Principle and Practice of Palliative Care: A Case Study of Mrs. Brown

This assignment discusses the principle and practice of palliative care, focusing on a case study of Mrs. Brown. It explores high priority palliative nursing strategies for symptom control and mental health support. The importance of ethical principles in delivering palliative care is also highlighted.

Introduction
WHO refers Palliative care as a practice of care in which quality of life of patients with
end-of-life illness and their carers/family members is improved by preventing and
minimising the suffering through early diagnosis and accurate assessment and
management of the disease and other issues such as mental state, spiritual needs,
social health, etc. (WHO, 2017). One of the major component of palliative care is control
of debilitating symptom. It is the professional and ethical duty of nurses and other health
care professionals as it causes physical as well as mental distress. This assignment will
explain the principle and practice of palliative care. It will discuss in detail two high
priority palliative for the case study of Mrs. Brown.
Discussion
Palliative care collaborates a range of expertise care which includes medical,
psychological, and social, etc. Nurses must make use of a holistic approach which
integrates these broad aspects of care to deliver efficient palliative care. In case of Mrs.
Brown, nurse must manage the palliative care ethically in various areas such as
symptom control such as acute shortness of breath, psychological care that is
preventing depression, and maintaining social status by ensuring social contact and
inclusion in society. The cardinal ethical principles followed by nurses while delivering
palliative are autonomy, beneficence, non-maleficence and justice. Certain factors that
can put palliative care nurses in dilemma are honesty, site of care, extension of
beneficial end-of-life care until death, use of antibiotics, blood transfusion procedure,
privacy, artificial nutrition and hydration and negligence towards human rights. Delivery
of the best possible terminal nursing care and services to Mrs. Brown and at the same
time maintaining the professional boundaries that respects human rights is necessary.
Collaboration of delivery of palliative care and ethical principles of medicine will improve
the safeguard and satisfaction of Mrs. Brown and her family (Mohanti, 2009).
Practice of Palliative Care in Mrs. Brown Case
The essential components in provision of palliative care to Mrs. Brown will include
symptom control, effective communication, rehabilitation to maximise autonomy,

terminal care, support in grief, education, etc. Nurses must maintain an empathetic,
compassionate, non-judgemental and impartial attitude while providing services to Mrs.
Brown. While palliative care planning for Mrs. Brown, her individual psychosocial
concerns of must be acknowledged by the nurse apart from disease management.
Nurse must obtain informed consent from Mrs. Brown or her husband prior to giving or
ending the treatment.
High priority palliative nursing strategy 1- Disease management
Issue- Managing acute shortness of breath is an essential high priority nursing strategy
for Mr. Brown. Shotness of breath is the most disabling symptom of COPD. An
important aspect of palliative care practice is that the strategies must be focused at
easing the suffering and improving the QoL of Mrs. Brown, and not necessarily at
continuation of life. Mrs. Brown was admitted to the hospital due to shortness of breath.
Increase in the chronic morning productive cough, rhinorrhoea and cough indicates the
chronicity and worsening of the disease which must be managed to improve quality of
life of Mrs. Brown.
Strategy- Nurses must acknowledge and accept self-reported level of dyspnea of Mrs.
Brown and also properly assess the shortness of breath. After assessing the level of
dyspnoea, suitable nursing interventions must be implemented that are medication
administration through the most effective of route, oxygen therapy, etc. Nurses must
collaborate with experts in respiratory field to deliver best possible care to Mrs. Brown
and provide maximum assistance to her family (Mudiginda & Mudigonda, 2010).
Justification- The level of perceived breathlessness is related to the respiratory effort.
More the ineffective respiratory effort exerted by Mrs. Brown, more the sensation of
breathlessness she will face (Bailey, et al., 2013). It is essential that her symptom of
shortness of breath is controlled or it may have adverse consequences for her including
death. Other symptoms can be managed later once her survival is ensured.
High priority palliative nursing strategy 2- Retaining mental/psychological health

