Nursing assignment on the palliative care planning procedure for a patient
Question
Task: Review and critique of a case study that depicts the care provided to a patient and their family in a palliative setting. Critical analysis will be based upon a clinical practise guideline to improve patient care. Using National Palliative Care Standards, NSQHS or NMBA standards, justify in your nursing assignment.
Answer
Introduction
Care that is provided to patients who are suffering from fatal or serious illness is known as palliative care. Palliative care is generally planned by healthcare providers because it helps in supporting patients who deal with fatal and unavoidable losses (Fadul, Elsayem & Bruera, 2021). Moreover, carers who emphasize on palliative care focuses on addressing the sufferings of an individual. Palliative care generally involves taking care of any challenges or issues of an individual which is beyond the physical symptoms (WHO, 2020). The purpose of palliative care considered for this nursing assignment is to treat patients who are at their terminal stage. Currently, patients who are at their dying stage are treated by healthcare professionals with the help of relevant clinical practice guidelines. These clinical practice guidelines are generally formed, governed, and monitored by governing bodies of several country. The objective behind following these guidelines is to maintain the dignity of the patients and to provide them comfort at their stage of dying. This nursing assignment aims at critically analysing the palliative care planning procedure of a person named Tyler James Morton.
Overview of the case considered for the nursing assignment
Tyler James Morton considered for this nursing assignment is a patient who has been interviewed for the purpose of advance care planning. This person has been interviewed by the healthcare professionals of NSW department. The findings of the interview of this patient suggest that this patient is family-centric. He wants to end his life if he fails to recognize his family member as a result of his disease. Moreover, he also communicates to the healthcare professionals about importance of communication in his life. It is found in this nursing assignment that Tyler Morton also wants to discontinue his treatment if he fails to converse with his family members. Finally, this patient wants to be treated in a hospice and he does not want to live in a ventilator.
Critical analysis
The guideline that has been selected for analysing the nursing assignment is titled as “Care of dying patient.” The objective of this guideline is to guide palliative carers while treating a patient at their terminal stage. This guideline consists of several goals. These goals further discuss about medications that should be provided to the dying patient in their last few days. Thus, it can be concluded in the nursing assignment that it is the responsibility of the palliative carer to help patients die with dignity and comfort.
Meeting psychological needs for the nursing assignment
While analysing the case study in the nursing assignment it can be found that to treat Tyler Morton, the healthcare professionals must focus on giving value to the need of the person. This can be done by maintaining the dignity of the patient and help them be at comfort at the time of their death. This scenario aligns well with the practice guideline named “Care of dying patient” (Australian Catholic University, 2018). The objective of this guideline guides carers to use Symptoms Observation Chart (SOC) while treating dying patients. Symptoms like pain, breathlessness, restlessness are observed and patients are treated accordingly. While analysing the case study in the nursing assignment it can be found that Tyler Morton wants to die in comfort so he has asked to give him pain relief medicines if required.
There are various goals associated with this guideline. Among several goals one goal suggest that it is the responsibility of the carer to provide care in positive physical environment and among family members of the patient. According to Self-determination theory, relatedness is the component when an individual wants to feel connected with their own family values and practices (Slemp, Lee & Mossman, 2021). While analysing the case study in the nursing assignment it can be found that Morton attached to his family members and he desire to die in the presence of his family members. This must be considered as one of the psychological needs of the patient and it can further help the carers to develop palliative care planning in the most effective way. However, when an individual is closely related to his/her family members, they tend to become vulnerable. This might create a conflicting situation. If the case of Tyler Morton is taken into consideration it can be found that Morton is closely related to his family. Thus, if he fails to recognize his closest family members and start depending upon them for basic movements then he can find life unbearable and might want to die. It is found in the nursing assignment that this desire of Morton might not match with the desire of his family members. Such differences of opinion with the family members of the patient often delay the palliative care planning. His family members might want to support Morton in his crucial time and do not want him to die. This can give rise to a conflicting situation and complying with the selected guideline might become difficult for the care planners.
Re-assessment of needs in the nursing assignment
In addition to this, the selected guideline for the nursing assignment suggests that to improve the palliative care setting, it is the responsibility of the care planners to focus on continuous assessment of the needs of the patient. Reassessing or continuous assessment of the patient needs is highly responsible for enhancing the quality of care (Donnelly, et.al., 2018). If the interview of Tyler Morton is assessed it can be analysed that he does not want to die in his home. It is analysed in the nursing assignment rather he wants to be in hospice where healthcare professionals, volunteers and other caregivers can work together and treat him with utmost efficiency. Moreover, as per the current needs of the patient, pain relief should be kept in front of the patient because he currently wants to die comfortably and in the presence of his family members. Apart from that if he suffers from any kind of breathing problems and cannot communicate the carer then the family member of this patient should be communicated for further caring procedures. However, if the section 2 i.e., “Personal values about dying”, is analysed thoroughly it can be found that the needs of Tyler Morton is very conflicting. In one section he is saying that he does need a pain relief because he wants to die comfortably. On the contrary, he is also saying that when he will unable to breathe at his death bed, he does not want to use any CPAP machine for comfort. Such conflicting needs of patient can prevent carer to plan the palliative care. Moreover, it can also decrease the likelihood of the success of the treatment (Dudzinski, et.al., 2018). It is found in the nursing assignment that this is how carers might not comply with the selected CPG. Thus, it is highly recommended to the care planners to focus on re-assessment of the needs of the patient. Dying patients often have hope and hope is responsible for changing their needs (Visvanathan, et.al., 2019). Finally, it can be said that the care planners should focus on continuous communication with the family members. Tyler Morton is an extremely family-centric person. He does not want to bother his family members at his dying stage. On the contrary, he wants to die in front of his family members. In such scenario mentioned in the nursing assignment, the goals of the selected guideline must be considered. The carers must create a positive environment in the care centre. This positive environment can only be created with the help of a positive negotiation between care planners and family members of the patient.
