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”)

2PALLIATIVE CARE PRACTICE
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

3PALLIATIVE CARE PRACTICE
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