Applying a Palliative Approach in Nursing Practice: Assessment Task 2

This assignment solution addresses a case study involving a patient, Ramesh, requiring palliative care due to adenocarcinoma. It covers holistic patient assessment, including physical, psychological, and spiritual needs. The solution explores pain management strategies, ethical considerations, and the stages of dying. It emphasizes the role of an enrolled nurse in providing comfort, emotional support, and practical assistance with daily activities. The document also examines communication techniques with patients and their families, bereavement care, and self-care strategies for nurses. It includes discussions on advanced care planning, ethical implications, and legal responsibilities related to end-of-life care, offering a comprehensive overview of palliative care principles and practices. The assignment references relevant literature and guidelines to support the discussed concepts.

Running Head: Assessment Task 2: Apply A Palliative Approach In Nursing Practice
ASSESSMENT TASK 2: APPLY A PALLIATIVE APPROACH
IN NURSING PRACTICE

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Table of Contents
Answer to question 1..................................................................................................................3
Answer to question 2..................................................................................................................3
Answer to question 3..................................................................................................................3
Answer to question 4..................................................................................................................4
Answer to question 5..................................................................................................................4
Answer to question 6..................................................................................................................4
Answer to question 7..................................................................................................................5
Answer to question 8..................................................................................................................5
Answer to question 9..................................................................................................................5
Answer to question 10................................................................................................................6
Answer to question 11................................................................................................................6
Answer to question 12................................................................................................................6
Answer to question 13................................................................................................................6
Answer to question 14................................................................................................................7
Answer to question 15................................................................................................................7
Answer to question 16................................................................................................................7
Answer to question 17................................................................................................................8
Answer to question18.................................................................................................................8
Answer to question 19................................................................................................................8
Answer to question 20................................................................................................................8

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Answer to question 21................................................................................................................9
Answer to question 22................................................................................................................9
Reference list............................................................................................................................10

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Answer to question 1
To ensure a holistic assessment of Ramesh, six actions need to be taken. A physical
assessment needs to be completed and potential stressors must be reviewed to assess the
psychology of the patient. Ramesh needs to be asked about his family networks and religious
belief. As mentioned by Welch et al. (2017), cognitive development and physical condition
of this kind of patient must be considered that can affect their health issue.
Answer to question 2
There are three oncogenic pathways that are deregulated in the majority of gastric carcinoma.
These are the proliferated stem cells, Wnt/beta-catenin pathway, and NF-Kappaβ. According
to the study of Lin & Gregory (2015), it is proved that interactions between these stated
pathways play an essential role in influencing behavior of disease and impacts on survival
rate of patients. Comfort care is the main need for Ramesh as he is suffering from intense
pain. Another essential need is mental support.
Answer to question 3
a. Ramesh’ pain can be evaluated by self-report of the patient. Moreover, Money & Garber
(2018) stated that behavior of patient like crying and guarding can also be analyzed to assess
pain of a patient. In addition, a pain management plan can be assessed to evaluate medical
history and dosage of analgesics and antibiotics.
b. Appropriate medicine including aspirin can be administered to Ramesh for managing pain.
Moreover, the strategy of messaging can be used to relieve pain of Ramesh. As stated by
Missen, McKenna & Beauchamp (2015), massage helps in soothing soft tissues and helps in
relaxation of the patient.

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
c. Medication-induced constipation of Ramesh can be addressed by making him consume
more fluids like water. Increasing dietary fiber, vegetables can help to address this problem of
this patient.
Answer to question 4
Ramesh needs comfort care as he is suffering from intense pain due to adenocarcinoma and
he also needs assistance in daily living activities. As an enrolled nurse, it is essential to
undertake the responsibilities of this need and help the patient to manage daily activities. In
addition, a pain management plan must be done by concerning the doctors. Moreover,
another essential need is mental support that can be provided by motivating the patient and
showing positive behavior to him.
Answer to question 5
Being and EN, this case must be handled with care. In this case, care is more required than
medicine. Meeting with team members and working collaboratively are the most important
tasks to be performed in this case. Consultation with registered nurses and doctors can help
EN to manage patient like Ramesh, who is on the end of life.
Answer to question 6
Diagnosis of chronic disease like cancer increases distress among patients and their families.
As opined by Thiemann, Quince, Benson, Wood & Barclay (2015), palliative care helps
psychologically a patient to remain active as possible until death by providing motivation and
positive influence. Moreover, it helps the family to cope up with patient’s illness by offering
a support system.

