NUR341: Case Study and Reflection on Hospice Care for Elderly Patients

This assignment presents a case study of an 86-year-old patient, Mr. McGregor, with a history of Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer's, admitted to a hospice for respite care. The case study delves into the complexities of end-of-life care, including advanced care planning, ethical considerations such as patient autonomy and substitute decision-making, and the creation of holistic care plans. It highlights the importance of assessing the patient's physical, psychological, emotional, spiritual, and socio-cultural needs. The self-care strategies for the caregiver, Dorothy, are also discussed, emphasizing the need for dietary management, exercise, social activities, and spiritual support. The assignment further includes a reflective component, using Gibbs' reflective cycle to analyze a personal experience with death and its impact on nursing practice. The reflection explores the emotional impact of witnessing a patient's passing and the importance of effective communication, empathy, and preparedness in providing palliative care. The assignment underscores the significance of reflective practice in enhancing nursing competencies and providing compassionate, patient-centered care. The assignment also presents a discussion of the role of nurses in providing care to the patient and his family. This case study offers a comprehensive understanding of the challenges and rewards associated with providing care at the end-of-life.

Case study and Reflection assessment
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Part 1: Case Study
Introduction
Patient McGregor is having a previous history of Chronic Obstructive
Pulmonary Disease and Alzheimer's. Due to his age, the patient is experiencing
difficulties on daily activities signifying the need for advanced care at this critical
point in time. As people get older and death approaches, body changes encountered
often progress to the advanced care state. End of life care for the patient is essential.
End of life is critical and requires a range of clinical decisions on palliative care, self-
determination of the patient, medical assessment, ethical and efficacy management
of medication process and ethics underlying continued medical use. End of life care
offers n opportunity for resource allocation and attention to the patient and making
critical decisions based on his state of health. End of life management entails
recognition of introducing advance care planning for the patient at this phase
(Stewart, Goddard, Schiff & Hall, 2011).
Advanced care planning for the patient entails the process of enabling the
individual to make plans with regards to his future health with respect to his medical
history state. Advanced care planning is essential for allowing adequate planning
during the end of life window. Advanced care planning entails critical ethical and
legal issues with regard to the consent of patient process such as patient autonomy
(Ferrell et al., 2018).
Advanced care is essential in helping to alleviate and limit life-threatening
diseases. The ultimate focus is to enable manage symptoms and provide crucial
assistance and comfort. Key aspects entail providing emotional, mental, social and
spiritual comfort. End of life is essential in providing practical help with the daily
duties and tasks. The goal often is to improve quality of life and that of the immediate
family. However, despite these key benefits, legal and ethical issues often arise in its
implementation on patient care (Cherry & Jacob, 2016).
Advanced care often requires the health care practitioners especially the
concerned doctor to develop appropriate skills to manage the decision-making
process. Choice of process needs to be a popular approach and be distinguished
from autonomous decision making (Radbruch et al., 2016). More often decisions
need to be applicable to the concerned patient. Mrs. Dorothy is trying to make the
decision for the patient contrary to fundamental approaches which guide decision
making for the end of life entail persons or patient rights to self-determination, truth-
telling, and respect for autonomy and choice (Druml et al., 2016).
Advance care directives
Advanced care directive is an essential aspect to McGregor state. Detailing
his health care preferences is essential for care planning. This will entail personal
values and goals at this end of life stages and define the circumstances which are
not acceptable to the patient and identifying preferences relating to the specific
medical intervention (Allen et al., 2015). Advance care directive will entail a written
document for taking the patient statement and a further doctors letter in completing
the letter directive which ensures that McGregor wishes are clearly documented in a

