Principles of Nursing: A Palliative Approach 

Nurses in the clinical placement are expected to use their theoretical knowledge into practise and apply their clinical practice skill to deliver quality and safe care to the patient (Atakro et al., 2019). National Palliative Care Standard is set guidelines for the health care professional to improve the quality and safety of the care concerning the health status of the patient (Temkin-Greener et al., 2015). The Nursing and Midwifery Board nurses standard are framed to improve the nurse’s clinical practise and NHQHS standard is important to improve the quality of care by addressing the gap in the health care services (Saunders et al., 2018). The case study is about a 60-year-old man Fortunato living with his wife in Australia and recently diagnosed with Glioblastoma Multiforme that is of IV stage which leads his admission to the palliative care. The essay is going to utilize three standards that are important to deliver the quality care to the patient to critically evaluate the care provided to the patient by comparing with the standards.

Nine Palliative care standards are important to deliver the quality care to the patient and the first is Assessment of needs that includes initial or on-going assessment incorporates the holistic approach. The interdisciplinary personnel’s should be involved in the assessment process and reassessment of the person needs (Palliative Care, 2020). The Comprehensive standard prosed by the NSQHS state that health care professional is expected to conduct right assessment and monitoring of the patient to deliver the quality care (Australian Commission on Safety and Quality in Health Care, 2017). This was also discussed in Nursing and Midwifery Board (2017) Standard one by stating that proper patient assessment is important in the initial care that is important for planning the care of the patient (Nursing and Midwifery Board, 2017). During the admission to the Palliative care unit, RN welcomed the Fortunato whole family and assessed to understand patient current health condition. The different assessments that were conducted in the care are Falls Risk assessment, Braden Pressure Risk assessment and pain assessment. The different assessment in palliative care helps the health care professional to understand the patient condition that can be addressed by the right intervention (Sujatha & Jayagowri, 2017).

The development of the care plan for the palliative patient is important so that every issue can be addressed properly to decrease the suffering and pain of the patient (Kelley & Morrison, 2015). The National Palliative standard 2 states those health care professionals are expected to develop the care plan by partnering with the patient and family to provide person-centred care. The patient and family member should be includes in the planning of the care procedure that will help to Improve the holistic approach of care. The NSQHS standard ninth recognize the need of advance care plan for the patient and health care professional should work in partnership with patient family also to improve the holistic approach of care (Australian Commission on Safety and Quality in Health Care, 2017). The Nursing and Midwifery Board (2017) standard five state about the development of the plan for the patient by utilizing the best evidence collected from the assessment. During the care process, health care professional helped Fortunato and his family to understand the health-related issue so that proper decision can be made during the care plan development. The Fortunato’s wife was actively engaged in the care and taking all the necessary decision to relate to his health and treatment process.

The palliative care patient needs change as per the time or prognosis of the disease which needs to be accurately addressed by the health care professional to improve the survival by reducing the difficulty of the patient (Hahne et al., 2017). The Fourth standard of National Palliative Care state that care should be delivered timely concerning the changing need of the patient or the family member keeping the care plan into consideration. The health care professional is expedited to decrease the distress that occurs due to any symptoms to improve health status (National Palliative Care Standard, 2020). The tenth standard of NSQHS state that health care professional is expected to document the changing observation of the patient and should escalate for the changing care need of the patient. The health care professional should communicate with a senior team member regarding the deterioration status of the patient to deliver quality care (Australian Commission on Safety and Quality in Health Care, 2017). The Nursing and Midwifery Board (2017) standard seven-state that nurses are expected to continuously evaluate and monitor the patient related to the current care plan and they can revise the plan concerning the changing health care need of the patient. During the different stage of deteriorating Fortunato condition, the palliative team members communicated and provide the right treatment that is important to improve the dignified death of the patient. Assessments were conducted before insertion of IDC or morphine administration that is important to stabilize the health status of Fortunato.

The health care professional communication in palliative care is important to accurately consider patient aspect and family belief that are to be incorporated in the care process. The right transfers of the care with referrals are important to improve the care of the patient by addressing the issue holistically (Block et al., 2015). The National Palliative care standard fifth state that the health care professional should deliver integrated care which doesn’t face issue due to the transition of the services. The continuity of the care should not be disturbed throughout person care experiences and effective communication should be developing between health care professionals to deliver appropriate care (National Palliative Care Standard, 2020). NSQHS standard sixth state that health care professionals are expected to deliver the rightly framed clinical handover during the transition of the care that helps in the easy transfer of responsibility of the patient to the nurse in care. The clinical handover should also be reviewed by the health care professionals, patient and family member to improve the accuracy (Australian Commission on Safety and Quality in Health Care, 2017). The Nursing and Midwifery Board (2017) standard fourth state that health care professionals are expected to work in partnership to accurately deliver the care by providing the right information or data related to the patient to other health care professional. In the case scenario, the palliative care team were provided by the care plan that was reviewed before starting the care that includes information related to medication, issue and referrals that were framed holistically.

The grief counselling of the family is important to help the family to understand and realise the suffering of the patient that end. Grief support helps the family to acknowledge and understand the reality to decrease any issue that can lead to disturbed mental wellbeing (Garten et al., 2020). The standard 6 of the National Palliative Care stated that family or carer should be accurately addressed by the bereavement support services to bear the loss of the family member. The health care professionals are expected to actively engage in grief support services to help the family members of the patient died (National Palliative Care Standard, 2020).

