Holistic Management in Palliative Care - Case Study Example

HOLISTIC MANAGEMENT IN PALLIATIVE CARE HOLISTIC MANAGEMENT IN PALLIATIVE CARE Introduction The intention of the paperis to show how the writer has an understanding, knowledge and practice that are based on evidence. It is required to offer care management that is holistic in palliative care for a person and their relatives. It will try to demonstrate the significance of a comprehensive assessment that is interdisciplinary, with management, planning, and evaluation. It has an effort to provide care that is palliative adequately, and it will be as a study of care. According to the 2015 Council of nursing and midwifery, a person’s confidentiality together with his or her family will be considered in the assignment. In addition, there will be the use of the pseudonym (Dougherty and Lister, 2015). A seventy-four-year-old lady by the name of Mrs. Steel became sick quite very fast and following an admission to hospital and numerous interventions, was discovered to have cancer of the pancreas. Before the admission in hospital, she was staying in her home and Simon her grandson was also living with her now. The old woman had two daughters Lucy and Sophia, and four grandchildren Ellie, Simon, Sarah, and Ruby. Robert, her husband, died a year ago following a small cancer diagnosis. In addition, she had also lost her daughter by the name Mary due to complications related to diabetes. The woman was very active and had a full life that was social. Six weeks before she was, Mrs. Steel was trekking in Peru. They were a knit family network that was very close and had a circle of friends that were wide which intermingle throughout the three generations, providing substantial support to Mrs. Steel. Support was also provided to all members of the family especially after the old woman was diagnosed with pancreatic carcinoma (McCormack and McCance, 2010) pancreatic cancer Literature demonstrates that cancer of the pancreas is the number ten most ordinary cancer in the United Kingdom and the number five leading cause of deaths brought about by disease. It has the lowest rates of survival of all the twenty-one universal cancers, with only four percent of those diagnosed and continues to exist for five years or more (Berry, 2014). Aaron et al., 2013, stipulates that in the Western World, cancer of the pancreas, irrespective of the stage of the disease, remain in the midst of the fatal malignancy. In addition, it has a rate of survival of one year of twenty-five percent and a rate of survival of five years of less than five percent. However, because cancer of the pancreas has limited signs in its beginning stages, it is not typically discovered. It is at the time when the patients start complaining of abdominal pains in the upper side later on, leading to many people being diagnosed when it is late (Berry, 2014). At the time of new diagnosis, the disease has already spread too many parts of the body (eMedicneHealth, 2009). There are principal risk factors that enhance the likelihood of a person getting cancer of the pancreas which include; diabetes, smoking, being overweight and no forgetting history of the family (Lynch, 2011). Mrs. Steel was not currently an active smoker, but she was one a number of years in the past, and the other factors of risk were linked. The World Health Organization, 2012, stipulates that that care which is palliative is a way that enhances the kind of life of individuals and their relatives who face the problems connected with the illness that is fatal. It improves through the relief and prevention of suffering by a way of identification in the early stages. The assessment that is impeccable and treatment of the pain and other troubles psychological, physical, or spiritual problems may be utilized (Strada, 2013).When an individual gets to the stage of the advanced illness that is life limiting, the approach of palliative care is. It is used to provide care needs that are holistic for the end of life care (Lugton and McIntyre, 2005). Considering the scenario of the condition of Mrs. Steel and her already speedy decline, she moved into the house of her daughter known as Sophia, which she shared with Edward, her partner. Ruby, her granddaughter, gave up her bedroom for Mrs. Steel, her grandmother. At the moment, the nursing team of the district got a referral from the MacMillan to go and visit the old woman. They had a mission to build a relationship with her together with the family to enhance the palliative care method (Matzo and Sherman, 2010). In an effort to allow the nursing team of the district to implement the approach of the palliative care, it is important to establish a therapeutic patient-nurse relationship to attain the goals that are. It will also help in getting to have knowledge of the patient. Assessment and communication is a tool that is vital in wanting to get knowledge about the patient. It helps the nurses to anticipate needs or interpret concerns in a manner that is quick (Mok and Chiu, 2004). More so some teams of nursing remain focused in offering the care that is physical, which is believed to be at some point in the disease that is life limiting continues (Kennedy, 2005). The Programme of End of Life Care (DoH, 2010) puts an emphasis on quality that is high on the end of life care. It has an ambition of attaining a better death, can be created by the identification that is early that a patient is about to end their life. It is determined through that an assessment that is holistic. The old lady had an assessment that was holistic which was conducted in her early visit using the records of the unified assessment adopted by the trust that was local. The exact documentation is the choice to have cared that is which is attained to provide quality of life that is good. The better quality of life requires to be ascertained even in the care that is palliative. However, the quality of life concept is complicated and hard to measure and define because it is to a personal level and multidimensional (Locker, 2008). After the patient was referred to Macmillan, an initial assessment, and advanced care, planning was conducted. Therapy for equipment was made, and there was the involvement of Marie Curie. The team of out of hours was also notified. Mrs. Steel was on 40mg MST two times a day due to her abdominal pain. Before her admission, she was taking Gaviscon, laxido, Oromorph and Paracetamol. She was commenced with a syringe driver. The syringe drivers are used to give out little amounts of liquid to a patient for utilization in biomedical and chemical research. They are mostly used for palliative care so as to administer painkillers continuously together with other drugs. The reason Mrs. Steel was commenced with syringe drivers was to prevent sessions when levels of medication in the