Dying Well and Living Well in Palliative Care: Case Study Analysis

This essay delves into the critical importance of 'dying well' within the framework of palliative care, arguing that a good death is as significant as a good life. It utilizes a detailed case study of Mr. Tan, a 75-year-old patient with stage 4 lung cancer, to illustrate the complexities and nuances of end-of-life care. The essay explores various aspects of palliative care, including pain management, effective communication, cultural and spiritual considerations, and ethical and legal considerations. It emphasizes the need for holistic care that addresses the patient's physical, psychological, social, and spiritual needs, while also taking into account their cultural background and preferences. The discussion highlights the role of healthcare professionals, especially nurses, in providing compassionate and informed care, and stresses the importance of advance care planning and open communication with the patient and their family to ensure a dignified and peaceful end-of-life experience. The essay concludes by reinforcing the significance of palliative care in supporting both the patient and their family during this challenging time, emphasizing the importance of preparing for death and providing comprehensive support. The case study underscores the need for interdisciplinary collaboration to deliver the best possible care and to respect the patient's values and wishes throughout their final journey.

Running head: DYING WELL AND LIVING WELL IN PALLIATIVE CARE
DYING WELL AND LIVING WELL IN PALLIATIVE CARE

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
To die well is as important as living well, Discuss this statement with a case study from
your previous working experience.
Case Study
Mr. Tan is a75 years old Chinese who is married and has two sons. His children only
make visits during festivals. He stays in a four-room HDB with wife and helper.
Previously he worked as a taxi driver. Mr. Tan started smoking at the age of 20, ten
sticks a day. He got diagnosed with lung cancer stage 4, nine months ago. Past medical
history of Mr. was a diagnosis of Diabetes Mellitus and Hypertension.
He had a right eye cataract surgery done one year ago. The due date for his left eye
cataract surgery (put on hold).Currently, the patient is bed-bound and uncommunicative.
He is presently on Morphine every 4 hourly PRN for pain and SOB. The patient got
discharged from the hospital as the family not keen for further treatment.
Introduction
Dying well is as important as living well as it involves asking the question ‘what is a
good death?'The Question is answerable through palliative care where there is the end
of life care, free from suffering, distress for families, patients, and caregivers. A good
death characterizes itself by the patient being pain-free, symptom-free and all decision
making done through effective communication. There is preparation for death,
affirmation as well as completion of the whole person. The case here involves. As in the

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
case scenario Mr. Tan who is bedbound and uncommunicative a good death for him
would be one that is pain-free and surrounded by his loved ones.
In my point of view culture together and spirituality plays a fundamental role in one's
journey through life. Health beliefs get often tied to one's cultural background, spiritual
and religious affiliation. The significance of the essay to identify how to give Mr. Tand
good care based on his spiritual and cultural association while relieving him from pain
and giving him a right end of life care.
Background Information
The world health organization (2014) defines palliative care as a strategy that assists in
uplifting the lives of the sick in quality as well as their families once faced with a disease
that is life-threatening. It gets done through the preventing as well through identification
and by identifying and assessing by pain curing together with spiritual, psychological as
reducing the extent of suffering and physical problems. Palliative care is a vital health
issue among the public as a result of the dramatic rise of aging persons in number. It
provides attention to their complex needs. It also provides relief to distressing symptoms
(Biswas, Leshabari, & Gebuis, 2015). Age appropriate care is essential while
addressing the issues of palliative care. It gives the specialists the opportunity to handle
the needs as per the lifespan.
Palliative care is essential to the patients due to their complex needs during the dying
moments. They suffer from diseases such as arthritis, and dementia which are
accompanied by a lot of pain. Significantly, it provides a team-based approach to the
needs of patients as well as their families and counseling on death in case it's needed.

