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Requirement
You will design and implement a comprehensive individualised care plan for the person and their family. The care plan will provide the opportunity to apply palliative care principles to the assessment, planning and management of ongoing care.
You will identify and describe a case from your experience. Your case study and care plan will address physiological, psychological, social and cultural needs and your care decisions will be justified using current and relevant evidence to support your clinical reasoning, and include an analysis and evaluation of the outcomes of care. Finally, you are to reflect on the concept of palliative care and unpack your views on your approach to caring for patients at end of life.
Solution
The Nursing practice requires many qualities. It requires specialised skills, knowledge and independent decision-making skills. There are many aspects of nursing practice. It includes the type of client, different disease management, care and also rehabilitation. This relation is based on mutual respect and trust. It is a helping relationship in which the nurse should be sensitive to self and others . Providing physical, emotional, spiritual support to the patient and their family.
The palliative practise involves communication between nurses with officials , patients and also their relatives. By effective communication, a comfort level with the patient is developed by which patient conveys his pain, fear , shares anxiety. Listening is a very important mode of communication. It requires nursing skills and attention. By this nurses can access the situation and problems of the patient. By being a good listener nurses can provide care at all levels of recovery.
Along with listening , speaking with the patient also becomes important .Conversations should be held in appropriate condition. Each patient has its own way to discuss the problem. After the nurse has listened to all the problems she can talk to the patient.
Physically palliative approach is followed to manage pain and physical discomfort in most of the situations. Pain being the most important complaint in the palliative approach to treatment. As the discomfort increases the need for palliative approach increases. It becomes very important where treatment is painful .Old age people become prone to life-threatening disease or their suffering increases due to the natural ageing process. In many countries, palliative services are provided at home only. Mostly people by the end stage of their life prefer to spend their time at home. The palliative approach helps patient’s family to cope with the terminal illness of the patient. Palliative care leads to hospice care which includes focusing on comfort and quality of life. A personalised action plan is required for every patient for comfort and care. In this, it has been found that the survival expectancy is increased by 6 months. In this, the main focus is on pain control which troubles the patient most. Pain control is done by analgesics and comfort measures which can be achieved at home.
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It is important to develop an integrated care pathway for the dying patient. This is for the patients whose diagnosis is known and loss of life is inevitable. In this symptoms are closely monitored and palliative approach is followed accordingly. In few cases, older people denied access to palliative care. In these cases, their admission in hospital and nursing home becomes very important. Specialised palliative care is required in many patients.
Proper symptom control is impossible in older adults without proper communication. An accurate assessment of patient’s health requires effective communication. Communication is the centre of all treatment. Communication will deliver a great amount of palliative care to the older adults. In the society conversation about death is often very awkward and difficult. Among the health care professionals, there is a requirement of improvement of techniques to overcome these obstacles. In last two decades, there is awareness of the importance of communication skills (Kinley et al, 2013).
A Patient age 60 years gets admitted to the hospital with uncontrolled type II diabetes. Nursing is very much required in this area. As a patient with Diabetes type II may require guidance, treatment and proper monitoring. Diabetes patients often stay on treatment for life-long. Here the nursing plans include the treatment to normalise blood sugar. The blood glucose should be around 120. More than these needs to be reported to the treating physician. Also to implement a strict and balanced diet for the patient. Also, it is important to make sure that adequate exercise regime is being followed. Also, it is important to monitor the day to day sugar levels of the patient. As here we can see the patient is having unstable blood sugar this can be due to many factors like inadequate blood glucose monitoring. There can be also non-adherence to diabetic management. A nurse needs to keep a check on these. (Dunning, 2013). Also, it is important to manage the timely medication of the patient. Also, it is important to give adequate knowledge to the patient regarding diabetes management. There should be a proper chart formed on the day to day development of the patient. So that the patient’s development can be monitored. Also, a nurse should be able to address any stress related concerns. As in diabetes, the main factor is stress. Stress causes aggravation in diabetic condition. Also, it is the duty of the nurse to encourage the patient for exercise. A sedentary lifestyle causes weight gain and this will cause increased chances of uncontrolled diabetes.
It is the duty of the nurse of access the sign and symptoms of hyperglycaemia through regular blood glucose tests. Also, it is important to keep a check on blood sugar before meals and along with blood sugar, it is important to access Hab1c values of the patient. It should be between 6.5 -7. Being a nurse it is important to monitor its level in every 2-3 months. At times the diabetic drugs cause immediate hypoglycaemia, There are few signs of hypoglycaemia like anxiety, tremors, slurring of speech. A nurse should be able to recognise these sign and symptoms. Also, it is important to keep a record of temperature and pulse of a diabetic patient. In many cases the patient is diabetic but he does not have any knowledge regarding diabetes. It is very important to inform and educate the patient about the changes he needs to bring in his lifestyle due to diabetes. Exercise causes lowering of blood sugar. It is important to educate the client about proper exercise regime. It will help managing diabetes. Also, the old patient is on insulin, it is important to give him insulin on the prescribed timings. Also once the patient is discharged from hospital he needs to teach how to monitor his glucose levels at home. There are many cases that hypertension is also associated with diabetes.
