NURSING 5: Analysis of Palliative Care Case Studies in Healthcare

This assignment presents a comprehensive analysis of three case studies focusing on palliative care in nursing. The cases involve patients with chronic kidney disease, mental health issues, and advanced-stage lung cancer. The analysis emphasizes the importance of patient-centered care, symptom management (including pharmacological and non-pharmacological interventions), cultural sensitivity, and the involvement of family members in end-of-life decisions. The assignment highlights the need for healthcare professionals to consider patients' cultural preferences and beliefs, providing appropriate referrals to support services. The conclusion underscores the value of understanding palliative care principles, ensuring patient safety, and adopting a patient-centered approach to achieve positive care outcomes. The assignment references several key articles related to palliative care and its application.

Running head: NURSING
NURSING
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Advancing age is associated with deteriorating physical health quality which diminishes
the overall health outcome of the elderly (Kelley & Morrison, 2015). Further, the end of life
stage is also laden with emotional insecurities that contribute to poor mental health. This paper
intends to critically evaluate the case studies of three patients who are suffering from a limiting
illness and make use of the principles of palliative care to devise an appropriate palliative care
plan. In order to devise an appropriate palliative assistance care plan a patient-centred approach
would be adapted and the holistic needs of the patient and the family members would be
appropriately addressed.
Case Study 1:
Betty is diagnosed with Chronic Kidney illness that has progressed to stage 5 and is also
affected with multiple co-morbidities that include Type II Diabetes, PVD, IHD, HT and STEMI.
Post the diagnosis of her chronic kidney illness, she has been experiencing symptoms such as
shortness of breath, lethargy, nausea and edema in her legs. Betty is aware that her illness is not
curable and that she would die soon but she focuses on current symptom management to
experience improved health outcome. Her current treatment management preference includes
symptom management of edematous legs, nausea and shortness of breath which is interfering
with her ability to swallow food or medication tablets.
The symptom management strategy for Betty would include a combination of
pharmacological and non-pharmacological intervention. In order to address shortness of breath,
the nurse practitioner would teach her breathing exercises which could help manage her
symptom (Urden et al., 2017). Further, the symptom of edematous legs can be managed by the

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nurses with the use of non-pharmacological interventions such as elevation, massage and
assisting the patient with compression stalking (Zyga et al., 2015). The symptom of nausea can
be managed by administering anti-emetic and providing oral care so as to reduce emesis and
promote improved comfort. The evidence base suggests that administration of anti-emetic can
help maintain electrolyte balance which can minimize the tendency of nausea (Zyga et al., 2015).
Key factors that should be considered while devising her preferred end of life care would
include active involvement of her family as she has a strong family network (Kavalieratos et al.,
2016). In addition to this, her culture and religious specific preferences must also be considered
while making referrals to community support services so as to enhance the recovery process
(Garneau & Pepin, 2015).
Case Study 2:
The case study suggests that Lan (English name Amy) is a 59 year old Chinese female
who has recently been experiencing problems with her mental wellness. Amy has recently been
finding it troublesome to retain her memory and feels increasingly exhausted which appears
quite unlikely of her to her son and her mother Mei. Mei had been taking care of her until the
family decides to place her within a residential care facility so as to assist Amy with specialized
care services.
Within the care facility, the multidisciplinary team involved in the care process of Amy
had been witnessing a number of cultural differences between Amy’s culture and tradition
compared to their individual culture and tradition. This is reflected from the first instance when
the worker asks the nurse about why Amy’s family brings in food for her everyday which she
does not consume and despite the provision of food within the residential care facility. The

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second instance can be sighted where the worker mentions about Amy’s mother placing a jade
below her pillow and she wearing a cross that indicated she was a Christian. The third instance
can be sighted when the Nurse assisting Amy mentions that she finds it difficult to comprehend
her native language and if her family members communicated in English, it would be much
easier and the final instance can be mentioned where the nurse questions the Doctor about the
loud grieving process of the family after Amy passes away.
It is integral to note in this context that the cultural differences between the care
professionals background and the patient’s background must be acknowledged and respected or
else it would foster disrespect which would eventually yield cultural insecurity and poorer
patient outcome (Mazanec & Panke, 2015). In addition to this, lack of a culturally competent
care service would result in loss of trust of the family members which would result in
discrimination and stigmatization that would subsequently yield poorer patient outcome.
Compromised cultural safety would trigger discrimination that would elevate the
psychological distress level of the family members of the patient and yield poorer care outcome
(Mazanec & Panke, 2015).
Case Study 3:
The third case study deals with a 55 year old Aboriginal male who is suffering from
advanced stage lung cancer. The patient was presented to the hospital after he collapsed on the
floor of the washroom. At present, Tom’s family members Cec and Jimmy are aware of the
critical illness of Tom and are aware that his days of life are limited. Their primary concerns at
this point is to ensure that Tom is psychologically and emotionally stable and that he gets to
spend his last few days in happiness. Other concerns for his family members include ensuring

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that a traditional healer is involved in the decision making process such that Tom’s health
improves and that even if her dies, his last rights are performed in accordance with the culture
specific requirements (Hui & Bruera, 2016).
Tom might want to return to his country to be surrounded by people of his community so
that he can die peacefully. Further, Tom might feel that the services being offered to him lack
cultural competence and safety and might feel comfortable in the presence of his community
members who might improve his emotional feelings and contribute to his mental wellness
outcome that would grant him strength to die peacefully.
As a healthcare professional, while dealing with a patient who follows a different cultural
belief, I would specifically consider the cultural preferences of the patient and the family
members of the patient and make appropriate referrals to support services (Ferrell et al., 2017).
Further, I would also refer a care professional to assist with care who belongs to the same culture
of the patient. This would help to ensure that the patient experiences a culturally safe and
effective care outcome.
Conclusion:
Therefore, to conclude it can be mentioned that the analysis of the case studies helped to
understand the principles of palliative care efficiently and also understand the value of ensuring
patient safety. In addition to this, the case studies also helped to understand the value of
practicing patient-centred care approach to acquire positive care outcome.

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References:
Ferrell, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E. M., ... & Stovall, E.
L. (2017). Integration of palliative care into standard oncology care: American Society of
Clinical Oncology clinical practice guideline update. J Clin Oncol, 35(1), 96-112.
Garneau, A. B., & Pepin, J. (2015). Cultural competence: A constructivist definition. Journal of
Transcultural Nursing, 26(1), 9-15.
Hui, D., & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature
reviews Clinical oncology, 13(3), 159.
Kavalieratos, D., Corbelli, J., Zhang, D., Dionne-Odom, J. N., Ernecoff, N. C., Hanmer, J., ... &
Morton, S. C. (2016). Association between palliative care and patient and caregiver
outcomes: a systematic review and meta-analysis. Jama, 316(20), 2104-2114.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England
Journal of Medicine, 373(8), 747-755.
Mazanec, P., & Panke, J. T. (2015). Cultural considerations in palliative care. Spiritual,
Religious, and Cultural Aspects of Care, 4.
Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis
and Management. Elsevier Health Sciences.
Zyga, S., Alikari, V., Sachlas, A., Stathoulis, J., Aroni, A., Theofilou, P., & Panoutsopoulos, G.
(2015). Management of pain and quality of life in patients with chronic kidney disease
undergoing hemodialysis. Pain Management Nursing, 16(5), 712-720.