Hospice care is the palliative care given to the patients who are in the last stage of their life-limiting illness. This is mainly for the care of chronic conditions and there is a special team of nurses who provides palliative care. This is a reflective essay that focuses on the facilitation of collaborative ethical decision making that is incorporated in the interdisciplinary team. This essay also takes into account the cultural aspects of palliative care and in particular the practices, beliefs and traditions that the patient wishes to uphold. This reflective essay is based on the given case study that reflects on the nurse’s personal bHeading 2eliefs that may have an impact on the professional care that they provide to the patients.
This is the case of a 20-year-old patient John who is at the end-stage renal disease. He is a young man who is an Aboriginal and Torres Strait Islander (ATSI) man receiving palliative care 500 kilometers away from his remote area. Recently, he refused for the treatment because doctors informed him that he is in his last stage and would be able to survive for three months on dialysis. He refuses the treatment because he states that he wants to spend the rest of his time of life with his family. This statement by the patient requires critical decision making because as a nurse I wanted to follow both that is the patient's benefit and his wishes during palliative care.
In order to fulfill the palliative care requirements, an interdisciplinary team was invited for facilitating collaborative decision making (Doyle & Panton, 2017). The decision was taken on the basis of ethical considerations that is beneficence and autonomy. The ethical principle that is beneficence states that the nurses should work in a manner that always benefits the patients and the principle of autonomy states that a patient’s wish should be fulfilled (Emtman& Strauss, 2016). As a result, the entire team decided to work in association with the patient's remote area health care services. This was done to ensure that the patient gets the sufficient time to spend with his family along with getting the best of care through dialysis at his place. One of the members of the interdisciplinary team that is counsellor tried to make the patient understand the importance of dialysis and convinced him to get the treatment at his place. The continued provision of the information and effective support has a significant positive impact on the patient and this also helps in changing their perceptions (Meeker, McGinley & Jezewski, 2019). The other members of this team were GP, palliative care nurses, mental health caretakers and senior manager of the health care organization. This is how I facilitated collaborative ethical decision making that incorporated an interdisciplinary team. The provision of dialysis was made in his remote area keeping his cultural aspects in mind. The nurse will provide him with information and motivate him to live his last phase of life by embracing the opportunity to prepare him for death and to focus on quality of living (Meeker, McGinley & Jezewski, 2019).
The cultural aspects of palliative care include reducing linguistic and cultural misunderstandings between the patient and health care professionals and also acknowledging his cultural preferences and wishes during care process (Silva et al., 2016). Health literacy is included in the cultural aspect of palliative care. The assessment of communication, sharing of information and the decision making preference are all integrated into the cultural aspects of palliative care (Cain, Surbone, Elk & Kagawa- Singer, 2018). This is the case of an ATSI man so there were a lot of cultural differences in the terms of cultural believes, values and opinions of me and this patient. It took me time to understand that how someone can refuse the treatment for the advantage of spending time with family which I had never accepted. John wanted to uphold his belief of not getting treated 500 km away from his place and he wanted to surround himself with his family members. There were different beliefs and traditions of John that he wanted to uphold like following his culture along with receiving palliative care from the nurses. The attitudes and approaches to palliative care vary to higher levels among different religions and cultures. The decisions that are taken are influenced by the cultural belief of the patients, their caregivers and that of the health caregivers (Holroyd- Leduc, 2016).
This patient and family-centered end of life care aims to deliver culturally safe care to the patients so that they feel highly satisfied in the end stage of their disease. The socio-cultural aspects were important to be respected for the John’s palliative care so the decision making was done respecting the same. There is a lot of cultural difference that exists between Indigenous and non- Indigenous communities in Australia (Taylor & Guerin, 2019). Family and language are the two most important elements of Indigenous people's culture. John an ATSI patient has a tradition of taking their own medicines and also has a lot of issues with non- Indigenous people of Australia because of their different language and culture. He wanted to uphold his tradition so he refused for the treatment and gave importance to his family.
There were many of my personal beliefs that had a direct impact on the type of care I delivered to the patient John. The personal beliefs of health care professionals impact their professional interactions and also have an impact on the strategies that are used to manage such issues. The personal belief that had an impact on my professional communication with the patient was first that he is an Aboriginal man so he might not understand the typical words of my language. This was the main reason that I was not interacting with him properly because I know anyhow he would not understand my language. I was using common words and then I realized this can have a negative impact on the quality of care that is received by him. The best strategy that can be used to manage this issue is to have a translator who will translate the talks of health care professionals so that he can understand the importance of dialysis well (Ji, Taibi & Creeze, 2019).
I personally believe that the patients who are Indigenous and admitted into hospital settings are not always in a healthy mental state because they have a fear of discrimination and other unusual things. This can be managed by appointing a nurse of similar cultural background as the patient so that he can make the nurse understand his needs (Ali & Watson, 2018). This is also very important because it helps the nurses in understanding the care needs of the patients well. This will also allow the patient to have a healthy professional interaction with other medical health care professionals and will also have a positive impact on the patient’s mental health. These were my personal beliefs that had a significant impact on my professional interaction with the patients.
An Aboriginal man John admitted in the hospital settings refused to continue the treatment of dialysis because he wants to spend quality time with his family. The nurses drew a conclusion respecting the ethical consideration of beneficence and autonomy stating that they will give him a provision of dialysis in his remote area. The nurses are the ones who understand the patient's cultural beliefs and values and this has a positive impact on the quality of care received by the patients. The cultural belief of the patient and the nurse is different especially in the cases where one is Indigenous and the other one is non- Indigenous individuals. In such cases, the nurses need to expand their horizon of cultural understanding so that they can deliver high quality nursing care to the patients.
Ali, P. A., & Watson, R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses' perspectives. Journal of Clinical Nursing, 27(5-6), e1152-e1160.
Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care: Preferences, communication, meaning, and mutual decision making. Journal of Pain and Symptom Management, 55(5), 1408-1419.
Doyle, E. E., & Paton, D. (2017). Decision-making: preventing miscommunication and creating shared meaning between stakeholders. In Observing the Volcano World (pp. 549-570). Springer, Cham.
Emtman, R., & Strauss, J. (2019). Aging: Balancing Autonomy and Beneficence. In Psychiatric Ethics in Late-Life Patients(pp. 3-20). Springer, Cham.
Holroyd-Leduc, J., Resin, J., Ashley, L., Barwich, D., Elliott, J., Huras, P., & Pullman, D. (2016). Giving voice to older adults living with frailty and their family caregivers: engagement of older adults living with frailty in research, health care decision making, and in health policy. Research Involvement and Engagement, 2(1), 23.
Ji, M., Taibi, M., &Crezee, I. H. (Eds.). (2019). Multicultural Health Translation, Interpreting and Communication. Abingdon: Routledge.
Meeker, MA, McGinley, JM, Jezewski, MA. (2019). Metasynthesis: Dying adults' transition process from cure‐focused to comfort‐focused care. Journal of Advanced Nursing, 75, 2059- 2071
Silva, M. D., Genoff, M., Zaballa, A., Jewell, S., Stabler, S., Gany, F. M., & Diamond, L. C. (2016). Interpreting at the end of life: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency. Journal of Pain and Symptom Management, 51(3), 569-580.
Taylor, K., & Guerin, P. (2019). Health care and Indigenous Australians: Cultural safety in practice. United Kingdom: Macmillan International Higher Education.
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