Nursing Assignment: Providing Palliative Care To Patients

Question

Task: The purpose of this nursing assignmentis to explore and apply the palliative care approach to the following case study. You will analyse different care contexts to deepen your understanding of palliative care nursing as part of person-centred, interprofessional care.

Case Study Description:
You are working with a palliative care team in the community. You have a referral from the Renal team to meet with Rose for the first time. Rose is a 78-year-old Aboriginal woman, who was diagnosed with Chronic Kidney Disease (CKD), Stage 3, 2 years ago. After consultation with the renal health care team, Rose has decided not to proceed with dialysis as a treatment option because she also has Hypertension and Type 2 Diabetes. Therefore, Rose has chosen a conservative management pathway that involves shared care between the nephrology team and the palliative care team. “Renal supportive care (RSC) is an interdisciplinary approach integrating renal medicine and palliative care. It supports patients with chronic kidney disease (CKD) and end stage kidney disease (ESKD) and their carers/families to live as well as possible by better managing their symptoms. It also encompasses advanced care planning and end of life care”. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0020/443072/Renal-Supportive-Care-Service-Model.pdf)

Rose lives with her husband Tom, 76 years old non-Indigenous man, in their own home. Their daughter Penny, 40 years and son Jon, 45 years live with their own families. Penny has two sons, 5 and 8 years old and Jon has a daughter 20 years old and son 15 years old. Rose is the eldest in her family having 3 brothers and 4 sisters. Tom is the youngest in his family, having one brother. Rose and Tom have a very supportive family. Rose is passionate about being an active Aboriginal community member.

Assignment Instructions:
Answer the following questions related to the case study. Draw on your online learning, tutorials and simulations to structure your answers. Provide an introduction and conclusion.

Section 1: 1400 words
1. In consideration of the key principles of palliative care, explain why Rose, having CKD may opt for conservative care rather than dialysis.
2. Outline how you will establish and promote culturally safe practice
3. Explain why a team approach, inclusive of the renal and palliative care teams, but not limited to, is an important approach to address the care needs of Rose, with consideration of her life-limiting illness.
o Consider the benefits and challenges in relation to Rose’s continuity of care.

Section 2: 400 words
Rose has now progressed to End Stage Kidney Disease. Rose has emphasised that she wants to die at home with support from her family.
1. Explain the palliative care focus specific to Rose for her end-of-life care.
o Identify the resources required, who will be involved and how the care team will coordinate care.

Answer

Introduction
People across the world often suffers from chronic disease and slowly they reach the “end of life” stage. Thus, in the present context ofnursing assignment, it can be said that palliative care is provided to patients who face critical illness (Edwards, Voigt&Nelson, 2017). The primary objective behind providing palliative care is to provide relief to patients from their symptoms. The aim of this report is to align a case study with the basic principles of palliative care. The report focuses on explaining the why patients often opt for palliative care instead of going through the traditional techniques.

Section 1
Reason behind adoption of conservative care
The case study that has been used for the purpose of conducting the report says that Rose who is suffering from stage 3 Kidney Disease chose conservative care as her primary treatment instead of dialysis. Palliative care provided to patient is family and patient centric and people is also centered to the person who is caring the patient (Agency for clinical innovation, 2021). Rose wants her family to take care related decisions, she also emphasizes on health & well-being. Furthermore, dialysis involves lots of pain and Rose does not want to take any stress through the process of treatment. This is one of the reasons Rose has adopted palliative care. Despite having several advantages, palliative care can have ethical challenges because members of family might not take proper decisions regarding the treatment of Rose. This can increase the pain of Rose.

The second principle of palliative care is providing care on the basis of the need of the patient. Rose is currently at the “end of life stage”. At this stage the needs and demands of the patient often changes. Nurses or care-providers tend to spend most of the time with the person who is suffering from the chronic disease (Al Qadire, 2014). Therefore, they can understand the needs of the patients more precisely than any one else. There is no exception in case of Rose. Due to the increase in the physical pain the needs and demands of Rose is also changing. So, she decided to adopt palliative care. On the contrary, patients in such scenario might demand something that is not good for his/her health. In such cases, the care-giver might face ethical challenges.

