Palliative Care Practice | Assignment 1

Running head: PALLIATIVE CARE PRACTICE
Palliative Care Practice
Name of Student:
Name of University:
Author Note:

1PALLIATIVE CARE PRACTICE
Q1
Anger is a common emotion in the palliative care setting and can be expressed by either
the patient, caregiver or family members. Anger may be expressed towards the family,
interdisciplinary teams, the patient themselves and their spirituality (O’Grady, Dempsey &
Fabby, 2012). Tom has been diagnosed with terminal-stage cancer and it is hard for him to
believe or accept it at first; it has brought anxiety and uncertainty to his life. Tom was naturally
upset at the delay in diagnosis and subsequent terminal prognosis. Ann allowed Tom to express
his feelings and she remained calm and responded kindly. Ann was cognisant that the anger is
not being directed her, but it is rather as a result of his frustration at coming to terms with his
prognosis. She did understand that it was not easy being a patient. She, therefore, showed
empathy (Julien, Thom & Kline, 2010). Ann actively listened and showed her concern and
refrained from being judgmental (Lampert, Lampert & Lampert, 2019). Ann used the Nurse
Model, a model which is described as a method to support empathetic communication, which
includes the following factors in working with strong emotions like anger:
- Naming (name the emotion/anger)
- Understanding (showing clarity / show understanding)
- Respecting (can be either a non-verbal or a verbal response)
- Supporting (supporting statements)
- Exploring (use of “tell me more”)

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An effective way of working with a person who is dealing with anger has been described
in a seven step approach (Phillip et al., 2006). The approach includes preparation, listening to the
person, utilizing experienced clinicians, reconsidering approach if the anger persists,
acknowledging limitations, supporting the care team and involving in the role of an independent
broker as and when necessary. Complimentary to this approach is providing an empathetic
response to directed anger, which is thought to reduce emotional distress, and improve
therapeutic relationships. Allowing patients to speak freely and listening to them without any
judgment has been reported to support the convergence of anger into expressions of fear and
concern (Alexander et al., 2011; Back, Arnold, Baile, Tulsky, & Fryer-Edwards, 2005; O’Grady
et al., 2012). When Ann went to see Tom, he claimed to have a stressful day and wished to go
back to bed since he did not want to talk to Ann, however, she did not take it personally and gave
him his space.
Q2
The development of rapport is crucial to be able to freely discuss sexuality. It is clear
from the discussion that Ann has achieved this with Tom. Ann shows interest in how the illness
is impacting on Tom’s life and by displaying empathy. The process of developing rapport can be
done by getting to know the patient as an individual, actively listening to them and using
empathy (Leung et al., 2016). After developing rapport, ideally, the assessment and management
of sexual issues should occur as early as possible to improve the quality of life.
The PLISSIT Model assists health practitioners to discuss sexuality. It includes asking
permission, providing limited information as to not overwhelm the patient and offering specific

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suggestions. It clearly tells that when introducing this sensitive topic, the nurse maintains a sense
of brevity on it; she keeps the matter short, stays focused on the topic at the moment because
communication works best when they it is focused (Iberg, 2013). The specificity of the nurse
enables her to get specific answers regarding the subject. This model also includes providing
concrete suggestions on how to cope with utilizing non-pharmacological and pharmacological
strategies. (Leung et al., 2016).
Q3
Tom mentioned about experiencing feelings of lethargy and tiredness almost all the time.
Ann should have provided further advice regarding the management of stress and fatigue, and
the side effects of treatments; perhaps suggest the palliative care clinician review for any
mediation. All avenues to improve quality of life has to be considered. Ann should also
understand that certain types of cancers and their treatments impact on a person’s sense of self
and on their expression of their sexuality. Having sound knowledge of how sexuality can be
impacted by certain diseases and treatments is a key skill for palliative care clinicians. No offer
of follow up was made. Ann could have suggested the palliative clinician to review his
medications for pain lethargy, sleep, laxative, antidepressant and other neuroleptic medications
to treat Tom’s anxiety, depression and sedatives. There is also a cost factor involved for Tom as
he is not working; the palliative medications are not subsidized through the Pharmaceutical
Benefits Scheme (PBS), even though Tom is a patient in the community. Hence the long-term
mediations should be frequently reviewed. Ann could have provided Tom with the nearest
Centrelink offices as these have financial information services. The nurse could have referred to
a physiotherapist to review his mobility and make a care plan, an occupational therapist could

