Specialized Nursing for a Patients History of Terminal Illness - Case Study Example

Specialized Nursing Name Course Instructor’s name Date Introduction This paper will discuss a patient’s history of terminal illness. The patient’s medical history and important information will be discussed. It will give a description of the patient’s illness, and the care they received from the diagnosis stage of their illness. The care they received will include surgical treatment, medications and the nursing care the patient received. Palliative care will also be discussed in general and the kind of palliative care the patient received. The paper will finally give an overview of what of improvement should be put in place to improve the palliative care that patients receive. Patient history Rosalina Parker was a 41 year old woman who suffered from cancer. She passed away on 16th October 2006 after a long struggle with cancer. Rosalina lived in Ontario, Canada. She was diagnosed with cancer in 2004; her cancer had metastasized when it was discovered. She had no history of cancer before. Rosalina experienced the following broad spectrum of symptoms for a time; weight loss, she lost weight unintentionally without any loss of appetite. The other symptom she had was persistent fatigue. Fatigue is common in the advanced stages of cancer as it was in her case (Induru & Lagman, 2010). Another symptom experienced was persistent pain. This was because her cancer had spread and was affecting her other organs and nerves; for example, she experienced shoulder pains and headaches. She also experienced a persistent fever which came and went frequently. Finally, the last symptom which she experienced was a chronic cough that would not go away even with common cough medication. Rosalina started treatment immediately. She underwent surgery, radiotherapy, chemotherapy and immunotherapy treatments for her cancer. Surgery was the first step that the doctors tried to control the cancer. The surgery’s main aim was to remove the cancerous tissue before it spread further (Varrass et al, 2010). Chemotherapy was also used for the purpose of removing the cancerous tissues. Surgery and chemotherapy are best when used together to remove the cancer cells from the patient (Litterini & Jette, 2011). In Rosalina’s case, the surgery was to lessen the physical interference of cancer with other organs. She used radiotherapy before and after the surgery; this was a way of trying to minimize the cancer cells and to reduce the spread of the cancerous tissues (Kay et al, 2007). This was done so as to remove the cancerous cells where it had not intensively spread to avoid multiple surgeries (Induru & Lagman, 2010). These treatments were given to Rosalina at different periods of time as a way to control the cancer. She also received morphine doses to reduce her pain; she had a dose of 30mg of morphine every 4 hourly. This gave her complete relief from pain. Nursing care received The kind of nursing care that Rosalina received during her illness was diverse. The nurses helped her with her chemotherapy and radiation treatments. The nurses explained and advised Rosalina and her family on the procedures. The nurses also explained to her the possible side effects of the treatments and also how to deal with the side effects. The other nursing care that the patient got from the nurses was, the nurses explained to her and her family in depth about the treatments that she would take and help them decide on the best treatment for her based on her values. The other nursing care that Rosalina received was palliative care for both her and her family to help them cope with Rosalina’s illness. The first stage of the palliative care was to help Rosalina and her family copes and understand Rosalina’s new health conditions. This was important as this helped the family and the patient deal with the illness in a positive way. When the patient’s health situation deteriorated, a 6months prognosis was given, the nurses offered palliative care this was spiritual, psychological and social support to help them understand and deal with the loss that was waiting to happen. This help from the nurses was useful and appreciated as it helps the family and patient deal with the situation (Robb & Ewer-smith, 2010). Rosalina also received palliative care; the first stage of this began immediately after diagnosis. The care was first psychological; this was to enable Rosalina and her family cope with the fact that Rosalina was diagnosed with cancer. This care enlightened Rosalina about her treatment and gave her the available options that were there for her treatment, this gave her control of her treatment. Palliative care received According to Besser (2009) alliative care is specialized medical care given to patients with serious illnesses. Palliative care is specialized in providing patients with relief from the symptoms, pain and the stress that comes from having serious illnesses (Emanuel, 2005). Palliative care is provided by a team of doctors, specialists and nurses who work together to provide the extra support to the patient. The main purpose of providing this care is making life easier for the patient and their families. Palliative care helps a patient gain the strength they need to carry on with their daily life and helps them tolerate the medical treatment. Palliative care helps the patient understand the choices and options for their treatment and have control of their treatment. Palliative care is appropriate for all stages of diseases, for example, chronic diseases, patients that are nearing death also treatment for curable diseases (Komaromy, Sidell & Katz, 2000). Palliative care is available for both adults and children. Palliative care should be given to a patient from the time of diagnosis of life threatening disease, moving on with the increase of the patient and into the terminal phase of the illness, this should be given to both the patient and their family (Meier et al, 2010). Palliative approach seeks to provide a common ground between practitioners and primary care services to individuals who have a life threatening illness; this is to improve the patient’s quality of life (Walter, 2004). Palliative care integrates all the needs of Rosalina, which is indicated in the assessment done by the doctor. The approach also caters for the needs arising from the physical, spiritual and pain treatment administered on the patient. Palliative care should not be