Case Study Analysis: Palliative Care in NURS1137, Semester 2

This case study analysis examines three scenarios in palliative care. The first case focuses on a patient with renal failure, highlighting the importance of pain management, medication considerations, and the need for holistic care including advanced care planning. The second case explores cultural sensitivity in providing care to an immigrant family, emphasizing the impact of cultural differences on healthcare access and the need for patient-centered approaches. The final case involves an Aboriginal man with advanced lung cancer, addressing the challenges of discrimination and cultural misunderstandings within the healthcare system, stressing the need for culturally competent care and the ethical considerations involved in end-of-life care. The assignment emphasizes the importance of ethical practices, patient-centered approaches, and the integration of cultural sensitivity in palliative care to improve patient outcomes and quality of life.

Running Head: PALLIATIVE CARE
PALLIATIVE CARE
Name of the Student
Name of the Author
Author Note

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Case Study 1:
Based on the case study provided the hospice care for the health compromised
individual, Betty identified palliative care as the preference for her health condition.
Pain in renal failure is due to renal bone disease. This causes increase in Betty’s anxiety
regarding prescribing as well as poor recognition. Codeine, strong opioids and morphine
should be avoided in renal failure. NSAIDs should also be limited to the use of the patient.
When the GFR falls below 20ml/min the solutions of buprenorphine and fentanyl solutions
should be used. She experiences neuropathic pain for which amitriptyline should be
administered at low dosage. She also expressed being nauseated at times. Low dosage of
haloperidol and levomepromazine are the anti-emetics that are used (Rak et al., 2016). The
palliative care is provided alongside with medication and the potential care at home is vital.
Hospice care for patients combating chronic kidney disease is complex and requires essential
planning. The care should essentially be holistic and the physical, social as well as the
psychological needs of the patient should be attended to. It should be noted that the health
deterioration is progressive in nature for chronic kidney disease. The comorbidities and
complex symptoms in relation to the chronic kidney disease also requires the palliative aid.
Hospice care for the renal patients had been inadequate in the recent past but
palliative care and nursing has helped in bringing a new approach to help the patients
improve their quality of life and be valued for in their final days (Foote et al., 2016). The
advanced care management would help Betty establish their priorities and preparing her
psychologically for death and establish subsequent control over their wants and wishes.
Advanced care planning management involves the process of interaction of the patient and
their health care providers and family members as well as the other individuals regarding the
preferred decision maker of the patient and the respective care required by the patient when
the patient is unable to take their own decisions. All the needs should be carefully

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documented and informed to the clinicians and the others to aid with the conditions of the
patient. The service will be taking place at her home. It is considered that the service helps
her husband and her daughter who visits her to cope up with the present situation. This care
demonstrates ‘cultural sensitivity’ to the patients which plays a crucial role in patient
satisfaction. Her family also provides high level of encouragement and unity for Betty. This
indeed helps in decreasing the levels of psychosocial morbidity. This is because lack of
support for the patient from their family negatively impacts their well-being (Kwok et al.,
2016; Foote et al., 2016).
Case Study 2
Care provided by the nurses to the patients is very much dependent on the cultural
perspective and the attitude of the healthcare personnel. As per the case study, Lan had
migrated to Australia with her parents Yi Ming and Mei when she was 18 years of age. After
migration Lan adopted an English name Amy and got married and had a son named Erick.
Thus they experience cultural differences among the workplace culture as well as in their
home. This is affecting the care that is provided to Amy and her family when her mother falls
short of English words whenever they are trying to communicate.
a) This is due to the fact that the delivery of quality primary care to the large
population is always challenging. Sometimes the patient who are seeking health
care leads to certain delays in obtaining the medical help for the reasons that are
more related with the culture, religious belief and social practice (Barrera et al.,
2013). As Amy and her mother belong to some other religion and culture the
healthcare system of Australia was very much different for them. On the other
side Erick was quite used to the system and faced no difference in the attitude of

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the people who were involved with the healthcare system (Truong, Paradies &
Priest, 2014).
b) As the psychological well-being is very much important for maintaining the
quality of life the discrimination or challenges faced by the Amy’s family can
affect their psychological well-being. It is thus important for the healthcare system
to have a patient centered approach in order to address the challenges faced by
them and also to provide quality of care to them. This kind of treatment will be
very helpful to them as it will support them at the time when they were feeling
isolated by the healthcare system (Betancourt et al., 2016).
Case Study 3
In this case there is detailed description of an aboriginal man who suffers with
advanced lung cancer and multiple metastases. He was admitted to the hospital after he
collapsed at home and after diagnosis it was known that now his disease is at the end stage.
As he was an aboriginal he had to face certain problems while getting the healthcare facilities
and services.
a) The key needs and concerns that is faced by Tom and his family after the
imminent death in the hospital involves the discrimination that is prevalent in the
healthcare system for most of the aboriginals. It might involve cultural
misunderstandings among the healthcare staff about Tom and his family and this
would create differences between the hospital staff and the patient. As the
involvement of the indigenous healthcare workers are very less in the system there
can be a lack of communication of Tom’s family with the nurses or other staff that
can impact their cultural beliefs that has to be performed at the time of death
(Oliver, 2013; Senior & Chenhall, 2013).

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b) Tom wanted to return to his native place before death as he was aware of the
cultural differences that are prevalent in the healthcare system involving the
aboriginals. The mainstream healthcare providers might be less aware of the
special needs of the indigenous patients and the cultural supports that are available
to them as they are not linked with the indigenous healthcare system. This thus
creates a gap and is a major reason for Tom to return to his own country so that he
and his family can have the proper support that is needed by them at the time of
death (Rix et al., 2013).
Based on the learning, the healthcare strategies that has to be incorporated in the
healthcare system is the involvement of various cultural belief and cultural competency
among the nurses that are very important for addressing the patients who come from a
background that is culturally different from that of the nurses or the other healthcare staff.
They should thus take care of the fact that the nurses should be ethically sound for addressing
all the demands of the patients without hampering their beliefs and rights. These rights help
to increase the positive patient outcome and along with that reduces the burden over the
healthcare system. The involvement of the ethical factors are thus a major factor that
influences the healthcare system so it should be properly addressed in the context of
healthcare sector as the ethical dilemmas are largely unaddressed in the multicultural settings
(Chung, 2015; Senior & Chenhall, 2013).

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