Principles of Nursing: A Palliative Approach

Introduction to Critique to GBM Care

According to Seyfried, Shelton & Arismendi-Morilloet al. (2019), glioblastoma multiforme (GBM) is a devastating brain cancer that results in death soon after it is diagnosed and it results in vomiting and headache as well. However, if such a dying patient is provided with effective care that is within the boundaries of nursing and palliative care standards then quality and respectful care are will be ensured for the patient and his/her family members as well. It is the right of the patient to receive respectful and safe care services. If the patient is about to die soon, then as per the clinical practice guidelines (CPG) for the care of the dying patient should be maintained (Fritz, Zwinkels&Koekkoek et al., 2020). In this case study, the patient Fortunato (Frank) Rossi is a 60-year-old male who is diagnosed with GBM but the care delivered to him is inappropriate in a few stages of care. The following section will discuss the critique in the care of the case study with respect to the different nursing standards. The critique of the care in the following sections will relate to the National Palliative Care Standards, National Safety and Quality Health Service (NSQHS) standards and National Midwifery Board of Australia (NMBA) Standards as well.

Critique to Frank’s Care

In this case study, Frank and his wife had no complete information about the severity and sensitivity of the health condition and this resulted in their wrong decision to refuse to advance care planning. The health professionals did not inform the patient about the seriousness of the health condition and treatment planning. The NMBA standard 5 of the therapeutic and professional relationship was not maintained in this case (Nursing and Midwifery Board of Australia, 2016). This is because the nurse should effectively communicate to ensure the right of safe care to the patient by informing him about the importance, risks, benefits, and the necessity of the care plans (Zauszniewski, Bekhet&Herbell, 2018). It is the right of the patient to get complete information about his medical services, his tests, or treatment that will be conducted in the future and the information about signs or symptoms. If the patient is taught or educated about his health conditions and associated risks factors then the patient and his family members will get encouraged for self-management; but if the patient is about to die then he should be informed about the reality for acceptance (Phelps, Winston &Wynn et al., 2019). This also shows that the palliative standard 4 of providing care was also not maintained in this case. In this case study, it was found that the patient had already told the medical staff that he does not want to die with GBM like his father. The nursing staff knew that he had GBM and his condition is poor still no advance care planning or a plan for safe care was also not developed; thereby violating standard 5 of NMBA and palliative care standard 2.

The priorities of the patient and his family members were not met. This shows that the care of the dying patient was not appropriate as per the CPGs.As per the CPG of care of the dying patient it is required to maintain services for the care of the family members as well such as toilet or tea. However, in this case, study as no such services was ensured, so the wife has to leave the patient alone for her reasons and has to go away. It was also found that the assessments were not completed comprehensively because Sophia had left the place. This shows that the National Safety and Quality Health Service (NSQHS) standard of comprehensive care was not maintained. This is because the assessments were not taken frequently and no frequent monitoring was performed. It is very important in case of serious or death-causing diseases that the patient should be monitored or evaluated for his medications and health outcomes so that an alternative plan can be prepared (Raju& Reddy, 2018). Frequent monitoring of reduced medication errors, unexpected outcomes, and improved quality care with safety for the patient. In this case study, it was found that although it was noticed that the health outcomes of the patient are negative still no alternate plan was made and the nurses and health professionals were also not accountable for their responsibilities.As per the nursing guidelines, health professionals are required to exhibit features of professionalism in their practices to ensure evidence-based practices. As per the CPG of care of the dying person, it is required to transfer the information about the patient’s assessment to the family members and this guideline was maintained.

In this case study, it was found that the assessment and records of the patient were not well structured or well maintained. If the handover or medical records are not well maintained or timely updated the transfer of information among the health professional is not effective and the patent-centered approach will also get negatively affected (Diamond, Panageas&Dallara et al., 2017). As per the CPG of care of the dying patient, the assessments were not scored as moderate, high, or as per the other scoring patterns. The handover maintenance involves checking the patient for his health status by clearly acknowledging the doubts and asking for wishes from the patients and feedback recording (Mannix, Parry & Roderick, 2017). As per the NSQHS standard of preventing and controlling healthcare-associated infections, the care delivered to the patient should ensure positive health outcomes in partnership with the consumers (Australian Commission on Safety and Quality in Health care, 2019). However, in this case, study, it was found that due to a few medications that patients develop issues such as vomiting and nausea but no effective care was delivered to manage such complications.

In this case study, the patient was not monitored frequently for his blood glucose levels, blood pressure, and temperature. The medications are always found to impact the vital signs of the patient (Meslin, Zheng&Day et al., 2019). However, in this case, the care of the dying patient as not well planned, well structured, and this indicated that the NMBA standard 4 and 7 for outcomes evaluation and comprehensive care was not well executed. All these factors disturbed Frank as a result he refused to take his medications and eat. The patient had a medical history of diabetes and smoking addiction still, he was never educated about his medications and health status at any of the nursing care stages. Moreover, it was found that the patient faced difficult walking, had confusion, and difficulty breathing still he was not provided with any aids for walking or oxygen supply (Mellema, 2020). During this time, he refuses his medication for oral administration so, subcutaneous administration was conducted. This showed that the palliative care standard 7 of service care was maintained as the patents respect and dignity were maintained during care delivery (Palliative care Australia, 2019). 

