Posted: November 22nd, 2014

Palliative Care

Palliative Care

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The essay is an analytical reflection on an episode of care of a patient,the issues it raised,not a case history or general discussion about a specific issue of symptom to focus on patient,family and one episode of care related to the 4 learning outcomes also focusing to what was done to patient and family during the episode of care.(It about thinking about what I did, Why I did it.Was it the right thing to do or not? how do I know Who said it)my own experience is also allowed as evidence if it agrees with theory. see plan and feedback please stick to feedback during writing each learning outcome should approximately have 600 words academic references journals articles and books if online not many real proper e.g DOH

Episode of care Formative

Introduction
The fictitious name is Jarvis. Jarvis 64 years old man frail married but wife was in rehabilitation service. Jarvis a Christian belongs to the catholic religion. Admitted at the for Palliative care  Diagnosed with cancer of the oesophagus, lung, bladder metastasis, Diabetes insulin dependent, Asthma and previous MI. Urinary retention plus hernia, and oesophageal stent in situ.  Jarvis in use of oxygen concentrator at 1 litre when required.  Jarvis was ambulant. My episode of care was I took over from night shift. During handover it was mentioned he was deteriorating was to manage pain, symptoms of nausea vomiting and breathlessness. Boud et al (1985) reflective model will be used (What happened, So what, Now what). Learning outcomes l, 2, 3 and 4 will be explored. A conclusion will be drawn.
LO1 Critically discuss the importance of Palliative care and evaluate its application to their area of practice
Palliative care is an active holistic approach of care given to patients who are terminally ill with a poor prognoses, the patients has a right to choose how they want to die and where they want to die. According to human rights Act (1978) with dignity and respect peacefully their pain being managed by health care professions in accordance with guidelines and standards. The World Health Organisation (WHO) and National Institute of Excellence (NICE). Where I work residents who are terminally ill are managed in a multidisplinary team to get the best effective way to manage complex situations to improve the quality of life and comfort. It is also a good opportunity for other professionals to meet the resident family and agree on the intervention and also the chance for the family to address concerns and being answered. A person centred plan put in place or reviewed to meet the individual needs to end of life. Reduce stress to the family facing the problem and receiving advice they might need.
Discussion of Framework GSF relating to my Episode:
Gold Standards Framework (2003) is another way of combining many different practices. The framework includes 7 Gold Standards which relate to key aspects of care, and guidelines for best practice on teamwork and continuity of care, advanced planning, symptom control and support.

LO3 – Recognise and assess common distressing symptoms and critically appraise the care required/give within the context of multi-professional teamwork

Jarvis came into rehabilitation due to his condition which was deteriorating needed to be looked after and be comfortable had complex needs impacting on his health incurable. Jarvis had been vomiting during the night occasionally once but on this particular night it was twice. The symptoms had presented a week before nausea and vomiting being managed by emetics the pain was being managed with paracetamol and codeine sulphate.
I carried out the vital signs observation assessment and the biopsychosocial needs to meet the holistic needs of the client. I managed to check his pulse rate which was high than normal. I used the numerical scale 1 to 10. I asked him how he could rate his pain said 10. I reassured him that I and the rest of the team are going to manage his pain and symptoms as per pain management protocol and would inform the palliative nurse and the doctor if there is no improvement.  Called for help to assist him back into armchair or bed he then refused saying he felt more comfortable, to wrap him with a blanket and leave him in the toilet. I administered 2.5mls of oramorph PRN as per guidelines and reviewed after an hour. He was in pain but subsided rating it at 5 and he requested to go and sit at his usual favourite place near to the big window front of the building.
I found the tool to be beneficial for effective management of pain because it was a good indicator as to when I would need to adjust his analgesia using the WHO analgesic ladder WHO (2008). This aims to give the correct drug, correct dose, given at the correct time and proves to be inexpensive and 80-90% effective WHO (2008). This ensured Jarvis was in the least amount of pain which enabled him to visit favourite place

Continued in bullet point
•    Called the Doctor for further assessment – prescribed Zomorph 20mg slow release
•      advice from GP to inform McMillian nurse
•    How I benefited from the framework I was using

•    Challenges faced and if faced with the situation again what I would do better

LO2- Demonstrate a sound understanding of the importance of effective communication and critically appraise the communication skills used in practice
Listening to patient and family , taking notes, documenting information, liaising with everyone involved in patient care managing time and the importance of strong communication used in palliative care how this can benefit the client or affect clients and their families. What I learnt from it, relating it to my episode of care communication what I will do respecting others values boundaries being sensitive empathy

LO4- Critically debate ethical and professional issue occurring in practice
•    sedation
•    Values and beliefs
•    Resuscitation
•    Conflicts with clinicians usually to what constitutes appropriate care
•    Dealing with grief of the family
•    The ethical dilemmas.

Conclusion
Knowledgeable, being competent, following guidelines and standards thriving for good communication skills. Patients to remain empowered and make informed choices regarding their wishes, preferences of end life and treatment with the help of health care professionals. I now understand how complicated symptom management can be cancer patients experience many symptoms from their condition and also side effects from their medication. Assessments are vital to ensure the appropriate treatment and management of symptoms.

References:
To added

Part of the episode of care done after feedback
Took over as nurse in charge, non-specialist nurse to Palliative care first contact with cancer patient. The episode of care is management of pain. Breathlessness, vomiting support to carers and the family. Little did I know that the cancer was at its progressive stage attended to him as I would do to any of my clients under my care? Didn’t understand the break through pain, deterioration was evident, as he mentioned that I don’t think tomorrow I would be here, ambulatory, the family were very supportive called the niece informing  changes and that the doctor was in his way  and signing not to resuscitate form which had been agreed with client and family the previous day within minutes the niece arrived though in pain client was responding better to her requests had refused to come out of the toilet due to pain had taken analgesia in toilet the relationship between both of them made it work realised that therapeutic relationships need to be built quickly as the client is admitted to be able to meet needs  they sat around him during lunch had lunch together but he did refute and had prescribed pro call shot interacting a bit but sleepy throughout but during the night it worse after 2 days he died I failed to take notice of the clues as they play a part to his religious beliefs I could have known if he needed a Chaplin.  It was a great opportunity after a week to start module in palliative care end of life. There was a lot of unsteadiness with family build up anxiety through reflection I can recognise that the family needed more explanation and client reassurance of stage, of what was happening to their beloved one or else they had information from internet  almost every day the client was raising concerns to relatives and also relatives escalating the concerns did not take it as part of grieving could have handled everything a bit more sensible and give them more information of what to accept and acknowledge  the behaviour as acceptable Although I called a doctor I feel with knowledge, I have  now I could have called in an emergency multidisplinary team or ask the doctor for an anticipatory prescription and develop an advance care plan to assist his wishes being meet or maybe control pain with syringe pump,

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