University Nursing Case Study: Palliative Care of John with ESRD

This case study delves into the ethical complexities of palliative care for a 20-year-old Aboriginal man, John, suffering from end-stage renal disease (ESRD). The assignment explores the nurse's role in facilitating collaborative ethical decision-making within an interdisciplinary team, considering John's desire to withdraw treatment and return to his remote community. The discussion encompasses ethical principles like autonomy, beneficence, and cultural sensitivity, highlighting the challenges of balancing patient wishes with medical recommendations. It examines the importance of advance care directives, interdisciplinary collaboration, and culturally competent care, including language interpretation and spiritual support. The essay reflects on the nurse's personal beliefs and strategies for managing potential conflicts, emphasizing the need for a patient-centered approach and the provision of pain management and support for both the patient and their family. The case study concludes by underscoring the multifaceted nature of palliative care, emphasizing the significance of ethical and cultural considerations in providing compassionate and effective end-of-life care.

Running Head: Nursing
Palliative Care
Name of the Student
Name of the University
Authors Note

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Introduction
End of life care or palliative care contains different standards and ethical principles
to serve the critically ill patient .The assignment is focused on a 20 year old boy john, who is
suffered from renal disease and was in the last stage of that disease. The Aboriginal boy
wanted to withdraw all the treatment facility and return to the aboriginal village from the
hospice care. As a registered nurse, different ethical principles should be maintained during
the patient’s treatment. The responsibility of registered nurse to assist the interdisciplinary
team members during palliative care with upholding ethics and standards of the care. This
assignment will focus on ethical consideration during end of life care treatment of John.
Discussion
Collaborative ethical decision making with interdisciplinary team
The physicians informed John that without dialysis he could not survive more than
three months during treatment. He wanted to withdraw all the life support and did not want to
take any help of assistance. He wanted to return to his home in the remote indigenous
community for spending his last days with his family and community members. However,
there is ethical dilemma to the healthcare providers as quality care might not be delivered in
the remote community. Ethical principles such as Clinical integrity, Respect for persons,
Justice and Benefit to the person with self-determination, truth telling, confidentiality and
informed consent (www.pallcarevic.asn.au.,2020). Ethical guidance and decision-making for
the end-of-life care are based on different factors such as alternation of context in the
treatment, relation between the team and the patient, collaborative nature of the team,
consensus building model, accountability and importance of palliative care for the patient.
Standards of the palliative care should be considered during the care plan of the critically ill
patient (www1.health.nsw.gov.au. ,2020). The team must assess the needs, develop a care

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plan take care of caregivers, provide treatment , maintain transition within and between
service, provide grief support, maintain the service culture, improve the quality of care and
emphasizes on trainings and qualification of the staffs.
Here, John did not want to continue hospice care so the principle of palliative care is
to respect the patient’s autonomy is maintained but primary goal of the treatment to preserve
life has not been managed. “Right to know and chose” and “withdrawing life sustaining
support” are maintained (www1.health.nsw.gov.au. ,2020). However, in multidisciplinary
teams disagreement might occur on withdrawing life supports. A collaborative care plan for
the patient must be chalked out by the team for the patient with the help of his family and
community members. Advance care plan is needed for the situation as any circumstances can
arise during the last days of the patient. Therefore the health professionals must use
“Advance Care Directives (NSW)” to treat the patient (Nguyen et al., 2017). Nurses and the
clinicians must execute their respective duties regarding administering medication and
educating patient with his family by the help of different ethical guidelines.
Identification and explanation of ethical decision making of interdisciplinary
team
The inter disciplinary tem should assess the needs of the person and after that take decisions
according to the ethical principle of palliative care. As a registered nurse and active part of
the interdisciplinary team , I understood that two ethical principles should be maintained
during John’s treatment. Decisions should respect his will and beneficence of the patient
according to his needs. Some issues can evolve regarding respecting the patient in the last
phase of his life , the issues are involving the person in the medical decision making and
provide all information regarding the chronic illness to the patient (McCreary, 2019).
Respecting the wishes of the patient might put the medical professionals to the ethical
dilemma as John does not want to continue the treatment in hospice care. Therefore a careful