For the care of the GBM patient, it is found that it can be cured with the help of craniotomy, radiosurgery, radiation therapy, and chemotherapy (Glaser, Dohopolski&Balasubramani et al., 2017). However, no such medical services were made available for the patient. The patient is also turned every 2 to 3 hours to ensure the patient’s skin integrity, safety, and prevention of pressure injuries. This shows that the palliative care standard of quality improvement was violated at various stages but was maintained at this stage. In old age, it is found that due to pressure injuries the seriousness and associated skin damage issues increase and the care of the dying patient is not well executed. While delivering care to the dying patient it should be ensured that the wishes, feelings, and emotional support are ensured and provided for the patient and his family members (Helfand, Christensen & Anderson, 2016). There should be well management of psychological support and coping strategies for the family member. The pain management, patient’s right to information, legal, and ethical concerns should also be ensured. However, in this case, study, it was found that many standards were not maintained and the qualities of care ultimately harm the patient. With this, the legal issues can arise as the patient did not receive fair and safe care as per the nursing standards.

In this case, the care of the dying patient was not as per the guidelines because the family members and the patient were not asked for any of the afterlife services and no grief support was delivered to the family. Hence, it indicated that the palliative care standard 6 of grief support was not maintained. There are many grief support activities that the nursing staff or the medical staff is required to ensure for the family members of the dead patient (Wasilewski, Serventi&Kamalyan et al., 2017). In this case, no effective communication took place with the patient during his entire medical care and no effective interaction with the family members for grief support.

Conclusion on Critique to GBM Care

It is concluded that in GBM the patient suffers from various complications such as headache or vomiting, and the dies soon after its diagnosis. However, if the care delivered is as per the nursing NMBA, NSQHS, and palliative care standards then the care of the dying patient will be more effective and comprehensive. There should be frequent monitoring and evaluation of the vitals as the drugs or medicines show their effects on the body and this might result in unexpected results. Therefore, to ensure the safety and negative health outcomes it is important to monitor the patient properly. There should be the maintenance of medical records to ensure the complete transfer of information to the patient and the health professionals as well. The patient should be asked for his feelings, wishes, and afterlife support as well. It should be ensured that advance care planning is started if there is a need for it and the patient and his family members are educated about the benefits and risks of the care plans and their decisions.

References for Critique to GBM Care

Australian Commission on Safety and Quality in Health care. (2019). National Safety and Quality Health Service (NSQHS) standards.Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards

Diamond, E. L., Panageas, K. S., Dallara, A., Pollock, A., Applebaum, A. J., Carver, A. C., &Prigerson, H. G. (2017). Frequency and predictors of acute hospitalization before death in patients with glioblastoma. Journal of Pain and Symptom Management53(2), 257-264.DOI:10.1016/j.jpainsymman.2016.09.008

Fritz, L., Zwinkels, H., Koekkoek, J. A., Reijneveld, J. C., Vos, M. J., Dirven, L., &Taphoorn, M. J. (2020). Advance care planning in glioblastoma patients: Development of a disease-specific ACP program. Supportive Care in Cancer28(3), 1315-1324.DOI:10.1007/s00520-019-04916-9

Glaser, S. M., Dohopolski, M. J., Balasubramani, G. K., Flickinger, J. C., &Beriwal, S. (2017). Glioblastomamultiforme (GBM) in the elderly: Initial treatment strategy and overall survival. Journal of Neuro-oncology134(1), 107-118.DOI:10.1007/s11060-017-2493-x

Helfand, M., Christensen, V., & Anderson, J. (2016). Technology assessment: Early sense for monitoring vital signs in hospitalized patients. Evidence Synthesis Program Evidence Briefs [Internet]. Department of Veterans Affairs (US).Retrieved from:https://www.ncbi.nlm.nih.gov/books/NBK384615/

Mannix, T., Parry, Y., & Roderick, A. (2017).Improving clinical handover in a paediatric ward: Implications for nursing management. Journal of Nursing Management25(3), 215-222.DOI:10.1111/jonm.12462

Mellema, M. (2020).Respiratory monitoring in critical care. Clinical Small Animal Internal Medicine, 373-380.DOI:10.1002/9781119501237.ch38

Meslin, S. M. M., Zheng, W. Y., Day, R. O., Tay, E. M. Y., &Baysari, M. T. (2018). Evaluation of clinical relevance of drug–drug interaction alerts prior to implementation. Applied Clinical Informatics9(4), 849.DOI:10.1055%2Fs-0038-1676039

Nursing and Midwifery Board of Australia. (2016). Registered nurses standards for practice. Retrieved from:https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Palliative care Australia.(2019). National Palliative Care Standards. Retrieved from:https://palliativecare.org.au/standards

Phelps, R., Winston, J. A., Wynn, D., Habek, M., Hartung, H. P., Havrdová, E. K., & Coles, A. J. (2019).Incidence, management, and outcomes of autoimmune nephropathies following alemtuzumab treatment in patients with multiple sclerosis. Multiple Sclerosis Journal25(9), 1273-1288.DOI:10.1177%2F1352458519841829

Raju, B., & Reddy, N. K. (2018). Perspectives of glioblastoma patients on death and dying: A qualitative study. Journal of Palliative Care24(3), 320.DOI:10.4103%2FIJPC.IJPC_171_17

Seyfried, T. N., Shelton, L., Arismendi-Morillo, G., Kalamian, M., Elsakka, A., Maroon, J., & Mukherjee, P. (2019). Provocative question: Should ketogenic metabolic therapy become the standard of care for glioblastoma?. Neurochemical Research44(10), 2392-2404.DOI:10.1007/s11064-019-02795-4

Wasilewski, A., Serventi, J., Kamalyan, L., Wychowski, T., &Mohile, N. (2017). Acute care in glioblastoma: The burden and the consequences. Neuro-Oncology Practice4(4), 248-254.DOI:10.1093/nop/npw032

Zauszniewski, J. A., Bekhet, A., &Herbell, K. (2018). Comprehensive evaluation of interventions: Eight vital parameters. Nurse Researcher26(3).DOI: 10.7748/nr.2018.e1603

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