Care of Dying Patient

This study explores the principles of a palliative approach, communication in palliative care, and principles for practice in the care of dying patients. It also discusses optimizing function in a person with a life limiting illness.

Care of Dying Patient

Table of Contents
ESSAY.............................................................................................................................................3
Principles of a palliative approach..............................................................................................3
Communication in palliative approach.......................................................................................4
Principles for practice.................................................................................................................5
Optimising function in a person with a life limiting illness .......................................................6
REFERENCES................................................................................................................................8

ESSAY
Care of dying patient is mainly associated with the providing of essential medical care to
the patient at the time of end of life. Care helps in improving the quality of life. This study will
include principles of palliative approach, communication in palliative approach, principles for
practice and also optimizing function of person with life limiting illness.
Principles of a palliative approach
Palliation is considered to be useful because it helps in improving the quality of life by
making patient feel more comfortable. Palliative care is an approach which improves quality of
life of patients who are facing problem associated with the life threatening illness. This is usually
done through prevention and and providing relief to the suffering (Masel, 2020). National
Palliative Care Standards mainly includes assessment of the needs, development of the care plan,
caring for the carers, providing care, transition within and between the services, grief support,
service culture, quality improvement and staff qualification and training. Promotion of dignity at
the time of care relations is considered to be as one of the key relevant aspect associated with the
ethical caring. Dignity is considered to be highly fundamental for supporting well- being to the
Frank within the health care setting. The social organization associated with the bereavement
practice is distressful. The culture tends to exert social influence on loss of the closed ones. This
is one of the stressful event and needs social support. Religious belief and age differentiation has
been pointed as one of the manner where the people tends to manage the issue associated with
death.
Family plays one of the keys significant role in providing of the palliative care to the
patient. Frank needs support from his wife Sofia. It is useful in providing emotional, physical and
spiritual support to the patient. It is of crucial importance to involve the care of the patient by the
nurse and other multidisciplinary team at the time of end of life (Mounsey, Ferres and Eastman,
2018). It is of crucial importance for the multi- disciplinary team and the nurses to provide the
best possible support and also educate them on what might happen at this time. It is significant in
addressing the key concern and also involve quality of life considerations. Quality of life
consideration and effective support to the Frank and his family members must be given to
promote comfort, support patients and relief of pain. Dying trajectories at the time of giving
palliative care treatment to the frank is linked with the terminal disease and restlessness.

As per the NMBA standards, the care practitioners and the multi- disciplinary team must
focus on providing safe, effective and responsive quality nursing practice. The nurse must focus
on effectively maintaining effective capability for practice and must also engage in professional
and therapeutic relationship (The NMBA Registered Nurse Standards for Practice, 2016). They
also focuses on thinking critically and also analysing specific nursing practice.
Nurse plays one of the key significant role in providing the best possible care treatment to
the Frank who has been seeking palliative care treatment (Sawatzky and et.al., 2017). The multi-
disciplinary team tends to plan, manage and assess the care treatment with their expertise skill set
and knowledge.
The major negative aspect in this case was that, the nursing team did not comply with all
the nursing standards and lacks focus on maintaining the emotional strains within the patient.
Communication in palliative approach
In palliative approach the communication is very much important as if communication
will not be effective then people will not be able to take care of patient in proper and effective
manner. For enhancing the quality care the most essential thing is effective patient centred
communication. Good and effective communication is necessary as this will provide for better
patient engagement and will assist in avoiding error and to improve the quality to result in better
health outcome (Brooks, Manias and Nicholson, 2017). There are many different drivers either
human or clinical which assist every person to chare their views. Communication assist in better
understanding of patient situation and also this will help in making the family of patient
understand in better situation. In the present case of Frank, the communication was very effective
and this assisted in better palliative care of Frank. In the case when Frank was admitted to the
Palliative care the in Monday morning the staff came to know that Frank had a fall overnight at
time of going to toilet as he felt his feet numb. But this thing was communicated to the staff who
was handling him in morning. This clear communication assisted the staff in managing the health
of the patient.
Further on Wednesday afternoon as well when afternoon shift nurse came then at that
time she found that Frank was alone and his wife left half an hour ago. He was breathing short
and the respiratory rate was 6 and Frank was very agitated and was trying to crawl out of bad.
With all these signs the palliative care team concluded that these symptoms are of terminal
restlessness and this will likely increase the ICP and will result in ongoing disease growth.

Hence, for this situation palliative care team immediately called Frank’s wife and communicate
all the issues to her. This on time communication is assistive in taking care of patient by the
palliative care team. The reason underlying this is that in this situation the remedy was providing
syringe driver as Frank refused to take oral medication (Bloomer and Bouchoucha, 2020).
Hence, with this on time communication with wife of Frank resulted in on time giving of
treatment to the patient.
The major negative aspect in this case was that the palliative care team did not think at all
and called wife of Frank. Instead of giving proper treatment they first called her whereas at that
time the priority was of providing treatment to the patient. But the palliative care team gave
importance to calling the wife of patient rather them giving him treatment.
Principles for practice
There are many different types of principles which are very essential for the nursing staff
and palliative care team to follow at time of providing quality care. These principles are related
with providing good quality care to patient so that they can recover in effective and much better
manner. These principles include the fact that better treatment must be provided, proper
pharmacology must be used, supportive intervention which are used in order to provide
treatment, role of multidisciplinary team and many other different types of principles (Ahern,
Gardner and Courtney, 2016). All these principles are to be followed in proper manner to
provide best treatment to patient and try to help patient to recover from the disease. In addition to
these principles the clinical reasoning also needs to be taken care of. Clinical reasoning is a
process through which nurses collects the cues and then process it in information and try to
understand the patient problem and then try to solve it. This is the major important role of nurses
in order to understand the situation of patient and this will assist them in developing their
position and try to help patient in recovering from the disease.
In the present study as well the palliative care team has made effective use of principles
of practices. For the treatment of Frank, the palliative care team has very fast taken decision for
treating the terminal restlessness. Firstly, he was taken on the syringe driver which contained
morphine, midazolam and dexamethasone. Also, he was fully bed bound and is on pressure
mattress and his RUG- ADL totals for 18 now. He was also provided with PRN doses of
glycopyrroalate S/ C which is an anticholinergic agent which assist in excessive secretion and
breathe in properly. But in the end Frank died even after so much of hard work of whole

