Nursing Care for Clients Requiring Palliative Care - Case Study Example

Introduction Palliative care usually involves taking care of patients with acute or even chronic pain. Palliative care needs to be quite holistic in nature such that the patients are taken care of physically, emotionally and even spiritually. Palliative care can also be described to be sedative in nature. (Foley and Gelband, 2001) In this case, health care givers do all that is possible to make sure that patients do not undergo a lot of pain during their ailing period. This paper therefore looks at Lorna Hetherington’s case study. She was diagnosed with breast cancer. She is eighty five years old. She was also recently diagnosed to be also suffering from pneumonia. Lorna is currently going through so much pain, has progressive weakness and a swelling chest. (Watson and Lucas, 2005) This paper also looks at how palliative care would be demonstrated towards this patient. It further describes the importance of teamwork in this specialised area. There is further an illustration of the participants in the development of the client’s care plan. There is also information on how support will be given to clients and others to contribute to the care plan and also identify spiritual, cultural, needs and lifestyle options. There is also information on the support that would be provided to the client and their family members to prepare them for the client’s death. This also includes how to maintain the client’s dignity after them. Finally there is a care plan that has specific needs of Lorna and her family. (Watson and Lucas, 2005) Palliative care approach A palliative care approach needs to be incorporated when taking care of Lorna Hetherington. From the case study, Lorna went through mastectomy and chemotherapy sessions. The disease recurred and has not responded to any of the recommended treatments. (Watson and Lucas, 2005) She is currently in the hospice wing though she recently had a bout of pneumonia. Lorna uses hearing aids though she forgets to switch it on thus making communication a hard task for all those around her. Lorna has so much pain and increased swelling. She has also developed decline in her cognitive ability. This clearly shows that Lorna really needs palliative care. When offering palliative care to Lorna, much attention should be given to her. She has to be assigned a nurse needs to be always there especially in situations when her relatives and friends are not visiting. The nurse should ensure that her hearing aid is switched on every morning. The nurse should give the patient maximum attention and should involve her in conversations. These have to be focused on other issues. This will help ease the effect of the pain on the patient. This helps by making the patient’s mind not to be focused on the pain hence relief from the effects. (Hallenbeck, 2005) In giving palliative care to Lorna, nurses can also organise for television programs that will help shift her attention from pain. This includes comedy movies that can make the patient laugh. These programs can also include tele-evangelists that preach hope even in situations where there is no hope. This is considering the fact that Lorna was a committed Christian before she started suffering from breast cancer and pneumonia. Nurses and healthcare givers also need to continue giving the patient pain killers. Importance of teamwork in this specialised area Teamwork is very essential when dealing with palliative care in the hospice. It is quite essential to note that a hospice section has different professionals therein. They include pharmacists, psychotherapists, clinicians, nurses and physicians etc. All these professionals have to work hand in hand in order to achieve maximum effectiveness and efficiency when dealing with terminally ill patients. (Packard, 2009) The care giving teams in the hospice section are usually in a position to respond to human problems that are quite complex in nature common in terminally ill patients. This definitely means that one caregiver cannot meet all the needs of such patients. Teamwork in the hospice section is quite essential since it brings together diverse disciplines hence caregivers are in a position to identify problems and solve or manage them easily. (Watson and Lucas, 2005) Caregivers are therefore exposed to different skills and this makes them learn easily. Teamwork helps caregivers to share success and failures. It also gives a better avenue for one’s work in the hospice to be evaluated by other professionals. Conflict management skills are easily developed by caregivers as they go about their daily activities as a team. Teamwork in the hospice section helps caregivers to have a holistic approach when taking care of terminally ill patients. It is not easy for single person or discipline to offer such a holistic care without the help of other experts in different areas of professionalism. It is quite essential to note that needs of patients in hospice section keep changing over time. Through teamwork, these needs are