Case Study on Palliative Gold Standard Comparison Assignment

Case Study (Palliative Gold
Standard Comparison)
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Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Scenario..................................................................................................................................3
Stage 1: Return to experience.................................................................................................3
Stage 2: Attend to feeling.......................................................................................................5
Stage 3: Re-evaluate the experiences.....................................................................................7
Stage 4: Learning (Added by Johns)....................................................................................11
CONCLUSION..............................................................................................................................13
REFERENCES..............................................................................................................................14
APPENDIX....................................................................................................................................15
Patient Biography.................................................................................................................15
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INTRODUCTION
Palliative gold standard is defined as the framework which enables good level of practice
that an practitioner should have to treat all those people who are nearing the end of their life. The
main motive of this framework was to develop the concept that how patient can be treated well
in this final stage of life (Milnes and et. al., 2019). Complex care is one of those situation where
patient must be treated in different manner as special guidance is required in it. In this project,
the main focus will be on disability that how does affect the life. There will be detail discussion
on the role and and responsibility of nurses that how they are required to work. Even discussion
will on some of the points that what are those essential areas where doctor and nurses need to
give special focus so that patient can feel better. The chosen model in this project to express
every point in detail is Model of Reflection by Bound et. Al 1985 and further points added by
Johns 1995.
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MAIN BODY
Scenario
James cook was admitted to hospital who fall into the accident on national highway. It
was one of the case where lots of complication were found as blood had covered most of the
body part of the patient. Here, doctor took the step to save his life but as infection on leg has
spread in high amount so doctor was required to cut his both the legs and he had to spend his rest
of the life without legs. Now, patient requires one of the nurse or doctor who can take his care
for the rest of life.
Stage 1: Return to experience
I am in the field of health care since last five and trying my best to deliver the best
services to the patient who comes within the premises of hospital. I my short period of time I
have solved number of cases but still I have found that various cases are there which need to be
solved. Among all those cases I got one of those case were James Cook was fine and capable of
doing his all of the work. He was just 43 years old and had some of the medical issues such as he
was the patient of diabetes (first stage) due to which any of the injury which occurs take
additional period of time to cure. As, James is the patient of diabetes he requires all those
treatment and medicines which do not contain the quantity of sugar. Patient of sugar are quite
slow recoverer due to which they requires additional health care facilities and even it is
important that doctor must prescribe those treatment which are helpful for his personal recovery.
Here, James is suffering from serious issues in his life as he is suffering from the problem
of diabetes which is mostly not cured for the rest of life from the day its symptoms are found.
Even he fall into the accident where his both leg were required cut down which show that it is
one of the life long medical issues which he have suffer in his rest of the life (Noppe, Veen and
Mooren, 2018). When it comes to current medication he is required to take medicines of diabetes
and all those medicines which has been prescribed by doctor. Here, James requires additional
person who take his care for the rest of his life because he will not be able to do most of the work
by himself as he lives alone. While talking about past medical history, he is one of the patient
who have suffered from minor heart attack at the age of 38 years and need need take only healthy
diet so that similar attack will not come again in his entire life. It means that James also need to
take care of his heart attack as it might occur again. Overall there are lots of complication in the
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medical department which need to be focused by James Cook as simple mistake can create huge
problem in his rest of life.
The social history of James cook says that he is one of those person who is connected
with different NGOs for doing some of the social work. He also loves to share his own ideas and
experience of life who other people so that if any of the person faces the similar situation then
best measures can be taken. He have the knowledge of different field which helps them to motive
other people through which any kind of issues can be solved. He works in the one of the
hospitality sector industry in the post of HR manager where his major role is to hire new
employee's for company. He guides them in appropriate manner so that working condition
becomes much easier and faster for them. His educated background is good and he had
completed his masters from Oxford University which shows that how good he is in academic
career but present scenario says that lots of complications are there due to which social life will
not be able to continue in most of the situation.
He lives in London in one of the apartment and he belongs to one of the reputed family.
But, his parents died in the same accident where he got life long disability (Dawber and et. al.,
2019). Because of his medical issue his family decided to not discuss with him about the
accident against as it might give him more stress. He is the father of two son Alex and Jason and
they both are study in secondary level. While talking about his wife he lives in United States as
she is software engineer and handle one of the software company. As his family background is
strong, he is able to survive for the rest of his life if he gets away from social life.