palliative care team. This states that even after using and abiding by all the laws and regulations
the patient died. But it can be said that palliative care team complied with all the principles of
palliative care and this assisted Frank in dealing with their problem in better and effective
manner (Bloomer, Hutchinson and Botti, 2019). Further the whole team of palliative care applied
all treatment relating to terminal restlessness and other supportive intervention and
pharmacology as well. Hence, all these application assisted palliative care team to take care of
the patient in effective and efficient manner.
The major negative aspect within the treatment of Frank was that his death was much fast
which the family of patient did not expected at all. This was because of the fact that they
anticipated that the staff will support Frank but this did not take place and ICP of Frank raised
and this resulted in brain herniation into the brain stem and died. If the principles of practice
would have been followed than it might be possible that Frank would have been saved.
Optimising function in a person with a life limiting illness
Life limiting illness is associated with the condition of the patient where there seems to
be no reasonable set of hope for cure. This in turn eventually results in the progressive
deterioration. Rehabilitation is considered to be significant in critically maximizing the
individual function and providing well- being to the person who has been facing life threatening
illness. Rehabilitation is considered to be as as valid intervention in order to effectively promote
optimal function, advanced set of disease, mitigating any deficits and improving the quality of
life (Mosenthal, 2019). The role of the nurse is considered to be vital at the time of responding to
complex needs associated with those who have advanced set of disease. In this specific case
scenario, the nurse work closely with the Frank to maintain quality of life standards. The nurses
also provide the bereavement support to the families at the time of end of life. The nurses focuses
on creating an environment of the pain relief and is also useful in comforting the patient by
supporting them with psychological, physical and spiritual needs. The nurses focuses on
providing physical support to the family at the time of end of life. This is useful in reducing the
anxiety levels and also reinforce related information associated with the terminal illness and
restlessness (Nunes, 2018). The nurse must comply with the NSQHS standards which is useful in
protecting public from harm and also focuses on improving the quality of health service. It is
significant in providing medical safety and also provide comprehensive set of care to prevent any
sort of clinical deterioration. It is useful in the prevention and the controlling of the disease

associated with the Frank. This is done by providing them with effective care support and
medical treatment. The nurse focuses on providing comprehensive treatment by complying with
the set of care standards in palliative care.
From the study it has been summarized that, palliative care is an approach which
improves quality of life of patients who are facing problem associated with the life threatening
illness. According to NMBA standards, the care practitioners and the multi- disciplinary team
must focus on providing responsive quality nursing practice. Good and effective communication
is necessary as this will provide for better patient engagement. The palliative care team has very
fast taken decision for treating the terminal restlessness. Syringe driver which contained
morphine, midazolam and dexamethasone was given. Life limiting illness results in the
progressive deterioration. The nurses focuses on providing physical support to the family at the
time of end of life.

REFERENCES
Books and Journals
Ahern, T., Gardner, A., & Courtney, M. (2016). Exploring patient support by breast care nurses
and geographical residence as moderators of the unmet needs and self-efficacy of
Australian women with breast cancer: Results from a cross-sectional, nationwide
survey. European Journal of Oncology Nursing. 23. 72-80.
Bloomer, M. J., & Bouchoucha, S. (2020). Australian College of Critical Care Nurses and
Australasian College for Infection Prevention and Control position statement on facilitating
next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the
intensive care unit. Australian Critical Care.
Bloomer, M. J., Hutchinson, A. M., & Botti, M. (2019). End-of-life care in hospital: an audit of
care against Australian national guidelines. Australian Health Review. 43(5). 578-584.
Brooks, L. A., Manias, E., & Nicholson, P. (2017). Barriers, enablers and challenges to initiating
end-of-life care in an Australian intensive care unit context. Australian Critical
Care. 30(3). 161-166.
Masel, E. K. (2020). While I breathe, I hope. Principles of palliative care in chronic
breathlessness and advanced lung diseases. memo-Magazine of European Medical
Oncology. 13(1). 98-101.
Mosenthal, A. C. (2019). Principles of Surgical Palliative Care. Surgical Palliative Care, 13.
Mounsey, L., Ferres, M., & Eastman, P. (2018). Palliative care for the patient without
cancer. Australian journal of general practice. 47(11). 765.
Nunes, L. (2018). Searching for bioethical principles related to palliative care. Hospice &
Palliative Medicine International Journal Review Article Open, 78-80.
Sawatzky, R & et.al., (2017). Embedding a palliative approach in nursing care delivery: an
integrated knowledge synthesis. ANS. Advances in nursing science. 40(3). 263.
Online
The NMBA Registered Nurse Standards for Practice. 2016. [ONLINE]. Available
through<https://blogs.utas.edu.au/snm-pep/2016/06/14/the-nmba-registered-nurse-standards-for-
practice/ >