Palliative Care: A Nursing Plan

Abstract

In this comprehensive nursing report, a woman diagnosed with a terminal illness is requiring at-home care. Effective methods of treatment to ensure health promotion and quality of life consistency in terminal patients are examined as well as the importance of quality of life regardless of prognosis. Strategies are provided using this methodology as a basis for a guide for treating the patient.

Palliative Care: A Nursing Plan

In this comprehensive nursing plan, a hypothetical scenario involving a terminally ill wife, and a clinically depressed husband, and medical strategies for how to best address these illnesses in the role as the at-home community health nurse is compiled. Before examining the familial dynamics in this situation, this paper will present the author’s personal views and a definition of “quality of life” as this affects how at-home care is approached. Quality of life is assessed by examining the patient’s mental and emotional state; the patient’s personal view of his or her life; the patient’s physical comfort and overall health; and the patient’s personal relations and familial life and how these people will contribute to the patient’s state of mind.

Personal Perceptions

For this specific piece, the terminally ill patient is a woman (hereafter referred to as Mrs. Thomas) whose cancer prognosis is bleak. Having completed chemotherapy, radiation, and two mastectomies for malignant tumors, the cancer metastasized. Mrs. Thomas’s personal relationships with friends have deteriorated at this point in her illness as she struggles to reach out to others in her current state. Familial relations are also strained. Mrs. Thomas’s husband is distraught over her prognosis and has sunk deep into his previously diagnosed clinical depression. Mrs. Thomas has no physical contact with her two grown sons who can’t bear to see her in the current state that she is in. These factors collectively lead to Mrs. Thomas suffering from anxiety and feelings of hopelessness in regards to her terminal diagnosis and feelings of loneliness related to such. In addition to being emotionally distraught, Mrs. Thomas is experiencing chronic pain but is unwilling to take opioid pain killers for fear of physical and mental dependence. Since palliative care has been recommended for Mrs. Thomas, and the logical conclusion is that convalescence is unlikely, health promotion would seem like a contradictory course of treatment. Assuming that life exists until death, which is defined as cessation of heart and brain function, research shows that encouraging a terminally ill patient to continue living life and maximizing their potential may alleviate cancerous symptoms.

Strategies for Improving Quality of Life

Patients who are diagnosed with terminal illnesses often require coaching or education on how to acquire or sustain a reasonable quality of life throughout their treatment. In this case of Mrs. Thomas, her cancer has essentially become a family disease. Her husband is so distraught over her prognosis that he has become ill (mentally) as well. Compiled here are some strategic tools to be used by the individual in the role of at-home community nurse to follow to improve Mr. and Mrs. Thomas’s quality of life during this time.

Medication Distribution

A hands-on approach of at-home community nursing includes medication education. The nurse and patient collaborate on a chart of medication times and sort through the medication in order to make sure all is readily accessible and not to be confused or mistaken by the patient. Because Mrs. Thomas’s cancer is out of her control, taking charge of this simple task will provide Mrs. Thomas with a sense of control over her disease.

Health Education

Another role of the at-home community nurse is to facilitate the education for both Mr. and Mrs. Thomas on the disease. This approach opens up the floor for communication and helps both husband and wife identify their concerns and fears related to cancer. Rather than fear of the unknown, the education is another sense of control that empowers patients.

Establishing a Relationship

Due to the recent disintegration of relationships in Mrs. Thomas’ life since her prognosis, it is vital to establish a relationship with the patient for positive quality of life turnaround.