Along with blood sugar management, the patient has to monitor its Blood pressure. BP control will prevent many diseases like stroke, retinopathy etc. Also, regular urinary checkups are also important as it will help the patient to monitor the urine albumin levels. Its increased levels are found in renal nephropathy. The oral medications and insulin schedule need to direct properly to the patient. Also as the patient is on insulin there are few things which you need to tell him. Insulin injection should not be given at the same site again and again. Insulin needs to be refrigerated at 2 degrees to 8 degree Celsius. Check the expiry date of insulin every time before use. Also, it needs to be told to the client that insulin has to be injected only once or twice daily. Regular prandial insulin which has been prescribed to the client has to be injected 30 minutes before the meals. Also, it is important to mention the patient that insulin dosages are to be reduced if he is fasting or not eating or when there is hypoglycaemia. Rotation of insulin site is very important. Pushing injections on the same side may cause fat deposits. Also, most important factor to be told is the injection should be injected perpendicular to the skin. Also, it is very important to check that the patient understands the demonstrations . Also patient needs to be taught to follow a low fat diet which is high in fibre and low in sugar. There should be a proper balanced three meals daily which can include a healthy evening snack. There should be an increase in fibres diet. Also if hypoglycemic conditions set in then treat it with a snack or a glucagon injection.
Infections are very common in diabetic patients. As due to high blood sugar, these infections don’t heal rapidly. It is important to observe the signs of infections. There are many signs of infection such as fever, cloudy urine and wound drainage. Immediate hospital admission may be required at this stage. It is important to follow some basic hygiene rules. The skin needs to be dry. The linens have to be washed properly and kept in hygienic conditions. It is important for the patient to monitor its vital signs during the stay at home. While instructing the patient we need to check that he is aware of his time and orientation. It is important to call the patient by name. This helps in gathering the attention of the patient. The instructions given to the patient should be short. We need to speak slowly and clearly. Also, we ask the patient to repeat in case he does not understand we need to explain him again. The patient needs to follow a strict routine so that he does not forget his medications and injections. It is also important to tell the patient that he need to avoid injury. Also, we need to access the problem-solving capacity of the patient from the past experience. Is patient able to take care of himself or there is a requirement of a home nurse. It is important to encourage the patient to take decisions, he should be able to take decision related to his care. Also, we need to schedule appointments and other activities henceforth. It is important to encourage the patient to take part in outdoor activities. It will keep his exercise regime good. Also, physical activity will help him reduce his blood sugar and live a healthy life. It will also promote positive health care in the patient and feeling of control over the situation.
A palliative care is an approach which reduces the stress and pain due to suffering from terminal disease. This is adopted mainly in life-threatening diseases where the cure is not possible. The palliative approach is utilised to improve the life of the patient from the pain and suffering related to the disease. This also helps and supports the life of the patient who is having a natural death. The life-threatening disease can be encountered at any stage of life. Different type of palliative care is required for different age groups .Hence an age-related palliative approach is required .The palliative approach is based on individual needs , it differs in different age and medical condition. The palliative approach helps to comfort the individual suffering from the disease (Aoun et al, 2015).
In palliative care a nurse should be able to carry out tough conversations with the patients family. These conversations include patient’s current health , the progression of a disease and anticipated death. The information provided should be honest and it should be provided in a way that the family members should be able to understand the situation. Palliative care nurses need to be knowledgeable and they should carry enough experience in nursing to deliver sensitive information in a proper manner. The role of the palliative nurse is extremely stressful . It is important for the nurse to focus on self-care along with the care of patient and family members
Physically palliative approach is followed to manage pain and physical discomfort in most of the situations. Pain being the most important complaint in the palliative approach to treatment. As the discomfort increases the need for palliative approach increases. It becomes very important where treatment is painful .
In end life patient involves the ability to both give and receive information. It is important for the nurse to make the patient understand his/her condition. Also to prepare the family for the near future events which will occur. However, In the case of old adults, it is sudden death. Thos may come as a shock to the family. It is the duty of the nurse to explain the correct situation of patient’s health to the family so that they can deal with any sudden emergency
. In this case, the nurse has to keep a clear communication (Katz et al, 2016). She needs to keep patient’s relative about patient’s condition. For the patient’s family circumstances change on a day to day basis depending on the patient’s health. Like in the case of older adult the family may need to discuss something which is very difficult and emotive. Open and sensitive communication works in the best way. It also depends on an appropriate situation. This applies to nurse, patient and family members. Communication in nursing practice comes naturally. It's not simple, it is always difficult to communicate with some terminally ill. It required education and experience. The need of great communication skills is required by nurses worldwide especially in a situation of serious illness or end life care. Nurses are the one who spends most of their time with the patient and around them (Brinkman-Stoppelenburg et al, 2014). Hence communication with them plays a significant role. Nurses help patient and their family to interpret the bad news , they also play a crucial role in listening to them post such information. In these case, nurses need to reflect positive care towards the patient and their family .Patients and their families have concerns regarding the dying process and death. In this stage, the patient is in great pain and many unrelieved symptoms. Nurses should actively participate in providing information and explaining the medical terminologies
As the medicines have already played their role. It is a stage where a patient wants to say want he actually feels and at the time someone who has knowledge and presence of mind is required (Moir et al, 2015).
