Principles of Nursing: A Palliative Approach 

Palliative care is the care that is provided to patients with serious illness and their families in order to improve their quality of life and reduce their suffering (Schroeder & Lorenz, 2018). The ultimate goal of relieving the suffering of patients and their families is achieved by the provision of wide-ranging assessment along with the treatment of patient’s physical, mental, and spiritual symptoms (Al-Mahrezi & Al-Mandhari, 2016). This assessment is based on the case study of Fortunato (Frank) Rossi and his wife Sofia. Frank was admitted to the emergency ward as he experienced a seizure. With some abnormal vitals and he was referred for a diagnosis and it revealed that he was suffering from Glioblastoma Multiforme (GBM) stage 4. According to Hanif et al., (2017) Glioblastoma Multiforme (GBM) has been considered as one among the most malignant types of tumours of the central nervous system that grows and spread rapidly. This assessment will critique the care provided to the patient in the case study as per one selected clinical practice guideline upholding the NSQHS standards, NMBA standards, and Palliative care standards. The selected clinical practice guideline for this assessment would be care of the dying patient. 

As per the clinical practice guideline for the care of the dying patient the symptom observation chart is used in order to record all the signs and symptoms of the patient. In the given case study all the symptoms shown by the patient has been incorporated. All the vitals including normal and abnormal vitals of the patient has also been mentioned. According to the standard 1 of National Palliative Care standards, (2018) i.e., Assessment of needs says that the initial and ongoing assessment of the patient is important and this must incorporate the patient’s physical, mental, social, cultural, and spiritual experiences along with the needs of the patients (Palliative Care Australia, 2018). However, in the case study patient’s physical and mental medical assessment is done and his past medical history is evaluated. Patient’s social, cultural and spiritual experiences have also been considered. For providing relief from the suffering an early detection and proper assessment is needed for palliative care (Sujatha & Jayagowri, 2017) and in the case study timely assessment and diagnosis was done but, the patient himself has come late and was diagnosed with stage 4 of GBM. However, there were some major aspects where the professionals lacked in the case study and it was the patient’s pain assessment. In the clinical practice guideline for the care of the dying patient pain assessment was considered as the foremost priority. The patient had pain and from the information provided in the case study, it is seen that patient’s pain assessment was not done. According to Sholjakova et al., (2018) pain assessment and its management are among the top priorities of health care professionals in palliative care. If the proper assessment of pain will be done then only the effective management plan for pain can be achieved. And, pain management is crucial in palliative care as it helps in improving the quality of life. This was the matter of beginning but, even when the patient had fallen he was not assessed for the pain but consulted with a urologist as he was finding himself in difficulty to void. Along with pain assessment patient’s breathlessness was also not assessed properly. In a study presented by Baker, DeSanto-Mdeya & Banzett, (2017) it has been stated that proper assessment, as well as documentation of patient’s breathlessness, should be done in order to address this issue and provide relief in his suffering. In addition to this nurses also did not recheck whether the patient was hydrated or not and whether he has taken his food or not. The patient was seen to refuse to take his medicines and he also had issues in remembering things. So, it becomes the duty of the nurse to take care of patient’s hydration and nutrition. In a study presented by Boomfield & Pegram (2012), it has been stated that it is the core duty of the nurses to ensure that the patient’s hydration and nutrition needs are met timely. Adequate hydration and nutrition are very important for improving patient’s deteriorating health, from both the physical as well as mental perspective. This must be considered as a priority by nurses. Along with this, the health care professionals must take some significant actions that must be focused on addressing the possible barriers that may create hindrance for the patients in receiving an adequate amount of food and drink.

The next criterion of the clinical practice guideline for the care of the dying patient is to establish and provide a care plan for the patient. An effective care plan that addresses patient’s issues is an important part of the nursing practice and it is important to develop the care plan according to the needs of the patient (Johnson, Edward & Giandinoto, 2018). Standard 5 of registered nurse standards for practice, developing a plan is important in nursing practice (Nursing and Midwifery Board of Australia, 2016). In this, all the aspects are needed to be incorporated however, in the given case study only medication care plan of the patient is given. According to the medication safety standard and comprehensive care plan standard of NSQHS standard (Australian Commission on Safety and Quality in Health Care, 2015), the health care professionals must abide by considering medication safety while preparing care plan for the patient and must deliver the comprehensive care. Along with this, they must maintain a system that helps in preventing and managing specific potential harms to the patients. In the medication care plan of the patient in the case study, the clinicians have taken care of the medication safety standard. This is so because the patient was being prescribed and administered with mannitol and in a study presented by Cheng et al., (2018) it has been stated that mannitol is an effective drug in order to reduce the intracranial pressure. Lyria was given to the patient for the seizure activity along with Diazepam, these medications were safe and effective for the patient. However, it was also seen that these medicines were safe but did not address the problem of delirium. The patient was also facing the issue of confusion but no medication was prescribed and administered to him regarding this. It was necessary for the patient to receive medication for this issue also because he was at risk of harming himself because of this problem. He had a fall because of confusion only. So, it becomes a priority for the professionals to address this issue in order to prevent the patient from any other risk of injury.