effectively met. (Packard, 2009) Participants in the development of the client's nursing care plan? A nursing care plan is quite essential especially when dealing with patients suffering from terminal illness. This plan usually illustrates the care that needs to be provided to a patient and in this case to Lorna Hetherington. It usually shows the actions that will be taken by a nurse as he or she provides day to day care to the patient. A nursing care plan is usually holistic and systematic in nature. It is also geared towards solving or reducing pain in the patient. Various people participated in the development of the client’s nursing care plan. First of all, the nurse in charge played a great role in coming up with Lorna’s care plan. Whenever a patient is brought in the hospice wing, he or she is assigned a specific nurse who is in charge of all the patient’s needs. (Packard, 2009) The nurse in charge therefore participated so much in the development of Lorna’s nursing care plan. It is quite essential to note that the initial stage of developing the hospice plan involves the nurse and the patient. This is where the nurse in charge inquires from the patient or her relative about her past in as far as treatment is concerned. This includes information about age, when the patient was diagnosed with disease and the treatment that the patient has gone through. This is carried out to ensure that the information given by the patient to the doctor is correct. The patient of relative also gives information about personal preferences such as religion, culture and lifestyle. All these were taken into consideration during the development of Lorna’s nursing care plan. (Tabbner, 2008) As earlier on illustrated, there are usually various professionals that work in the hospice area. The nurse in charge therefore had to consult all the professionals in the hospice wing during the development of the nursing plan for Lorna. These include physicians, pharmacists, social workers, clinicians, other nurses and chaplains. This is considering the fact that Lorna’s nursing care plan had to be holistic in nature. After drafting the care plan, it had to be evaluated by the head nurse and doctor in charge of the hospice wing. Support clients and others to contribute to the care plan Clients usually require support in order to contribute to the care plan. In providing support for Lorna Hetherington, one has to ensure that her hearing aid is switched on. Support would also be given to the patient by assuring her that the care plan will work towards her wellbeing. In this case, Lorna will be assured that her ideas are very essential and that they will be taken into consideration in the development and implementation of the care plan. Clients need to be reassured that each of the patients in the hospice is different and therefore care has to be tailored towards their individual preferences. They can be supported by asking them the channel through which they prefer to air their views. That is whether they prefer writing or speaking out what they desire as far as care plan is concerned. Support would also be provided by ensuring that they are in best position to speak out and also by assuring them of overall confidentiality as far as their views are concerned. (Tabbner, 2008) The patients would also be supported by actively listening to their concerns and desires and ensuring that every point they say is noted down. Clients and other stakeholders’ preferences for spiritual, cultural and lifestyle options need also to be identified. In this case, Lorna and her daughter can be interviewed by using previously prepared questions that pertain to the spiritual, cultural and lifestyle options of the patient. This will help to accrue relevant data as in relation to above named dynamics. (Tabbner, 2008) Support would you provide to the client and their family members to prepare for the clients death Research has shown that doctors and other healthcare givers do not like the part of preparing patients for their death. It is quite evident that majority of healthcare practitioners evade this rather imperative task in healthcare. In the case of Lorna, it is quite easy to provide support to the client and their family members to prepare for the client’s death because of her age. (Tabbner, 2008) It is however very essential to note that death of a loved one is usually painful no matter their age. First of all, Lorna’s family members have to be guided and counselled. In counselling sessions, they have to be told that death is inevitable to all. The family members will have to be told that their loved one may soon pass on. They need to be encouraged to visit Lorna and reassure her of their love for her even in such situations. It is also quite essential to counsel the patient on the possibilities of death in the near future. This helps them to air out their views about their wishes even after they have passed on. In case the patient has not written a will, she can be encouraged to write one so that there are no wrangles once she is gone. The