Here, while understanding about the situation it can be said that James Cook is in serious
condition and need to find the best alternative way so that he can survive in his life. He will not
be able to walk any more and even support is required in most of the situation so that things can
become much and more easier for him. Even he don't know about his parents it will be difficult
task for other member of the family that their parents are no more with them (Iaboni and et. al.,
2018). Normally, in this condition patient will not be able to walk from one place to another
without support so it can be said that he will not be able to connect with his social life and that is
one of the drawbacks for him. In addition, James requires one of the nurse who can take care of
him and gives the medicine to him which he requires. It is necessary for him to appoint one of
the person who can support him in each and every stem. Support service will be helpful for
James he can shares his point of view that what need to be done and what should not be done.
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Support service will provide all of the things which is required by him. As disability is of
complex nature it is necessary that complex care must be given to them.
In context of UK & Wales, it can be said that nurses are the one who takes proper care of
each and every patient so that health level of any of the patient can be improved. Here,
government have given the responsibility to healthcare centre to take decision of own that who
should be given the facility of nurse for providing the complex healthcare facility. Nurses of UK
are able to deliver the actual result as they are giving proper health care facility to patient. There
major is to give proper care to patient for example: if patient is suffering for from illness and
need to be given medicine 4 times a day in appropriate manner then nurses are the one who takes
care of patient in that time.
Stage 2: Attend to feeling
As I am the one who is appointed as the nurse of James Cook, it was important for me to
take proper care of his rest life and need to treat him well because my support could be crucial
for him. I was working here with four other support staff in which all four of them use to direct
me from the premisses of hospital where I was the one who required to give proper treatment by
seating in home. Whenever any of the person works for any other person it is important that any
of the roles and responsibility which is given must be completed on specific time period and it is
necessary that how they are being done because single mistake can create lots of issues and
differences between involved parties.
In my point of view, when I was appointed as nurse of James Cook it is was important for
me to find that what are those things which can help patient to recover as soon as possible but
disability is one of those situation where people are required to be cared for long long period. I
was able to treat him well. But, when I was connected with James I found that in most of the
situation he used to get frustrated because he was in one of those situation where he was required
to survive for the rest of his life. He was among one of those person who loves to be connected
with social activities but due to disability all of his dreams were not completed. When I use to
see this sort of action from James I used to think that how improvement can be done because it
was important for me to make him understand that it was past and future demand something
different (Pearson, 2018). Although, situation says that James was is not willing survive in his
rest of the life so it is important for me that how I treat him because what patient think is not
important but the important part which matter the most is that how I motive him to spend his rest
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of the life. If that can be done then it will be easy to take most of the decision. As James is the
patient of diabetes it is not that easy for any of the patient recover as soon as possible but here I
need to think differently motivate him that he can do most of the work even setting on
wheelchair also.
In this I found that case was little bit typical but I was able to treat him well because there
was the support of other member who can guide me to take better decision through which targets
improvement can be done. There were many of the situation where I used to get pleasure in my
work because I was doing one of those work were I need to make patient understand that
although he is disable but still he can do most of the work. This was helpful because in most of
the situation I was able to convince James that what is his importance in this life. After all this, I
found that James was convinced to do most the work which I used to suggest him. Now, he was
ready to take any of the medicine which is prescribed by the senior member of team. Overall I
found that there were lots of issues in this particular cases but I only think that how can help
myself to bring positive outcomes because that what actual matter to me the most.
In context of James Cook, I found that the way he was being treated was not so good in
initial stage because their was lack of tuning between nurse and James but afterwords it was
found that condition was favourable for him. The reason behind elation of James was the way his
nurse was treating him because it gave him the idea that how he can spend his rest of the life.
There were lots of negative feeling in the mind of patient but the way his nurse treated him
helped him to spend his life freely and happily. James started to find the way through which he
can continue his social work in future. It shows that at the end James found the positive feeling
which was really helpful for him.
In context of Other teammate, it was one of the most difficult situation because they need
to take best decision through which life of a patient can be saved because he was in one of those
situation where single mistake can end his life. The main reason behind this was the health level
of patient because he was suffering from the problem of diabetes and heart attack so the
medication which was required to be prescribed to him was not a easy task. They were totally
worried about James because in many of the situation James was not ready to take medicine
because the thinking which he had developed was like: I am not enough to do my work of own
so it is better die. This was this reason which was creating more problem for the team to handle
the complex situation of patient. It can be said that whole team had developed the negative mind-
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set but due to the efforts which was given by appointed nurse was brilliant because it helped
them to take best corrective measure through which positive outcome was near to comes
(Milnes, S. and et. al., 2019).
