Palliative Care and Hospice Services

This assignment explores the importance of quality indicators in palliative care and hospice services. It emphasizes the need for thorough patient assessments that encompass physical, psychological, spiritual, and social dimensions. Furthermore, it highlights the crucial role of accurate symptom screening procedures for conditions like shortness of breath, nausea, and pain. The document underscores the significance of strong interpersonal skills among palliative nurses to effectively understand and address patients' verbalized concerns.

RUNNING HEAD: NURSING – REFLECTIVE ESSAY
Nursing
Name of the Student
Name of the University
Author Note

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PART A: Approaches for Leadership
1. Example of the Leadership Model Witnessed
In a clinical setting, it becomes difficult to arrive at absolutely proper decisions if the subject has
been sensitive for a while. Such situations are usually witnessed in the Department of Oncology.
During clinical placements in the respective department, the manner, in which my senior
registered nurses implemented a democratic style of leadership for effective care of their
patients, could be identified. Their profiles as leaders in nursing team were authentic and they
could effectively combine the interpersonal communication and planning to provide faster
resolution to conflicts arising among cancer patients. In an Oncology Department, things are to
be planned carefully through collective consultancy involving axillary nurses, technicians,
doctors and radiologists prior to interaction with the patients who arrive at hospital.
1.1 Specific Examples
During the entire period of my stay at the healthcare environment, coordination was to be
performed with Miss Phoebe who was the head of the nursing team for administering
Chemotherapy. She was quite empathetic and fairly realized that things are dynamic when it
comes to dealing with psychological disturbed patients and therefore she used to take each
member’s advice before arriving at a decision regarding handling diversified patients.
2. Description of the Approach
2.1 Identification of the Leadership Approach
As per my personal identification, it can certainly be opined that the kind of leadership approach
she adopted was of democratic nature. She could prepare the entire team to deal with changes
that are speculated in a nursing care for cancer. Things were not confined to the care only and the
leadership model reflected within the education and research works also. I performed the
exploration of management techniques from the initial phase of training itself to prepare myself
professionally for similar situations in future (ONS, 2012).
2.2 Explanation of its Key Features and Characteristics
Democratic style of leadership is sometimes also termed as Participative leadership. There were
various definitions framed for this particular kind of leadership seen among nurses. The
definition changes as per the theories adhered to. Any effort to define a perfect model of
democratic pattern is operationally inconsistent. Some of the key features in the pointed out
leadership approaches are:
 Relatively Lesser Degree of Control over Subordinates than In case of Autocratic style
when it comes to Work-Related Decisions
 Provision for Much Freedom for the Workplace Subordinates to Participate in Group
Discussions.
 Emphasis on the Active Participation of the Group in Decision making
 Active Stimulation Among the Group During Participations and Discussions
 Collective Framing of Policies, Activities and Techniques that are required to cope with
Any Kind of Tasks.

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 Resemblance of the Leader as a Regular Member of the Group without Considerable
Investment of Effort in the Work.
 Leader’s Effort for Extension of Existing Knowledge and Competencies of the Team
Members.
 Partial Resemblance of the Autocratic Behaviour in Highly-Specific Situations Where
Accuracy is Critical
 Non-Directive Control over Members’ Actions and Bidirectional Flow of
Communication (Neuss, et al 2013).
From the past learning outcomes, it has been sufficiently understood that a democratic leader has
high moral values in any kind of situation irrespective of gender perceptions and beliefs. Some
argue that the democratic style of leadership is outweighed by the transformational one but the
same might not be true. According to personal analysis, it can be revealed that the former do not
result in low productivity rather the latter one may. The possible drawback can be the lengthy
time consumed to decide over simple and short-termed executions. But the benefit leader brings
among by encouraging volunteer efforts in its member far outweighs the drawbacks. A
democratic leader notably demonstrates some desirable characteristics. He/she tends to be
knowledgeable and stimulating and therefore can have high influence on the subordinates for
accomplishing a task properly. Such leader observes winning in cooperation and often provides
desirable consequences that are logical and situation-oriented (Ray, et al 2012).
2.3 Observation of Mentioned Key Features from the Clinical Practice
The level of competencies and standards that Miss Phoebe demonstrated was commendable
which are also required for effective administration of chemotherapy. Poor decision making
skills while being in that setting can be impactful for any patient irrespective of his/her age or
literacy factor. Chemotherapy can be costly and a patient might become extremely depressed
post-realisation of any terminal illness. In such cases, Miss Phoebe has multiple times effectively
demonstrated the participation of her patients and its family members for making medical
decisions. During the clinical practice, it was observed that Miss Phoebe followed some
preliminary procedures in case a patient refused treatment methods as prescribed by the doctor.
Her procedure primarily reflected the effort to find out the cause for avoiding chemotherapies.
This kind of situation truly indicates the sensitivity of a subject and therefore Miss Phoebe used
to discuss with her team regarding the method of communication they were supposed to have
with different patients. This implies a collective decision making and consultancy which are
major characteristics of a democratic leader. A democratic leader is also participative in nature
and the same was revealed when her intrapersonal skills were evaluated by colleagues and other
healthcare professionals. She could build rapport with her patients with ease and thus succeeded
in altering the medical decisions of her patients for positive health outcomes. This again implies
that she is a democratic leader because of her active participation, which is a key characteristic of
democratic leadership (Lanzoni, et al 2011).