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
Palliative care never intends to postpone or shorten the lifespan of patients (Beard et
al., 2016). It works better for the needs of the sick person more than the family
members.
All the healthcare service providers in the world who believe in providing holistic
healthcare have risen to realize the vital requirement of palliative health care among
aging persons. Nursing care homes offer palliative care to most of the people over the
age of 65years. These people consider the nursing homes as the best place to end their
life. Developed countries such as England and Spain as well as Australia have most of
their aging populations dying in the palliative care homes (World Health Organization,
2014).
Spirituality and Culture in Palliative Care
Culture and spirituality mark the most vital measures that define a person's values as
well as the social relation of an individual to others (Matzo &Sherman, 2010). Mr. Tan is
a Buddhist maintains his values and beliefs and spiritual stands which affect either
positively or negatively the palliative care given. Rego et al, (2016) argue that palliative
care having been practiced for a couple of years now, a basic understanding of spiritual
and cultural matters are significant when then needs and wants of a dying person
become the subject to address. Assessing the cultural background for Mr. Tan ensures
that quality palliative care gets treated him. It is essential to offer holistic care to the
adults who have cancer. Culture and spirituality of people go hand in hand. It is a
significant dimension for providing quality care. To address the needs of the patient

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
sufficiently, an interdisciplinary team is essential, and each member should actively
participate in his or her role. It has proved to be a primary strategy when dealing with
the end of life care (Smith, 1996). It is essential to respect and consider the spiritual
character of a patient because it interconnects directly with his or her life.
Nurses in all complex and straightforward environments have come to adopt these
methods of care to the aging people as they await death. The nurses are prioritizing the
issue in their planning strategies (Johnston et al., 2015). They have an essential role to
play in this approach alongside the spiritual professionals. It is perfect in nursing homes
because it provides ill people with the ability to make decisions on their health status
(Saini et al., 2016).
Effective Communication in Palliative Care
Efficient communication with the patient or his relatives is essential during the palliative
care process. Conversation is supposed to be at its best during the palliative care
process. The interface is a way of sharing information between people with the aim of
sharing ideas or clarifying issues to reduce uncertainty.
Excellent communication in palliative care aims to meet all needs of the parties involved
which include the family, relatives and the patients that are; spiritual, social, cultural
and, physical needs. It should focus on giving out information as per the patient's
preferences whether ill or good. The communication should be based on truth to ensure
accuracy. Prognosis, diagnosis, and disclosure, as well as fear of the patient's health,
include the most vital aspects communicated. The health service provider also needs to
effectively converse with the patient as well as the relatives of the patient on the disease

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
progression as well as the end of life care (Abney et al., 2014). It's the role of the health
practitioner to explain to the parties the extent of life of the patient and inquire to know
the spiritual, cultural and social basis of the patient.
The doctor should brief the patient's family with their primary style of coping with grief,
loss, and bereavement. Mr. Tan's family should be well informed on when death is
expected, and how they should deal with the loss. In this case, the patients need no
more medication, so the family is aware of presumed death. Counseling of the family
members done professionally is vital.
Cases that involve covering the patient from knowing what he or she is suffering from
need effective communication and professional handling. The way disclosure of health
prognosis is given should be well handled considering the context of the receiver of the
sad news.
In the case of Mr. Tan, the health worker should provide the family with the best
guidance for the advantage of taking him through an end of the care plan. It will ensure
the patient parts with his life with reduced pain and distress.
Pain Management
Palliative care patients are affected by total pain which includes physical, social,
physical and spiritual distress and anxiety. Aged people need palliative care because
they suffer from significant illnesses accompanied by other diseases such as arthritis,
and dementia which are accompanied by a lot of pain. Their needs at this stage are
very complex and in the case of Mr. Tan had a past diagnosis of diabetes mellitus and
hypertension. Implicative pain and distress are what Mr. Tan is going through much. He