However, in many cases, the patient might take a good amount of time to understand the approach of the therapeutic relationship and respond to it. To appreciate the effects of therapeutic relationship we must look for its outcome. Researchers have shown that therapeutic relation improves the quality of the life of the patient (Teno et al, 2013). Moreover, they are able to communicate in a better way and therefore sharing their concerns which are very important.
Nursing has a very strong impact on our society .Nurses can use their research knowledge and skills to answer questions related to nursing diagnosis also they can prepare care plans for patients. It includes learning about drugs and diseases. Obtaining information from the patient which is a very crucial practice for nurses which will help them in their further research. Through patient interaction, they can investigate new topics pertaining to their interest. All this will promote the professional development. There are certain laws related to nursing. Over 100 years ago these laws were made to ensure the safe nursing practice.
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Place Your OrderCaring is the term always associated with nursing (Larkin, 2013). The nurse's behaviour should be holistic and the actions should aim at creating and maintaining an environment which will support healing. To support the nursing profession the nurses need to engage themselves in a broad range of activities when enacting professional roles. There should be a deeper understanding of the term care. There are multiple levels of care. Caring comes with professional experience. It may have a different meaning for different nurses. The concept of care depends on different factors. It depends on the amount of professional experience, the level of nursing education, professional values and how and where the nursing skills and concepts are being applied. The caring concept is central to the nursing practice. It requires great amount of discipline and dedication to follow. There should be intentional and conscious caring. This will bring out the best of the nursing practices from you. Being a nurse means you have to be fully present in that moment and take proper care of the patient. It is all about having a trusting, helping and caring relationship with the patient. This should not be limited to the patient but also should be extended towards the other staff and most important the caregivers of the patient (Anstey et al, 2016). This gives a positive feeling in the patient and the caregivers. Caring is a very integral part of nursing. It is important to engage yourself in genuine care by learning through various experiences with the patients. This will come with years of practice and dedication. Caring is an art which has to be studied but more than this it is an attitude in life which nurses should flow for the patients and also the people around them. It is a there duty to create a healing environment. Researchers have proved that if a patient is given adequate care and timely medication it can even have miraculous results. For terminally ill patients care is the most important thing they required. This may add few more months or years in their lives. Caring is the most important aspect of the nursing profession. As we know that in old age many patients suffer from lack of care. A proper caring institution can give relief to old age patient in many aspects (Gélinas et al, 2012)..
References
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Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., ... & Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.
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Larkin, P. J. (2013). Listening to the still small voice: the role of palliative care nurses in addressing psychosocial issues at end of life. Progress in Palliative Care.
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Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 0269216314526272.
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Katz, R. S., Johnson, T. A., & Johnson, T. G. (Eds.). (2016). When Professionals Weep: Emotional and Countertransference Responses in Palliative and End-of-life Care. Routledge.
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Gélinas, C., Fillion, L., Robitaille, M. A., & Truchon, M. (2012). Stressors experienced by nurses providing end-of-life palliative care in the intensive care unit. CJNR (Canadian Journal of Nursing Research), 44(1), 18-39.
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Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. J. (2015). Communicating with Patients and their Families about Palliative and End of Life: Comfort and Educational Needs of Staff RNs. International journal of palliative nursing, 21(3), 109.
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Anstey, S., Powell, T., Coles, B., Hale, R., & Gould, D. (2016). Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Supportive & Palliative Care, bmjspcare-2015.
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Kinley, J., Froggatt, K., & Bennett, M. I. (2013). The effect of policy on end-of-life care practice within nursing care homes: A systematic review. Palliative medicine, 27(3), 209-220.
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Aoun, S., Deas, K., Toye, C., Ewing, G., Grande, G., & Stajduhar, K. (2015). Supporting family caregivers to identify their own needs in end-of-life care: Qualitative findings from a stepped wedge cluster trial. Palliative medicine, 29(6), 508-517.
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Towsley, G. L., Hirschman, K. B., & Madden, C. (2015). Conversations about end of life: perspectives of nursing home residents, family, and staff. Journal of palliative medicine, 18(5), 421-428.
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Dunning, T. (2013). Care of people with diabetes: a manual of nursing practice. John Wiley & Sons.
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