Issue- Preventing relapse of depression and ensuring mental well-being is another high
priority palliative nursing strategy in Mrs. Brown’s case. It is found that individuals with
advanced chronic illness frequently face psychological distress. Mental distress is
natural and anticipated in people who have terminal illness however, the difference
between a normal and suitable reaction to the illness and a more serious psychological
disorder such as depression can be demanding (Rosenstein, 2011). Since, Mrs. Brown
already has a history of depression and she is experiencing mental distress in current
situation, it is likely that her depression may relapse. Depression may decrease the
likelihood of disease management and reduce her quality of life and her family
members.
Strategy- Nurse must assess the level of depressive symptoms in Mrs. Brown’s case as
interventions are tailored as per the demands of her case. The underlying cause of
depression is that Mrs. Brown felt like a burden on family due to her reduced abilities.
So, if god palliative care is delivered to Mrs. Brown to reduce her symptoms and
increase her abilities, her condition will improve. Other nursing strategies that should be
used are effective communication and social support to Mrs. Brown. A psychoanalysis
must be done and if required psychotherapy or antidepressant can be recommended.
Nurse must also focus on patient and family education so that they could be informed
about the nature and severity of the disease and treatment options can be discussed
(Rayner, Higginson, Price, & Hotopf, 2010). Meetings with nurses may also be a source
of support and assistance for Mrs. Brown and her family members which is a part of
palliative care (Olaitan & Ololade, 2016).
Justification- Depressive syndromes are frequently observed in palliative practice, but
are still misunderstood, underdiagnosed, and undermanaged (Marks & Heinrich, 2013).
So, it should be diagnosed early even as a comorbidity as when physical disorder is
compounded with mental illness, likelihood of improving symptoms and improving the
quality of life may reduce.
Conclusion

To obtain desired results in palliative care, it is vital that the principles of palliative care
are followed. Palliative care maintains life and considers death as a natural and normal
phenomenon. It aims to neither hasten nor delay the death. Its chief objective is to
improve the quality of life of the patient before death. It manages symptom control by
providing relief from pain and other troubling symptoms. It integrates spiritual needs of
the patient into psychological care as it gives importance to the patient’s outlook on
purpose and meaning of life and his/her choices. Palliative care also aims to offer
satisfaction and support system to help the families of the patients to manage patient’s
advanced illness and their own bereavement. To give continuous symptomatic and
assisting care until death is the fundamental goal of palliative care. A multidisciplinary
approach from nurses and other experts is required while providing care to Mrs. Brown
which will include effective healthcare care, specialized nursing, complementary
services such as social support and social care’s assistance for patients' family
members.
References
Bailey, P. H., Boyles, C. M., Cloutier, J. D., Bartlett, A., Goodridge, D., Manji, M., &
Dusek, B. (2013). Best practice in nursing care of dyspnea: The 6th vital sign in
individuals with COPD. Journal of Nursing Education and Practice, 3(1), 108-122.
Marks, S., & Heinrich, T. (2013). Assessing and treating depression in palliative care
patients. Current Psychiatry, 12(8).
Mohanti, B. K. (2009). Ethics in Palliative Care. Indian Journal of palliative Care, 15(2),
89-92.
Mudiginda, & Mudigonda. (2010). Palliative Cancer Care Ethics: Principles and
Challenges in the Indian Setting. Indian Journal of Palliative Care, 16(3), 107-
110.
Olaitan, S., & Ololade, A. O. (2016). Palliative Care: Supporting Adult Cancer Patients
in Ibadan, Nigeria. Journal of Palliative Care & Medicine, 6(3).

Rayner, Higginson, Price, & Hotopf. (2010). The Management of Depression in
Palliative Care: European Clinical Guidelines. London: Department of Palliative
Care, Policy & Rehabilitation.
Rosenstein, D. L. (2011). Depression and end-of-life care for patients with cancer.
Dialogues Clin Neurosci, 13(1), 101-108.
WHO. (2017). WHO Definition of Palliative Care. Retrieved February 8, 2018, from
http://www.who.int/cancer/palliative/definition/en/