Deliver Case Services Using a Palliative Approach

This document discusses the delivery of case services using a palliative approach. It includes case studies, strategies for holistic care, family involvement, effective communication, end-of-life care, and more.

Running head: DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Name of the student:
Name of the university:
Author note:

1DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Case study A:
Holistic care of a patient is defined as the complete care of a person which includes the
care of soul, mind of body of the patient. It is the complete care of an individual and is necessary
to see them as a person not just a patient (Hussey & Kennedy, 2016).
In the case of Matthew, he needs holistic care in terms of Education, Employment,
Recreation, Support network, Financial/housing and Religious.
1. Education:
Matthew has been diagnosed with severe form of cancer. During the holistic care, he
wants to know the status of his cancer and how long he is going to live.
2. Employment:
He works at a lumber yard which is a physical-active job. During the holistic care of
the Matthew, it should be considered by the health acre staff
3. Recreation:
He likes getting involved in painting and painting, hence in the holistic needs he
needs to be getting involved in such games.
4. Support network:
Due to the drug issue of Matthew, he lost all his support network. To ensure the
holistic care of the patient, it is important to provide that support.
5. Financial/housing:

2DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Matthew has been struggling from residential issue and also has been facing
financial issue due to his continuous drug use. Hence, in such case it is important to make
the person financially secure and provide him some permanent residence
6. Religious:
He needs to involve in the religious work as he recently started volunteering a
Christian group and also visits church every Sunday.
Case study B
After conducting the Matthew’s interview, her sister has been contacted to inform about
his illness. It is necessary to include family members in the care of the patient for effective result
and better recovery (Olding et al., 2017). Matthew’s sister is worried because of her and is ready
to help her in any possible ways. She is ready to provide financial support to her but cannot take
her home as she have small house where she lives with her two children. When Sarah (Mathew’s
sister) was informed that, Matthew needs family support and wants to meet her. She immediately
agreed and suggested for taking him to the church on Sunday. Sarah also confirmed that she will
talk to her parents, especially to her mother regarding meeting Matthew on Sunday. She is also
willing to contribute in his care by the help of counselling, as she recently lost her grandmother
and now does not want to lose her brother.
Case study C:
Palliative care is referred as specialized care that is provided to patient who has been
suffering from serious illness (Pratt & Wood, 2015). As frank is receiving palliative care, due to
which there are certain restrictions were made. After communicating with frank’s daughter it is

3DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
confirmed that frank is having issue with the palliative care and is like to make several changes
which are listed below:
A. Frank likes little independence which he is not getting. He likes to prepare meals in
his own.
B. Frank is not even allowed to walk to his garden, which is eventually preventing him
to continue his exercise. Hence he wants that to be included in his palliative care.
C. Frank is a non-religious person and finds religious remarks as stressful. The cares
involved in the palliative care continuously making those remarks which is irritating.
Hence he wants the carer to not make such remarks till secretly needed.
Case study D:
Communication among the family members is extremely necessary as it help in the quick
recovery of the patient (Kaakinen et al., 2018).
Hello Catherine,
We have acknowledged your concern in our previous communication. As you mentioned
that Mr frank needs freedom of his own to do little things, we will be happy to support him and if
he wants we can even arrange carers- in person for him. However, we cannot allow Mr Frank to
go outside on his own as he lately fell down in the garden and also not able to reach the panic
button. We have community centre where he can go with the help of bus which is free for elderly
person. The pic up time is 9:30 to 10: 30 and drops at 3 pm to 4 pm. As per your concern, we
have reminded our carers to not to make any remarks on religious view.
Thanks for your concern and kindly let us know if you have any further issue.
(X hospital)

