Palliative Care Nursing: Strategies for Holistic End-of-Life Care

This essay discusses ways to provide the best possible holistic end of life care and determine the best approach to manage own personal values and beliefs and its effect on end-of-life patient. It emphasizes the importance of effective communication, cultural assessment of patient, and spiritual understanding of illness to improve the quality of care. Culturally sensitive end of life is effective in improving patient outcomes and supporting the patient to approach illness and death with a positive and courageous attitude.

Running head: PALLIATIVE CARE NURSING
Palliative care nursing
Name of the student:
Name of the University:
Author’s note

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Palliative care is the care approach that focuses on holistic management of patients with
life limiting illness by consideration of physical, emotional and spiritual dimensions of care and
illness (Kamal et al., 2015). Although multi-professional team is involved in providing the best
palliative care to patient, however the efficacy of the care provided is dependent on individual’s
staff sensitivity towards cultural and spiritual values of patients and their family members and
management of their own personal values to eliminate conflict of interest and inefficiency in the
delivery of care (Centeno et al., 2016). In this context, the main purpose of this essay is to
discuss about ways to provide the best possible holistic end of life care and determine the best
approach to manage own personal values and beliefs and its effect on end-of-life patient.
To address all the dimensions of illness as part of holistic palliative care, the method of
communication with patient is the most critical factor. Communication skill can help palliative
nurse to appropriately listen to concern of patient and acknowledge their feelings and emotions
(Kelley & Morrison, 2015). However, my own personal beliefs and cultural values can act as
barrier in the process of therapeutic communication with patient. For example, the research study
by Gardiner et al. (2011) argued that attitudinal differences act as barrier in providing high
quality palliative care. Many nurses were found to have ageist attitude towards elderly end of life
patient. Hence, I also need to replac such biased attitude and nurse my communication skill so
that I can provide optimal palliative care regardless of age, culture and religion difference of
patient. Good communication skill is necessary for patient engagement, improving patient’s
satisfaction with care and promoting positive health outcome in critically ill patient. The best
approach that I would take for therapeutic communication with patient and to prevent my own
personal beliefs to influence palliative care includes having a non-judgmental attitude during
interaction, communicating in a respectful manner and refraining from giving personal

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comments on a situation. As a palliative care nurse, I will align my body language as per the
cultural values of end of life patient so that patient do not feel disrespected. Hence, five skills set
of non-verbal and verbal communication skill, recognition of cultural differences, adaptation of
cultural knowledge and negotiation skill can enhance the quality of interaction with end of life
patient (Brown et al., 2015).
The best quality end of life care is one where best action is taken to maintain the quality
of life of patient and family members by the management of physical, psychosocial and cultural
morbidities in patient. While interacting with patient in real setting, my challenges can increase
when I lack awareness about cultural and spiritual needs of patients and when my own personal
values are in conflict with patient’s value (Kelley & Morrison, 2015).. This is the most common
issue encountered by palliative care nurse. However, if the goal of holistic nursing care and
individualized nursing care for patient needs to be fulfilled, then I would try to accustom myself
with cultural diversity in palliative care setting. The goal of end of life care nurse should be to
create an environment that is respectful of individual patient’s cultural beliefs. To achieve this
goal, palliative care must have the understanding that illness is influenced not only by biological
context, but also by psychosocial factors like emotions and cultural beliefs of patient. To deliver
such culturally competent care, I would refer to all the resources that gives information about
individual patient characteristics such as religion, income, gender and spiritual beliefs of patient.
This kind of cultural assessment of patient can support me to align practices according to cultural
needs of patient (Bhat et al., 2015).
Culture is a source of resilience for patient and cultural values of patient is the factor that
influences patient’s preference and decision making related to palliative care. Many times
palliative nurses will also face the need to disclose bad news to patient or their family members