patient is also encouraged to air out her views concerning burial arrangements and other preferences in relation to funeral arrangements. The patient needs to be given the choice of allowing family members to prepare for her burial and funeral requirements prior to her death or not. (Tabbner, 2008) Maintaining the client's dignity after their death The client’s dignity has to be maintained even after their death. This will be carried out by firstly considering her wishes on how to handle her after death. Lorna’s interests will be taken into full consideration even after her death. Her relatives and friends will also be consulted immediately after her death so that their preferences are taken into consideration. This is quite therapeutic to them. According to Tabbner, (2008) different cultural and ethnic groups have diverse ways of taking care of the dead. Lorna’s cultural preferences will also be considered after her death. It is however quite essential to note that there are basic principles in the nursing practice that relates to handling a patient with dignity after her death. (Tabbner, 2008) Once the doctor certifies that Lorna is dead and the cause of her death, the curtains around her bed will be drawn. This is according the patient rightful dignity. After putting on gloves, and an apron to avoid infections from body fluids, intravenous devices will be removed and disposed off accordingly. (Watson and Lucas, 2005) Her open or entrance sites will be covered using a dressing that is waterproof. It is quite clear that death can alter a patient’s appearance and this can be disturbing to Lorna’s relatives. Her jaw will be closed and her eyes closed using enough downward pressure. Her mouth will be cleaned and any dentures replaced accordingly. (Watson and Lucas, 2005) This helps to avoid any possible bad odour from the patient’s body. Lorna will then be undressed, washed and dressed in a shroud or her preferred clothing. Her legs and arms will then be straightened and her head placed on a pillow. The body will then be wrapped tightly in a sheet to avoid any possible damage during transfer to mortuary. An identity tag will then be put on her ankle and wrist for easy identification. A death certificate will be attached to her sheet with a tape and not a pin to avoid piercing her body and also any possible injury to those handling her. All her personal belongings will be recorded accordingly and kept in a tagged closet. They will later be given to her relatives. Other patients will also be talked to about the client’s death to avoid anxieties and fears. (Watson and Lucas, 2005) Lorna’s care plan Name: Lorna Hetherington Age: 85 years Religion: Roman Catholic Gender: Female Medical history: Was diagnosed with breast cancer and underwent mastectomy. Client has received chemotherapy. Disease has recurred and not responded to treatment. Patient recently had pneumonia and it has not resolved. Her pain has increased, has chest swelling and progressive weakness. Has developed decline in her cognitive ability. Lorna has uncontrollable pain in her chest. Interventions: -Administering analgesics to the patient This will help to relieve the pain that she is going through. In this case different analgesics will be given to the patient especially the times when she is in so much pain -Managing pain This will be carried out by ensuring that she is in best position at all times in such a way that she will not feel so much pain -Implement intrapersonal, cultural aspects that will help relief pain in the patient. This will be implemented after carrying out research from the patient’s relatives. Her friends and relatives will be allowed to visit her and share with her. This is will give her relief from pain. -Respond to Lorna’s complaints of pain immediately. This is because by merely responding and talking to her, her mind will be distracted and she will be less conscious of the pain -Use of anti-inflammatory and non-steroidal medicine -Create a relaxed atmosphere for the patient e.g. allows Lorna to watch her favourite programs and listen to her favourite songs through the use of an ipod etc. An environment plays a great role in a patient’s wellbeing. The patient once in a while has to be taken out to recreational areas, her home etc so as to revive her spirits and shift her mindset from pain and being sick. -Due to Lorna’s faith, she will be given a bible for use while in the hospice wing. She will be taken for Sunday services in Roman Catholic Church. Her church members will be allowed to visit and offer prayers for her while she is in the hospice wing. (Watson and Lucas, 2005) Conclusion In conclusion, palliative care deals with taking care of patients with chronic pain. It is quite essential for professionals in hospice area to maintain teamwork for maximum success. It is usually quite imperative for stakeholders to prepare the patient and her relatives for death. It is never enough to take care of the patient during her lifetime. Dignity needs to be upheld even after the client passing on. Read More