Principles of Nursing: A Palliative Approach 

Introduction to Palliative Care in Nursing

Palliative care is a specialized nursing and healthcare profession that aims to provide care to the patients who are at the end of life stage (Ghandourh et al., 2018). The focus of end of life care practice is to ensure dignity and quality care for patients to improve the quality of life, provide support, and minimize pain (Chosich et al., 2020). The dignity and high quality care is the primary right of every patient and palliative care, therefore, ensures the same for patients who are terminally ill and in old age (Olver et al., 2020). This paper will focus on the assessment of care provided to a patient, Frank Rossi who developed Glioblastoma (GBM) and was admitted in regard with same. Glioblastoma is a malignant tumour that affects the brain and spine of the patients and results in significant loss of function, health deterioration, and leads to fatality (Cunha & Maldaun, 2019). This paper will underpin the case against the clinical practice guidelines that focus on the care of a dying patient as per the National Palliative care standards and the National Safety and healthcare standards.

Case Brief

Mr. Frank Rossi is a sixty year old man who immigrated to Australia and resides with his wife. Frank plans to retire as a science and mathematics teacher in the catholic school and spend his time with his family. Mr. Rossi and his family are strong believers of Christianity and identify as Catholics. Frank has been diagnosed Glioblastoma in his frontal lobe that has metastasized and reached his temporal lobe. The diagnosis was ensured as Frank was admitted in the facility after a seizure. The symptoms associated with the patient included headache, confusion, blurred vision, muscle weakness, and sleepiness. Frank also has a sluggish response to light. The health condition of the patient was reported to be constantly deteriorating in a clinical facility that eventually resulted in his death.

Clinical Practice Guidelines: Care for A Dying Patient

The purpose of clinical practice guidelines established by the Government of Australia to focus on the care of a dying patient is to ensure quality care for the patients who are at the end of their lives (ACU Practice Guideline, 2018). The guidelines aim to improve the care provided to dying patients and provide effective management of their health to ensure comfort and support. The critical factors that are included in the care of a dying patient guideline are to ensure symptom management, reduction in unwanted interventions, and effective communication with the patient as well as the family (Ghandourh et al., 2018). In the case of Frank Rossi, the clinical practice guidelines for the care of a dying patient were not applied appropriately, as per these guidelines, the observation of patient should be done in every four hours (ACU Practice Guideline, 2018). However, in the given case, frequent observations were not conducted for Frank that resulted in a delayed response in the application of interventions and further deteriorated the health of the patient. The symptom observations that are associated with the clinical practice guidelines for a patient at the end of life care include assessment of pain, restlessness, breathlessness, secretions, nausea, and myoclonus. The categorization of the symptoms should be done into Absent, mild, moderate, and severe, based on the intensity. Even when these observations were taken for Frank Rossi, categorization of the symptoms was not clear. Other critical aspects that must be included in the care included bowel movements, repositioning of the patient for comfort, mouth care, and medication adherence (ACU Practice Guideline, 2018). The interventions should be applied as per the escalation guidelines and Advanced care protocol (Hope et al., 2018). Due to poor management and negligence in the care setting, the Advanced care protocol was not developed for Frank. This affected the overall course of care and impacted the health status and quality of life of the patient. Bowel movements and fluid retention in the patient were also not addressed regularly that resulted in a fall in the clinical setting and caused further health deterioration in the patient. Mouth care and pain assessments were done appropriately and as per the care guidelines established. The clinical guidelines for the care of a dying patient also assert the importance of family support and care in the course of treatment and management of the patient (ACU Practice Guideline, 2018). As per the guidelines, support should be ensured to the family through the development of a supportive environment and social work referrals. A grief counsellor should also be considered when ensuring the acre of the patient (ACU Practice Guideline, 2018). The communication of the patient’s family and the healthcare services was not adequate as evident from the absence of family at the time of death of the patient. This indicates that the family was not clear and aware of the health condition of the patient. Considerations about the appointment of a grief counsellor and facilitations were not included impacting overall patient and family experience.

