Diploma of Nursing Assignment: Palliative Care and Cultural Safety

This nursing assignment delves into two key areas: palliative care and cultural safety. The assignment addresses various aspects of palliative care, including assessment, pain management, and psychosocial issues. It explores the roles of healthcare professionals, communication strategies, and advance care planning. The document also examines cultural safety, particularly concerning Aboriginal and Torres Strait Islander (ATSI) peoples, covering culturally safe healthcare environments, cultural competency, and the experiences of ATSI individuals in healthcare settings. The assignment incorporates specific questions related to both topics, providing detailed answers and demonstrating an understanding of the ethical and practical considerations within nursing practice. The document emphasizes patient-centered care, cultural sensitivity, and the importance of effective communication and support for both patients and their families throughout the healthcare journey. It also includes details on end-of-life care, including physical changes, management strategies, and ethical considerations.

Running head: NURSING QUESTIONS DIFFERENT TOPICS 1
Nursing Questions Different Topics
Name of Author
Institution
Date of Submission

NURSING QUESTIONS DIFFERENT TOPICS 2
Nursing Questions Different Topics
Palliative Approach: Assessment Task 1: Questioning
1. A caring attitude, Consideration of individuality, consent, communication, cultural
considerations, clinical context, Inter-professional care and care excellence.
2. Holistic assessment of a patient requires consideration of many parameters. These include
meeting the patient in person and not talking to them through phone or any other channel
of communication. The setting chosen for discussion should be private to prevent
disruptions and interruptions, the patient is given enough time to talk about them, sitting
down with the patient, and giving the patient a chance for a family member or a friend for
support. Proper communication skills are used to find what the patient understands and to
inform them about the whole concept of care to tell them about the medical information.
Further, the client is to be informed about future possibilities in relation to care that
include prognosis, admission into care facilities, care dynamics and options such as “do
not resuscitate orders” (Temel et al., 2010).
3. Chronic pain, dyspnoea, Medication Therapy, Nausea and Vomiting as well as
Cormobidities.
4. A. Lifestyle Modifications, Medications, Anorectal Biofeedback.
B. The steps for the administration of Syringe Driver are Selection of the site of infusion
for the insertion of the plastic/metallic Cannulae into the sites that include Anterior chest
wall, anterior abdominal wall, anterior aspects in the upper arm, and anterior aspects of

NURSING QUESTIONS DIFFERENT TOPICS 3
the thighs. Secondly, there is minimization of infection at the site of infection and thirdly
there is monitoring of the infusion. The last step entails the management of the
breakthrough symptoms (Watson et al., 2019).
C. Indications: When patients are unable to take medications orally and when there is
poor absorption of oral medicines.
Contraindications: Syringe driver should not be used when the patient is extremely
agitated and when the patient experiences chronic allergic reaction to the use of the
syringes.
D. Analgesia Indications include post-operative pain relief and for severe pain relief,
unable to tolerate oral analgesics.
Nausea indications include persistent nauseating feelings by the patient and lack of
response to nausea medications administered by the doctor.
Steroid injection indications include extreme feeling of pain by the patient and
inefficiency of other pain relief methods to relieve inflammation.
5. Palliative care for the patients requires competencies to ensure satisfaction and
improvement of patient’s quality of health. To respect the social, emotional, spiritual and
cultural needs of the patients requires that they are engaged in the healthcare process.
Listening to them and understanding their needs through effective communication,
engaging their friends or relatives during the care process. Further, the patients must
would be involved closely in the decision making process for instance in choosing the
sites for their care. Lastly, I would endeavor to implement culturally competent care by

NURSING QUESTIONS DIFFERENT TOPICS 4
understanding and working according to the cultural characteristics of the patient (Wiener
et al., 2015).
6. EN: development of patient’s plan of care, care manager coordinating the implementation
of the care plan, conducting advocacy role for the patients and their families with the
medical team, development of collaborative relationships in the palliative team, pain and
symptom management as well as physical assessment of the patient, and collection of
family and patient data based on their spiritual, social, emotional and cultural needs.
Roles of Other team members: Initial and ongoing meetings to determine needs,
concerns, goals, which treatments to pursues, etc., Prescribing treatments, medications,
and activities to manage pain and other symptoms and side-effects, Providing medical
and emotional support and guidance throughout the entire process, Allowing the
healthcare providers to focus on treatment while we ensure your comfort, Helping guide
patients and their families through the healthcare system and coordinating all medical
needs (Quill & Abernethy, 2013).
7. Psychosocial Issues include loss, financial issues, culture and Communication. The
expectation of loss in the family can cause depression and affect the health outcome of
the patient. In palliative care some of the losses are immediate while others are long term
and yet expected. It may cause grief and affect the coping of families to the disease
process adversely. Financial issues are a major cause of psychosocial issue. Palliative
care is a very expensive and resource demanding process. The burden of the disease
would especially affect families from low socio-economic backgrounds and may
minimize their accessibility to quality healthcare. The culture of the patient would affect

