Principles of Nursing: A Palliative Approach

Introduction to Critique to The Patient Care

According to Kuchinad et al. (2017), the boundaries of ethical and legal practices should always be maintained in nursing duties. The nurse should always follow the nursing professional standards in the workplace to ensure the patient’s safety and maintenance of the dignity and respect of the feelings and values of the patient and his/her family members. These actions not only ensure the patient’s safety but also ensure that the nurse is working professionally with which will never result in legal complications. The nursing standards ensure therapeutic care, comprehensive care, effective communication, effective evaluation and monitoring of the patients, and efficient planning for improved patent health outcomes (Giammalva et al., 2018). In this essay, the following sections will critique the care delivered to the patient in the case study and it will be related to the nursing standards. The selected clinical practice guideline for the case study is the care of the dying patient. 

Principles of Palliative Care and Theme

According to Ambady et al. (2018), palliative care is the support that is provided to the patient and his/her family members. This care is only provided to those patients who are suffering from a life-limiting illness like dementia, cancer, or last stage kidney disorders; such diseases cannot be cured or will lead to the death of the patient soon.There are 9 national palliative care standards, these are including the following features: service culture,staff training and qualification, improvement of quality, grief support, transition between and within the services, providing care, caring for carers, developing the care plan, and assessment of need (International Association of Hospice and Palliative Care, 2020). According to Head et al. (2018), the principles include: ensuringsymptom and pain relief, integrate the spiritual psychologicaland aspects of care, delivering supportivecareto the patient to ensure complete care until his/her death, and supporting the family members of the patient by providing coping approaches. The various themes associated with the principles of the palliative care are as follows: supports the needs of the family members;a caring attitude;shared decision-making; patient’s consent; choice of the site of care;effective communication with patients, and his/her family;respects the feelings and choices of the dying person; looks after the social,emotional, mental and psychological needs of the patients and his/her family members; helping the patients to gain access to health care providers and medical services.

Critique of The Case Study

In the case study, it was found that even after Frank informed the medical staff that his father died from glioblastomamultiforme (GBM), then also the staff did not take action for advance care planning. The patient said he does not want to die like his father still the staff did not ensure any continued, coordinated, and consistent medical care to ensure the death of the patient with this disease; thereby violating the themes of the palliative care. This action not only violated the principles of palliative care but also did not maintain the Nursing and Midwifery Board of Australia nursing practice standard 5 and National Palliative Care Standard 2 that states that a care plan should be developed immediately with a patient-centered approach for safe and effective care delivery (Nursing and Midwifery Board of Australia (NMBA), 2017). If consistent medical care is provided then it ensures a reduction in the chances of risks that are unexpected or sudden. At later stages of the patient, it was found due to poor planning of the medical staff the patient enters a condition where he cannot take decisions for his treatment. This happened because initially, the family thought that they have a lot of time to manage the health condition of the patient and did not plan for any advance care.

According to Hemminger et al. (2017), it is found that a patient with GBM is found to suffer fromsymptoms such as nausea, vomiting, weakness, headache, and a few others. The patient in this case also suffered from these symptoms still he was administered with dexamethasone, this medication is found to have such effects such as vomiting, nausea, headache, dizziness, restlessness, depression, anxiety, and few others. This shows that the Nursing and Midwifery Board of Australia nursing practice standard 7 that states that evaluation of the outcomes should be ensured based on priorities and goals for improved health outcomes of the patient (NMBA, 2017). Moreover, this also clearly shows that the National Palliative Care Standard 8 of quality improvement and 9 for staff education and training was not maintained, because of the poor planning and education of the staff about the advance care plans and the health condition of the patient resulted in his death (Palliative Care Australia, 2020). The staff did not transfer the information to the family that Frank will not be able to survive longer and he did not have much time. This ultimately resulted in a deteriorating phase in palliative care. It was found that as per the clinical guidelines for the care of dying patients the pain assessments should be taken appropriately with labels as low, moderate, or high. However, in this case, study, it was found that the assessment was not taken appropriately and as the patient was asleep and Sophia who is the medical power of Attorney of the patient was not present so, the assessment was left incomplete in between.

As per the clinical guidelines of the care of the dying person, it is recommended to share the assessment and the observations with the family members (Fritz et al., 2016). In this case study, the information on the assessments was discussed with the family members. It is the duty of the medical staff to ensure the complete comfort and safety of the patient, but in this case, it was found that the patient was discomfort issues in the initial part of the admission and this discomfort continued till the last stages of his medical care; thereby indicating that the clinical practice guidelines were not maintained. Furthermore, the patient was administered morphine to assist in his discomfort, but this medication is also found to contribute to nausea, vomiting, constipation, dizziness, headache, and few others as side effects (Stupp et al., 2016). So, this is observed that in the care of the dying person, no monitoring of the outcomes, side effects management, and evaluation was conducted. It was found that the patient was not assessed frequently but his position was changed after particular time intervals. However, no infection assessment was conducted for the patient’s safety, these indicate that the guidelines of the care of the dying patient were not effectively maintained.

