• Subject Name : Nursing

Importance of Holistic Care at the End of Life

Mr Dack is 85-year-old Catholic man and he was living in Australia from the past 15 years with his wife in the remote area. He was admitted to the palliative care centre after diagnosis of the chronic kidney failure that was evident due to the insufficient urine production, oedema in leg and malaise. The past medical history of the Dack indicates the presence of the type 1 diabetes that also affected his mother and high blood pressures that were diagnosed 2 years ago but were not addressed by the medication. The present complaint of the patient is the persistent pain, discomfort, sleeping issue, loss of appetite that directly decreases the physical as well as mental wellbeing of the individual. The Dack medical history also indicates the presence of depression that lead him to attend different counselling setting but he is still struggling with the low mood and decreased self-esteem. His wife holds his medical rights after he is diagnosed with the depression that was evident due to his family history of the father having anxiety and depression issue. He has been visited the general practitioner three times before this visit to avail assistance and he was prescribed with Metformin and Fosinopril to improve his health-related issue. He was not able to adhere to the prescribed medication due to the lack of knowledge and understanding regarding the medication use on daily bases thus proper educational session was conducted with the pharmacist in the palliative care team. The session is important to convey the necessary information concerning the medication to the Dack and Rosy so that there are no changes of non-adherence to the medication. The patient assessment conducted by the palliative team members reveals that his blood pressure is still is high that can increase complication and he has a pain of intensity 8/10 that was revealed by using the Numerical Rating Scales. These two are the chief current compliant of the patient that needs to be addressed to improve the current health condition.

The Palliative care head in the team discussed the need for the dialysis to help the Dack and improve his health status. After discussing the issue with the Dack and his wife they refused for the dialysis by adding that they want Dack’s end-stage renal failure to be treated without dialysis. The decision was respected by the palliative team head and they ask to avail the right assistance to support the patient end-stage renal failure state. The palliative team head provided different medication like Methadone to help him in increasing comfort by reducing the pain and combination of diuretic to decrease the elevated blood pressure. Furosemide is also prescribed by the palliative care head to reduce the leg oedema that is increasing complication for the patient. During the care process, Dack reveals reluctant and irritant behaviour toward the palliative care staff that directly hamper the medication process thus the scenario was immediately informed to his wife (Rosy). When Rosy arrived at the hospital the palliative team head explained that she needs to indulge in the care process to support the Dack so that proper care can be provided. Rosy after that incident actively engaged in the care process that helped to calm down Dack which is important to provide the right care. The advanced care plan was conducted after discussing the whole scenario with Rosy about the Dack medical crisis and planning the care that should be preferred during that duration to stabilize the patient condition.

After controlling his current health issue that helped to stabilize his condition then he was refereed with the home-based nurse care to maintain the fluctuation in the health status. Rosy was informed concerning all the different aspect of the care related to the Dack so that she can actively engage with him with the help of the nurses to assist the patient. The activity routine was also consulted with the Rosy so that she can help to prioritize the Dack session as per the preferences that will help to improve the wellbeing of the patient. The psychological intervention session was conducted to help the patient to be positive and reduce his stress concerning the deteriorated health status. The patient was invented to different activities that are conducted in the palliative care day centre that include social gathering and outdoor activities to provide holistic care to the patient. The spiritual needs of the patient were also considered during the different session and helped him to uplift his mood by attending these sessions. During the different session and care procedure, his wife was also invited to participate by helping in designing the specialised care for the Dack to develop a personalized care plan. Theses session helped to improve the wellbeing of the jack as it helps to improve his social presence that decreases the depressive episode he encounters. The different medication helped to stabilize his health condition that is important to decrease the suffering.

The patient suffering from the end-stage disorder should be providing the right palliative care to help them by reducing the pain and improving the health (Seow & Bainbridge, 2018). Some of the disorders that require palliative care cancer, neurological disorder, chronic kidney disorder and congenital disorders (Seow & Bainbridge, 2018). There are different aspect of the palliative care that is expected to fulfil during the care includes integrated teamwork of health professionals, management of pain and physical symptoms, holistic care, compassionate care, timely care and patient and family preparedness. The patient with end-stage disorder needs to be treated with extra care by equal participation of the family members to improve the perspective of the care (Seow & Bainbridge, 2018). Dack was facing the chronic kidney failure that needs to be addressed by the specialised palliative care team and his wife also included in the care to improve the perspective of the care. The palliative care philosophy discuss that individual with a life-limiting illness should be supported and empowered to provide hope for life. The palliative care philosophy states that health care professionals are expected to provide a healthy environment to the patient so that they can improve their physical, mental and emotional being. The action and treatment process adopted by the palliative team should address the patient issue to improve the quality of care up to an extent (Merino, 2018). Dack was provided with the healthy palliative environment where he explained his issue and health condition that is increasing his complication. The health care professionals in the team help Dack to improve his wellbeing by providing the right care to the patient. The palliative care team in the case scenario has tightly regulated their clinical practise so that they can provide the holistic care to the patient which will help to decrease the suffering or the health issue faced by the Dack.