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3. Self-Reflection
3.1 Underlying Assumptions about the Suitable Role Carer, Patient and Health care
Professional
The cancer chemotherapy care that is being provided by both senior and junior registered nurses
is assumed to be based on autonomously made decisions. It is an underlying assumption that all
advocacies are performed in the best interest of the patient only and there is no medical
obligation even if an illness has been evidently found to be terminal. In a technical aspect,
chemotherapy is a person-centred approach as the nursing team and other care providers ensure
that the patients maintain their optimism levels and stay psychologically and psychosocially
stable. The underlying assumptions mentioned above are in context with the healthcare
professionals. During the clinical practice with other senior nurses, it was learnt that testing of
cell lines and studies related to animals act as determinants of efficacy and toxicity in anti-
cancerous agents. Clinical trials still seem to be the only method for determining the same effect
on humans. Thus it is assumed that patient plays the role of an experiment sample and new
therapy are supposed to be adopted or brought into effect strictly only after multiple clinical
researches. The underlying assumption in case of a clinical trial is that any clinical trial which is
fairly conducted makes the agent worthy for testing. Other aspects are also considered practically
like the population to be accessed, consideration of ethics while making nursing related
decisions, competence level of fellow practitioners etc. The healthcare professionals have a big
role to play as investigators. They are presumed to facilitate the implementation of study and
adhere to such protocols that are designed for diagnosing the participants; in this case the
participants are the patients that visit hospital premises for screening of cancer symptoms. For
effectively operating within the clinical setting of an oncology department, there is strong need
of some other operational assumptions. The definition of an Oncologist should not be generic but
rather confined to such a physician who perceives the treatment of cancer patient as his/her
primary responsibility. Such a domain of physician can include the surgeons, haematologists and
the oncologists themselves. As Chemotherapy is strongly guided by scientific protocols, some
aspects like eligibility criteria of patient, toxicity related modification of dose, informed consent
and confidentiality of records are supposed to be concerning. Thus the nursing care can be
moulded into a person-centred care with regards to the psychological sensitivity of patients in
different age groups. The procedures for nursing care in Chemotherapy are compatible with the
principles of person-centred care.
3.2 Contribution towards Quality Health Care
Multiple researches have been conducted in the past that evidently reveal that a person-centred
care model can be more fruitful in the department of oncology to provide patients with holistic
healthcare services. The principles of person-centred care can be incorporated into a
comprehensive manner of cancer management program that might be on-going or is about to
commence in future. By adopting PCC, the approach becomes integrative and therefore
additional focus is given to the patients’ quality of life apart from the fundamental therapeutic
regimens. According to Nandini et al (2011), a cancer management program which is based on
principles of palliative care can enhance the patients who are usually in their terminal illness.
The practice of Person-centred care is not recognised in a wider zone because of the already