The next principle of palliative care is the care givers, patients and their family members can take help of local network to meet the need of the patients(Agency for clinical innovation, 2021). Rose lives with her husband and her children along with their family lives in different homes. Rose wants to be treated in her house so that she can have access to quality healthcare services. She decided to take support from the nephrology team and her family members who live nearby to assess her needs. On the contrary, aboriginal people who live in remote areas often have limited palliative care services and their network is also less. Since, Rose is an Aboriginal lady, her carer might not have access to the nearby network to meet her needs. This may deteriorate her health conditions and increase stress among the family members.

The fourth principle is palliative care is safe, it is effective and is also marked as culturally-safe. Palliative care is effective because it enhances the satisfaction of the patients and is cost-effective (Gomes, et.al., 2013). Rose has adopted RSC. This means Renal medicine as well as palliative care will be provided to Rose that will enhance the living conditions of Rose at this stage of her kidney disease. Despite, having several benefits, if the condition of Rose starts declining at any point of time then it might become difficult to treat her at her home. This can also lead to her death. This can be marked as one of the ethical challenges of palliative care.

Palliative care can be integrated and coordinated. In the case of Rose, nephrology team will be constantly coordinated and integrated while treating Rose. Despite, this if the treatment or suggestions from the Nephrology team is delayed then it can be life threatening from Rose. The sixth principle of palliative care is care should be equitable. This means Rose will have culturally-sage and equal access to the basic care irrespective of their cultural or linguistic background. On the contrary, it is often found that people who belong to the aboriginal community or whose age is above 65 years often fail to access support from their family and they also cannot afford palliative care. This can throw challenges and can be a barrier to the decision undertaken by Rose.

Promoting culturally safe practice
When cultural identities of each and every person is respected while going through any practice it is known as culturally safe practice. Culturally safe practice also has close association with palliative care. Indigenous people across the world like Aboriginals of Australia are currently opting for palliative care when they reach final stage of their chronic illness. Thus, it is the responsibility of the care givers to focus on cultural sensitivity healthcare practice. Patientswho have adopted this palliative care, wants to be respected and treated well (Shahid, et.al., 2018). There is no exception in case of Rose who is an Aboriginal woman. Therefore, adopting culturally safe practice for providing palliative care to Rose is of utmost importance. Primarily, it is the responsibility of the care giver to empower cultural identity of the patients and traditions followed by the patients (Schill &Caxaj, 2019). The care giver of Rose should value the cultural aspects and beliefs of Rose.

Furthermore, shared decision making is also important for culturally safe practice. Since, the primary objective of palliative care or “end of life care” is to reduce stress of the patients and focus on maintaining the health & well-being of the patients.It is the responsibility of the care giver of Rose to take major decisions about her health and care by collaborating with the nephrology team, Rose herself and members of her family. Rose herself should be informed about the decisions it can further empower her.

Interprofessional Care Team
The role of interprofessional care teams has gained significance because physicians alone cannot provide all the necessary clinical and educational services that patients often require in various new emerging models of care. Interprofessional teams consist of various physicians, doctors and nurses working at different levels, dieticians, physician assistants, medical assistants, nutritionists, mental health workers, health navigators, social workers, community health workers, health coaches, quality improvement and informatics, patients and family members, exercise physiologists and others (Weiss, et al., 2014). These professionals form a team for offering the best care and practices to the patients and communities. This teamwork would be beneficial for Rose in breaking down existing walls and converting fragmented care into integrated care for her illness.