delayed to a patient until the end stages of their illness rather it should be started immediately after diagnosis (Komaromy, Sidell & Katz, 2000). The focal point of palliative care is the understanding of loss and bereavement as important parts of life (Emanuel, 2005). The approaches to palliative care begin with assessment, at this stage; practitioners assess the patient’s illness trajectory, the symptoms and the functional status. Here, estimating a prognosis for the patient allows optimal use of the limited time for patients and their families (Naeim, Reuben & Ganz, 2012). The other approach is an investigation approach, before the investigations for Rosalina were ordered; the doctors ensured that the results would change the management to improve the quality of life. The next approach of palliative care is management; here the patient’s performance status and the symptom burden are assessed so as to decide on whether to add support and symptom management for them. In management, there are steps that are followed to come up with a conclusive decision. The first is monitoring the patient’s functional capacity (Royal College of Physicians of London, 2007). Rosalina’s functional ability was really low as she spent more than 40% of her day in bed that is, when the doctors saw the urgency to put her under palliative care as she had limited time. At this stage, there was a need for co-ordinate care with other health care providers that were working with Rosalina. For the proper co-ordination, Palliative Performance Scale (PPS) was applied to determine the need for increased patient’s support (Meier et al, 2010). There was a need to establish the goals of care with the patient and her family. The doctors discussed Rosalina’s wishes with her over several visits; these visits were to determine her wish to get involved in decision making about her cancer. This was also done to make sure that Rosalina understood the disease and her condition. It was important for doctors to acquaint a legal substitute decision maker for Rosalina (Mooney, 2007). The substitute decision maker had to understand her preferences and had to be well informed about Rosalina’s condition. In this case, the appointed legal decision maker was Rosalina’s husband. Management strategies approach that was used for Rosalina is as follows (the doctors goals were to try and prolong her life). Her nutritional needs had to be looked at as she had reduced appetite; the dieticians helped her make decisions and advised her on the kind of food she should eat, cancer patients have to have a balanced diet (Naeim, Reuben & Ganz, 2012). The care givers took time to give psychological support to the family that would help the family deal with Rosalina’s condition. The family was also given a little training that helped them care for Rosalina when she was at home. Contact numbers that they would call in applicable situations for example, home nursing when they could not handle a certain situation with the patient. Rosalina also received psychological, spiritual and social support that helped her cope with the disease, this care was also given to Rosalina’s family. Rosalina’s condition became worse, psychological and spiritual care was given to Rosalina and her family to help them and her deal and understand her prognosis. This was to help them understand that bereavement and death is part of life (Morrow & Jordan, 2003). It is a vital factor that the family should be prepared to deal with the grief of their beloved’s death after a long terminal illness. According to Schwartz (2004) most patients diagnosed with cancer at most times do not see the need to receive the palliative care. Palliative care highlights on the need to deal with symptom and pain management. Furthermore, it also tackles the need for spiritual and psychosocial support of both the family and the patient. Therefore, palliative care is important for patients with terminal diseases as this helps them and their families cope and understand the disease and the hurdles that may come with the disease (Varrass et al, 2010). Improving care to meet palliative care standards There are some recommended improvements for palliative care that arose during and after Rosalina’s treatment. There is a need for the staff and practitioners to understand the patient’s and the family values, goals and need, this way both practitioners and the doctors will avoid conflicts during the treatment based on their different opinions (Morrow & Jordan, 2003). The other improvement that should be put into consideration is the provision of consistent care for the patient and the family according to the care plan. There were days when Rosalina could not get the proper medical attention she needed due to either the doctors absence or other situations. Another improvement is that, there is a need for appropriate training and supervision for the staff and volunteers that provide palliative care. Volunteers and staff that do not have complete training, should not be given the responsibility of looking after the patient as they might be insensitive (Naeim, Reuben & Ganz, 2012). The other recommended improvement is that there should be constant check up and assessment for the patient and family when the patient’s ability to function is below 50%, and are at home (Naeim, Reuben & Ganz, 2012). This way, the patient can be under strict and professional observation. This would be easier for a family as any change with the patient will be noted and appropriate steps taken. The final recommendation is that the family should also be trained on some issues that would come in handy, in case of emergency and the patient is at home. The training that a family receives will help them in caring for their patient. Conclusion Palliative care is very important to patients with terminal illness. This care helps the patients and their families understand and deal with the illness in a positive way. Palliative care should be given by a well trained professional as they understand the illness and the condition better. Palliative care is not medical care given by one person; but it is team work from the medical doctors, nurses, psychologists and other specialized practitioners (Royal College of Physicians of London, 2007). This care is important to the patients and their families, thus it should be given by well trained persons to avoid misleading the patient and their families. 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