. (2020). Mechanisms of mindfulness meditation, cognitive therapy, and mindfulness-based cognitive therapy for chronic low back pain. The Clinical Journal of Pain, 36(10), 740-749. https://doi.org/10.1097/AJP.0000000000000862

Farabelli, J. P., Kimberly, S. M., Altilio, T., Otis-Green, S., Dale, H., Dombrowski, D., ... & Jones, C. A. (2020). Top ten tips palliative care clinicians should know about psychosocial and family support. Journal of palliative medicine, 23(2), 280-286.https://doi.org/10.1089/jpm.2019.0506

Gijsberts, M., Liefbroer, A. I., Otten, R., & Olsman, E. (2019). Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature. Medical sciences (Basel, Switzerland), 7(2), 25. https://doi.org/10.3390/medsci7020025

Jóhannesdóttir, S., & Hjörleifsdóttir, E. (2018). Communication is more than just a conversation: family members' satisfaction with end-of-life care. International journal of palliative nursing, 24(10), 483-491.https://doi.org/10.12968/ijpn.2018.24.10.483

Radbruch, L., De Lima, L., Knaul, F., Wenk, R., Ali, Z., Bhatnaghar, S., ... & Pastrana, T. (2020). Redefining palliative care—A new consensus-based definition. Journal of pain and symptom management, 60(4), 754-764.https://doi.org/10.1016/j.jpainsymman.2020.04.027

Sherman, D. W. (2019, June). A review of the complex role of family caregivers as health team members and second-order patients. In Healthcare (Vol. 7, No. 2, p. 63). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare7020063

Sholjakova, M., Durnev, V., Kartalov, A., & Kuzmanovska, B. (2018). Pain Relief as an Integral Part of the Palliative Care. Open access Macedonian journal of medical sciences, 6(4), 739–741. https://doi.org/10.3889/oamjms.2018.163

Wei, X., Liu, B., He, L., Yang, X., Zhou, J., Zhao, H., & Liu, J. (2019). Acupuncture therapy for chronic low back pain: protocol of a prospective, multi-center, registry study. BMC Musculoskeletal Disorders, 20(1), 1-10.https://doi.org/10.1186/s12891-019-2894-4

WHO. (2022). Palliative care. Who.int. Retrieved 19 April 2022, from https://www.who.int/health-topics/palliative-care.