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Clinical Practice Guideline: Care of the Dying Patient

This assessment is a critical analysis based on the given case study of a patient named Fortunato (Frank) Rossi. This written piece will be focused on the delivery of Frank’s care. The patient in the case study was admitted to the settings when encountered with some abnormal vitals and later on was diagnosed with the Glioblastoma Multiforme (GBM) stage IV. The care delivered to the patient was palliative care and the actions taken by the health care professionals will be critically evaluated in order to identify whether the care delivery to the patient was good or not. For the analysis of the case study, the care delivery will be compared with a selected clinical practice guideline. The selected clinical practise guideline is the practice guideline for the care of the dying person. The essay will also include some national standards such as palliative care standards, National Safety and Quality Health Service (NHQHS) standards, and Nursing and Midwifery Board of Australia (NMBA) standards.

The case study is of a patient named Frank who was admitted to the hospital when he witnessed seizure and confusion. According to Stafstrom & Carmant (2015), seizure could be understood as a paroxysmal variation of the neurologic function that occurs due to excessive and hypersynchronous discharge of neurons in the brain. Along with this, he had some other complaints also such as blurred vision, headache, etc. After diagnosis, it was revealed that the patient has Glioblastoma Multiforme (GBM). Sofia is Frank’s wife and she was there with him every time. After the unanimous decision of the patient and his wife, the patient was shifted to a palliative care unit. There, he had a fall at night when he went to the washroom. The patient’s condition was deteriorating and the patient died soon in the palliative care unit. This was just a brief of the case scenario and there were many incidents that happened with respect to the care delivery of the patient on the basis of which the critical evaluation will be done.

The clinical practice guidelines aim to maintain the dignity of the patients and provide them with comfort during the time of their end of life. The first step to achieve this is to make a symptom observation chart. The symptom observation chart must be updated and documented within every four hours. The chart must contain all the vitals of the patient including pain, restlessness and agitation, vomiting, nausea, dyspnoea, and involuntary jerking. In the case study, all the important symptoms were assessed. However, the patient’s pain assessment was not done. Neither the pain assessment of the patient was done in the beginning not it was assessed when the patient had a fall. According to Booker & Haedtke (2016), pain assessment is very important especially in older adults who are receiving palliative care. As per standard 1 of National Palliative Care standards initial and ongoing assessment of the patient is important in order to understand the needs of the patient (Palliative Care Australia, 2018). Standard 4 of registered nurse standards for practice also states that the comprehensive and systematic assessment must be conducted (NMBA, 2016). However, comparing the initial step i.e., assessment of the symptoms of a clinical practice guideline for the care of the dying patient; national standards of palliative care; and NMBA standards with that of the assessment done in the case study it can be stated that the health care professionals lacked in performing the assessment of the patient and does not meet the standards.

Next criteria of the clinical practice guideline are the establishment of a care plan with the goal of addressing the issues faced by the patient. According to Standard 5 i.e., comprehensive care standard of the NSQHS Standards, the health care professionals must establish systems that would be able to deliver the comprehensive care to the patient in order to manage identified as well as potential harms of the patient (Australian Commission on Safety and Quality in Health Care, 2015). In standard 2 of national palliative care standards also, it has been stated that developing a care plan for the patient is important. And, the family and the carers of the patient must work collaboratively and an informed decision should be there (Palliative Care Australia, 2018). In the given case study, it was seen that upon arrival and the admission of the patient to the palliative care unit, care planning was done which entailed the interventions that would help in addressing the issues of the patient. Along with this, the care plan and all the aspects that were related to the patient were done by informing and involving the patient’s wife. This showed that the care planning for the patient meets the standards of the clinical practice guidelines as well as of the NSQHS standards and the National Palliative Care standards.

Another concern of clinical practice guideline for the care of the dying patient is caring for the patient’s family. According to the clinical practice guidelines, the environment of the hospital could also turn out to be overwhelming for the family of the patient. This is why the well-being of the patient’s family should be maintained by supporting them. In a study presented by Javed & Herrman (2017) it has been stated that involving patient’s family in the decision making and providing them support is a very important factor that must be taken care by all the health professionals. In addition to this, in standard 3 i.e., caring for the carers of the national palliative care standards it has been explained that the preferences and needs of the patient’s family and carers must be assessed and acknowledged (Palliative Care Australia, 2018). This will result in family-centred care (Kokorelias, 2019). In the given case study, it has been seen that the preferences of the patient’s wife were acknowledged by the health care professionals. A supportive environment was also provided to her. Everything was first being informed to the patient’s wife. So, this aspect of the clinical practice guideline was fulfilled in the case scenario. However, there are some other aspects of the clinical practice guideline regarding caring for the family of the patient such as meeting the spiritual needs of the family and providing a grief counsellor to the dying patient’s family. According to Fourozi et al. (2017), assessing and accomplishing the spiritual needs of the patients and their families improve the quality of life of the patient and family centred care. In addition to this, standard 6 i.e., grief support of National Palliative Care standards states that the family should always be informed immediately regarding the loss and they must have access to the services that will provide them bereavement support (Palliative Care Australia, 2018). In the given case scenario, it has been seen that the spiritual needs and preferences of the patient’s wife were respected and acknowledged. When it comes to grief support, the patient’s death was so fast that the grief support was provided to the family of the patient by staff. So, it can be said that yes, in terms of providing support to the family of the patient, the standards were met by the organization.