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have been involved, to advise and support Tom to buy or rent any equipment or supplies as
required. (Palliative care Victoria website) Contact with support group run by many cancer-
related organizations could also have been provided.
Q4
In working with strong emotions, it is further reported that the investment in time is often
required in the form of meeting with patients individually to explore strong emotions and
directed anger, ensuring care plans are appropriate and reflective of patient goals; and family
meetings to ensure adequate communication with all parties involved and consistent
understanding of goals of care are conveyed (Back et al., 2005; O’Grady et al., 2012; Philip et
al., 2006). Ann did not invest in the time which is necessary to deal with stress emotions, she
visited Tom on a weekly basis.
In the conversation between the nurse and Tom, he explains to the nurse how he feels the
colostomy bag getting in the way as they get intimate. Ann failed to give advice when Tom
expressed concerns about his colostomy bag and how to manage his colostomy during intimacy.
Ann made no offer of follow up and she could have involved a stoma therapist or nurse to
provide Tom with further management of his stoma. Sally, who is Tom’s wife, is also his
caregiver. She is worried and tired as she copes with her husband’s cancer; Ann should address
the new challenges and concerns of Sally by talking about respite care.
Anxiety is also an emotion strongly felt by family members and caregivers. A large
percentage have unmet needs for support, fears concerning the patient's condition and stressors
of whether they will cope, leading to their own heightened level of anxiety and a need for
emotional support for themselves (Sklenarova et al, 2015).

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Continuation of care and emotional support, understanding the patient’s and or family’s
concerns, needs and fears and discussions regarding the nature of the anxiety opens up the lines
of communication between the patient, their families and the health care worker. This then
allows for the addressing of these specific concerns and fears whilst also offering open and
concise explanations of treatments and assurance of continual support from the health care team
(Palliative Care Expert Group, 2016).
Ann could have made Tom feel more supported, which would increase the possibility of
finding a way to work more effectively together. When a patient or family is persistently
angry, it is suggested that if strategies such as alerting senior staff and setting limitations are not
effective, the introduction of an independent broker may be required or the referral to another
discipline is deemed necessary. A palliative care specialist will be the first preference to treat
medical problems. Referral to psychologist, psychiatrist, councilor or social worker may be
beneficial as well.
Some option of care which are open for Tom are: to keep trying aggressive treatment or
deciding to control the symptoms of cancer, since all patients’ have right to comfort and quality
of life, (National cancer Institute.) Doctors may recommend chemotherapy to slow the growth of
a tumor that is causing pain and not to cure cancer.
Hospice care is recommended for the future which is not intended to hasten or postpone
death. The focus is caring not curing, having quality of life spending more time with loved ones
and friends. Hospice care is available and can provide support for months before the patient’s
death.

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Q5
Relationship: A number of individuals might discover that the challenges related to
cancer and cancer remedy enhance the bond and strengthen relationships (Cook, Dezangre, & De
Mol, 2018). At times, various couples report a rise in tension and strain; the relationship between
Tom and Sally has changed, where Sally is now not only Tom’s wife but also his caregiver. Ann
needed to help Tom and Ann, offering support.
The reading by Morris, King, Turner & Payne (2015) discusses the role in which the
caregivers take on looking after their loved ones at the end of life, in the home setting. They
describe the impacts this has on the caregivers, and they acknowledge the gaps that remain
around how it is best to support them; Tom is unable to lead a normal life with his cancer and a
stoma. Since Tom is not active as he used to be it has put extra pressure on Sally to run the
family and look after their two girls causing extra strain on the relationship. Tom is showing his
frustration on the kids by showing anger and they are reacting to it. Some support of close
friends and family can be of help during this time of crisis, as Tom does not place trust in his
doctor.
Family Life: Tom is showing his frustration on the kids by showing anger and the
children are reacting to his anger, Tom is worried what is going to happen to his wife and kids
after his death and he even hopes someone better would come into Sally’s life to help her raise
the children and keep her happy.
Intimacy: Tom should be advised to share his thoughts and needs with Sally. Sally needs
to remain intimate and discuss issues openly. Tom is worried about his stoma coming in between
while having sex; however the nurse could recommend a small & compact stoma bag which can

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be used during intercourse. Tom is anxious and fearful about not being able to perform sexually,
as on most days he feels tired and has no stamina. It is important for Tom and his wife Sally to
understand this is common so that they will remain calm and not be alarmed if difficulties occur.
A referral can be made to a sex counselor by Ann.
Grief: The diagnosis of cancer is devastating for Tom and everybody else at home; the
grief of gradual loss of functionality experienced by Tom. Tom is grieving for the things he used
to be able to do and is manifested in feeling low in energy; Sally is grieving over Tom’s loss of
heath and possible death. Tom is uncertain about Sally and the children’s future. The support of a
pastoral care worker, social worker, or a counselor from the palliative care team or the
community may be recommended to discuss and prepare for death.

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References
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