Case Study: End-of-Life Care for Aboriginal Patients (Nursing)

This report analyzes the case of Tom, a 55-year-old Aboriginal man with advanced lung cancer and multiple metastases, focusing on his end-of-life care. The report identifies key issues, including severe pain, breathlessness, cultural considerations, family conflicts, and ethical dilemmas. It outlines the goals of care, which include promoting quality of life, providing palliative care, supporting the family, and addressing communication challenges. The course of action emphasizes pain management, cultural sensitivity, and effective communication. The report highlights the need for a holistic approach, considering both physical and emotional needs, and the importance of the nurse's role in coordinating care, managing symptoms, and facilitating communication between the patient, family, and healthcare team. The analysis incorporates the principles of legal and ethical decision-making, communication strategies, palliative assessment, and symptom management, using scholarly literature to support the discussion. The report also addresses the daughter's role as power of attorney and the need for an NFR order, emphasizing the importance of respecting the patient's wishes and providing appropriate end-of-life care.

Running head- END OF LIFE CARE
END OF LIFE CARE
Name of the Student
Name of the University
Author note

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Table of Contents
Introduction......................................................................................................................................2
Identification of the issues...............................................................................................................2
The goals..........................................................................................................................................3
Course of action...............................................................................................................................4
Conclusion.......................................................................................................................................6
Reference.........................................................................................................................................7

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Introduction
The end of life care or EoLC means the health care that is provided to a person who has come in
the terminal stage of his life (Chan, Webster and Bowers 2016). The end of life care requires
different ranges of decisions including questions regarding palliative care, the patient’s right for
the self-determination, experiments regarding the medical condition of the patient, the ethics and
efficacy of the hazardous medical intervention (Shepperd et al. 2016). The given case study is
about a 55 year old aboriginal man. In the case study, it is shown that he has fallen down in the
bathroom and after that his wife and son took him to the hospital. I am his registered nurse. I will
identify the different issues that he is dealing with, establish the goals and prepare his care plan
so that he can get cured after some days.
Identification of the issues
The patient is already suffering from advanced lung cancer and also have multiple
metastases. In this incident, he has come to the hospital as he collapsed last night suddenly in the
bathroom. At present, I have identified the issues that he is dealing with are severe pain and
breathlessness and the man reason of this is the lung cancer. The metastases has spread
throughout the body. A person suffering from multiple metastases, suffers from body pain
(Curtis et al. 2016).. Tom regularly takes morphine, the doctor has prescribed him morphine as
he is suffering from severe pain of cancer but regular intake of morphine has side effects like
restlessness, watering eyes, nausea, sweating and severe pain in the muscles. Tom’s wife told her
son and also the nurses that Tom was very hot and was sweating a lot. Tom is an aboriginal
people and these people suffer from respiratory diseases due to lifestyles which are unhealthy
and inappropriate clinical services. Another important issue is regarding Tom’s daughter

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Carlina, she has been found to be very angry as she is raising her voice. Tom is very much
vulnerable to pain, apart from the different physical issues and social issues, other issues like
cultures, emotions and spiritual aspects also contributes to pain. For these people death is not
actually the end and these people believe in mourning. In this case the family members help the
other family member to get cured. She is telling that she had the power of attorney for her father
and she is asking for the morphine to be stopped and it should be changed by something better.
She is asking me to do everything so that her father can be saved. The other most important issue
is the conflict in between the family members. At the time of his last admission in the hospital in
the progress report it was written that this case needs to be discussed with the team NFR, so this
case needs an NFR order in each admission. NFR is a legal order which indicates that a person
do not need any cardiopulmonary resuscitation, advanced cardiac life support and other different
interventions in case, the heart of the person stop breathing (Subramanian and Zalewski 2016).
The goals
The nurses must follow the different nursing intervention policies for curing a patient.
The nursing intervention does not only involve providing the patient medicines. The nurse must
include the palliative care approaches for treating a patient (Grace et al. 2016). In this case the
care should be given by considering the conditions of the aboriginal people. These people are
dependent on various cultural, social and emotional aspects.
The goals are to prepare a care plan to promote the quality of life, to affirm whether the
person will be alive or not, to treat the person, support his family to prevent the conflicts that is
happening in between the family members and a family meeting is required to be arranged as I
need to discuss with the family members about the issues that I have identified. I need support
from the family members of Tom for carrying out his treatment.