The palliative care is considered to be careful that needs extra care and attention to deliver the culturally competent care that is important to address the holistic approach. The cultural competent care helps to address the different cultural values and belief that are important to assist the patient (McGee & Johnson, 2013). The standard seventh state that health care professional is expected to provide health care services that respect the philosophy, values, culture of the patient which led to the person-centred palliative care. The cultural competent palliative care helps the individual to provide a supportive environment so that people can die with dignity (National Palliative Care Standard, 2020). The first standard proposed by NSQHS state that health care associates are expected to utilize the leadership and culturally safe care to improve the quality of care that leads to a better patient health outcome. The clinical practice of the health care professional should reflect the cultural safe care with effective leadership to address the patient issue (Australian Commission on Safety and Quality in Health Care, 2017). Nursing and Midwifery Board (2017) prosed standard 1 which state that care should respect the diversity of the patient by addressing the different cultural need of the patient and the family. The health care professional is expected to respect and included different cultural aspect in the care to deliver culturally competent care. In the case scenario, the strong Catholic faith of the Fortunato was considered and referrals include the visit to the Catholic priest that indicates the presence of culturally competent care. 

The quality improvement in the care is important so that different health-related issue of the patient can be addressed with the right intervention concerning the health status of the patient (Kamal et al., 2015). The eight standards of the National Palliative Care state that health care professional should actively engage in the quality improvement of the health care services that are important to justify the quality of the care. The clinical performance and care strategies should be reviewed by the expert to improve the quality (National Palliative Care Standard, 2020). The first NSQHS standard states that quality improvement is important to deliver the right care to the patient by justifying the quality standard of the organization. The right management team can help in surveillance and implementation of the quality improvement program (Australian Commission on Safety and Quality in Health Care, 2017). The care process in the case study was updated according to the patient health that is important to improve care quality and deliver the right care to Fortunato.

The essay can be concluded by adding that the palliative care in the case study has justified the standard and health care professional accurately supported the patient with the family to respond to a patient health situation. The health care professionals accurately helped the patient during the care by changing the care corresponding to patient need and incorporate the family in the care to improve the holistic perceptive of the care. The National Palliative Care, NSQHS and Nursing and Midwifery Board standard are framed to improve the quality of the clinical practise that is important to deliver the quality and safe care to the patient to improve health outcome. The palliative care should address the different aspect of the patient health in holistically so that patient can participate to improve the design of the care plan which leads to better health status. The health care professionals are expected to follow these standards in the clinical practice to improve the quality of care that will help to justify the professional role. These standards are important to include all the important aspect of the care which are necessary to assist the patient by proving the right intervention.

References for Fortunato Palliative Care Case Study

Atakro, C. A., Armah, E., Menlah, A., Garti, I., Addo, S. B., Adatara, P. & Boni, G. S. (2019). Clinical placement experiences by undergraduate nursing students in selected teaching hospitals in Ghana. BMC Nursing, 18(1). DOI: 10.1186/s12912-018-0325-8 

Australian Commission on Safety and Quality in Health Care. (2017). Standards. Retrieved from: https://www.safetyandquality.gov.au/standards

Block, L., Pivodic, L., Pardon, K., Donker, G., Miccinesi, G., Moreels, S. & Onwuteaka-Philipsen, B. (2015). Transitions between health care settings in the final three months of life in four EU countries. The European Journal of Public Health, 25(4), 569–575. DOI:10.1093/eurpub/ckv039 

Garten, L., Globisch, M., von der Hude, K., Jäkel, K., Knochel, K., Krones, T., Nicin, T., Offermann, F., Schindler, M., Schneider, U., Schubert, B., Strahleck, T., & PaluTiN Group (2020). Palliative care and grief counseling in peri- and neonatology: Recommendations from the german palutin group. Frontiers in Pediatrics8, 67. DOI: 10.3389/fped.2020.00067

Hahne, P., Lundström, S., Leveälahti, H., Winnhed, J. & Öhlén, J. (2017). Changes in professionals’ beliefs following a palliative care implementation programme at a surgical department: A qualitative evaluation. BMC Palliative Care, 16(77), 1-13. DOI: 10.1186/s12904-017-0262-4 

Kamal, A. H., Harrison, K. L., Bakitas, M., Dionne-Odom, J. N., Zubkoff, L., Akyar, I., Pantilat, S. Z., O'Riordan, D. L., Bragg, A. R., Bischoff, K. E. & Bull, J. (2015). Improving the quality of palliative care through national and regional collaboration efforts. Cancer Control: Journal of the Moffitt Cancer Center22(4), 396–402. DOI: 10.1177/107327481502200405

Kelley, A. S. & Morrison, R. S. (2015). Palliative care for the seriously ill. The New England Journal of Medicine373(8), 747–755. DOI: 10.1056/NEJMra1404684

McGee, P. & Johnson, M. (2013). Developing cultural competence in palliative care. British Journal of Community Nursing, 18(6), 296–298. DOI:10.12968/bjcn.2013.18.6.296 

Nursing and Midwifery Board. (2017). Registered Nurse Standard of Practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Palliative care. (2020). National Palliative Care Standards. Retrieved from: https://palliativecare.org.au/standards

Saunders, D. R., Arnold, E., Seaman, K., Green, A. & Gullick, K. (2018). Graduate registered nurses’ reflections on implementing safety and quality improvement projects. Reflective Practice, 19(5), 678–689. DOI:10.1080/14623943.2018.1538958 

Sujatha, R. & Jayagowri, K. (2017). Assessment of palliative care awareness among undergraduate healthcare students. Journal of Clinical and Diagnostic Research: JCDR11(9), 06–10. DOI: 10.7860/JCDR/2017/29070.10684 

Temkin-Greener, H., Ladwig, S., Caprio, T., Norton, S., Quill, T., Olsan, T. & Mukamel, D. B. (2015). Developing palliative care practice guidelines and standards for nursing home–based palliative care teams: A Delphi study. Journal of the American Medical Directors Association, 16(1), e1–e7. DOI:10.1016/j.jamda.2014.10.013

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