In clinical practice guideline, the next aspect is the communication that whether the patient and the family was getting informed about each and everything or not. According to Howick et al. (2018), effective communication between the health care professionals and the patients is considered as the heart of the health care system. Communicating with the patient in an effective manner and informing the patient regarding their care processes and all the related aspects helps in enhancing the accuracy of diagnosis and in promoting patient-centred care. Not only this, but it also helps in improving the health outcomes of the patient. Effective communication also reduces the risk of claims for malpractice. While communicating with family during and after the meetings with the family leads to family satisfaction and family-centred care. Informing the patient’s family regarding the health status of the patient is a very important part of nursing practice (Pecanac & King, 2019). Standard 6 of NSQHS standard i.e., communicating for safety standards state that it is important for the health care providers to support and communicate with the patients and their families effectively. In the given case study, it was seen that the health care providers were informing everything regarding the patient’s health to his wife. When the patient had a fall and his condition was critical, the patient’s wife was informed immediately because of this patient’s wife was able to be by the patient’s side in his last times.

Reviewing the care goals and interventions of the patient timely is important and this is another aspect of the clinical practice guideline. According to standard 8 i.e., recognizing and responding to the patient’s acute deterioration of the NHQSH standard, recognition of a patient’s clinical deterioration timely is important. This helps in taking immediate action if the condition of the patient is found deteriorating (Australian Commission on Safety and Quality in Health Care, 2015). In the case study when the nurse of the afternoon shift arrived she reviewed every regarding the patient once and found some abnormal vitals. From this, it could be said that the practitioners met this standard.

Medication management is also an important aspect of a clinical practice guideline. According to the standard 4 i.e., medication safety standard of the NSQHS standard, the health care providers must focus on the issues faced by the patient and provision of the safe medication to address the patient’s issue (Australian Commission on Safety and Quality in Health Care, 2015). However, the patient’s medication management revealed that he has been given medication for each of the symptoms showed by him but, did not get any for the issue of delirium. Because of delirium, only the patient was encountered with a fall. So, giving medication to address the issue of delirium should be the nursing priority. This showed that this standard did not meet.

Overall, it has been seen in the case study that some of the standards were not met by the professionals and this led into the patient fall and from that day the patient’s health condition started deteriorating. Clinical deterioration resulted in the death of the patient very soon. So, it can be concluded from critiquing the case study that abiding by the clinical practice guidelines, national palliative care standards, NMBA standards, and NSQSH standards while the care delivery leads to the patient safety and improved quality of the life of the patient.

References for Fortunato Rossi Glioblastoma Multiforme Case Study

Australian Commission on Safety and Quality in Health Care. (2015). Medication safety standard. Retrieved from https://www.safetyandquality.gov.au/standards/nsqhs-standards/medication-safety-standard

Australian Commission on Safety and Quality in Health Care. (2015). Communicating for safety standard. Retrieved from https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard

Australian Commission on Safety and Quality in Health Care. (2015). Recognising and responding to acute deterioration standard. Retrieved from https://www.safetyandquality.gov.au/standards/nsqhs-standards/recognising-and-responding-acute-deterioration-standard

Australian Commission on Safety and Quality in Health Care. (2015). Comprehensive care standard. Retrieved from https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard

Booker, S. Q., & Haedtke, C. (2016). Assessing pain in verbal older adults. Nursing, 46(2), 65–68. https://doi.org/10.1097/01.NURSE.0000473408.89671.52

Forouzi, M. A., Tirgari, B., Safarizadeh, M. H., & Jahani, Y. (2017). Spiritual needs and quality of life of patients with cancer. Indian Journal of Palliative Care, 23(4), 437–444. https://doi.org/10.4103/IJPC.IJPC_53_17

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X.-Y., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: A systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252. https://doi.org/10.1177/0141076818769477

Javed, A., & Herrman, H. (2017). Involving patients, carers and families: An international perspective on emerging priorities. BJPsych International, 14(1), 1–4. https://doi.org/10.1192/s2056474000001550

Kokorelias, K. M., Gignac, M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family centered care: A scoping review. BMC Health Services Research, 19(1), 564. https://doi.org/10.1186/s12913-019-4394-5

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Palliative Care Australia. (2018). National palliative care standards 5th edn, PCA, Canberra. Retrieved from https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/11/PalliativeCare-National-Standards-2018_Nov-web.pdf

Pecanac, K., & King, B. (2019). Nurse-family communication during and after family meetings in the intensive care unit. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 51(2), 129–137. https://doi.org/10.1111/jnu.12459

Stafstrom, C. E., & Carmant, L. (2015). Seizures and epilepsy: An overview for neuroscientists. Cold Spring Harbor Perspectives in Medicine, 5(6), a022426. https://doi.org/10.1101/cshperspect.a022426

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