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established medical training, culture and clinical practice that has ingrained into the socio fabric.
Typically in institutions that are concerned with tertiary care of cancer-related illness, the needs
and desires of patients are wrongly interpreted to be mere interventions that could modify any
disease. The conventional system of relief against cancer symptoms is designed by means of a
team of oncologists and palliative care specialists. A PCC-reflective oncology program would be
highly interactive and help in holistic assessment of patients’ needs and concerns. PCC shall also
make it possible to provide suitable and precise inputs from professionals hailing from
multidisciplinary teams within the oncology departments. Moreover, the medical care for each
patient will be a compassionate and a continued one. Subsequently the existing culture can also
be altered to carry out systematic record processing and enhance the medical care services.
3.3 Opportunities for Nurses who are Graduates
The person-centred program will provide great opportunities for the graduate nurses to develop
their leadership skills while conditioning them to operate in a practical setting. The graduate
nurses will be working with the multidisciplinary teams associated with Oncological departments
and they can perform networking with the prevailing healthcare service on a regular basis. This
is obviously a part of the healthcare environment which is a big benefit for the nurses to
practically implement their theoretical concepts gained over academic years. The group policy
can also be enhanced through a PCC approach if each nurse performs focused interaction in a
regular manner. This is because collaborative interaction among members is a crucial step
towards building of an effective team. Person-centred approach can also assist graduate nurses in
gaining an insight of patient’s needs and priorities. In-depth communication or subtle
connections can bridge the level of trust a patient has on nurses. The organisational reputation
and regards for nurses can also rise among patients if the latter are provided with autonomy for
medical decisions. Operational strategies shall help the graduate nurses to build their
professional competence as a necessary factor for delivering holistic care. PCC-approach might
help to achieve this if specific training activities are targeted towards the graduate nurses and if
the same is incorporated into the existing program associated with oncological trainings.
Contribution towards quality health care will certainly reflect within a short period if the
attitudes and skills for palliative nursing are built up within the graduates. Precisely, that would
be a gross building in the field capacity of those nurses. Person-centred care is usually followed
by recruitment of a specialist who can rectify the common mistakes and turn the human assets to
something more valuable (Kulig, et al 2016).
PART B: Critical Evaluation of the Knowledge and Skills Gained and Development of
Early Career Plan 1st person
1. Aspiring Nursing Role
Within the first 12 to 24 months of my professional career, I would certainly like to apply for the
job role of a palliative nurse. This is because the chosen alternative opens more opportunities to
refine my professional as well as personal skills. I will be operating in a practical setting along
with a multi-disciplinary team that has high chances of providing me with extended areas of
operations apart from my core competence. By performing informed and consistent interactions
with healthcare professionals from various disciplines, my horizon will get widened and I shall

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become more dynamic than I am at a present stage. I can also contribute towards improvement in
the policies and compliance procedure that are associated with regulation of quality in hospitals.
Also, a PCC approach would help me to improve my rapport building abilities and I can connect
with my patients in a holistic manner thereby establishing deeper level of connection with them.
This is an indirect way to enhance my understanding of patients and their needs & priorities
without having them invest much. By working in a multi-specialized team, I can also efficiently
stay uninfluenced from cases of incidents that are individual based and start building analytical
mind for the wider solutions. Last but not the least, by practicing a Person-centred based delivery
of nursing service, I can connect with people from diversified groups and my theoretical
interpretations will not be limited as I shall be getting to interact with more subjects of interests.
All these will definitely skyrocket my professional experiences as a nurse in different
environment (Han, et al 2010).
2. Two Factors Considerable for Transitioning to the New Role
To be able to operate efficiently in the Palliative Unit, as a Graduate nurse it is important to
consider 2 factors in a serious manner. As it is observed in the palliative unit that there is a
dominant strength of such patients there are already suffering from poor physical and emotional
outcomes. The indicators of service quality can be accessed if these patients are delivered with
fast actions. It is equally important to gain a fair command over Hospice which is a highly
customized palliative care for patients in their last phase of life or those in their terminal phase of
illness. The two most considerable factors are as follows:
1. The assessment of patients must be comprehensive when it comes to different dimensions
including the physical status, the psychological conditions, belief systems, patient’s spirituality
and his/her social interpretations. Even the Hospice needs to be a comprehensive one. The
emotional needs should be additionally documented apart from a comprehensive assessment of
overall dimensions of patient (Roth-Rochester, 2015).
2. The screening procedures meant for diagnosing patients for symptoms should be as accurate
as they can be. The screening is counted for issues pertaining to shortness of breath, vomiting &
nausea and pains in different parts of the body. Issues can be well documented only when the
interpersonal skills of a palliative nurse are at par with the doctors with regards to understand the
issues that have been verbally provided by a patient or subject.

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References
Han, P.K. and Rayson, D., 2010. The coordination of primary and oncology specialty care at the
end of life. Journal of the National Cancer Institute Monographs, 2010(40), pp.31-37.
Kulig, J.C., Kilpatrick, K., Moffitt, P. and Zimmer, L., 2016. Rural and remote nursing practice:
An updated documentary analysis. University of Northern British Columbia School of
Nursing.
Lanzoni, G.M.D.M. and Meirelles, B.H.S., 2011. Leadership of the nurse: an integrative
literature review. Revista latino-americana de enfermagem, 19(3), pp.651-658.
Nandini, V., Sridhar, C.N., Usharani, M.R., Kumar, J.P. and Salins, N., 2011. Incorporating
person centred care principles into an ongoing comprehensive cancer management
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Ray, S.A.R.B.A.P.R.I.Y.A. and Ray, I.A., 2012. Understanding Democratic Leadership: Some
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Roth-Rochester, C., 2015. In palliative care, these 10 factors matter most. Retrieved 20
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