blood are tiny or too high and avoids the utilization of many tablets (Locker, 2008). When the pain in the abdomen got worse, she began to deteriorate, and she was given diamorphine 30mg. The effect of the drug was vomiting and nausea. When her breathing changed she was taken to Wales end of life care pathway, she was given hyoscine patch for increased rattle and secretions. The medication was used to prevent rattle and secretions. The bad side of it is that the side effects occur within 24 hours after the patch is. The reason that contributed to her death was that midazolam 5mg leads to adverse reactions which are life threatening for people who are over sixty years, even though it helped her reduce the itching (Locker, 2008). Importance of the bereavement visits It is important since to the career, it can be a loss that is final and can be a turning point for him or her. In addition to the death, the family and the care may experience negative emotions such as pain and shock. In addition, the feelings of the death may take a long time to get out of the mind of the carer and the family (Locker, 2008). Gold standard frameworks The context of Gold Standards is a method that has been put into use by the team of the district nursing together with many others in the United Kingdom. It assists in providing the best care for patients with their family members. In the case of Mrs. Steel, it will be applied using three steps; firstly, it will be to identify and locate her. Secondly, her needs will be assessed and recorded, and thirdly there will be planning and provision of the care (Locker, 2008). Advanced care planning The advanced care planning will help Mrs. Steel to live and die in the manner and place of their liking. The primary goal is to provide an end of life care that is good so as to be able to make clear her wishes (Locker, 2008). End of life care pathways They are utilized to guide decision-making and provision of care that is efficient. In the commencing stage of the pathway, the team of professional should come to an agreement that Mrs. Steel will die. Therefore, the team should decide whether medication should continue or not (Locker, 2008). Implementation of interdisciplinary, holistic, and evidence-based for Mrs. Steel In the implementation of the palliative care, it is important to increase the family awareness about the approach by making them understand what it is. It is also important to ensure that the people delivering the care have the competencies, skills, and knowledge for efficiently providing the care. Mrs. Steel should feel confident in the knowledge and skills of the people providing the care. She should also be aware that their expertise is by a teamwork that is right and twenty-four hour support accessibility (Monroe and Oliviere, 2007).The palliative care approach can be through the following stages; Creating awareness and an understanding of the Palliative care From the history of Mrs. Steel, it is evident that the family was aware of the approach and had an understanding it. One of the primary problems of creating awareness will be to strengthen the understanding of the family members and the team of the nurses. The problem will understand that the palliative care is a part of the large social and health care system that is integral to improving the old woman’s quality of life (Connor and Aranda, 2003). The other challenge will be the perception of the nurses that the palliative care is a failure treatment. The lack of awareness can result in an impression that is negative about the value and the potential of the care (Sinclair, 2007). Health that is, advances in medicine and the management of disease that is successful has indeed increased expectancy of life. With the findings, that over the past decades people have kept themselves far from dying and death. In addition, individuals are less comfortable or open to talking about death, bereavement or dying because they are like the last taboos of the society. Therefore improving the level of awareness of the palliative care approach will need a behavioral and cultural shift in how the method is and perceived (Margereson and Trenoweth, 2009) For Mrs. Steel, who will be receiving the palliative care, understanding and improved awareness of the benefits and purpose of the care will offer her family with the confidence. It will also provide the knowledge they require participating actively in the decisions about their care. They may entail the identification of specific services and management of the psychological, physical, and spiritual needs of living with the old woman. Therefore, awareness of the palliative approach should be increased to promote understanding and deal with the negativity that can be to it (Speck, 2006) Training, Education, and Development The improvement of service within the palliative care depends on having a knowledgeable, compassionate, and skilled and workforce that is competent. The usefulness of accessible and flexible training and education in the palliative care has been currently on the emphasis at both regional and national level (Portenoy and Bruera, 2003).There should be quality training and education so as to ensure the required competencies, skills, and knowledge are accessible to the workforce providing the care in an effort to implement an effective approach. The training and education should be aware of the diversity of the old lady. It should also put into consideration that individuals have different expectations and needs of the care which are influenced by their culture, beliefs, background and circumstances that are personal (Fallon and Hanks, 2006) In addition, partnership between the nurses and the educators of the palliative care is imperative. It helps to have programs of training and education that are effective. The programs will also meet the needs of the nurses and will eventually lead to a continuous culture of development professionally. There are four areas that have been discovered for the development of the palliative care by the nurses; · Communication · Assessment of preferences and needs. · Care planning that is advance. · Management system of the four common signs like agitation, breathlessness, nausea and pain (Old and Swagerty, 2007). The palliative care should become a primary element of all post-registration, pre-registration, and programs of clinical education for the care providers. Such undertakings may help in ensuring that related generic skills are put in place when offering quality palliative care. The amount of competence that is for the families, volunteers, and careers will not be the same in every situation. It should be by the assessment that is ongoing to discover the capabilities and needs of the old lady. The programs are also accessible which have been developed by learning principles that are life-long, and