Critical Reflection on a Challenging Clinical Scenario of Palliative Care - Literature review Example

CRITICAL REFLECTION ON A CHALLENGING CLINMICAL SCENARIO OF PALLIATIVE CARE BY: STUDENT’S NAME: UNIVERSITY AFFILIATION: COURSE: Introduction Palliative management refers to medical care offered to patients whose illness do not respond to drugs or are not cured by drugs. The care in this case involves actions aimed at lessening the symptomatic effects of the medical. O'Neill and Fallon (1997) observe that palliative care involves effective management of the symptoms, effective communication to close relatives and all others involved in handling the sick. What are the challenging Features of the Woman’s Scenario? There are a number of challenging issues that stand the way of the palliative care service given that I am Muslim. The issues include: Islamic Perspective of Palliative Medicare The cancer patient and family are informed of her condition and the fact that she will die from that condition. The husband appears to have appreciated his wife condition. The behaviour of her three teenage children indicates loss of hope in their mother. According to Islamic culture, undue suffering is “not acceptable” (Gatrad and Sheikh, 2002, p. 5). The patient feels not to seek any therapeutic medication despite the pain. This scenario is challenging because, from nursing perspective, it is understood that the pain can be relieved through administration of drug, a service that the patient does not want. Secondly, Islam view life as sacred and hence deliberate death is forbidden [Quaran 5:32] (Gatrad and Sheikh, 2002). The bowel cancer is terminal, the patient has a blocked bowel and is groining in pain. In such a situation of conflict, a decision to induce death in the patient is inevitable. However, this is forbidden by Islamic laws. This situation is therefore challenging. Handling of the Husband Despite his understanding of the wife’s condition, the husband is determined not to have his wife suffer in pain. He left a message informing of the aggravated condition of the patient and as I enters the family bathroom to see the sick, the husband activates a call for an emergency ambulance. Two factors are challenging here. The husband feels that his wife should die in hospital and not languish in pain at home; and he feels that he is failing his husband responsibility of caring for his sick wife. These issues are challenging since they also conflict the perspectives of Islamic law. There is dire need to serve the interest of the man as this will lessen depression. The Islamic Shar’iah provides that the husband must take care and protect his wife. It says “Men shall take full care of women with the bounties which Allah has bestowed more abundantly on the former than on the latter, and with what they may spend out of their possessions...[Qur’an 4:34]” and “They (wives) are garments for you, while you are garments for them.[Qur’an 2:187]” (Lemu). Conversely, Gatrad and Sheikh (2002) observe that “making death clinical or having somebody die in a hospital setting is not in conformity with Islamic tradition” (p. 3). These factors are very critical; as a Muslim, one must remain relevant to the Islamic culture. Equally serving interest of the husband is imperative. If the call for ambulance is approved the husband will be relieved. But this will only distress the convulsing patient and can potentially kill her. If death occurs as a result of this, there will be conflict with the Islamic norms that forbid death in hospitals and as well induced death for palliative patients. Management of the distressed Children This is the most demanding aspect of this case, dealing with the distressed sons. The husband, having accepted his wife condition, can be handled more easily to accept a medical direction. However, the sons’ condition is worse. To start with, they cannot accept the level of diagnosis of their mother. Secondly, they see their mother languishing in pain, groining relentlessly and fear that she will die. This is totally unacceptable at their age. Cohen (2000) observes (as described in Lander, Hodgins, & Fowler-Kerry (1992)) that “Children's expectations of distress prior to an invasive medical event are related to their anticipatory anxiety”. It is reported that, after watching their mother helplessly, the boys left home. It should be observed that the three sons suffer from stigma of having a very hostile home. Their father is distressed to an extent that he cannot provide proper emotional care to the sons. This is even adding to his stress. What recommendations would you give based on moral and ethical judgment of the above situation? The situation in the case above is in demand of critical and creative intervention. This is necessary to serve the interest of all concerned, majorly the family of the sick woman. The intervention must also not undermine Shar’ia and Islamic ethos observed. From the Nurse perspective, there are at least four players in this case whose interests should be addressed to ensure stability: The patient, her husband, the three sons, and the Islamic moral values which must be observed. The