The end-stage renal disease is one of the significant sources of the decrease quality of life of the patient that lead to premature mortality of the patient (Benjamin & Lappin, 2020). The deteriorated kidney functioning cause the hyperfiltration of the nephrons which decrease the filtration rate that lead to increase complication. The chronic kidney disorder arises when there is dysfunctioning of the kidney that leads to the build of the body waste which increases complication for the body functioning. Different symptoms are directly associated with the chronic kidney failure which includes muscle cramps, swelling in feet, breathlessness and sleeping issue (Benjamin & Lappin, 2020). The patient in the case study was also diagnosed with the end-stage renal disease that occurs due to chronic kidney disorder. The different symptoms that were revealed by the patient lead to the diagnosis of the chronic kidney disease which ultimately leads to admission to the palliative care centre. There is a different risk factor that is associated with the prevalence of the renal failure but two that were evident in the case study are type one diabetes and hypertensive state these two are a topmost risk factor for the prevalence of chronic kidney disease. The article presented by Tsai et al. (2016) added that different risk factors lead to the prognosis of the chronic kidney disease that includes cardiovascular episode, diabetes and hypertension. These risk factor if remain untreated increase the risk for the prognosis of the renal disease. Diabetes leads to damage of the blood vessel in the kidney as a result of the high blood pressure that is not addressed by proper medication. The hypertensive state leads to the damage of the artery surrounding the kidney that carries blood which eventually deteriorated the kidney functioning.

The article presented by Rak et al. (2016) added that increasing age increases the risk of different disorders that will eventually lead to a poor health outcome. The 40% population greater than 75 years eventually lead to the stage of the renal failure that was followed by the dialysis. Sometimes the patient doesn’t want dialysis due to different spiritual or individual aspect and the patient autonomy should be respected in the care to improve the ethical aspect of clinical practice. In the case scenario, Dack was not in the favour of the dialysis and offered for the alternative care approach that is according to him was right to stabilize his health condition. The palliative care head with Dack decided to avail alternative care services that were followed by advance care planning. There are different learning objective related to the case scenario that can help to improve the clinical practice of the health care professional working in the palliative care unit.

One of the learning objectives is the better understanding toward patient condition can help to assist the patient in the right way that is important to improve the patient condition. The article presented by Fitch et al., (2016) added that health care professional in the palliative care setting is considered to be extra careful in recognition and acknowledgement of the patient current health condition to provide the right assistance. The better understanding related to the patient health condition help to identify the issue with the normal functioning of the body that is important to plan the care that can be able to address the subsequent issue to improve health. In the case study, the high blood pressure and pain of the patient are well addressed that helped him to improve his current health complication. The palliative care head helped the patient by providing the right medication to decrease the discomfort due to the pain and reducing the hypertensive state of the patient.

Another learning that is directly related to the case study is providing holistic care to the patient in the palliative care to support his physical emotional and mental wellbeing. The study presented by Hackett (2017) discussed the Bio-psychosocial-spiritual model for the palliative care that helps to deliver holistic care to assist the patient-facing end-stage disorder. The model covers the biological, psychological, social and spiritual aspect in the care which helps to improve the remaining period of the patient by dealing with the disorder. The Bio-psychosocial-spiritual model is important to increase the hope in the patient toward life and increase the dignity in the social gathering. In the case study during the home-based care, Dack was provided referrals to provide him with holistic care by adding all the different care aspect. Dack care was planned to address his biological, psychological, spiritual and social need related to the care so that all-round care can be provided to improve the mental, physical and emotional wellbeing of the patient.

The last learning outcome of the case scenario is the patient and family-centric care that helps to improve the care perspective which is important in palliative care. The article presented by Arora et al. (2016) added that palliative care is crucial in the life of the patient and the family due to the end-stage disorder. The patient and family-centric care are important to provide the patient or family preferred care to support the patient to reduce the suffering associated with the diseases. The decreasing quality of life with limiting functionality increase the physical as well as the psychological issue of the patient in the palliative care that needs to be addressed by increasing patient and family participation in the care. In the case scenario, the palliative care head equally involved the Dack and his wife in the care so that personalized care can be delivered by including their perspective in the care. These learning outcomes are important to improve the quality of the palliative care that will help to accurately assist the patient health-related complication.