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
is spiritually distressed, but the addressing of each dimension of stress and anxiety may
help alleviate it. Assessing and managing distress should be incorporated into everyday
practices. In cases where social distress is reported or found, it only requires subjective
measures of guidance such as education, and skills on how to cope with it. Physical
pain for Mr. Tan who has cancer which is accompanied by trauma and a lot of pain
should get managed.
Ethical and Legal Consideration in Palliative Care
Advance care planning, as well as advance medical directives, involve some of the
examples of the legal and ethical considerations in palliative care. The former is a
process where ill people plan for a time that they can't make informed decisions or they
won't be able to make any at all through a communication process. As for the case of
Mr. Tan who is unable to communicate and make informed decisions, the care involves
reflection of what he said earlier, determinations of his values and deliberation of his
wishes. ACP should also encompass between Mr. Tan, and or his relatives, health care
providers and decision makers concerning his preferences and values as well. There is
excellent evidence-based literature about the ACP, but in the case of Mr. Tan, decisions
have to be made by his loved ones on his preferences of an end of life treatment taking
into consideration his values both spiritually and culturally (Coyle & Ferrell, 2016).
Conclusion
In many circumstances, the aged may be affected by life-limiting illnesses which may be
resulting in death. During these moments, the family and the patient need a lot of care.

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
The family should be prepared to accept death as a natural life termination mechanism
and also the patient should be taken care. Instead of adopting the clinical and
diagnosis measures, palliative care is the best because it suits the needs of the patient
correctly. It gives the family of the old person with a chance to use well the remaining
time and have themselves ready for death, through the provision of spiritual,
psychological, social and physical support as well as the patient (Brugnoli, 2014).
Using the framework in the essay, Mr. Tan could get the best care for the end of his life.

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
References
Abney, L., Burks, A., Pitman, W., Taylor, J., Obert, L., & Kern, N. (2014). Effective
communication regarding advanced care planning and end-of-life care options.
Women's Health Care, 2.
Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J. P., ... &
Thiyagarajan, J. A. (2016). The World report on aging and health: a policy
framework for healthy aging. The Lancet, 387(10033), 2145-2154.
Biswas, A. K., Leshabari, K., & Gebuis, E. P. (2015). Living with family at old age.
International Journal of Collaborative Research on Internal Medicine & Public
Health, 7(10), 186.
Brugnoli, M. P. (2014). Clinical hypnosis in pain therapy and palliative care. Illinois: CH
Thomas.
Coyle, N., & Ferrell, B. R. (Eds.). (2016). Legal and Ethical Aspects of Care (Vol. 8).
Oxford University Press. https://doi.org/10.1177/1359105316664138.
Johnston, B., Larkin, P., Connolly, M., Barry, C., Narayanasamy, M., Östlund, U., &
McIlfatrick, S. (2015). Dignity‐conserving care in palliative care settings: An
integrative review. Journal of clinical nursing, 24(13-14), 1743-1772.
Lea, E. J., Andrews, S., Stronach, M., Marlow, A., & Robinson, A. L. (2017). Using
action research to build mentor capacity to improve orientation and quality of
nursing students' aged care placements: what to do when the phone rings.
Journal of clinical nursing, 26(13-14), 1893-1905.

DYING WELL AND LIVING WELL IN PALLIATIVE CARE
Matzo, M., &Sherman, D.W. (2010).Palliative care Nursing-Quality of care to the endof
life (3rd ed.).New York, Springer.
Rego, Francisca, and Rui Nunes. "The Interface between Psychology and Spirituality in
Palliative Care." Journal of Health Psychology, 2016, 135910531666413.
Saini, G., Sampson, E. L., Davis, S., Kupeli, N., Harrington, J., Leavey, G., ... & Moore,
K. J. (2016). An ethnographic study of strategies to support discussions with
family members on end-of-life care for people with advanced dementia in nursing
homes. BMC palliative care, 15(1), 55.
Smith, J W. "Cultural and Spiritual Issues in Palliative Care." Journal of Cancer Care
World Health Organization. (2014). Palliative care for older people: better practices.