Nursing Assignment: Case Study of Palliative Care for Lung Cancer

This nursing assignment presents a case study of a 55-year-old patient, Tom, suffering from advanced lung cancer and multiple metastases, admitted to the hospital with breathing difficulties and pain. The essay delves into the ethico-legal and clinical complexities of his palliative care, including the role of the Aboriginal liaison officer, Nancy. It evaluates issues surrounding morphine use, the roles of the power of attorney and enduring guardian, and the importance of advanced care planning and shared decision-making. The discussion covers palliative care goals, assessment tools, communication strategies, and pharmacological considerations, emphasizing the patient-nurse relationship and cultural sensitivity in end-of-life care. The assignment highlights the challenges and strategies involved in providing comprehensive palliative care to improve the patient's quality of life while addressing the needs of the family and the patient's preferences.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Palliative care is a special kind of medical care given to the patient who are suffering
from critical diseases such as cancer. It is given to patient to improve the quality of life as
early as possible. It addresses the patient as a whole rather than their diseases and its primary
goalprovides support to both patient and its family (Aslakson, Curtisand Nelson2014).Some
specialized person who has undergone special training and certification in palliative care
usually provides this care. These include a multidisciplinary team consists of doctors,
pharmacists, registered dietician, social workers and also nurses. In the given case study,a
patient named Tom of 55 years of ageis suffering from advanced lung cancer and multiple
metastases. He was admitted to hospital after falling down on the floor. Though he was able
to talk to nurse, but he was facing trouble in breathing and also suffering from lot of pain.
Hospital engaged Aboriginal liaison officer, Nancy tocare for himand escaping him out from
these life-limiting conditions. This essay will provide an evaluation of the ethico-legal and
clinical issues of this case study. This will also establish some goals of palliative care and
describe about palliative assessment tool, communication and pharmacological issues and
patient nurse relationship.
Discussion:
The end of life carestrategy endorses high quality care for patients during the end of their life.
It focuses on raising public awareness with respect to incidence of death. In the given case
study, Tom hadreturned from his country to hospital for end of life care due to further
deterioration of his health condition. He was suffering from advanced lung cancer with
multiple metastasis. Recently he was experienced a severe pain and trouble in breathing. His
family was concerned and worried about his poor health condition. One of the nurse named
Sarah suggested some pain reliever but he refused to take this. He mentioned that his aunty

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Joyce after taking morphine became drowsy, lost her ability to speak and died the next day.
Later on, the nurse made her understand the factthat small amount of Morphine will help him
to manage his pain and breathing without making him drowsy. After his consent, her
daughter Carina arrived to hospital, claims herself as the power of attorney. Power of attorney
is a legal document that has been given to one person in the power to perform or act on behalf
of another person. This is widely used in case where a person is disable, may be due to poor
health condition and cannot make decision by his own (WALES2015). In this case study his
daughterwanted to stop the use of morphine, and told nurses to change this to something
better. Jimmy, who is the son of Tom, confirms that his mother is Tom’s enduring guardian.
An enduring guardian is someone whom the patient can appoint for making lifestyle, health
and medical decision on hisbehalf. An enduring guardian may also decide the place the
patient should live, what services to be provided and what medication to be taken (Tsohet al.
2015). Both enduring guardian and power of attorney are complementary documents that are
made separately or sometimes together. Patient will decide whom he wants to have the
authority.He also mentioned that his father did an advanced care paper that take priority over
enduring guardian.This pointed out legal and ethical issues in decision-making.The process
of advanced care planning help to plan medical care in advance based on the assumption that
patient will become too sick to make his own decision (Carter et al.2016). This scenario
results in a conflict and a matter of obvious distress to the rest of Tom’s family along with
Tom’s health condition.
Clinical issue that raised was based on the usage of Morphine that is an opioid
analgesic. Tom was suffering from pain and nurse suggested him to take a pain reliever like
morphine. His daughter wanted to stop the medication due to some known side effects of
Morphine. These include shallow breathing,slow rate of heartbeat, stiffness in muscle, trouble
in swallowing, appearance of seizure, drowsiness and severe weakness (Mangliket al. 2016).