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manner that portrays his decision and substitution for advance care directive. This
will aid in substitution of decision making in the future which documents the needed
assistance for the patient.
In case there is no clear advance care directive for the patient, substitute
decision making can take place. Substitute decision making is essential when the
patient does not have the capacity or communicate the care decisions on himself.
Substitute decision making can take place in various forms. A statutory form can be
undertaken for the patient. In case of absence f statutory method, a substitute
decision-maker can be any responsible persons in place. In this Mrs. Dorothy can
take the place of the substitute decision maker for the patients; however, the
patient's wishes must be talent into account. This process to inform the choice of
decision maker entails the proper and relevant compilation of proper paperwork
submission for the patient. Substitute decision-making process entails making
decisions based on substituted judgments or best interest process.
Substitute judgments entail arriving of decisions based on bests
approximation of time the patient wishes to have. This should arrive on known
patient interests and preferences. Best's interest process of decision making is
essential in substituting decision making to focus on the interests of the patient
(Booth & Lehna, 2016). Thus Mrs. Dorothy will have a crucial role to play in this
process in advising on the best interest of the patients based on his preferences and
not her own wishes.
Creating a holistic care plan
Patients at the end of life often experience extreme symptoms which entail
physical, spiritual and psychosocial issues; these prevent overall management of the
patients and limited optimization of the quality of care for the patient (Connor, 2017).
There are crucial factors which are essential for managing the patient state such as
achieving self-control.
Assessment of the patient state needs to take interest in physical needs d
signs which reflect the progression of the disease state. The assessment will reflect
on Macs psychological, emotional spiritual and socio-cultural needs so as to
establish the willingness of the patient in addressing these concerns. Assessing
psychological and emotional needs is vital towards recognizing the overall
psychological and emotional needs of the patient so as to identify appropriate
processes and decision to take in the future. Reflecting on socio-cultural needs is
essential. Values and beliefs on death are essential for the patient. Understanding
these aspects is vital for assessing patient preferences.
Self-care process
Self-care processes entailed the caring actions and behaviors which promote
well being and health. Self-care has been viewed as self-initiated action and
behavior to promote good health and overall well being. As the caregiver, Dorothy's
role is essential in health care practices and is fundamental in ensuring the patient
receives appropriate care. To enhance these techniques, there is a need for Dorothy
to incorporate the following key fundamental strategies in the care process (Sanso et
al., 2015).

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Appropriate dietary management for the patient is essential for the overall
care process. Engaging in exercise is vital for the patient, thus enhancing these
aspects will improve the overall score of the patient. Further involving the patient on
social activities is essential for the care process. Involving the entire advanced care
team is essential planning with the doctor for appropriate action and procedures to
guide on the end care is essential. Further involving spiritual leaders in the overall
health care managed is essential for the patient to have spiritual comfort. Further,
involving positive social support for the patient is essential for the overall care
process. Patient interests are essential especially the overall advanced care
planning process. Entrenching the interests of the patient in self-care management
practices plays a vital role in the overall care process. Coping mechanism entails
providing high touch care is essential for recovery and demonstrating feelings of
affection. Finally providing emotional support is essential for the patient to age
gracefully. This is essential for Dorothy so as to reduce signs of anger and rage
which the patient might be harboring from the assumption of neglects (Mills, Wand &
Fraser, 2017).
Conclusion
Palliative care is essential in the overall care process for patients. It improves
the overall wellness of the patient and aid in the peaceful aging process. Self-care
entails the promotion of health and well being and is essential for patient McGregor.
Entrenching positive self-care strategies are essential for the overall care process for
the patient and enhance the implementation of holistic care for positive patient
outcomes.