Here, all of them (patient, nurse and other team member) are required to support each
other because it will help them to find the better way to treat patient because patient is required
to be treated well. As complex care was required in it, appointed nurse use to do every single
work of James which was required to be done. Being as a nurse, my main focus was on medicine
and food diet which was required to be given because it was directly related with the health of
James. Single mistake could have created serious problem for everyone. As proper care was
being given to the patient it was helpful for all of them that positive outcomes were able to be
obtained because there was the feeling in James that although he is disable but still he can
manage all of the work by setting in home.
Stage 3: Re-evaluate the experiences
Healthcare sector is continuously changes with increase in complexities of issues related
with patients' care, which completely modifies the care provider systems. For an instance, when
a person suffering from an acute medical problem, then service providers are expected to give
short-term with intensive care. Thereafter, completing the treatment procedure, home care
services are provided to support such patients for well-being and treat them with dignity and
respect till entire life. In context with present case, where a person having pre-medical history
with diabetes and have face an accident with major injuries (lost his legs), shows a complex
situation for healthcare sector in providing effective treatment at home. In such case, after
surgery when nurses are provide for home care treatment, whose main role is to provide
comprehensive care to meets complex and diverse needs of patients, faces a number of issues.
Though my role in healthcare sector is to perform as a nurse, whereby to accomplish this
responsibility, it is important for me to improve nursing competency of mine as well as utilize it
the same in daily routine practice. In nursing field, competence can be defined as ability to
provide highly satisfied services to ill-people for their well-being, so it can only be acquired via
experience and long-time working (Iaboni, A. and et. al., 2018). This concept of competence is
also describes as two-fold, viz. potential abilities to work in efficient and effective manner under
certain circumstances; and second one is motivation skill to encourage patients to work for own
well-being. Along with this, competency is also measured as behavioural characteristic in HSC
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which is highly based on one’s interests as well as ability to influence others via motivation and
attitude. Therefore, during working in healthcare sector, I have faced many complex situations
including the case of James Cook, who was admitted to hospital after a major accident on
national highway, this would give me opportunity to enhance my skills, experience and
developing competence to perform at my level best.
Mr. James Cook is a special case that I have taken, who have complex care needs, due to
suffering from the combinations of multiple chronic conditions. It includes mental health
problems due to disability, drug interactions, dependence on others for doing daily routine
words, social vulnerability etc. All these conditions have led to overuse, under-use or misuse the
healthcare services. Typically, such patients also face a number of interactional issues due to
unmet decisional needs, related with possible options such as in a cascade of interrelated
decisions for involving himself positively with families’ members, care providers, medical
practitioners and more. Along with this, due to increase in frustration level, patients with acute
chronic disease do not give support to care-takers i.e. nurses for quick recovery and well-being.
This would lead to create a number of complex situations where I have personally experienced
and get learnt through cooperation of seniors how to deal with the same. For this purpose, to
handle such situation and help patients to come out from mental problems and motivate them to
accept the challenges of life after acute chronic diseases, it is essential as a nurse for me to
understand their basic needs first (van Deijck, R. H. and et. al., 2016)
.
Under the above mention problems, the healthcare institutions where I have been worked
from long years, use the concept of IP-SDM model i.e. Inter-professionals shared decision-
making model.
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Here, in this process, where health professionals and patients work together in order to
take better decisions for recovery and well-being. This would help in providing careful
deliberation for addressing uncertainties which are inherent to evidence-based medicines and
weigh the risks for benefits of patients (An inter-professional approach to shared decision
making: an exploratory case study with family caregivers of one IP home care team, 2014). I
have learned that this model includes a step-by-step process for understanding the personal needs
of people suffering from a disease or facing a major surgery after met with an accident. It
includes –
a) Choose best options to explore the related options for identifying basic needs.
b) Exchange information with patients and their family members about choices made for
patients' healthcare.
c) Clarify values as well as preferences
d) Access feasibility of entire decisions which are made by care-takers for service delivery
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Illustration 1: IP-SDM Model

e) Choose best options by consulting with patient and relative ones to completing basic needs
and recovery of illness
f) Implement decisions in desired manner
g) Obtain and analyse the outcomes of interventions
All these steps help care-providers to quick respond towards needs of patient-centred care
needs.