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Course of action
The course of action is nothing but a logical set of facts that are sufficient for justification
of the enforcement of any right against any party. In the medical sciences, the nurses and the
different health experts follow a course of action for the purpose of curing a patient. The nurses
prepare a care plan which they follow regularly for curing the patient (Coyle et al. 2015).
In the given case study, the patient is suffering from the life threatening disease lung
cancer. Immediate action should be taken against the pain. The cultural background of Tom is
showing that his family members are more tensed about his diseased condition so these external
stresses should be eliminated to treat him. Tom should be encouraged for taking rest, the family
members must allow him to relax. It is better for him to be administered with morphine. Non
pharmacological treatments like distractions, regular exercises must be involved for his
treatment. Tom must be encouraged for proper ailments of the body for breathing as much as
possible. Normally the aboriginal people and different health workers are not much bothered
about palliative care (Bartholdson et al. 2015). In this case, the patient after getting collapsed, in
the hospital he was not accepting about what has happened the day before and as a registered
nurse I will be in the dilemma about whether I will give him the medicines or not as he is willing
to take any medicine.
When a patient suffer from extreme diseases all that he needs is the palliative care.
Palliative care services are there which help the patient and their family for the future planning.
The team members help to achieve the goals of the treatment approaches (Hullmann, Robb and
Rand 2016). The palliative care social workers help I designing a treatment planning method for
the purpose of the treatment of the disease (Rassouli et al. 2015). In this case study, the patient
do not need any palliative care as the patient in already at his last stage of his life. In his last

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admission in the hospital in the progress report it was written that this case need discussion with
the NFR team. I think he needs congnitive treatment. Cognitive therapy is a king of
psychotherapy. The cognitive theory is based on the cognitive model which tells that the
feelings, thoughts and behaviour are all connected with each other and people can be cured by
changing the thoughts. The change in thoughts changes the feelings and thus their behaviour also
changes. When the chemotherapy is the part of the cancer treatment, then palliative care is
needed by the patient for managing the side effects of nausea, pain, vomiting, fatigue,
constipation and diarrhea, insomnia and depression. I will give him medicines time to time so
that he never miss his medicines. I will change his diet and add more proteins in his diet to
reduce his drowsiness and restlessness. I must listen to all the things that the patient wants to tell
me and must speak politely as he is in the last stage of his life. I must definite coordinate with his
family members time to time informing them whether he is recovering or there is no sign of him
getting cured. I need to spend most of the time of a day with this person. The symptom
management is another important part of the care approach. Side effects are always there when a
patient go through a treatment procedure. In this case, as the patient is going through the cancer
treatment, it is obvious for him to suffer from severe pain, drowsiness, nausea, vomiting and
many other symptoms. So along with the medicines of cancer I must provide him with the
medicines of reducing pan, nausea and vomiting.
Effective communication is another important factor upon which the curing of a patient
depends. Not only the family members, the nurses and the doctors also have the responsibilities
to communicate properly with the patient (Gluyas 2015). Tom and his family members were not
aware of the palliative care and therapeutic approaches and probably this is the main reason of
miscommunication between Tom, his family and the nurse (Foster et al. 2015). The verbal

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communication between the family members and the patient is not proper. The members are not
at all listening to what the patient is saying, they were lacking proper listening skills even in such
a weak physical condition of the patient. At this time their psychological conditions were also
weak, so to avoid any miscommunication the non-verbal communication must be avoided, as he
will not understand any gestures. Along with me, the family members should also give mental
support to such a cancer patient. It has been proved that mental support increases the life span of
a person suffering from any deadly disease (Sprangers, Dijkstra and Romijn-Luijten 2015).
Conclusion
For treating the aboriginal people actual identification of the clinical issues and the legal
issues are the most important things. Proper communication should be established for providing
the best palliative care.

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