following interventions are recommended. The nurse needs to make the sick persons husband appreciate the conflicting factors surrounding her wife treatment. The husband must be informed that the Nurse observes Islamic culture. The husband must also be convinced that the wife condition is still manageable from home and that her pain will subside soon. Thirdly, the husband must be made to acknowledge that his marital responsibility of supporting the sick wife is not compromised by having the wife served from home. He can still support her while at home. The sick should be offered continued palliative care to lessen her pain. Her will not to seek therapeutic medical care should be respected. Randall (1999) observes that medical personnel “have moral obligations to strive to relieve pain, to be competent in basic pain control, and to endeavour to give patients an adequate understanding of their illness and painkillers”. The nurse must, therefore, assure the patient that her medical condition is not worse and that the family and medical personnel are available to provide any necessary support. This is very important is sustaining peace with the sick and by extension the entire family. Zahedi, Larijani & Bazzaz (2007) observe that “For people reaching the end of life, continuing to suffer may appear worse than death” (pg. 2). It is therefore important that the stability of the sick person is ensured. The nurse will also be obliged to initiate a regular medical check up for this patient. Mehta (2012) states that “A bleeding tumour of the bowel may give rise to iron deficiency anaemia” the palliative care giver must, therefore, do this personally or be assisted by a specialist familiar with the case and the family. The three sons are psychologically depressed. The nurse should appreciate that, it was morally wrong to disclose to the sons their mother’s ill health condition. According to Islamic faith, palliative patients and their families should not be made to lose hope as hope and optimism are “fruits of Islamic faith” (O’Neil & Fallon, 1997. p. 3). To this end, an immediate and carefully tailored counselling process need be initiated to handle the run away boys. This will avert any psychological implications of their mothers condition now and even if future. The counselling procedure should also be structured to seal the social gap experienced in the family. It is also necessary to engage chemotherapy with an objective of reducing pain. This will lessen the situation and enable palliative care to be effective. According to National Health Service (2012), people with advance or progressive palliative illness fear pain. The condition can, however, be alleviated by proper medication. This includes the use of drugs like opioids in correct dose. Pain-topics.org (2012) agrees with this view. It says that managing symptoms during the later stage of palliative infection involves incorporating both pharmacological, non-pharmacological and the use of complementary treatments. In extreme cases of pain, it will be necessary to limit contact between mother and the sons. This will work to lower tension existing in the family. What other health related services would you involve? A series of health related services can be offered to palliative patients and their families. The most common services are: family support counselling, chemotherapy and spiritual care. Family Support Counselling Tan (2011) suggests that working closely with the entire family of the patient is more beneficial than concentrating on the patient alone. This is to the view that a family is “closely knit and remain together” during adversities. To this end, the concern of the entire family is paramount for the sustainability of the condition. In the case above, the medical care specialist need to engage family counsellors to closely work with the family to enable the sons cope with their mother’s illness. Secondly, the husband must be supported psychologically to lessen his depression. It is also important to engage Joint Guardianship in the therapy at this point. “Joint guardianship gives children the security of knowing they will be cared for if anything happens to their parent” (Publiccounsel.org, 2010. pg. 5). Such an effort will spare the teenage sons some mental torture. In addition, it will also relieve the sick mother of excess pain since she will be assured to proper care to her sons if she dies. In the choice of a joint guardian, the entire family is consulted. Chemotherapy Much as the sick mother expressed discomfort with therapeutic medical care, it will be necessary to administer drugs at certain instances. American Geriatrix Societry (2012) says, “Seeking treatment is recommended but is not obligatory for incurable diseases” (p. 89). Drugs used here are focused on reducing pain. Spiritual Care This involves integrating a palliative patient with factors that reflect the essence and substance of her being. That is “the values, thoughts, emotions, motivations, dreams, experiences, assumptions and relationships that make the person a unique individual” (growthhouse.org, 2010). Relevant spirituality aspect of the patient condition should be