The two Characters that are actively engaged in the care process of the Dack are Rosy his wife and the palliative team head. They both continuously communicated during the care to discuss different aspect that is important to help Dack in reducing suffering and improving survival. During the reluctant behaviour of the Dack in the care process rosy was informed about her need to help Dack to be calm down. The palliative care head help rosy to understand and assist in the care that eventually decreases Dack reluctance behaviour and improved quality of care. The article presented by Lee et al. (2018) discussed that patient in palliative care can face behavioural issue due to the deteriorating physical or mental health. Family member participation helps to improve the patient adherence to the treatment that is important to decrease the suffering by improving the care aspect that addresses the different health-related issue of the patient. The decision from home-based nurse care was also discussed between the rosy and palliative team head so that proper information can be transferred to her to support Dack. Rosy was informed about every aspect of the care that is related to the Dack and she was informed about the different referrals that can help Dack to improve his social, spiritual or psychological need. The article presented by Volicer & Simard (2015) added that during the palliative care family should be communicated with the all the necessary information related to the patient so that proper care can be conducted in the home-based approach also. Rosy also played an important role in planning the advance care plan by discussing the different values and belief that are related to the patient. Palliative care head was informed about the different care aspect that needs to be considered in the future during the drastic situation. The article presented by O'Halloran et al. (2018) added that advance care plan is considered to be important care aspect in the palliative care as it helps the patient or the family member to discuss the care preferences that should be adopted in future. The advance care plan helps them to decide the treatment process that is cultural and personal sensitive that help in the dignified death of the patient suffering from the end-stage disorder. The family members are also suggested to participate if the patient solely not able to decide the different cares aspect that is to be included in advance cares. The family participation in advance care is important to improve the care planning while considering the patient preference related to the patient that is important to decrease the suffering.

References for Mr. Dack Case Study

Arora, N. K., Gayer, C., DiGioia, K., Mason, N., Lawrence, W., Clauser, S. B. &Whitlock, E. (2017). A patient-centered approach to research on palliative care for patients with advanced illnesses and their caregivers. Journal of Pain and Symptom Management, 54(4), 16. DOI:10.1016/j.jpainsymman.2017.06.012 

Benjamin, O. & Lappin S. L. (2020). End-Stage Renal Disease. Treasure Island, United Kingdom: StatPearls Publishing.

Fitch, M. I., DasGupta, T. & Ford, B. (2016). Achieving excellence in palliative care: Perspectives of health care professionals. Asia-Pacific Journal of Oncology Nursing3(1), 66–72. DOI: 10.4103/2347-5625.164999

Hackett J. (2017). The Importance of Holistic Care at the End of Life. The Ulster Medical Journal86(2), 143–144.
Lee, E. E., Chang, B., Huege, S. & Hirst, J. (2018). Complex clinical intersection: Palliative care in patients with dementia. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry26(2), 224–234. DOI: 10.1016/j.jagp.2017.06.015

Merino M. T. (2018). Palliative care: Taking the long view. Frontiers in Pharmacology9(1140), 1-5. DOI: 10.3389/fphar.2018.01140

O'Halloran, P., Noble, H., Norwood, K., Maxwell, P., Shields, J., Fogarty, D., Murtagh, F., Morton, R. & Brazil, K. (2018). Advance care planning with patients who have end-stage kidney disease: A systematic realist review. Journal of Pain and Symptom Management56(5), 795–807. DOI: 10.1016/j.jpainsymman.2018.07.008

Rak, A., Raina, R., Suh, T. T., Krishnappa, V., Darusz, J., Sidoti, C. W. & Gupta, M. (2016). Palliative care for patients with end-stage renal disease: Approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses. Clinical Kidney Journal, 10(1), 68–73. DOI:10.1093/ckj/sfw105 

Seow, H. & Bainbridge, D. (2018). A review of the essential components of quality palliative care in the home. Journal of Palliative Medicine21(S1), 37–44. DOI: 10.1089/jpm.2017.0392

Tsai, W. C., Wu, H. Y., Peng, Y. S., Ko, M. J., Wu, M. S., Hung, K. Y., Wu, K. D., Chu, T. S. & Chien, K. L. (2016). Risk factors for development and progression of chronic kidney disease: A systematic review and exploratory meta-analysis. Medicine95(11), 1-9. DOI: 10.1097/MD.0000000000003013

Volicer, L. & Simard, J. (2015). Palliative care and quality of life for people with dementia: Medical and psychosocial interventions. International Psychogeriatrics, 27(10), 1623–1634. DOI: 10.1017/s1041610214002713

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