It is within the clinical practice guidelines of thecare of the dying patient that the medical staff should conduct timely monitoring and evaluation should be performed but it was found that in this case study, no timely evaluation if the outcomes, management of side-effects, appropriate documentation with the maintenance of the medical records such as SOC was not performed. The family members and the patient were not educated and informed about the health complications, risks, or the plans or treatments that Frank will have the next day. This indicated that NMBA standard 2 for therapeutic and professional relationship was not maintained and National Palliative Care Standard 1 for assessment of need was also not effectively maintained.According to Seibl-Leven et al. (2018), GBM is a condition that can be treated with the help of chemotherapy and radiation. While delivering palliative care for GBM patients it is required to take care of psychological and emotional factors as well as a part of palliative care practices. These factors ensure quality care and safe care delivery but in this case study, there was also a time when Frank was not able to meet or squeeze the hands of his family members. This indicates that his emotional support was not taken care of.

As per the NMBA standard 1 for critically and analysis of nursing practices, the nurse should ensure the ethical framework of the medical care by ensuring that no harm is caused to the patient during the medical care. The National Palliative Care Standard 4 for providing care to the patient was also not maintained. A GBM patient often offers form anxiety, depression, and distress, but in palliative care, no plan was prepared for the patient to manage with these factors (Seekatz et al., 2017). The care of the family members was also not maintained as per the clinical practice guidelines of a dying patient such as tea or toilets, no such care was ensured for the family members. Moreover, the afterlife care and rituals were not documented by the medical staff. Not even the patient or his family members were asked for afterlife rituals. The medical staff did not offer any condolence or any emotional support to the family after the death of the patients. The nurse can contact the funeral home if requested by the family members so that support and assistance are ensured to the family even after the death of the patients.

Conclusion on Critique to The Patient Care

It is concluded that GBM patientsis required to deliver care that ensures emotional and psychological support to the patent and his family members as well. The patient’s concerns about the future care plan and disease should be focused on. It is should be ensured that advance care planning is maintained or the patient and his family members are transferred with effective communication for the assessments or referrals. The documentation and monitoring should be as per the clinical guidelines, palliative care standards, and nursing practice standards. It should be ensured that frequent monitoring is conducted and the patient’s health outcomes are evaluated for safety concerns or improve the health of the patient. GBM patient should be asked for advance care planning if the condition of the patient is deteriorating over time. The medical staff should always make sure that assessments are comprehensively taken and briefly recorded.Moreover, the afterlife rituals and care should be ensured so that culturally safe and respectful care is delivered.

References for Critique to The Patient Care

Ambady, P., Hambelton, C., Fu, R., Firkins, J., &Neuwelt, E. A. (2018).Early palliative care interventions in patients with glioblastoma. Journal of Clinical Oncology, 36(15). https://doi.org/10.1200/JCO.2018.36.15_suppl.e22203

Fritz, L., Dirven, L., Reijneveld, J. C., Koekkoek, J. A., Stiggelbout, A. M., Pasman, H. R. W., &Taphoorn, M. J. (2016). Advance care planning in glioblastoma patients. Cancers8(11), 102.https://doi.org/10.3390/cancers8110102

Giammalva, G. R., Iacopino, D. G., Azzarello, G., Gaggiotti, C., Graziano, F., Gulì, C., Pino, M. A., &Maugeri, R. (2018). End-of-life care in high-grade glioma patients:The palliative and supportive perspective. Brain Sciences8(7), 125.https://doi.org/10.3390/brainsci8070125

Head, B. A., Song, M. K., Wiencek, C., Nevidjon, B., Fraser, D., &Mazanec, P. (2018). Palliative nursing summit: Nurses leading change and transforming care the nurse’s role in communication and advance care planning. Journal of Hospice & Palliative Nursing20(1), 23-29. https://doi.org/10.1097/NJH.0000000000000406

Hemminger, L. E., Pittman, C. A., Korones, D. N., Serventi, J. N., Ladwig, S., Holloway, R. G., &Mohile, N. A. (2017). Palliative and end-of-life care in glioblastoma: Defining and measuring opportunities to improve care. Neuro-Oncology Practice4(3), 182-188.https://doi.org/10.1093/nop/npw022

International association of hospice and palliative care.(2020). 6 principles of palliative care. Retrieved from: https://hospicecare.com/what-we-do/publications/getting-started/6-principles-of-palliative-care

Kuchinad, K. E., Strowd, R., Evans, A., Riley, W. A., & Smith, T. J. (2017). End of life care for glioblastoma patients at a large academic cancer center. Journal of Neuro-Oncology134(1), 75-81.https://doi.org/10.1007/s11060-017-2487-8

Nursing and Midwifery Board of Australia.(2017).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.(2020). National palliative care standards. Retrieved from: https://palliativecare.org.au/standards

Seekatz, B., Lukasczik, M., Löhr, M., Ehrmann, K., Schuler, M., Keßler, A. F., & van Oorschot, B. (2017). Screening for symptom burden and supportive needs of patients with glioblastoma and brain metastases and their caregivers in relation to their use of specialized palliative care. Supportive Care in Cancer25(9), 2761-2770.https://doi.org/10.1007/s00520-017-3687-7

Seibl-Leven, M., von Reeken, C., Goldbrunner, R., Grau, S., Ruge, M. I., Galldiks, N., &Golla, H. (2018). Clinical routine assessment of palliative care symptoms and concerns and caregiver burden in glioblastoma patients: An explorative field study. Journal of Neuro-oncology138(2), 321-333.https://doi.org/10.1007/s11060-018-2800-1

Stupp, R., Toms, S. A., &Kesari, S. (2016). Treatment for patients with newly diagnosed glioblastoma. Jama315(21), 2348-2349.https://doi.org/10.1001/jama.2016.1847

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