NURSING QUESTIONS DIFFERENT TOPICS 5
their beliefs, attitudes, values and perception of care. Hence, patients and their families
require culturally sensitive palliative management to cope with disease process well.
Lastly, communication is key during palliative care. Lack of proper communication may
cause anxiety and misunderstanding of the patient’s disease progress. Communication
should be well planned to manifest understanding of the patient’s issues and that of their
family members (Ferrell et al., 2017).
8. The communication identifies and aims to address all the needs of the patient, family and
care provider (i.e. psychological spiritual social cultural and psychological, spiritual,
social, cultural and physical issues); Also, the communication provides information
according to the patient s’ preferences (whether good or bad news); The communication
should also invites the patient to share their agenda in a conversation; Aims to
communicate the truth by means of by means of accurate essential information. The
communication should also entail the use of effective body language and emotional
aspects as well as good listening skills to respond and express views appropriately.
9. A. (I): Advance care planning is the process by which patients make decisions that can
guide their future health care, if they become unable to speak for themselves. It is based
on the ethical principle of respect for patient autonomy. Advance care plans reflect
patients’ own values and concerns, and require patients to understand their medical
condition, and also the benefits and burdens of possible treatments. They are important in
guiding decision-making at the time when a patient is too unwell to make their own
decisions, or is unable to communicate.

NURSING QUESTIONS DIFFERENT TOPICS 6
It is based on the ethical principle of Autonomy and should be respected by the medical
professionals. It is also regulated by the mental capacity Act that presupposes that
patients should be able to refuse certain treatments under certain circumstances (Temel et
al., 2010).
(II): Advanced Care Directives involves learning about the types of decisions that might
need to be made, considering those decisions ahead of time, and then letting others know
—both your family and your healthcare providers—about your preferences. These
preferences are often put into an advance directive, a legal document that goes into effect
only if you are incapacitated and unable to speak for yourself. It is a legally binding
document whose content must be respected and upheld accordingly.
B: When a patient is in the process of dying and all the impacts of medical processes are
dwindling, it is important to accept that they are dying in the first place. It is also
important to undertake a continuous assessment of their symptoms and their spiritual
needs. Also, there is need to be able to anticipate health issues before they arise for
prompt management. The patient should also be given enough time and be encouraged to
mingle with their loved ones for more emotional support (Quill & Abernethy, 2013).
10. A. Changes in breathing behavior, negative attitude towards food, preference to liquid
food content only, changes in skin color and changes in functional ability. Management
including minimizing their stress and anxiety, good body positioning, use of
pharmacology and review of the patient’s wishes regarding nutrition and hydration.
B. Hydration: Administration of clean water to the patient through a spoon, syringe and
through intravascular administration.

NURSING QUESTIONS DIFFERENT TOPICS 7
Nutrition: Administration of fluids of high nutrition value and Improving of the food
presentation and flavor to be attractive to the client.
C. Drainage or debridement may be necessary to remove slough and devitalized tissue, as
these slow wound healing and can affect the efficiency of topical antibiotics.
Antimicrobial dressings, including those that use silver technology, may be used to help
reduce bioburden.
D. Changes in pulse quality (irregular, bounding, weak, or absent), slow or delayed
capillary refill, abnormal swelling or edema, dizziness, syncope, nausea, chest pain, and
diaphoresis as well as their level of consciousness. Monitoring your patient's temperature
is also important. These are reported to the medical team and the family members.
E: Prior to patients Passing-Respecting their end of life wishes, allowing them time to
have their families, and counseling their family members and themselves as
empowerment.
After Death: Treating their body with respect and support those they loved before
death, following their death wishes, verification of their death, and professionally
preparing their body after death before handing over to the funeral director.
F: Ethical issues identified in end-of-life care include autonomous decision making
whereby patients direct care according to their preferences. Communication to the patient
regarding withholding and withdrawing of futile treatments including expected
repercussions. Further, aspects of allowing advanced directives to take effect are a major
ethical issue (Temel et al., 2010).

NURSING QUESTIONS DIFFERENT TOPICS 8
11. A. I would prepare for rigor mortis aspect by involving their family members, confirming
the manuals of the facility and the local requirements regarding preparation of the body
and respect of the cultural considerations and requests.
B. Avoiding direct contact with body fluids, wearing personal protective equipment at all
times, and increasing the level of hygiene and decontamination of surfaces.
C. Rigor Mortis, religious and cultural beliefs, legislations, policies and procedures.
D. Bereavement counseling and funeral directorate services for planning of body
disposal.
E. Supporting their wishes and assuring them that the medical team did all that was
possible to save the life. Assuring family and relatives that the patient was happy and
satisfied with the health support and care offered (Wiener et al., 2015).
.
12. A. Adaptive coping strategies to cope with stress instead of avoidance and emotional
distance. Also, Implementation of self-care techniques helps with coping, and also
communicating the feelings with colleagues and family members for emotional support.
B. Internal Support: Mental strength and preparedness, Emotional control, Experiences,
engagement in relaxation activities and prayer.
External Support: Family members, Colleagues and professional counseling.

