• Internal Code :
  • Subject Code : NURS1137
  • University : RMIT University
  • Subject Name : Nursing

Assessment 

Introduction

 A terminal illness is a condition or disease that cannot be cured and is probable to lead to the death of the person. It is called a life-limiting disease sometimes. Some individuals may use distinct definitions, so if not sure what someone is saying or what it implies, it is essential to ask (McHugh, 2015). Palliative care is the strategy that increases the quality of care and quality of life of family and the patient confronting the issue of life-threatening disease through early evaluation and identification and treatment (White, & Willmott, 2018). This assessment deals the reflection on the given case studies that describes the importance of palliative care during terminal illness and also laws and rights of aboriginals and migrant

Case study 1- Betty’s story

1. Betty has identified and psychologically stable. She is at 5th stage of chronic kidney failure and Alan and Betty have knows that she is going to die soon. She is suffering from symptoms like extreme lethargy, tiredness and shortness of breadth. As consulted with the psychologist, Betty is sure that she doesn’t need dialysis and she prefers home death. 

Betty has been reviewed with the current status of her disease, her physical and psychological symptoms and social and cultural concerns. Her disease will be managed by the end of life care and by providing palliative care (Wachterman et al., 2016). 

2. End of life care is the patient and family centered program that provides care to patient with active and progressing disease. It is provided for the patient who is expected to die soon and there is no prospect of cure. This will be focused on the needs of Betty and her preferences (Barratt, et al., 2018). As in case of Betty she chose home death so maintaining her dignity and comfort palliative care will be provided to her. There will be multidisciplinary team that will be taking care of her medications, symptoms and will provide support to the family members (Barratt, et al., 2018). The standards of palliative care recognize the importance of the age and person. The quality will be maintained in end of life care according to the Australian standards of end of life care.

3. For this a patient centered care plan is made (Murray, et al., 2017). This involves symptoms management medication management, nutritional management and palliative care (Murray, et al., 2017). Betty has GFR 6ml/min/1.73m2 and Createnine 238 umol/L. She is suffering from nausea and extreme lethargy and she is not able to swallow her tablets so she will be given subcutaneous medication whenever required. For the pain management she will be given syringe drive. Her nutritional intake and diet will be taken care. Palliative care provides support to the family members. Alan and Sheryl will be provided with support. 

Case study 2- Amy’s story

1. It has been found that people having diverse culture and languages are more likely to suffer difficulty in accessing the end of life services compared to other native groups. They have lack of knowledge about the services that are provided, their lower socioeconomic status, they are socially isolated sometimes based on their beliefs and practices and sometimes because of their native language also. Western societies believe that end of life care should be provided with biomedical aspects but Amy family believes that they should maintain the logistic and spiritual aspects (Fang, 2016). In case of Amy and her family,  they follow a lot cultural practices like Mei comes every morning to her mother He places a jade under her pillow in order to ward off the evil spirits (Fang, 2016). This might look irrelevant for other staff members. And they would feel uncomfortable going to them while providing care. This might influence the staff assistance towards Amy and it would be difficult to make choices for them. Mei prepares food for Amy every morning. They believe that gathering to eat is important. Food provider might find it different and would not be able to provide the food that is required to overcome her symptoms. A lot of times their language is not understandable by the staff and they feel a little uncomfortable and it can lead to ineffective communication (Cain, et al., 2018). Doctor says that it is normal that the family speaks in a native language when they are together. And providing care to her should not be affected by this. One staff member questions about the way the family of Amy grief. Grief is shown differently by different people (Coelho & Barbosa, 2017). Some might cry loud and openly in public on the other hand some people remain calm (Neuberger, 2018). 

2. Having cultural differences can make the patient and her/his family isolated (Wijsenbeek, et al., 2015). This affects the psychological condition of the patient and their family. They might not be properly assisted and they themselves do not know all the services available for their psychological assistance during the hard time of the family. The end of care should provide support to the family but the staff attitude seems to be unsuitable as staff is not understanding the way they grief. It can lead to distress among the family.