Through personal experience, I have analysed that patients having complex health needs
are required to get both medical as well as social services for better treatment. They also want to
get support from professionals and caregivers, to get patient-centred medical home services
offers a promising model for providing comprehensive, coordinated care. Smaller practices, after
major surgeries to face particular challenges and do daily routine works efficiently. For this
purpose, to work in efficient manner and motivate patients to live stress free life and face
challenges with patience, I have evaluated that work within an inter-agency team-work is
considered as seamless approach to service delivery (Ernecoff, N. C. and et. al., 2018). A
hallmark of working as a team refers to a new level of collaboration which includes a
professional team of medical practitioners such as physicians, social workers, pharmacists,
caretakers, nurses, physician assistants and medical assistants etc. Clinical knowledge of nurses
and presence across all care settings are hereby likely enable me to take primarily responsibility
for navigating the interactions between service-providers and patients, along with continuum of
care. Nurses also play a main key role for developing systems, in order to ensure that primary
care patients have received the proper treatment via professional consultations, specialist in
physical therapy, nutrition counsellors and medication reconciliation with pharmacists. All these
processes will help in giving out best care services to patients who are facing complexities after
medical surgeries.
In providing care to patients after major surgeries, there are so many problems faced by
caret-takers, family members and care-takers who are living around them. Due to high frustration
level of dependence on others to complete basic needs, mental illness may arise a variety of
psychosocial problems like decreased quality of life of family members of patient. It also
increased the social distance for ill-people with relatives, friends and family who may influence
during take care of them. Psychosocial challenges are generally enhanced through a stigma
which is attached to mental illness, that affects not only the patient but also people or family
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around them. In context with nurses and medical professionals, due to high frustration level of
patients, it becomes difficult for them to handle psychological issues and provide proper
treatment for their well-beings (Parpa, E. and et. al., 2017). Through personal experience, when I
have given responsibility to provide care to Mr. James Cook who was suffering from diabetes
and due to meet with accident, he has lost his legs, all these uncertainties have highly impact
both on physical and mental health of patient. Therefore, I have faced various issues to take care
this patient and support him to overcome from mental health issues and lives a normal life. I
have analysed that mental health of this patient was much disturbed due to certain factors. It
includes lack of social support, financial constraints, stigma, disruption of family and nearby
people functioning, discrimination or sympathy and disruptive behaviour of patient and more.
Therefore, it is essential for society and family to give support to patient instead of sympathy to
live a normal life and face challenges calmly.
Stage 4: Learning (Added by Johns)
It was one of those case study which will help me throughout the career and it was totally
new experience for me because now I am sure about tackling the cases in best possible manner.
There are number of cases which need to be deal in future because this the field of practise.
Before starting this project, I was nervous that can I solve this issue and bring changes but after
completing it, I found that whenever people try something new they are able to achieve. The
main thing which is required to be focused is that how I can solve out this issues and problem.
This experience will support me to take any of the decision when I will be standing in the similar
position in future.
This was one of those experience which I will never forget in my entire life and it is
important to know that whether all the area was covered or not and if not what could have been
done much better in it. Here, I found that almost everything went as per the plan and policies of
Health centre. The case was complicated become patient was suffering from the problem of
diabetes and it was important to deal that how complication can be reduced (Zhuang, Q. and et.
al., 2019). There were many of those condition in which patient lost his hope but still we were
able to deal with situation and because of that it was easy to solve the case. Yes, this case could
have been dealt much better when patient came to hospital. In that situation if doctor could have
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treated him early then there was huge possibility that patient would not have to be disable.
Secondly, there are lots of technologies being used these days so here we could have plan to fit
artificial legs to patient as he was financial strong. Here, it was also important how case is being
dealt. Here, more study on similar types of cases can help to improve in future so whenever this
types of case arrives.
From this experience I have learn that how patient is required to be treated and what are
those medicines which need to be given in this type of difficult situation where patient is
suffering from multiple number of diseases. I have learned that patient cannot be fit and fine
until and unless they are motivated. I have understood that patient should that whenever any of
the care taker stays with the patient they must try to treat each other as a family member because
that helps a lot and even bring positive changes in the health status. In addition, I have
understood that I must try to find the best suitable to deliver the services. Even in the premises of
hospital quick actions are required to be taken and for that permission or any of the special order
should not be taken because it can directly affect the life of common people (Raus, K. and
Sterckx, S., 2018).