Nursing Action Plan

When assuming the role of an at-home community nurse, dealing with a case such as Mrs. Thomas, a patient in palliative care, a structured and appropriate holistic plan needs to be constructed based upon health promotion for the patient. Some components of the plan authored specifically for Mrs. Thomas are all based upon the nurse/patient relationship. Mrs. Thomas’ situation has led her to experience an extreme amount of fear and hopelessness. The need for Mrs. Thomas to engage in an intimate connection can be placated through a relationship with her at-home nurse. The most effective and efficient way that the nurse should approach this relationship is through a method of ‘palpitating’ or qualifying with the patient (Waliszewski et al., 1998). Qualifying will inherently lead to a relationship of deeper feelings and trust (Stein & Cutler, 2002). Once establishing a trusting relationship with the patient, the at-home nurse can gain a better understanding of what the patient needs, as the patient feels that the nurse is genuinely interested in her well-being. This is vital because since receiving her prognosis, supportive relationships have been lacking in Mrs. Thomas’ life.

Optimizing Functional Abilities

Palliative nursing care treats the entire patient rather than focusing just on the disease. This method facilitates healing through both contemporary and alternative modalities. Hughes (2013) studied an oncology nursing program which offered holistic nursing consults in which patients could choose between healing touch, guided imagery, aromatherapy, or massage. The nurses assessed the patients’ anxiety, nausea, and pain before and after the treatments and observed significant drops in all areas after the treatment. An effective treatment plan for Mrs. Thomas’ functional abilities would include a holistic approach designed to aid in the psychological and emotional effects of her cancer and cancer treatment. Since Mrs. Thomas does not want to take the narcotic pain medication, these methods can be particularly useful in reducing her discomfort. Meditation and breathing techniques are also useful in this.

Mrs. Thomas’ treatment plan also must include ongoing assessments of her functional ability and the level of care necessary for her to remain in her home. The at-home nurse should assess on an ongoing basis Mrs. Thomas’ ability to engage in self-care such as taking her medications and feeding or bathing herself. Herbal remedies such as amino acids can help with her emotional state, and ginger can be useful in reducing nausea.

Further Care

When Mrs. Thomas’s illness comes to a point where she can no longer care for herself, the community nurse must assist with decisions regarding her care. The nurse should provide resources and information on palliative care options at this stage. Mrs. Thomas can opt for home care with a full time provider or inpatient care such as hospice. Additionally, the nurse should provide information on spiritual or religious support if Mrs. Thomas chooses to make use of these. Counseling at this stage of life can greatly help in reducing fear about death. Additionally, the nurse should provide information for Mrs. Thomas’ husband and family about coping with loss of a loved one.

Lastly, it is crucial to encourage communication between Mrs. and Mr. Thomas regarding end-of-life preparedness. Depending on what Mrs. Thomas’s personal preferences are regarding her end of life care, the nurse can then begin to make arrangements. Financial and legal advice will need to be sought, and power of attorney designated while the patient is still alive. As well as addressing any stress and familial issues and conflict that may arise from end of life planning.

Care for Mr. Thomas

In order to reduce stress on the family unit, it is recommended that the at-home nurse advocate for Mr. Thomas to seek treatment for his depression, which will likely worsen during Mrs. Thomas’ debilitation. One option is the PEARLS program (Program to Encourage Active Rewarding Lives for Seniors). This program will help Mr. Thomas to develop coping mechanisms and social and physical activities and may provide referrals to physicians for anti-depressant medications (Ciechanowski et al., 2004).

Conclusion

This comprehensive plan is a realistic approach to a hypothetical situation of an at-home community nurse providing treatment for a family who has a member diagnosed with a terminal illness.

Resources

Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P. & LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults. JAMA: The journal of the American Medical Association, 291(13), 1569-1577.

Hughes, D. (2013). Holistic Nursing Measures Can Control Symptoms Associated with Cancer Treatments. Washington, DC: ONS Annual Congress.

Stein, F., & Cutler, S. (2002). Psychosocial occupational therapy: A holistic approach. CengageBrain.com.

Waliszewski, P., Molski, M., & Konarski, J. (1998). On the holistic approach in cellular and cancer biology: Nonlinearity, complexity, and quasi‐determinism of the dynamic cellular network. Journal of Surgical Oncology, 68(2), 70-78.