Case study 3- Tom’s story

1. Key needs are :

  1. Symptoms management 

  2. Communication- at this stage tom family should have the right information.

  3. Holistic clinical assessment 

  4. Traditional healers and traditional medicines to be used at this stage (Farquhar, 2018). 

2. Reasons that tom would like go back to his country and die are that h needs to share his stories with the folks back home. With his friends and people of his age. 

3. As a health care professional

  1. It is important to follow culturally safe practices.

  2. Proper communication 

  3. To follow standards for palliative care 

  4. To follow standards of engages in therapeutic and professional relationships. 

Conclusion 

End-of-life care and decision-making promoting convenience and dignity are commonly supported by government policy and law. These may be considered ethically permissible by applying the doctrine of double effect in ethical assessment of palliative care measures that are argued possibly to hasten death, if the purpose of the doctor is to relieve pain and not cause death. During this assessment I learnt about end of life care and its key needs, cultural differences and their effects on palliative care and aboriginal palliative care programs. 

References 

Barratt, S. L., Morales, M., Spiers, T., Al Jboor, K., Lamb, H., Mulholland, S., ... & Sharp, C. (2018). Specialist palliative care, psychology, interstitial lung disease (ILD) multidisciplinary team meeting: a novel model to address palliative care needs. BMJ Open Respiratory Research, 5(1), e000360.

Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care: preferences, communication, meaning, and mutual decision making. Journal of Pain and Symptom Management, 55(5), 1408-1419.

Coelho, A., & Barbosa, A. (2017). Family anticipatory grief: an integrative literature review. American Journal of Hospice and Palliative Medicine®, 34(8), 774-785.

Fang, M. L., Sixsmith, J., Sinclair, S., & Horst, G. (2016). A knowledge synthesis of culturally-and spiritually-sensitive end-of-life care: findings from a scoping review. BMC geriatrics, 16(1), 107.

Farquhar, J. (2018). Knowing practice: The clinical encounter of Chinese medicine. United Kingdom: Routledge.

Gebauer, S., Knox Morley, S., Haozous, E. A., Finlay, E., Camarata, C., Fahy, B., ... & Marr, L. (2016). Palliative care for American Indians and Alaska Natives: a review of the literature. Journal of Palliative Medicine, 19(12), 1331-1340.

Grassi, L., Caruso, R., Sabato, S., Massarenti, S., & Nanni, M. G. (2015). Psychosocial screening and assessment in oncology and palliative care settings. Frontiers In Psychology, 5, 1485.

McHugh, N., Baker, R. M., Mason, H., Williamson, L., Van Exel, J., Deogaonkar, R., ... & Donaldson, C. (2015). Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives. BMC medical ethics, 16(1), 14.

Murray, S. A., Kendall, M., Mitchell, G., Moine, S., Amblàs-Novellas, J., & Boyd, K. (2017). Palliative care from diagnosis to death. Bmj, 356, 878.

Neuberger, R. J. (2018). Caring for dying people of different faiths. Florida: CRC Press.

Shahid, S., Taylor, E. V., Cheetham, S., Woods, J. A., Aoun, S. M., & Thompson, S. C. (2018). Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliative Care, 17(1), 72.

Wachterman, M. W., Pilver, C., Smith, D., Ersek, M., Lipsitz, S. R., & Keating, N. L. (2016). Quality of end-of-life care provided to patients with different serious illnesses. JAMA Internal Medicine, 176(8), 1095-1102.

White, B., & Willmott, L. (2018). Double effect and palliative care excuses. Health Law in Australia (Third Edition). Thomson Reuters, Pyrmont, New South Wales, 625-646.

Wijsenbeek, M., Bendstrup, E., Ross, J., & Wells, A. (2015). Cultural differences in palliative care in patients with idiopathic pulmonary fibrosis. Chest, 148(2), 56.

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