they should be where it is viewed as beneficial to do so (Perrin, 2012). Research and Development Development and Research is a primary role in implementing the palliative care. If the part of development and research is into consideration, it will lead to an improvement in the quality of palliative care given to the old lady. It will also contribute to the development of the desired outcomes (Watson, 2009). Commissioning of Palliative care that is based on the quality A palliative care that is based on the quality will depend on commissioning arrangements that are effective which will support the development of the services of the palliative care provided by the nurses. It would be by the collaborations and partnerships that are creative between the nurses. The reason for commissioning is to secure the possible social and health care that is best with the resources that are available. Having quality and the presence of palliative care, so that is responsive to the needs of Mrs. Steel is a primary aspect of the social and health care of the role of the commissioner. The commissioning of the palliative care that is effective depends on the development of service specifications that are robust that lead to the identification of the long and short term goals of the service supposed to be. There are various elements which make contribute to palliative care that is good, and they include; · Increased personal involvement especially Mrs. Steel. · Efficient systems of information. · Ordinary guidelines for the management of situations and signs. · Objectives of performance such as priorities of targets for action that establish ordinary methods of quality measuring to ensure the services meet what is. · A reliable infrastructure for Mrs. Steel, her family, and the service providers. That will make them be able to work in a collaborative manner in an effort to deliver and design and improve the services of palliative care (Baldwin and Woodhouse, 2011). Delivering the Palliative care that is based on the quality. In the delivery of palliative care that is based on the quality needs the partnership of the nurses and Mrs. Steel. Examples of the services of care that deliver the palliative care include the following; · Daycare · Primary care · Access to equipment and information · District Nursing · Language and Speech Therapy · Care that is out-of-hours · Advice that is financial · Voluntary and community services · Chaplaincy and Spiritual support · Therapies that are complementary · Social care that is personal · Medical care that is severe · Therapy that is occupational and support that is psychological (Payne and Reith, 2009). Implementation of a care pathway for quality palliative care The care pathway for Mrs. Steel will involve the following; Identification and discussion of her preferences and needs, planning across the settings of attention and conditions. There is also the delivering and coordination of care across settings, care in the final days of life and the last bereavement of care (Puchalski, 2006). Action plan for the quality palliative care The action plans include the recommendations that have been discovered throughout the development of the approach. It offers clear direction to support the service providers to deliver and plan the palliative care. Every level of recommendation that is high is recommended by deciding which group of service providers will be responsible for delivery and planning, the anticipated implementation timescale. It will also assist in discovering the observed results and how they will be (Taylor, 2012). Decisions about further support or treatment There should be arrangements which will give way to the most significant person in the family of Mrs. Steel to communicate valuable information with her. In addition, there should also be suitable triggers and tools which are supposed to be so as to identify the preferences and needs of Mrs. Steel. There should also be the presence of a register that is local, with the permission of the old woman. The register should have suitable information about the patient, her family, and the preferences of the service provider which should ensure the continuity and coordination of the quality of living. The specific care pathways conditions should have suitable trigger points for the assessment of the needs of Mrs. Steel that is holistic (Buckley, 2008). The other decision for further treatment is the presence of the comprehensive evaluation that is timely by a multi-disciplinary team of care which should be by individuals who possess needs of palliative care. The individuals are to make sure that the dynamic and complex requirements are into consideration, reviewed, and recorded (Watson, Lucas, Hoy, Wells, 2009). The holistic assessments that are timely should also be executed by the family members and nurses. They should be provided with care so as to ensure that their needs are identified and addressed. The old lady together with her family members and the nurses should have access to suitable and pertinent information (Fleming and Hagan, 2010). Care that is a respite should be available to Mrs. Steel in settings that are appropriate for her demands. The government should also implement policies in respect of care plans that are advanced for patients with the needs of palliative care together with Mrs. Steel. There should also be the availability of tools required to deliver the palliative care. They include; Preferred Priorities for care, the framework of Gold Standards and the Macmillan Out-of-hours Toolkit. The teams of out-of-hours are supposed to be competent so as to offer responsive palliative care and to advise Mrs. Steel and her family in the setting (Kinghorn and Gaines, 2007). More so, the palliative care program should be available twenty-four hours, seven days a week. There should also be a potential for a clinical network that is which should be explored to make sure there is integration, leadership and governance of palliative care. The old lady should be a primary worker or a case director. There should also be the existence of central principles of palliative care which should be a component that is generic in all programs of training. Also in social and health care and induction of in staff, programs in all settings of care (Ling and Síoráin, 2005). Conclusion The paper is a case study of an old lady by the name Mrs. Steel. She is 74 years old, suffering from cancer of the pancreas and needs palliative care. The lady was put on medication, but she finally died. The importance of bereavement visits is. There is also the inclusion of Gold standard frameworks, advanced care planning, and end of life care pathways. Finally, there is the implementation of the palliative care method and decisions for further treatment. 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