The next criterion to be critique according to the clinical practice guideline for the care of the dying patient is Caring for the family or loved ones of the patient. The clinical practice guideline says that the hospital environment must provide a supportive environment for the patient’s family members so that they can spend time with the patient. National Palliative Care standard 3 offers Caring for the carers and it says that the needs, as well as preferences of patient’s family members, must be assessed. Along with this, there should be a directly informed stipulation of competent support and assistance to the family grief (Palliative Care Australia, 2018). In the case study patient’s wife, Sofia was with a patient and the hospital setting provided a supportive environment as Sofia was with her husband every time. In National Palliative Care standard 6, the family members must have access to the grief support services and should always be given with the information about the grief (Palliative Care Australia, 2018). In a study presented by Aoun et al., (2017) it has been stated that the standards for the grief care intend that the support provided to the family members should be coordinated with the associated risk and requirements of the family members. And, in palliative care services a generic approach must be adopted by the hospital settings in order to offer support to the bereaved family members. And, in the case study, the health care professionals also provided grief support to the patient’s wife, Sophia along with considering Sophia’s spiritual needs. Taking decisions by involving patient’s family is also an important part of supporting the family and it has been seen in the case scenario that Sophia was involved in patient’s care decisions and her decisions were also being acknowledged.

Communication is also another aspect of clinical guideline practice. The communicating for safety standards of NSQHS standard (Australian Commission on Safety and Quality in Health Care, 2015) the health care professionals of the health care service organisation must provide and support an effective communication relationship with the patients and their family members; among the multidisciplinary teams and the health care providers; and not only this but also among the other health service organisations. The hospital settings must use effective communication and this will result in ensuring safety. In a study presented by Fakhr-Mohavedi et al., (2016) the role of effective communication has been explored. It is said that effective communication plays an important role in maintaining professional disciplines and ascertaining effective communication with the patients and their family members is a crucial aspect of nursing care. With the help of effective communication skills, the health care professionals can easily recognise the health care requirements as well as preferences of the patients and their family members. It also helps the nurses in enabling them to enhance a thorough knowledge regarding individual patients along with their personal characteristics. In the given case scenario, the health care professionals maintained effective communication with the patient as well as his wife and this helps in building trust between them. According to the NMBA standards for registered nurses standard 2, there is a need for engaging the patients in the therapeutic and professional relationship. The way everything was conveying to the patient and his wife in the case scenario clearly justifies this standard.

References for Frank Glioblastoma Multiforme Case Study

Al-Mahrezi, A., & Al-Mandhari, Z. (2016). Palliative Care: Time for Action. Oman Medical Journal31(3), 161–163. https://doi.org/10.5001/omj.2016.32

Aoun, S. M., Rumbold, B., Howting, D., Bolleter, A., & Breen, L. J. (2017). Bereavement support for family caregivers: The gap between guidelines and practice in palliative care. PloS One12(10), e0184750. https://doi.org/10.1371/journal.pone.0184750

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

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

Baker, K. M., DeSanto-Madeya, S., & Banzett, R. B. (2017). Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance. BMC Nursing16, 3. https://doi.org/10.1186/s12912-016-0196-9

Boomfield, J. & Pegram, A. (2012). Improving nutrition and hydration in hospital: the nurse’s responsibility. Nursing Standard, 26(34), 52-56. doi: 10.7748/ns2012.04.26.34.52.c9065

Cheng, F., Xu, M., Liu, H., Wang, W., & Wang, Z. (2018). A retrospective study of intracranial pressure in head-injured patients undergoing decompressive craniectomy: A comparison of hypertonic saline and mannitol. Frontiers in Neurology9, 631. https://doi.org/10.3389/fneur.2018.00631

Fakhr-Movahedi, A., Rahnavard, Z., Salsali, M., & Negarandeh, R. (2016). Exploring Nurse's Communicative Role in Nurse-Patient Relations: A Qualitative Study. Journal of Caring Sciences5(4), 267–276. https://doi.org/10.15171/jcs.2016.028

Hanif, F., Muzaffar, K., Perveen, K., Malhi, S. M., & Simjee, S. (2017). Glioblastoma Multiforme: A Review of its Epidemiology and Pathogenesis through Clinical Presentation and Treatment. Asian Pacific Journal of Cancer Prevention : APJCP18(1), 3–9. https://doi.org/10.22034/APJCP.2017.18.1.3

Johnson, L. Edward, K. L., & Giandinoto, J. A. (2018). A systematic literature review of accuracy in nursing care plans and using standardised nursing language. Collegian, 25(3), 355-361. https://doi.org/10.1016/j.colegn.2017.09.006

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

Schroeder, K., & Lorenz, K. (2018). Nursing and the Future of Palliative Care. Asia-Pacific Journal of Oncology Nursing5(1), 4–8. https://doi.org/10.4103/apjon.apjon_43_17

Sholjakova, M., Durnev, V., Kartalov, A., & Kuzmanovska, B. (2018). Pain Relief as an Integral Part of the Palliative Care. Open Access Macedonian Journal of Medical Sciences6(4), 739–741. https://doi.org/10.3889/oamjms.2018.163

Sujatha, R., & Jayagowri, K. (2017). Assessment of Palliative Care Awareness among Undergraduate Healthcare Students. Journal of Clinical and Diagnostic Research : JCDR11(9), JC06–JC10. https://doi.org/10.7860/JCDR/2017/29070.10684

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