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and take consent for future course of treatment. While performing such task too, cultural
competence skill is necessary so that ethical and legal conflict is prevented and nurses take the
right approach to disclose bad news or fulfill patient autonomy clause. I can effectively handle
informed consent process by asking patient’s regarding the person who would decide about the
treatment. Secondly, I can identify the cultural values of patient by asking question from nurse
regarding their views on serious illness and the cultural practices or beliefs that might affect
patient or family members throughout stage of serious illness. Such method of inquiry can
promote understanding about cultural beliefs and preferences of patient. Secondly, during
assessment of patient, my strategy is to document regarding cultural aspects of care. The plan of
care should also be made in a way that respects patient/family’s cultural and religious traditions
and accommodate their cultural practices in care (Mazanec & Panke, 2015). Hence, a nurse can
keep their own personal values aside by reflective self-awareness, knowledge of cultural values
of others and having the right skills to manage differences (McGee & Johnson, 2014).
Cultivating the value of cultural self-awareness can increase nurse’s understanding related to
how their own cultural values, beliefs and biases influence their perception about patient. It can
also reduce health disparities while providing care to patient (Mazanec & Panke, 2015).
Spirituality is also an important domain of palliative care and spiritual understand can
help nurse to make sense of patient emotional and psychosocial outcome during care. Spirituality
also determines the quality of patient and their illness and healing experience. As a palliative
care nurse, I can fulfill spiritual needs of client by ensuring that all spiritual preferences of
patient is respected during the delivery of care. Family support, forgiveness, hope and faith are
all form of spiritual values of patient and nurse must understand the phenomenon of spirituality
to improve the quality of care given to patient. Successful application of spirituality concepts can

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improve a nurse’s confidence in supporting and care for patient at the end of life (Evangelista et
al., 2016).
The essay summarized the important elements needed for holistic approach to palliative
care and the strategies needed to provide the best possible palliative care to patient. As nurse’s
own personal beliefs and cultural values comes in the way of providing care, the essay gave the
idea that increasing knowledge in the area of effective communication, cultural assessment of
patient and spiritual understanding of illness can improve the quality of care. Culturally sensitive
end of life is effective in improving patient outcomes and supporting the patient to approach
illness and death with a positive and courageous attitude.

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References:
Bhat, A. M., Wehbe-Alamah, H., McFarland, M., Filter, M., & Keiser, M. (2015). Advancing
cultural assessments in palliative care using web-based education. Journal of Hospice &
Palliative Nursing, 17(4), 348-355.
Brown, E. A., Bekker, H. L., Davison, S. N., Koffman, J., & Schell, J. O. (2016). Supportive
care: Communication strategies to improve cultural competence in shared decision
making. Clinical Journal of the American Society of Nephrology, CJN-13661215.
Centeno, C., Ballesteros, M., Carrasco, J. M., & Arantzamendi, M. (2016). Does palliative care
education matter to medical students? The experience of attending an undergraduate
course in palliative care. BMJ supportive & palliative care, 6(1), 128-134.
Evangelista, C. B., Lopes, M. E. L., Costa, S. F. G. D., Abrão, F. M. D. S., Batista, P. S. D. S., &
Oliveira, R. C. D. (2016). Spirituality in patient care under palliative care: A study with
nurses. Escola Anna Nery, 20(1), 176-182.
Gardiner, C., Cobb, M., Gott, M., & Ingleton, C. (2011). Barriers to providing palliative care for
older people in acute hospitals. Age and Ageing, 40(2), 233-238.
Kamal, A. H., Hanson, L. C., Casarett, D. J., Dy, S. M., Pantilat, S. Z., Lupu, D., & Abernethy,
A. P. (2015). The quality imperative for palliative care. Journal of pain and symptom
management, 49(2), 243-253.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England
Journal of Medicine, 373(8), 747-755.

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Mazanec, P., & Panke, J. T. (2015). Cultural considerations in palliative care. Spiritual,
Religious, and Cultural Aspects of Care, 4.
McGee, P., & Johnson, M. R. (2014). Developing cultural competence in palliative care. British
journal of community nursing, 19(2), 91-93.