National Safety and Quality Healthcare Standards

Quality and effective care has been identified as the fundamental rights of the patients of Australia ascertained by the Australian Healthcare Charter (Hudson et al., 2016). The key aim of these standards is to improve the quality of experience of the patients in the care facility (Government of Australia, 2017). An essential component of care that is involved in the National Safety and Quality Healthcare Standards is to ensure effective communication for safety, recognition, and response for care in a patient with deteriorating health (Government of Australia, 2017) The health of Frank deteriorated in the clinical setting rapidly that transitioned to the terminal due to delayed application of interventions and limited follow ups for health status. The health deterioration of the patient had accelerated with the fall that occurred when the patient was trying to move to the washroom. Leaving a patient alone in a critical stage as that of Frank indicates negligence and breach of the National Safety and Quality Healthcare Standards. The quality of care is also enhanced by ensuring support of family and shared decision making (Haun et al., 2017). The involvement of the family in the case of Frank Rossi was not prominent and this affected the overall course of care and quality received by the patient and also by the family.

National Palliative Care Standards

The National Palliative Care Standards have been developed by the Government of Australia to ensure quality care for the patients of old age in the facilities (Government of Australia, 2018). The primary standard of palliative care practice is to develop an assessment of the well being of the patient (Collins et al., 2017). In the case of Frank Rossi, initial assessments regarding physical health, cultural, and social needs were done appropriately and in accordance, however, the genetic component of disease incidence was not incorporated. Inclusion of the genetic risks of the disease could have improved the care, helped in the development of interventions, and further assessments (Mills & Mills, 2016). The second standard of care focuses on the fostering of partnerships and collaborative care with a family in the process of shared decision making through effective communication (Government of Australia, 2018). In the case of Frank Rossi, collaborative partnerships were not evident that affected the overall care received by the patient and also the support. The third standard of the National Palliative care is to assess and meet the family and carer needs (Government of Australia, 2018). In the given case, the cultural and religious needs of the patient were met as complete freedom to practice and attend the catholic faith were ensured by the care facility. However, in terms of family, the inclusion of a grief counsellor and supportive service inclusions could have enhanced the quality of care and service received by the family. Inclusion of religious and cultural sensitivity is of high importance in palliative care as the patient is able to get support and comfort through the same (Sallnow et al., 2016). The fourth principle asserts the need for proper planning and application of evidence-based interventions (Government of Australia, 2018). This standard was violated in the care of Frank Rossi as an Advanced Care directive was not prepared for Mr. Rossi. This resulted in poor management of care and was one of the causes of poor health service received (Kellehear, 2016). The fifth standard of the service is to include patient experiences in the care. This standard was also not followed in the care received by the patient (Government of Australia, 2018). The only request was of the family and the patient was to receive dignified care. The patient expressed concerns on how his father had died and did not wish to receive the same fate. However, poor coordination and practice resulted in an accelerated deterioration in the health of the patient resulting in a fatality (Hilbers et al., 2018). The sixth standard of palliative care nursing established by the government of Australia seeks that emotional support services for grief management should be provided to the family (Government of Australia, 2018). The seventh standard of successful palliative care practice is to ensure person-centred care (Government of Australia, 2018). Collaborative and multidisciplinary action could have been thus of beneficence for supporting the family and the patient but was not achieved the case (Hilbers et al., 2018). The eight standard guides the palliative nurses to improve the quality of service and the final standard asserts the need for qualified staff (Government of Australia, 2018). These standards were not successfully fulfilled and resulted in poor care and health deterioration and uneventful termination of Frank Rossi.

Conclusion on Palliative Care in Nursing

End of life care is a great responsibility on the healthcare professionals as the patients in palliative care seeks immense emotional as well as physical support in the care. This essay highlights the case of Frank Rossi who had been admitted in the palliative care facility after an incidence of seizure. The patient was diagnosed with Glioblastoma and eventually died in the facility. The care provided to the patient was inappropriate and has been analyzed in this essay under the guidelines of care for a dying patient. This document also analyses the practice of the healthcare professionals involved in the case in light of the National Safety and Quality Healthcare Standards and the National Palliative care standards. Through this assessment, it can be concluded that the initial assessments and diagnosis of the patient were accurate but could be improved with the inclusion of the familial history of the disease. The care provided could have been improved through frequent assessments and the development of the advanced care plan. The participation and inclusion of the family of the patient were also limited in the care that impacted the course of quality service received and emotional support for the grief management of the family.