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discussion should be conducted with him and his family to understand their opinions. As a
registered nurse, I should ask John whether he wants to take help of Advance care directives
or not. If John’s family would not agree with his decisions, the social workers , pastoral care
workers and other counsellors with medical staffs try to assist them in resolving problem .
The beneficence should be maintained for John even after he wants to return back to his
community. As a health professional, it is our earnest duty to resolve the problems of the
patient. We can appoint a full time nurse with him who will take care of John after
returning to his remote village. We can help him to reduce his the pain and to slow down
progress of the disease if possible. We will suggest John and his family to allow us for home
dialysis where dialysis will be done in his house. If they would agree with us, we will plan for
the home dialysis to assist him (Nair & Borman, 2018). However, the decisions of john and
his family should be prioritise and to support them psychologically counsellors and nurses
should motivate them to uplift their spirit in the crisis period.
Cultural aspects of palliative care with respect to the patient
John is an aboriginal by birth, therefore he should be provided with culturally
competent care. If a nurse will appoint with him or if he arrange some second option in
his community , that person should understand beliefs and values of the culture . Medical
professionals should try to convince him come and visit the hospice care within a period of
30 days or stay at the hospice care only. The person care centred care approach should be
provided to the patient with cultural background. If John prefer to communicate with his
native language , the palliative service care should arrange an interpreter or the nurse who
understand the native language(Cain et al., 2018). The team would suggest John to visit
spiritual or religious counselling with his family. Chaplaincy service can help John and his
family to understand the feelings and the spiritual context of difficult situations regardless of
faith (Handzo, Atkinson & Wintz, 2019).

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Reflection of personal beliefs on professional interactions and strategies for
management
John decided to terminate the hospice care but as a registered nurse I cannot support
his decision. However, disagreement with patient can affect the autonomy of the patient and
interfere his personal decision. We can only suggest him to stay at the hospice care for longer
time and continue his treatment. Personal and cultural values might lead to situation of
conflict as dietary patterns and religious engagement may disrupt the plan for the treatment.
Strategies should be made with the collaboration of the patient in the palliative care.
A proper diet plan should be suggested by the dietician and medication chart should be made
by the nurses according to the documentations and doctors’ advises(Reidy et al., 2017).
Analgesics and pain reliefs should be given to the patient with his consent. We will try to
appoint a nursing assistant to the patient for 24 hours after the discharge. If any second
opinion can be arranged, we should make contact with the doctor to continue his treatment
in his community.
Conclusion
The essay concludes that the palliative care involves different ethical and cultural
considerations. The procedure of palliative care is complex as both the patient and medical
teams are involved with the family and community people of the patient. There are
multiple possibilities of conflict between medical team and patient as per the decision
making and primary goal of palliative care is to provide the patient with proper care and
assistance.

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References
Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care:
preferences, communication, meaning, and mutual decision making. Journal of pain
and symptom management, 55(5), 1408-1419.
Handzo, G. F., Atkinson, M. M., & Wintz, S. K. (2019). National Consensus Project’s
Clinical Practice Guidelines for Quality Palliative Care: Why is This Important to
Chaplains?. Journal of health care chaplaincy, 1-14.
McCreary, B. (2019). Professional Ethics, Decision-Making, and Interdisciplinary
Collaboration: An Exploration of Teacher Preparation Programs and Practice.
Nair, S., & Borman, N. (2018). Palliative home dialysis: a new paradigm in the holistic
management of dialysis patients. Journal of Kidney Care, 3(5), 278-284.
Nguyen, K. H., Sellars, M., Agar, M., Kurrle, S., Kelly, A., & Comans, T. (2017). An
economic model of advance care planning in Australia: a cost-effective way to respect
patient choice. BMC health services research, 17(1), 797.
Reidy, J., Halvorson, J., Makowski, S., Katz, D., Weinstein, B., McCluskey, C., ... & Tjia, J.
(2017). Health system advance care planning culture change for high-risk patients: the
promise and challenges of engaging providers, patients, and families in systematic
advance care planning. Journal of palliative medicine, 20(4), 388-394.
www.pallcarevic.asn.au. (2020). NHMRC ethical framework for integrating palliative
care. Palliative Care Victoria.
www1.health.nsw.gov.au. (2020). End-of-Life Care and Decision-Making - Guidelines.
Retrieved 23 March 2020, from
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2005_057.pdf