Rose was diagnosed with Chronic Kidney Disease (CKD) and further possessed Hypertension and Type 2 Diabetes. This shows that an integrated approach undertaken by both nephrology team and palliative care team alongside dietician would be helpful in addressing her life-limiting illness. These three types of professionals would be able to look after all the health requirements of the patient by covering all her needs. These interprofessional team consisting of three professionals would be able to leverage health information about Rose, use their experience, technologies and foster a culture of teamwork to ensure value for the patient and her family (Bosch& Mansell, 2015). These are expected to generated both benefits and challenges arising from the interprofessional care provided to Rose. There would be improved care through increasing coordination between the services of palliative care team and rental care team along with a certified dietician. This integrated healthcare would be beneficial for a wide range of health needs of Rose, such as, kidney disease, diabetes and hypertension problems. Furthermore, it would also include the patient herself as an active partner, thereby enabling her to participate in her own recovery process (W. Hutchison Jr, 2014). Besides, it would also result in efficient use of time and services for ensuring better care to the patient. In addition, Rose was a Aboriginal woman with diverse cultural background, which would be addressed through this interprofessional care.

Despite the benefits, there also exist some challenges of this interprofessional care team. It has been observed that not all healthcare professionals would be willing to work in teams (Nester, 2016). This possibility might have resulted in effective communication in providing service to the case study patient Rose. It could have also arisen because she is a complex patient having multiple providers and customized needs (Nester, 2016). Besides, this might also become time consuming for healthcare providers working under pressure to meat organizational and patient goals. Furthermore, the process of team formation itself can be time consuming and matching of schedules from the palliative care team, nephrology team and the dietician, which might delay the process for care to Rose (Med.mun.CA, 2021). The collaboration and communication required between team members can also reduce the time from the patient’s appointment schedule. In addition, there also exists the challenge of constant conflict resolution and goal re-assessment.

Section 2
End of Life Care
Rose was suffering from a life-threatening kidney disease that made her eligible for palliative and end-of-life care. This care is beneficial for the patient by focusing on improving her quality of life for the remaining days by managing her symptoms and supporting her emotionally, spiritually and practically (Better Health Channel, 2021). Here, a person-centred approach is more suitable for the patient as she has emphasized on dying at home with her family members by her side. Rose can be made at the centre of planning and decision-making around these last months. Furthermore, all her cultural, religious and individual needs should be included while planning for her palliative care and she should only be treated in the way she wants (Marie Curie, 2021). Besides, the interprofessional team should focus on identifying her values and preferences and accordingly include them for planning her care. She would also be treated respectfully and dignified manner in this care. This end-of-life care would aim at ensuring that the patient can live as comfortable as possible for the rest of her days (Marie Curie, 2021). In this regard, Rose should also be encouraged to speak to the healthcare providers and her family to better understand her expectations and preferences from this treatment for ensuring her increased satisfaction.

End-of-life care can be provided with the help of a wide range of providers. These providers mainly work in health, community agencies or human services and are capable of providing such care. They might include staff from local community health centre, staff at local clinic, local government agencies, cultural and religious service providers, disability services, hospitals, medical specialists and residential care facilities (Better Health Channel, 2021). This care would involve listening and speaking with the patient, being empathetic to her needs and concerns and referring to more customized care and support. Thus, a range of people and services can be regarded as resources in this care for suiting the needs of Rose.

The end-of-life care should begin with an open and honest discussion about the disease and outcomes of the patient and should continue to listening to her needs and thoughts about the same. In this step, it is essential to build a foundation of trust with both Rose and her family members. Plain language must be used for providing an overview of the entire situation, the diagnosis, implications and ensuring no assumptions are made about the patient’s understanding. Utmost care and comfort both physically and emotionally would also be ensured during this process.

Conclusion
The report focused on understanding the use of palliative care to the case study of the patient named Rose, who was suffering from CKD, hypertension and Type 2 Diabetes. She was in the crucial stage of her kidney disease alongside other chronic illnesses. Thus, an integrated care approach from both palliative and renal care teams was suggested. The report analysed the reasons for offering conservative care to the patient and further helped in understanding the importance of culture specific care. In addition, it displayed the use of interprofessional care team and the end-of-life care for the patient.

References
Agency for clinical innovation, 2021. End of life & palliative care. Retrieved from https://aci.health.nsw.gov.au/palliative-care-blueprint/the-blueprint/principles
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