Communication
The standard that has been selected for the purpose of critical analysis in the nursing assignment also suggests that it is the responsibility of the carers to communicate or verbalise with the patient if possible. A team consists of professionals from various backgrounds. They have their own process of working and they are responsible for collaborative participation while focusing on palliative care (Kesonen, et.al., 2022). If the case of Tyler Morton is undertaken, he does not want carers to support him with any machinery if he starts suffering from breathing problems. As per this guideline team of carers can take alternative actions. These actions include positional change; discuss symptoms and the care planning procedure with the patient and their family members. To treat a dying patient, their symptoms must be well-managed (Ting, et.al., 2020). As per the selected guideline for the nursing assignment if Morton suffers from any kind of distress at his dying stage, the primary responsibility of the carers is to communicate with the patient if possible. If not then, carers must give attention to the non-verbal cues. These non-verbal cues can also help carers understand the need of Morton. This can further help these palliative carer to change their treatment plan.
However, complying with the selected standard might create conflicts among the team members. When an entire team works together and starts treating a patient who is dying, then conflicts in interests and opinion can be one of the significant challenges. As per the selected guidelines for the nursing assignment, it is the utmost responsibility of the palliative care team to communicate the condition of the patient and medications adopted to reduce pain to their family members. Support from each team member is required while communicating with the family member. Moreover, before communicating any kind of message medical consensus is required. When current evidence of a patient and their conditions are reviewed by the medical team it is known as medical consensus (Cooper, et.al., 2021). Apart from that, the selected guidelines for the nursing assignment, meeting religious and spiritual needs of the patient and appointing a grief counsellor to remove grief among patients are responsibilities of individuals who are providing palliative care to these patients. Moreover, conflicts among team members might create a negative environment and this is how these carers might fail to comply with the CPG guidelines.
Conclusion
This nursing assignment aimed at discussing about palliative care setting and how clinical practice guidelines must be followed by healthcare professionals to focus on advance care planning. From the nursing assignment it can be concluded that a person named Tyler Morton has given an interview. In this interview he has expressed his wish regarding his end-of-life care. The wish of this person aligns well the standard that has been titled as “care of dying patient.” The objective of this guideline is to assess the needs of the patient before focusing on palliative care planning. Moreover, the goal of this guideline is to help patient die with dignity and comfort. While analysing the interview of Tyler Morton, it has been found that this person wants to die comfortably. He wants to avoid ventilation or any kind CPR while dying. Moreover, this person is also attached to his family, so he wants to die in front of his family member. The guideline that has been used in this nursing assignment can help in analysing the needs of the patient in a systematic manner. However, carer might encounter conflicting situation while setting palliative care. These conflicting situations can only be handled through effective collaboration of the family members of the patient, team of carers and the patient himself.
References
Australian, Catholic University, 2018. Care of Dying patient. Retrieved from https://freelanceindia.org/uploads/chat_img/care-of-the-dying-patient-cpg-1598628849_1303982296.pdf
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Donnelly, S., Prizeman, G., Coimín, D. Ó., Korn, B., & Hynes, G. (2018). Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC palliative care, 17(1), 1-13. https://doi.org/10.1186/s12904-018-0365-6
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Kesonen, P., Salminen, L., Kero, J., Aappola, J., & Haavisto, E. (2022). An Integrative Review of Interprofessional Teamwork and Required Competence in Specialized Palliative Care. OMEGA-Journal of Death and Dying, 00302228221085468. https://journals.sagepub.com/doi/pdf/10.1177/00302228221085468
Palliative Care Australia, 2018. National Palliative Care standards. Retrieved from https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/11/PalliativeCare-National-Standards-2018_Nov-web.pdf
Slemp, G. R., Lee, M. A., & Mossman, L. H. (2021). Interventions to support autonomy, competence, and relatedness needs in organizations: A systematic review with recommendations for research and practice. Journal of Occupational and Organizational Psychology, 94(2), 427-457. https://selfdeterminationtheory.org/wp-content/uploads/2021/03/2021_SlempLeeMossman_Interventions.pdf
Ting, R., Edmonds, P., Higginson, I. J., & Sleeman, K. E. (2020). Palliative care for patients with severe covid-19. Bmj, 370. http://dx.doi.org/10.1136/bmj.m2710
Visvanathan, A., Mead, G., Dennis, M., Whiteley, W., Doubal, F., & Lawton, J. (2019). Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients’ experiences, views, information needs and approaches towards making treatment decisions. PLoS One, 14(9), e0222500. https://doi.org/10.1371/journal.pone.0222500
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