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Moreover, Tom is suffering from advanced lung cancer and these side effects will affect him
more in future.
There is an important role in shared decision-making. This enables a healthcare
professional to participate jointly in making decision based on health. It is used as a
trademark for good and healthy clinical practice. This is most applicable to the case where
there is uncertainty in choosing the right option (Hoffmann and Tooth2017). In case of Tom,
this shared decision making process had imparted a positive effect in his treatment. They
consult jointly and discuss about the benefits and harm of the medicine considering the value
of patient, his preferences and circumstances.
Palliative care service generally addresses the issues related to physical,
psychological, social and spiritual factors of a patient’s disease. Palliative care community of
Australia acknowledges the sensitivity of end of life care. It also identifies the necessity of
cultural awarenesswhile giving services to aboriginal people(Rogers and Student2017). In
this case study,health professionals should understand the needs of Tom and increase
knowledge of palliative care among them. Several factors play a role in accessing palliative
care services among aboriginal patientor their family carer. One of the main issue is
palliative care professional are non-indigenous. This often serves as a difficulty for aboriginal
patient to develop a trusting and personal relationship with healthcare professionals.
Goals involve in developing this care service firstly includes communicationswith the patient
(Bernacki and Block 2014). Before introducing all the facilities to them, health care
professionals should make possible face-to-face interactions withTom as well as with his
family carer. While making contact, health professionals should be aware of the Tom’s
preferences about the mode of contact. Second goalis to discuss regarding care management
(Schenkeret al2015).This will discuss about who will take in the role to provide care to their

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health in detail. Care should be well timed and should be delivered in a co-ordinate fashion.
Another goal is to be flexiblewhile giving services. Services should be flexible in terms of
borders and boundaries applied to those programs. Last goal is to build relationship among
palliative care service professionals and Tom along with his family members in order to
reduce barriers for accessing proper care.
Patient’s Goals of care determination is the crucial principle for palliative care
services.The course of action to be taken also follows a goal-care plan.First goal of care is
creating an environment that has privacy and minimal level of interruptions. This will enable
health professionals to listen patient properly all through the palliative care process.Second
goal taking actionto explore patient’s story as a whole. This will help to learn about their
priorities and values. Third goal is to determine the knowledge of patient and family
members regarding the present health condition of the patient. Forthaction of goal-plan
should discoverwhether family and patient have any hope, worries and concern about the
disease. Professionals should enquire patient’s inner strength and family’s support systems as
well. Fifth goal is to set a realistic approach to achieve the goal. Other actions involved
making responses empathetically, arranging an alternative plan and reviewing and responding
to patient’s need periodically.
Palliative assessment give priorities to patient and his family’s issues and concerns.
Palliative care assessment tools facilitated assessment that include illness history. This is
assessed by reviewing patient’s disease course and summarizing previous treatments and
previous responses of patient. Secondly physical symptoms assessment should be done by
examining patient’s physical condition. This can be used to confirm illness history findings
and to analyze the response of patient’s goal of care. Third assessment key is the assessment
of psychological symptoms of patient that investigate about emotions, mood, cognitive state
and unresolved issues(Grassiet al. 2015). Another assessment is done on decision-making

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capacity of the patient and social assessment to evaluate various social circumstanceslike
family, community and environment that are disturbing the patient (Aounet al. 2015). One
more assessment tool is done on the basis of some spiritual factors like patient’s faith and
religious beliefs and practices. Some practical needs such as domestic and residential needs
should also be assessed to identify the change of these needs with the progression of the
disease. Communication issuesare a major problem faced during palliative care process. The
quality of this communication always require special skills of professionals. Many
professionals avoid end-of-life discussions as they are overstrained. Both health professionals
and patients are sometimes uncertain about this discussion process. Moreover, medical
professionals avoid such discussion due to high emotional impact that creates a burden for
them. They should initiate a sensitive way to make such end-of –life communication
(Galushko, Romotzkyand Voltz 2012).Pharmacological issues are also a part of initial
palliative care. Palliative treatment of symptoms like pain, anxiety, depression, restlessness
and nausea requires administration of drugs and has been reported to have significant side
effects. Patient suffering from these symptoms have to undergo medications for their relief.
Medicines like opioids, neuroleptics, corticosteroids are prescribed for initial palliative care.
These drugs have many side effects. One study with oncogenic patients was conducted where
palliative care was provided on symptoms like constipation, urinary retention, pain
andvomiting. Many side effects were observed like respiratory depression, hypotension and
drowsiness amongst patients (Taniguchi et al. 2015)These are the basic pharmacological
issues arises during palliative care.
Conclusion:
From the above discussion this can be concluded that proper approach to palliative
care can partially help Tom to overcome his ill health condition. Though some legal and
clinical issues raised in this case study yet shared decision-making process helped them to

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sort out from these issues. Lastly, some points on palliative assessment tools and goals are
mentioned that that will help health care professionals to give proper care to patients.

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Bernacki, R.E. and Block, S.D., 2014. Communication about serious illness care goals: a
review and synthesis of best practices. JAMA internal medicine, 174(12), pp.1994-2003.
Carter, R.Z., Detering, K.M., Silvester, W. and Sutton, E., 2016. Advance care planning in
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