References for Palliative Care in Nursing

ACU Practice Guideline (2018). Care of the dying patient. Retrieved from:_______________UNIVERSITY LINK OF CLIENT to be added here

Chosich, B., Burgess, M., Earnest, A., Franco, M., Runacres, F., William, L., ... & Yoong, J. (2020). Cancer patients’ perceptions of palliative care. Supportive Care in Cancer28(3), 1207-1214. https://link.springer.com/article/10.1007/s00520-019-04917-8

Collins, A., McLachlan, S. A., & Philip, J. (2017). Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers. Palliative Medicine31(9), 825-832. https://journals.sagepub.com/doi/abs/10.1177/0269216317696420

Cunha, M. L. V. D., & Maldaun, M. V. C. (2019). Metastasis from glioblastoma multiforme: A meta-analysis. Revista da Associação Médica Brasileira65(3), 424-433. https://www.scielo.br/scielo.php?pid=S0104-42302019000300424&script=sci_arttext

Ghandourh, W. A. (2016). Palliative care in cancer: Managing patients’ expectations. Journal of Medical Radiation Sciences63(4), 242-257. https://onlinelibrary.wiley.com/doi/abs/10.1002/jmrs.188

Government of Australia (2017). National Safety and Quality Health Standards. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwifloWtuaXsAhXz7XMBHQ0GD-wQFjAAegQIBRAC&url=https%3A%2F%2Fwww.health.qld.gov.au%2F__data%2Fassets%2Fpdf_file%2F0023%2F833315%2Fcpdp-care-plan-hp-guidelines.pdf&usg=AOvVaw07oe2G9ggy7DxQLNwz-4EW

Government of Australia (2018). National Palliative care standards. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjUtaLwtpjsAhWNzTgGHcjJBj4QFjABegQIARAC&url=https%3A%2F%2Fwww.clinicalguidelines.gov.au%2F&usg=AOvVaw16LhKPBb715iXf3OC2cn3u

Haun, M. W., Estel, S., Rücker, G., Friederich, H. C., Villalobos, M., Thomas, M., & Hartmann, M. (2017). Early palliative care for adults with advanced cancer. Cochrane Database of Systematic Reviews, (6). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011129.pub2/abstract

Hilbers, J., Rankin-Smith, H., Horsfall, D., & Aoun, S. M. (2018). “We are all in this together”: Building capacity for a community-centred approach to caring, dying and grieving in Australia. European Journal for Person Centered Healthcare6(4), 685-692. http://www.ejpch.org/ejpch/article/view/1660

Hope, J., Recio‐Saucedo, A., Fogg, C., Griffiths, P., Smith, G. B., Westwood, G., & Schmidt, P. E. (2018). A fundamental conflict of care: Nurses’ accounts of balancing patients' sleep with taking vital sign observations at night. Journal of Clinical Nursing27(9-10), 1860-1871. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14234

Hudson, P., Collins, A., Bostanci, A., Willenberg, L., Stephanov, N., & Phillip, J. (2016). Toward a systematic approach to assessment and care planning in palliative care: A practical review of clinical tools. Palliative & Supportive Care14(2), 161. http://search.proquest.com/openview/c6ae3c7dfa24fad696258573e1e224d6/1?pq-origsite=gscholar&cbl=39238

Kellehear, A. (2016). Commentary: Public health approaches to palliative care–the progress so far. Progress in Palliative Care24(1), 36-38. https://www.tandfonline.com/doi/abs/10.1080/09699260.2015.1103499

Mills, S., & Mills, J. (2016). Future directions for community engagement as a public health approach to palliative care in Australia. Progress in Palliative Care24(1), 15-18. https://www.tandfonline.com/doi/abs/10.1179/1743291X15Y.0000000012

Olver, I., Keefe, D., Herrstedt, J., Warr, D., Roila, F., & Ripamonti, C. I. (2020). Supportive care in cancer—A MASCC perspective. Supportive Care in Cancer28(8), 3467-3475. https://link.springer.com/article/10.1007/s00520-020-05447-4

Sallnow, L., Kumar, S., & Kellehear, A. (Eds.). (2016). International perspectives on public health and palliative care. Routledge. https://books.google.com/books?hl=en&lr=&id=cl-pAgAAQBAJ&oi=fnd&pg=PP1&dq=%22health+approach%22+palliative+care+in+australia&ots=hM67Dukpz2&sig=Agec_WwqBf7z7tYqe1x1mOWWuJ4

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