NURSING QUESTIONS DIFFERENT TOPICS 9
Aboriginal and Torres Document: Assessment Task 1, Questioning
Cultural Safety
Q1. Culturally safe healthcare facility denotes care services that are culturally competent and
resonates with the values, beliefs and cultures of the patients. It also, entails the invitation and
accommodation of cultural expressions in the continuum of care. As such, the healthcare facility
understands the historical and social context in relation to the structural and interpersonal power
imbalances shaping health and healthcare experiences (Taylor & Guerin, 2019).
Q2. A culturally competent service takes into consideration the social, cultural and linguistic
needs of the patients while the cultural awareness is the ability to identify the patients’ cultural
needs in care and responding to them accordingly to improve their healthcare outcomes. Hence,
cultural competency and awareness are essential elements of cultural safety (Pauly et al., 2015).
Q3. Development of mutual respect between the patients and the medical professionals,
Promotion of the patients empowerment and responsibility in healthcare and lastly development
of trust from the patients about quality of care (Holland, 2017).
Q4. Mainstream services should promote the creation and development of culturally safe
environments for the ATSI people. Secondly, there is need for enhanced engagement with the
local community members towards improvement of their wellbeing and healthcare accessibility.
Lastly, there is need by the government to increase funding towards improvement of healthcare
services to the ATSI including health promotions and recruitment of community liaison
(Garneau & Pepin, 2015).

NURSING QUESTIONS DIFFERENT TOPICS 10
Q5. Some of the experiences that are likely to be experienced by the ATSI in receiving health
include racism, discrimination, marginalization from the society and forceful separation of
families by removing children from their Aboriginal families. Further, the Aboriginals tend to
experience cultural disparity and hence lack of their cultural appreciation by the medical
professionals (Repo et al., 2017).
Q6: Translators, good patient-medical professional relationship and mutual respect.
Q7. Using customer feedback forms and conducting surveys on patient satisfaction (Taylor &
Guerin, 2019)..
Q8. Health Performance Framework provides the necessary data that is used to influence policy
based on ATSI experiences on defined parameters that include health status and outcomes,
determinants of health, and health system performance.
Q9. I would allow the patient to contribute to the decision making process in healthcare. This
would include listening to their views and care preferences to guide care practice.
Q10. Cultural bias entails a belief that one culture is superior relative to others and hence
deserves differential treatment in terms of healthcare service provision.
Q11. Understand that there are cultural differences. Learn the characteristics of the other cultures
to be culturally competent as a way of delivering culturally safe care (Cai, 2016).
Q12.
At one instance, I got involved in a community initiative aimed at health promotion in the
community. I got involved with an organization that provides a lot of charity help to Africa. I
envisioned the involvement to be a noble idea. Due to curiosity I had always wanted to meet the

NURSING QUESTIONS DIFFERENT TOPICS 11
African representatives and learn their experiences and the impact of the help they receive to the
wellbeing of people in marginalized communities.
Predominantly, I had lived my life and interacted with individuals from my country and others
who shared common characteristics. When an opportunity came to interact with the Africans I
got excited and looked forward to a very interactive and fulfilling interaction. When I got to the
meeting room, I met a group of very jovial and energetic people burning with the desire to justify
the usefulness of the project. Although, the Africans could speak in English, their intonation and
language proficiency was different. Their English was affected by heavy accent from their
primary languages affecting the communication largely. Further, it was clear that they did not
care a lot about eye contact. When I got an opportunity to talk, it was clear that some of them
could not understand what I was saying. That signified a major communication breakdown. I was
forced to cut my comments half-way.
I felt a little bit embarrassed and disturbed about how best to communicate to the Africans. Later,
the senior members of the organization who had worked with the Africans for a while confirmed
that there were significant cultural differences. They confessed that during the initial stages of
the project, they could use majorly written communication. Later, they would understand the
Africans very well. The transition and development of relationship emerged due to cultural
competency of the senior officials.
From that occasion, I realized that in a multi-cultural setting one should be careful and flexible
enough to appreciate other peoples’ cultures. The need to learn other cultures is also motivated
by the fact that globalization is fast removing cultural barriers at work and in the social
environment. Global diversity is a major strength when taken positively. Moreover, in the

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medical profession, one may be invited to promote the quality of health anywhere globally. Lack
of the right attitude and mindset might affect the performance of an individual.
As such, cultural awareness and cultural competence are very important aspects of cultural safety
that must be incorporated into professional practice. I have since committed myself to respect the
culture of other individuals. When I come across individuals from different cultures, I have
learned to appreciate differences and coexist with them. This also comes against the backdrop of
the traumatic and discriminatory experiences that were faced by the ATSI in Australia. Cultural
difference is components of individual beliefs and values that they value a lot. Changing these
values and beliefs may not be easy, the only easy option is to learn to undertake and promote
cultural safety in all spheres of life.
Assessment Task 2: Case Study
a. Eye contact and need for introduction.
b. No eye contact and a formal introduction.
c. Personal space, No eye contact, building of rapport and trust, and explanation of the
procedure.
d. Seek help from an ATSI organization.
e. Securing membership of the organizations, and having the contact details like emails and
phone numbers of the organizations.