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Case study E:
With increasing age, the needs and preference of a person changes with respect to
emotional, financial, physical and mental well-being. Hence, it is the responsibility of the carers
to consider those changes for the further treatment of the patient (Leicher & Mulder, 2016).
Since last 1 year, Mildred needs and preferences are changed. Last year she lives with his
wife in a big house who takes care of her, but after his death she has moved to a small house or
to a nursing home. Her son also moved to a place which is an hour away from her home, who
used to reside 20 minutes away from her home last year. Husband’s sister used to visit frequently
last year which is also reduced and now she visits less frequently, however neighbor is still there
at next door. Her digestion problem is solved whereas her mobility is decreased and sometimes
need support to walk. Her ability to recognize is also decreased. Financial position has no
concern but is considering to move.
Case study F:
1. Non-judgmental approach is necessary among the healthcare staff to provide best care to the
patient. It is to ensure that the person’s social, spiritual and cultural needs are achieved
(Richardson, Yarwood & Richardson, 2017).
In yarran care plan three factors that should be considered are listed below:
Social: He is not able to walk properly but enjoys active social life. He likes to meet his
family often and live with his wife Brian.
Cultural: He is an aboriginal descendant and enjoys such Australian aboriginal art.
Spiritual: with time he has become more interested in his ancestors and started talking
about dreaming, according to which death is the next step of eternal cycle.

5DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
2. If yarran would discuss about his beliefs to me, I would listen him carefully so that I can
build a rapport with him which is effective in further treatment. I will later try to
acknowledge him with the facts rather than involving in such beliefs.
Case study G:
In nursing care, there are certain condition which should be handled very effectively to
avoid any further complications. It might happen that the nurses are not qualified enough or are
not allowed to do so. Hence in such it is important to take help of any guide or supervisor
(Holloway & Galvin, 2016).
Respected sir,
(X- pseudonym)
This is to inform about the case of Gerald brown who is an catholic old age man. His
health condition is worsening which is making him worried. According to him, he is going to
pass away in his sleep due to which he wants me to perform the last rites fir him in order to
prepare him for the afterlife. Hence I need your support in order to handle Mr. Gerald for his
treatment.
Case study H:
Effective communication is very effective in the palliative care of the patient. According
to the code of conduct of nursing “each and every patient should be treated with respect,
compassion and care” (Schmidt, MacWilliams, & Neal-Boylan, 2017).
With the help of effective communication the patient and the healthcare staff can build a
rapport. By observing the case, it can be stated that there are several mistakes conducted by the

6DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
healthcare staff during the communication. The care worker instead of making him relax, said
that it is a shame for her and started stating her own problems. When the patient asked her for
painkillers, she said that she will look for the same but cannot promise anything. Third
communication error observed is, that the care workers instead of providing him food she started
arguing that the food does not have chicken. Such error can lead to poor communication which
can become hurdle in the recovery. Another mistake which is observed that the patient is not able
to get their preferred food as the patient is vegetarian and the food cooked over there is non-
vegetarian and the nurse instead of offering her the food, spoke over the topic.
Case study I:
1. Before Gerald loses his ability to take decision, he stated that he wishes to change his
end- of life care plan. Hence the end of life care plan is conducted accordingly. For
example, resuscitation, which is very necessary for the emergency treatment, artificial
feeding is also used as he is not able to feed on his own, antibiotics is also given in
limited amount along with bladder catheter. Blood transfusion is done if any emergency.
2. Gerald lost his consciousness, after which his wife said that she from onwards she will
make all the decision related to him. If the patient loses his decision ability, the person
who is legally made by the patient is able to make the decision on the behalf of the
patient (Jox et al., 2015). Hence, it is ethically not legal for his wife to make decision on
his behalf.
3. According to doctors, no treatment can make his condition better hence in such condition
only the limited additional intervention and the treatment used for comforting the patient
is used for his end of life care plan.