When it comes to future learning it can be said that professional body should be expertise
in their field and even they should have practical knowledge because that directly impact on the
outcome. When taking education, students should focus more on practise then theoretical
knowledge because it doesn’t help individual to obtain desire goals. Also, it is necessary for any
of the person that they must focus on obtaining various kind of skills because that helps to take
best possible decision whenever difficult situation arises in front of them (Madden, K. and et. al.,
2019).
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CONCLUSION
From the above report, it can be understood that Palliative Gold Standard is one of the most
essential thing which tells that how any of the patient is required to be treated. Doctor are the one
who deals with the life of human being and try to find the best possible way through which
patient can be cure as soon as possible. While treating any of the patient, professional should
know about past medical report because there are number of problem that can be caused if doctor
is unaware about this factors. Special treatment and healthcare facilities are required by the
patient those who suffer from the problem of life long illness. Lots of improvement and changes
are required to the person who are engaged in this particular field health care. Complex care is
one of those situation where patient must be treated in different manner as special guidance is
required in it. Model of Reflection by Bound et. Al 1985 and further points added by Johns 1995
is one of the refection writing model which helps to express each and every points in detail. In
UK, nurses are the one who takes proper care of each and every patient so that health level of
any of the patient can be improved. Healthcare sector is continuously changes with increase in
complexities of issues related with patients' care, which completely modifies the care provider
systems.
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REFERENCES
Books & Journals
Milnes, S. and et. al., 2019. A prospective observational study of prevalence and outcomes of
patients with Gold Standard Framework criteria in a tertiary regional Australian
Hospital. BMJ supportive & palliative care. 9(1). pp.92-99.
Noppe, D., Veen, H. I. T. and Mooren, K., 2018. COPD patients in need of palliative care:
Identification after hospitalization through the surprise question. Chronic respiratory
disease. 16. p.1479972318796219.
Dawber, R. and et. al., 2019. Comparison of informal caregiver and named nurse assessment of
symptoms in elderly patients dying in hospital using the palliative outcome scale. BMJ
supportive & palliative care. 9(2). pp.175-182.
Iaboni, A. and et. al., 2018. A palliative approach to falls in advanced dementia. The American
Journal of Geriatric Psychiatry. 26(4). pp.407-415.
Pearson, A., 2018. Evidence-based practice in palliative care. In Palliative Care Nursing (pp. 7-
21). Routledge.
Milnes, S. and et. al., 2019. A prospective observational study of prevalence and outcomes of
patients with Gold Standard Framework criteria in a tertiary regional Australian
Hospital. BMJ supportive & palliative care. 9(1). pp.92-99.
Iaboni, A. and et. al., 2018. A palliative approach to falls in advanced dementia. The American
Journal of Geriatric Psychiatry. 26(4). pp.407-415.
van Deijck, R. H. and et. al., 2016. Level of discomfort decreases after the administration of
continuous palliative sedation: a prospective multicenter study in hospices and
palliative care units. Journal of pain and symptom management. 52(3). pp.361-369.
Ernecoff, N. C. and et. al., 2018. A Novel Screening Method to Identify Late-Stage Dementia
Patients for Palliative Care Research and Practice. Journal of pain and symptom
management. 55(4). pp.1152-1158.
Parpa, E. and et. al., 2017. Psychometric Properties of the Patients’ Satisfaction Instrument
FAMCARE-P13 in a Palliative Care Unit. American Journal of Hospice and Palliative
Medicine®. 34(7). pp.597-602.
Zhuang, Q. and et. al., 2019. Validity, Reliability, and Diagnostic Accuracy of the Respiratory
Distress Observation Scale for Assessment of Dyspnea in Adult Palliative Care
Patients. Journal of pain and symptom management. 57(2). pp.304-310.
Raus, K. and Sterckx, S., 2018. Ethics in Palliative Care Research. Textbook of Palliative Care,
pp.1-15.
Madden, K. and et. al., 2019. Systematic Symptom Reporting by Pediatric Palliative Care
Patients with Cancer: A Preliminary Report. Journal of palliative medicine.
Online
An inter-professional approach to shared decision making: an exploratory case study with family
caregivers of one IP home care team. 2014. [Online] Available Through:
<https://link.springer.com/article/10.1186/1471-2318-14-83>.
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APPENDIX
Patient Biography
The name of the patient is Mr. James Cook who lives in London, UK. He is 43 years old
and suffering from the problem of Diabetes of first stage. At, the age of 39 years he also got
minor heart attack. In current scenario, it was found that he is suffering from the problem of
disability. His wife lives in United States and works as the Software developer in one of software
company. He has two sons who stays with him. His parents died in a car accident.
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