Palliative Care: Nursing Priorities and Interventions

This essay discusses the nursing priorities and interventions for palliative care, focusing on a case study of a patient with COPD and breathlessness. It also emphasizes the importance of patient education about palliative care and power of attorney.

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

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PALLIATIVE CARE
Introduction
Palliative or end-of life care requires a holistic approach for addressing the symptoms
that are beyond physical needs like spiritual, cultural and psychological needs of the patient.
While giving care to terminally ill patients, nurses are required to identify the clinical
priorities in order to satisfy the patient needs. The following essay of palliative care is based
on the case study of Mrs. Brown, a 62-year old lady who is suffering from breathless and has
previous reported history of COPD. The essay will analyse the nursing care needs of Mrs
Brown followed by framing of nursing interventions to satisfy those needs. Patient-centred
palliative will maximise emotional and psychological well-being of service users.
Nursing Priority 1: Improving Shortness of Breath
As per the case study, Mrs Brown has called an ambulance as she was experiencing
shortness of breath and coughing for several days. These symptoms began 3-day ago with
rhinorrhoea. She has also reported chronic morning cough productive of white sputum that
has increases during the past two days. Effective management of breathless is the main
physical care need for Mrs Brown. This is because; Mrs. Brown has exacerbations of COPD
in the past year for which she was admitted to hospital thrice. Moreover, she also has acute
breathlessness. According to Steindal et al. (2018), patients’ with COPD report high
symptom burden of breathlessness. Breathless affects numerous aspects of patients' live.
Kyngäs et al. (2017) reported that COPD patients with breathlessness have significant
negative impact in their life starting from frustrating lack of mobility along with consequent
difficulties in accomplishing daily living activities and maintaining proper social contacts.
Breathless also reduces overall physical activity like ability to climb stairs. The case study
highlights that the Mrs. Brown family members take care of her domestic and physical needs.
Breathlessness is also accompanied with fear, anxiety and pain followed by generation of

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depression and cough (Steindal et al., 2018). The case study highlights that Mrs Brown has
previously been diagnosed with depression along with panic attacks. Thus taking care of her
breathless will help to improve her comprehensive well-being. The nursing intervention from
the management of cough while ensuring proper breathing will be breathing exercise and
coughing and sleeping in Fowler’s position. Breathing exercise and coughing will help to
promote the clearance of the cough or white sputum from the lungs and thereby helping to
ease the process of involuntary breathing (Westerdahl, 2015). Ünver, Kıvanç and Alptekin
(2018) highlighted that deep breathing exercises help to decrease the chances of pulmonary
complications and thus reducing the chance of generating hypoxia among COPD patients. It
is the duty of the nursing professional to educate the patient and at the same time demonstrate
how to conduct deep breathing exercise. The breathing exercise will start with deep, slow
breath followed by slow exhaling, three to five times after every one to two hours. Deep
breathing exercise will help to reduce the respiratory rate while increasing the rate of the
alveolar ventilation Patients’ education in deep breathing helps to promote increased exercise
participation and thus generating improve outcome (Ünver, Kıvanç & Alptekin, 2018).
Breathless among COPD patients reduces the level of oxygen saturation in the body (Kyngäs
et al., 2017). In order to improve the oxygen saturation Mrs Brown must be positioned in
Fowler’s position. In this position, the head of the patient is kept raised at an angle of 45
degree from the waistline. This raised positioning of the body helps to increase the surface
area of the diaphragm of the lungs. Diaphragmatic descent leads to maximum inhalation
leading to increase in the flow of the oxygen in the lungs while decreases laboured breathing
(Ceylan et al., 2016). The evaluation of the outcome will be done by measuring the level of
oxygen saturation within the body along with decrease in the sense of laboured breathing and
cough with white sputum.

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Nursing Priority 2: Patient Education about Power of Attorney
According to the case study, Mrs Brown hasn't planned for her future care and she
was waiting for her GP to tell her what she needs to do. Her GP has recommended to move
towards palliative care approach however, she is confused about the entire concept.
According to Kozlov, Reid and Carpenter (2017), palliative care is intended to be
complementary to the curative treatment and is offered throughout the tenure of the serious
illness in comparison to the hospice which is a subtype of palliative care that is reserved for
the last few months of life. Although palliative care is increasingly prevalent in Australian
healthcare system, the majority of the patients who will benefit from palliative care have
limited access to care due to lack of proper knowledge about the palliative care. Thus it is the
duty of the nursing professional to educate the patient about the palliative care service.
Increasing the patient’s knowledge about the palliative care will helps the prospective service
users to understand how this care is relevant to their situation and thus helping to increase the
overall access of care and improving the quality of life (Kozlov, Reid & Carpenter, 2017).
Thus the nursing intervention will be directed towards the education of Mrs Brown about the
importance of palliative care and how this care will help to improve her overall mental and
physical well-being. The education about the palliative care will be given by execution of the
interpersonal communication skills of the nursing professionals (use of verbal and non-verbal
communication skills). Use of interpersonal communication skills will increase the provision
for the generation of the therapeutic relationship and thus promoting increased level of
patient’s satisfaction and education (Dahlin, Coyne & Cassel, 2016). The education of Mrs
Brown in the palliative care need will also include how accessing the palliative care will help
to reduce the burden from her family which is one of her prime concern. This mental
satisfaction will help to overcome her sense of depression. Mrs. Brown must also be educated
about Power of Attorney. Assigning power of attorney is like assigning substitute decision

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maker to a palliative care patient in order to make decision on behalf of them when they
(palliative care service users) are no longer able to make their own decisions. The power-of-
attorney is capable to providing decision on behalf of the palliative care service users in the
domain of health-related decision, financial care or property matters and personal and
lifestyle matters (Maubach et al., 2019). In case of Mrs. Brown, it will be wise to select the
power of attorney within her family member as she family member is responsibly satisfying
her daily living activities.
Conclusion
Thus from the above discussion, it can be concluded that the patient-centred palliative
care plan helps in maximising the emotional and the psychological well-being of the end of
life service users. The main priority of care for Mrs Brown in order to improve her emotional
well-being is effective management of breathlessness as she is COPD patient. Management
of breathlessness will be done via the use of the breathing exercise and maintenance of the
Fowler’s position while in rest. The breathing exercise will help to excrete the cough in the
chest and thus ensuring easy breathing. The maintenances of Fowler’s position will increase
the surface area of diaphragm and thus will help to ease breathing. The second nursing
priority is patient education about the importance of the palliative care this will be help to
improve her emotional or psychological well-being. This will be done by the use of effective
nursing communication skills. The outcome of the care is improved patient satisfaction and
decreased sense of depression and thus improving overall health and well-being.

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References
Ceylan, B., Khorshid, L., Güneş, Ü.Y. & Zaybak, A., 2016, ‘Evaluation of oxygen saturation
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