identified. This should then be integrated with the palliative care. Surbone & Baider (2009) acknowledge that “Cancer patients do not expect spiritual solutions from oncology team members, but they wish to feel comfortable enough to raise spiritual issues and not be met with fear, judgmental attitudes, or dismissive comments”(p.229). Puchalski (2001) suggests that spiritual care “help people find meaning and acceptance in the midst of suffering and chronic illness”. It also helps alleviate pain related to mental and spiritual suffering. Spiritual care will enable such patients to acknowledge their conditions and as a result recover faster. Puchalski says “Healing can be experienced as acceptance of illness and peace with one's life”. While Schultz, Baddarni & Bar-Sela (2012) add that “By asking patients directly about their spirituality and religious beliefs, [nurses] better understand patients as a whole person, deepen the caring relationship, build trust, and can potentially uncover spiritual distress or spiritual beliefs that will impact on decision making”. To this end, spiritual intervention is very necessary. What kind of support would you need to effectively work with the family? To manage the palliative care of the above discussed patient, assistance of different forms will be necessary. The nurse will need: assistance from medical personnel, family counsellors, and support from close relatives and friends of the affected family. The medical personnel will assist the nurse in carrying regular checks on the patient and as well technical advice on handling the complicated conditions that might overwhelm the care giver. Crawford & Price (2003) observe that team work is a very pivotal aspect of palliative work. They say that “when responsibilities are shared, a service greater than the sum of each team member competencies is offered”. In addition to the medical personnel service, there is need to engage a family counsellor. The family counsellor will work closely with the sons and the husband and ensure the family is knit together. Close relatives and friends to the patient will be invited and be associated in providing care to the patient and to her family. This is important in two ways. The patient will feel supported when she sees close friends engaged in her care. The presence of close friend and relatives will enable her cope will the illness and accept her conditions. Secondly, it will be easier to handle the family through close friends who are familiar with family members and understand the strength and weaknesses of the family. The husband will similarly receive moral support from close friends. Appendix Case Summary This paper reviewed the management of a 37 years old woman suffering from bowel cancer in a critical condition. The woman is a mother of three teenage sons and has a caring husband. She has struggled with this condition and has managed it for the past 6 months. The sick person has, however, developed complications for the ill condition. This paper reviewed conflicting ethical and religious factors experienced during palliative care offered to this woman by a Muslim nurse. The paper observed that the religious and ethical underpinnings influence the management of the patient. It also assessed the support needed for effective management of the palliative condition. Reference list American Geriatrics Society. (2012). Doorway Thoughts: Cross-Cultural Health Care for Older Adults. Vol. 3. Retrieved from: http://books.google.co.ke/books Cohen. L. Lindsey et al. (2001). Children's Expectations and Memories of Acute Distress: Short- and Long-Term Efficacy of Pain Management Interventions. Journal of Paediatric Psychology Volume 26, Issue 6 Pp. 367-374. Crawford G. B. & Price S. D. (2003). Team working: palliative care as a model of interdisciplinary practice. Retrieved from: https://www.mja.com.au/journal/2003/179/6/team-working-palliative-care-model-interdisciplinary-practice Gatrad A.R. & Sheikh A. (2002). Palliative care for Muslims and Issues before Death. International Journal of Palliative Nursing, Vol. 8 No. 11. Farzaneh Z, Bagher L, & Javad T. B. (2007, February). End of Life Ethical Issues and Islamic Views. Iranian Journal of Allergy, Asthma and Immunology. 6 (Suppl. 5): 5-15. Growthhouse.org. (2010). Elements of Spirituality. Retrieved from: www.growthhouse.org/spirit/.../bodek_spirituality_in_eol_care_2010. Lemu A. B. The Ideal Muslim Husband. http://www.missionislam.com/family/husband.htm . Mehta. A. (2012, October 10). 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Retrieved from: [US National Library of Medicine National Institutes of Health]. http://www.ncbi.nlm.nih.gov/pubmed/10522743 Surbone, Antonella, & Baider Leah. (2009). The spiritual dimension of cancer care. Critical Reviews in Oncology and Hematology. Volume 73, Issue 3. Schultz. M. et al. (2012). Reflections on Palliative Care from the Jewish and Islamic Tradition. Evidence-Based Complementary and Alternative Medicine Volume 2012 (2012), Article ID 693092, 8 pages. Doi:10.1155/2012/693092 Tan H. M. (2011). BMC Palliative Care. Retrieved from: http://www.biomedcentral.com/1472-684X/10/7 Read More