Short answers questions Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    2
  • Words:
    1202

6SHORT ANSWER QUESTIONS

Short Answer Questions

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Key Case Features

The current case study investigates issues related to the provision of palliative care and end of life decisions for patients with respiratory disease. The film describes the struggles of a COPD patient Martin Cavanagh within the last months of his life. Particularly, the health professionals sought to improve Martin’s end of life care through an advanced care planning concept since they realized that the traditional palliative care they were providing for patients like Martin was inadequate and ineffective. Specifically, the practitioners noted that the normal palliative care procedures were often in conflict with the patients’ needs; whereby health professionals are trained to prolong life at all costs while patients view this as prolonged suffering. This was highlighted by Martin, who stated that while recovering at the ED after an acute episode he thought that the doctors did procedures that he did not want. In providing a good death, the practitioners sought to improve care for Martin through the provision of adequate pain and symptom management and clear communication regarding decisions by Martin, his family and practitioners. The model applied in Martin’s case also sought to avoid a prolonged dying process; prepare Martin and his family for death; provide Martin with a sense of control in his care; and reassure Martin to find a sense of spiritual and emotional completion through strengthened relationships with his loved ones. The main focus was to ensure that Martin was never alone and was in charge of his own care.

Legal Considerations

The model of care provided for Martin was guided by two main legal considerations. The first was consents for medical procedures whereby the practitioners ensured that they were able to obtain informed consent for the treatment options prescribed to Martin. The nursing specialist discussed the advanced care plan objectives and activities with Martin and his family members to obtain his consent. According to Brown et al. (2012) obtaining informed consent for the end of life care options among COPD patients ensures that patient preferences are identified and incorporated into the treatment (Brown, Brooksbank, Burgess, Young, & Crawford 2012). The second legal consideration was ensuring that Martin had a detailed Advance health Care Directive, which would guide the health care providers in his case, as to the nature of care he desired. An advanced Care directive has been identified as useful in determining the effective approaches towards improving patient quality of life and EoL care as well as minimizing unnecessary interventions or treatments (Dean 2008).

Ethical Considerations

Martin’s case involved a number of ethical Principles that guided the nature of care he received. Firstly, the doctors considered the concept of clinical integrity, where they sought the expertise of specialists in that various areas of his care. In addition, they exercised superior personal integrity in helping Martin transition to EoL care through clear communication on the disease’s trajectory and anticipated care needs (Rosenberg, Lamba, & Misra 2013). To this end, there was a high level collaboration among the various specialists involved which ensure continued and integrated care for martin as his health care needs changed. The second principle was the principle of Beneficence where the doctors acted in the best interest for Martin during treatment and care decision making (National Health and Medical Research Council 2011).

Notably, all suggested treatments and interventions for Martin involved careful consideration of the involved costs and risks alongside the potential benefits. Thirdly, the doctors respected the autonomy of Martin, by inspiring his participation in care approaches and allowing him to make decisions about the form of EoL care he wanted, between palliative care at a hospital or hospice. Fourth, Martin’s care team was responsive to his social needs and was able to ensure that he received care in the presence of his family. Moreover, the care providers treated him with respect and consulted him on his views feelings regarding his condition. Lastly, the multidisciplinary team in Martin’s case ensured that they had clear communication with his family whereby they discussed his prognosis and care options (National Health and Medical Research Council 2011).

Reflection

Significant investigations and research have been carried out in the context of End of Life care provision particularly in COPD patients. Accordingly, a variety of principles have been considered towards ensuring that patients and their families experience a ‘good death’. These principles include advance planning and preparation for death, participation in treatment or intervention decisions, life completion characterized by meaningful faith and spiritual experiences, avoidance of undesirable life support, continuity of care, and effective communication (Spathis & Booth 2008). In essence, good EoL care should augment the patient’s quality of life, optimize patient functioning, aid in decision making and offer opportunities for individual growth (Waller, Girgis, Currow, & Lecathelinais 2008). Indeed, EoL care for COPD patients is challenged by an increased symptom load, emotional distress and subsequent social isolation. As such, this requires collaborative efforts among healthcare professionals as demonstrated in Martin’s case, to provided quality generalist palliative care.

Reflectively, as a health practitioner in a case similar to Martin’s, I would consider a collaborative practice which involved palliative care providers both at the emergency care departments and the hospice. Specifically, I would emphasize on the need to ascertain the patient desires during treatment at the ED so as to develop congruent treatment or intervention approaches. Further, according to Curtis et al. (2005) inadequate communication is a leading barrier in the provision of quality EoL care (Curtis, Engelberg, & Wenrich 2005). Consequently, the element of communication would be integral in my approach, whereby I would ensure the development of effective and clear channels of communication with both the patient and their families. This would be achieved through open discussions with the patient regarding disease terminal trajectory, preferred place of care or care providers, and treatment preferences. Good communication skills would be emphasized towards the dual approach of reassuring and propagating hope while at the same time preparing for death. These communication channels would also be vital in providing post-death and grief or bereavement counseling for the relatives and loved ones prior and after the death of the patient.

Bibliography

Brown M, Brooksbank , M, Burgess T, Young M, & Crawford, G 2012,’The experience of patients with advanced chronic obstructive pulmonary disease and advance care-planning: A South Australian perspective’, J Law Med 20(2), pp.400-9.

Curtis J, Engelberg R, & Wenrich M 2005,’Communication about palliative care for patients with chronic obstructive pulmonary disease’, J Palliat Care.21(3), pp.157-64.

Dean M, 2008,’End-of Life Care for COPD Patients’,Primary Care Respiratory Journal 17(1), pp.46-50.

National Health and Medical Research Council, 2011, ‘An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions’, National Health and Medical Research Council:Canberra ACT.

Rosenberg M, Lamba S, & Misra S, 2013,’Palliative Medicine and Geriatric Emergency Care: Challenges, Opportunities, and Basic Principles’,Clin Geriatr Med 29 , pp.1–29.

Spathis A & Booth S,2008,’End of life care in chronic obstructive pulmonary disease: in search of a good death’, Int J Chron Obstruct Pulmon Dis.3(1), pp.11–29.

Waller A, Girgis A, Currow D, & Lecathelinais C, 2008, ‘Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals’, Palliat Med.22(8), pp. 956-64.