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Part 2: Reflection
Introduction
The reflective process is an essential aspect which is vital in entrenching
effective nursing competencies and reflective learning process (Levett-jones &
Bourgeois, 2015). It is essential for nursing practices as it enhances the review of
actions undertaken through a thoughtful process on past actions (Husebo, O'Regan
& Nestel, 2015). It promotes continued and enhanced professional development and
allows for future better understanding of various patient critical states in the future.
Reflection in palliative care is essential for nursing practices and is geared
understanding of the overall holistic care for patients and caregivers at a critical point
in the care process. This reflection offers an avenue through Gibbs reflective process
on patient palliative state and occurrence in the nursing practice arena.
Description
My encounter entails patient Mark aged 75 years of age admitted and
managed at the Wellcare Hospice on the management of lung cancer after prolong
occurrence of breathlessness and constant backache suffering at home. These
symptoms emanated from lung metastases. This occurrence happened during my
shift at the normal nurse routine care process. The patient current state at the
hospice care center presented with poor prognosis and the family members were
called so as to receive the care progress and state of their kin. The consultant in
charge delivered the news for the patient and the state of the patient as end-stage
lung cancer as the patient had started weakness and reduced ability signs of
emergency support mechanism to sustain life. However as the family gathered for
the progress of patient Mark, unfortunately, the vital signs were weak and patient
state was slowly weakening. Moments later he passed on. The family was informed
through the consultant in charge together with the nurse in charge and social support
team at the patient bedside on the demise of the patient. This news brought great
devastation to the family on hearing this sad news.
Feelings
This situation had a huge impact on my experience at the care facility. This
was an initial case on my practice attending to bad news being broken to the family.
The reactions occasioned and observed form the deceased family drained my
strength and emotions and I was nearly crying not forgetting I am part of the health
care team. In this state, I was helpless to the family as I was not in a position to
relive the pain they were encountering of losing their beloved. Despite this, I
motivated myself to offer better palliative care for patients such as Mark during their
end-stage disease progression.
Evaluation
The manner in which the news was broken to the family offered me a great
deal of experience and to better understand and handle various nursing situations as
it occurs in the nursing practices. The environment to offer such news to families and
caregivers need to have privacy. The consultant in charge was able to offer a
detailed explanation of the stages of the disease to the patient while maintaining

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direct contact and open language was crucial in delivering the news for the family.
This offered an avenue for enabling understanding and clarification for the patient
prognosis until his body state weakening and eventual demise after body weakness
and inability to sustain life. My colleague; a practicing nurse was able to offer
emotional support and care comfort for the family during the process offers relieve
and comfort.
Analysis
The overall assessment of the situation offered me a great deal of effective
communication from the Doctor consultant in charge. This offered me an opportunity
to develop both verbal and verbal skills in delivering critical key messages to the
patient families and their caregivers. Trust from the family members was noted with
the caring health care team. Building and en-cultivating trust in the nursing process
has been observed as a key factor in enhancing and enabling positive association
between health care and family members in the care process (Charalambous et al.,
2016).
Further, in palliative care always expected to receive bad news. As health
care professionals there is a need for all time preparedness in dealing with various
reactions related to nursing care such as denial and emotions such as anger and
blame. Often denial is linked with a coping mechanism for the state of the disease.
Open discussions and is essential for disease understanding and helps in coming up
with the disease. Management of anger is vital, as anger can at times be directed to
the health care team responsible for discharging appropriate care process. Enabling
the therapeutic process to understand the disease and the state of the patient is
essential to facilitate this process (Knaul et al., 2018).
Conclusion
Reflective process in nursing care is an essential aspect which offers
guidance for the continued professional development of nurses and a learning
process to enhance nursing care. Gibbs cycle offers a comprehensive reflection on
nursing action encounters. Entrenching effective communication is essential in
nursing process and allows for effective communication between the staff and family
members as well the patients themselves on care process they intend to receive.
Nurses play a vital role in palliative care settings. Delivering information such as
death calls for wise and essential nursing skills which embed empathy and being
inconsiderate. Thus in enhancing clear communication pathway, effective
communication skills are vital in communicating these key messages to patients,
family members, and even health care staff colleagues.
Action Plan
This experience in the nursing palliative care settings offered me a valuable
and critical lesson and also an opportunity to get to adapt to how to manage a similar
situation in my future practices. Experienced gained has made me feel much better
on how to manage this situation in the future. Application of both verbal and
nonverbal communication skills are essential in the nursing process. Offering touch
as a comfort avenue in the nursing process is essential and offers a feeling of
affection to the affected persons.

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Overall Conclusion
A fundamental aspect of reflective exercise is that it shapes own experience
and overall nursing practice. This encounter in a palliative care setting was essential
for me and entrenched key pertinent aspects of interpersonal skills in nursing
practice. Understanding how caring actions characterized by nonverbal cues are of
the essence to relief patient and family encounters. Thus my goal forward is to learn
more of these aspects and entrenched in my overall practice of care in palliative
settings.

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