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Case study J:
1. Alice have chosen his end of life care plan when she was in her conscious state. She has
chosen to end his life at hospital instead of home after thinking all the consciousness.
Hence, in such condition she cannot be forced to change his life of care plan as it is her
decision, to remain at the hospital. It is her right to end her life at the location chosen by
her (Wittmann-Vieira & Goldim, 2018).
2. John was distressed by his wife condition, he want his wife to end her life at home
instead of hospital. Due to her illness, he have to regularly visit the hospital, which is
even making his health condition worse. As a signs of stress, he has stopped having
meals and showering also which is due to the lack of energy. Excessive sleep is also one
of the symptoms of stress, which is observed in John (Grossi et al., 2015).
3. In the above case, it is observed that John wants his wife to spend the last days at home
not at hospital. It is important for the nurse to support john to make his final days easier.
In order to do that, he should be provided meals on the wheels as he often skips his meal,
male carer should be provided for his company. John should also be provided with carer
who will take proper care of him such as his daily activities, hygiene and diets.
Case study K:
Documentation of the patient condition is extremely necessary for the treatment of the
patient. It helps in acknowledging the improvement or deterioration of the patient. Hence, it
should be done regularly by the health care staff (Goodwin, 2019).
Monday Tuesday Wednesday
Morning Pain in the throat Pain in the throat
along with
 The pain has
been reduced

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headache. to five from
six on the
scale of ten.
 She was not
able to move
properly due
knee
stiffness.
 Pain in the
throat has
been
managed due
to which she
is able to
drink much.
Afternoon Pain in the throat
worse.
Slept in afternoon She cannot feel her
knee due to pain.
Night Pain us reduced and
she is able to drink
and eat soft foods.
The pain is rated as
6 on the scale of 10.
Knee is also swollen
due to her fall.
The pain has rated as
4 out of ten.

9DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Case study L:
Comforting the patient by implementing different strategies is extremely necessary in
case of elderly patient. It is the responsibility of the carers to implement strategies which can
comfort the patient as well as helps in better recovery of the patient (Digby, Williams & Lee,
2016).
The goal of the care plan implemented for Han:
 Improve social opportunities: to improve the social opportunities of the Han, the
care workers should talk with his daughter to meet or take him out more often. He
should also communicate with the neighbors. The care workers should also
communicate with his son, and ask him if he can meet Han. The patient is also
provided with wheelchair and cheap transport so that he can roam around.
 Maintain physical strength: Han is physically very week, hence it is the
responsibility of the healthcare workers to maintain his physical strength by
encouraging him to involve in physical activity such as, walking (Coats et al.,
2017).
 Prepare him emotionally and financially for the end of his life: As Han does not
want to end his life and hence he has not written his will. In such cases, the care
workers should take him to a counselor who can prepare him for that by
organizing some legal aid for him. To prepare him financially, they should also
suggest him to prepare his will by taking advice from the accountant.

10DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Case study M:
Regular monitoring of the patient condition is necessary as it helps in determining the
effectiveness of the implemented strategies. To evaluate the effectiveness of the strategies,
documentation were done (Tang et al., 2016).
1. What has been achieved: He has become more open to the idea of preparing will. His
connection with his son has become better and are planning to meet in person soon. His
mood has been greatly improved.
2. What still needs to be achieved: Though he has opened to the idea of preparing will but
still has not prepared it. Physical condition of the patient has not improved. Socializing
opportunities has also remained the same and needs improvement. Another thing that
needs to be achieved is completing the will.
3. When it was implemented: The strategies were implemented on 15th of June, 2017 and
after one month it is evaluated.
Case study N:
Morphine, which is an opioid is used as pain killer in the treatment of the patient (Papini,
2018). Misconception regrading such pain medication is common among the individuals
(Sigakis & Bittner, 2015). Misconception for pain medication is listed below:
Misconception 1: Morphine is not addictive it is only used to comfort the patient. Hence
considering that there is high risk of the addiction to the pain killers is a misconception.
Misconception 2: For all pain, similar kind of pain medication is used. Pain medication are
prescribed based on the type and severity of the pain. Hence it is a misconception.

11DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Misconception 3: pain medication is the tool of the last resort. Pain treatment helps in comforting
the patient instantly. Hence it is a misconception.
Case study O:
The care plan is formulated by considering the condition of the patient and should be
regularly monitored. It should be changed if necessary to provide proper treatment of the
patient. In case of end of life care, limited treatment should be provided to the patient
(Tuinman et al., 2017).
After comparing the previous and current care plan of Gerald Brown, it can be stated that
resuscitation, artificial feeding , antibiotics for the painful and nonpainful injections, bladder
catheter and blood transfusion is provided to patient as full time treatment in both the care
plan. Limited additional interventions are provided only in case of antibiotics for the painful
ad on painful injections in the current care plan, whereas Limited additional interventions
was also provided for bladder catheter in the previous care plan. In the previous care plan,
antibiotics for the painful injections and bladder catheter is also provided to comfort the
patient, which is not included in the current care plan. In the previous case the patient is
provided with blood expanders while in the current case the blood plasma products of the
patient is analyses to ensure the recovery of the bone transplant and the blood plasma and if
not, whether an autopsy is required or not.
Case study P:
To get the better recovery of the patient, it is important to provide supportive
environment to the patient. It includes supporting his needs and interests. If not done, the patient

12DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
might get irritated which can become one of the major hurdle in the further treatment of the
patient (Itri 2015).
By considering the case study it can be stated that Andre’s environment is not supportive. The
reason are listed below:
1. The patient is not allowed to shut the doors of his room, due to which he can hear the
conversation between other patient and their families and also sure that they can hear his
voice too.
2. He want Bible from the edhospital staff as he forgets to bring of his own. However, the
hospital staff declined that they do not provide such religious texts and suggested him to
talk to his family.
3. Andre is not allowed to control the room temperature. He has offered blanket but is told
to not alter the room temperature.
Case study Q:
1. In case of Jehovah, who are Christian denomination and prefer that is written in the bible.
According to them, blood transfusion is unethical as it is forbidden by the god. To
provide end of life care in such patient is critical as there are limited options of treatment.
It is the responsibility of the healthcare workers to educate the patient about the
importance of such treatment in providing end of life care. It is done in such a way that
their cultural sentiments are not hurt, instead should be respected (Nelson, 2017).
2. In case of Jehovah individual, certain preferences are needed to clarify with the patient.
In such people, before starting the treatment the preferences are clarified, as some
Jehovah individual prefer blood transfusion and organ transplant while others do not.

13DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Their diet preferences are also noted as most of them do not prefer meat where the blood
is not full drained. According to them, autopsies should be performed only if their is a
valid reason. Hence after noting the preferences, the care plan for end of life care is
formulated according to the preferences of the patient (Balboni et al., 2018).
Case study R:
Maintaining the dignity of the patient is extremely important in the healthcare setting as it
assist the patient in recovery of the patient. In the end of life care of the patient, the patient is
to be respected and their dignity is maintained (Harstäde et al., 2018).
By considering the case study of the patient it can be sated that, the patient’s health has
taken an unexpected turn and his health condition worsen and his death is believe to be
imminent. His relatives are also not current staying with him. In such condition, the questions
which are used to maintain the dignity of the patient is, if the patient is aware of his condition
and if not the patient is acknowledged about his condition, relatives should be aware about
his condition. As it is believed that his death is imminent, hence the suitable place fir the
death is noted. Information regarding the amendment of the will should also be evaluated by
the patient. The patient preferences regarding the organ donation is noted and is make sure
that the patient is not alone at the time of death.
Case study S:
Health deterioration of the patient is considered by evaluating the signs and symptoms of
the patient. At the time of death, the signs and symptoms worsen. Hence, by considering the
symptoms it can be sated that the death of the patient is imminent (Sandvik et al., 2016).

14DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
The signs and symptoms which demonstrates the imminent death of the patient are listed
below:
1. Shortness of breathing and long periods of the apnoea.
2. Patient sates that they are going to die soon
3. Building of fluid in the lungs
4. Coolness in the fingers and toes due to the lack of the blood circulation
5. Sudden drop in the systolic and diastolic blood pressure; diastolic pressure is
dropped to 50 whereas systolic pressure dropped to 70, which is extremely lower
than the normal ( 120/80) (Dempsey & Seri, 2018).
6. Rigidity is observed in the body
7. Numbness is also observed in the patient’s feet and the lungs
8. Purple and/or bluish hue is observed in the limbs which is known as cyanosis
(Kharabish et al., 2018).
9. Mottled vein is also observed due to the lack of circulation.
10. Jaw drop is also observed.
Case study T:
Emotional support is as important as physical and mental support for the family of the
patient. It is the duty of the healthcare workers to provide emotional support to the individual
who has recently lost their loved ones (Carson et al., 2016).
According to the case study, emotional support is provided to patient by the process
which includes, introduction, fact gathering, reaction, symptoms, stress response, suggestion,
incident and referral. The process helps the person to de brief after a death to the individual. By

15DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
communicating with the learner, it can be sated that that process helps the patient to know about
after death. The group examines the feelings of the person and also the effect of certain incident
(death of a close person) on the life of the individual. From the process the positive aspect of the
incident is evaluated which helps to reduce the stress of the patient. The organization also assist
to implement stress coping strategies. If it is observed that the patient needs further counselling
then they are referred to other specialist.
By communicating with the another learner, it is evaluated that the process helps the
individual to cope with the situation and reduces stress.
Case study U:
Ethical issue is considered as any complication or barriers to the ethical system. Ethical
issue in healthcare setting is commonly observed due to patient’s confidentiality, right of the
patient, conflict due to change of interest and other legal decision (Butts & Rich, 2019).
According to the case study, the patient who is under my supervision since several
months has annoyed and agitated due to the less frequently visit of their family. He has decided
to amend the will on my name which is a major issue, however the worst part is he did not even
recognize me due to senility. In such cases, I would inform the manger as soon as possible, then
will discuss the same with the finds and family of the patient. Then the decision which are made
by the manger should be followed and several actions were taken to avoid such ethical issue in
future.

16DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
Case study V:
Emotional response is referred to as the reaction of the individual to a certain incident or
situation. Death of a person makes the person emotionally ill which hampers their daily routine
as well as disrupt their mental and physical well-being (Wisenden et al., 2018).
In the case study, it is mentioned that the nurse was attached to the patient as the patient
was under her supervision from a year. Death of the patient made her emotionally weak. After
her joining, she was not able to concentrate on her work and made several mistakes. The nurse
continuously thinks about the patient and if she could have done something better fir the
recovery of the patient. She feels sick whenever she visits the old room of the patient. As an
emotional response she gets agitated very frequently to every person who ask her about her
health. According to her, they could have provided better care to patient. Due to all these, the
nurse feel fatigue all the time due to low energy.
The nurse is emotionally attached to the patient and his death has made her week. As a
response both her professional and personal life is hampered as well as poses negative impact on
the mental well-being of the nurse.
Case study W:
1. Self-care is defined as any activity which includes the better care of the individual with
respect to our physical, mental and emotional wellbeing (Mills, Wand & Fraser, 2015).
To implement the self-acre there are certain positive self-care strategies are listed below:
 Getting good sleep: good sleep is very necessary to mental the physical, mental
and emotional well-being of the individual. Less sleep or excessive sleep both

17DELIVER CASE SERVICES USING A PALLIATIVE APPROACH
have negative impact on the health of the person. Hence at least, around 7 hours
of sleep is necessary for self-care.
 Involving in physical activity: physical activity helps the person to maintain their
physical strength.
 Eating balanced and nutritious diet: eating food that are nutritious in managed
amount posses’ positive impact on the mental and physical well being of the
individual.
2. Apart from the strategies, other methods of the support is also mentioned in the case
study which helps an individual to maintain their personal response (Bradley, Lindsay &
Fleeman, 2016). These methods of support are:
 Support groups, which provides coping strategies and provide support to the patient.
 Counselling, which helps the person to take care of their mental health.
 Professional help and advice assist in taking proper decision in life
3. Negative selfcare strategies poses negative impact on the mental well-being of the patient
(Alegría & Larsen, 2015). These are:
 Consumption of excessive alcohol
 Involving in risky and dangerous action
 Excessive gambling.

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