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Answer to question 7
EN needs to listen to spiritual needs and issues of Ramesh and his family. It is the duty of EN
to ensure meaningful presence at this kind of situation. Gentle touch can be considered as
effective for comforting and reassuring patients. According to Ryan & McAllister (2017), EN
must understand culture of patient to provide value to spiritual and religious needs. It is
important to communicate with them to provide proper moral support.
Answer to question 8
Honest communication technique can be adopted while communicating with Ramesh's
family, which can help to relieve the burden of difficult treatment decisions. Empathic
communication technique can be adapted for communication with Ramesh. This aspect can
help him get relief from mental distress (Tyrrell & Siddiqui, 2019). Pain management plan
and wound management on the forearm is an essential service that must be provided to
Ramesh. Facilitation of family meetings is another service that can help transparency of
treatment process.
Answer to question 9
According to DABDA model, there are five stages of dying including denial, anger,
bargaining, depression, and acceptance (Buckley, 2017). In this scenario, Ramesh first denied
having meal. This stage is clear. After that, Ramesh’s health condition deteriorates very fast
and he died. Increasing pain in limbs and his denial attitude were signs of dying. From 8:00
AM this patients started deteriorating and at 1500 hours, he died peacefully.

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Answer to question 10
During dying vital parameters like heart rate and blood pressure falls below normal level. In
the scenario, it can be seen that heart, respiratory rate of Ramesh decreased. Respiratory rate
decreased from 26/minute to 10/minute. Blood pressure also fell below normal level. During
physiological death vital systems like digestive systems become inactive. Ramesh was
suffering from constipation and lost his hunger. It is essential to describe these parameters
and symptoms to Ramesh's family, which can help them to prepare themselves mentally for
the incident.
Answer to question 11
Respiratory rate of Ramesh was decreasing gradually and at 12 pm, he was making unusual
sounds while breathing. Has had started coughing while drinking water. Ramesh has not
made ADR for appointing a person to make healthcare decisions on his behalf. EN needs to
communicate with RN and doctors for further treatment of patient who is at the end of life.
Answer to question 12
Ramesh has a severe malignant wound on the forearm that needs to be managed through
palliative care. Wound management strategies include pain management that can be done
through application of analgesics (Green et al. 2015). Those dressings need to be used that
are less traumatic and stressing while removal. Proper nutrition needs to be provided through
oral support that helps to stop spreading of the wound.
Answer to question 13
According to ACP guideline, signs of deterioration of cancer patient include the followings,
 Diagnosis of malignant wound

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
 Patient fails to perform daily activities and symptoms get worse day by day
 Spreading of malignant cells to different parts of the body
 Persistent symptoms are spotted despite treatment including optimal therapy
Answer to question 14
Emotional and spiritual needs of patient need to be addressed for supporting the dignity of
patient. Communicating with the patient and listening to their thoughts helps to understand
their emotional needs. On the other hand, spiritual needs of patients must be considered for
supporting the dignity of the person, who is dying. After death, family members of patient
must get moral support for praying for the dead person.
Answer to question 15
Patient did not want to have meal. However, EN had faced ethical issue as patient was not
giving consent for meal. It was very important to feed Ramesh for his well being. However,
medical professionals including EN need to be calmed stable-minded to provide the best care
to the patient. In this case, Caroline cried in front of patient’s family that can make them
weaker. EN needs to control emotions to maintain work ethics.
Answer to question 16
It is the legal responsibility of an enrolled nurse to convey the news of death to family
members of the patient. Moreover, nurse should communicate with higher officials regarding
the reason of death (Kelley & Morrison, 2015). This can help in preparing proper
documentation related to death. Privacy needs to be maintained and information regarding
death must be conveyed only to family members and concerned doctors only.

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Answer to question 17
The first step involved after death is verifying the death of Ramesh with the help of doctors
and certifying the death. General precautions like covering the wound and closing openings
of the body like mouth and nostrils must be taken. Proper respect must be given by cleaning
hair and dressing the deceased properly. All the catheters and drains must be capped to
prevent any leakage of fluids.
Answer to question18
Bereavement care is a formalized care and support that is provided to benefit a family for
helping them in dealing with emotional problems following loss of a beloved one. Ramesh’s
wife and daughter are crying and they want to do special prayers in front of Ramesh. Human
resources with proper training policies documents regarding bereavement care are essential
resources available to provide bereavement care.
Answer to question 19
Firstly, permission for special prayer must be given that will act as a support to the bereaved
family. Secondly, active listening technique needs to be adopted for providing other needs of
this bereaved family. Showing sympathy for the loss and asking for any required needs can
help them to cope up with the loss.
Answer to question 20
Being and EN support from team members and self-care are required for good performance.
As mentioned by Reierson, Haukedal, Hedeman & Bjørk (2017), and EN needs to meditate
on a regular basis and EN must perform light exercise daily for sustaining emotional and

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
social wellbeing. Listening to music can release occupational stress and an EN needs to be
socially active to refresh mind and thoughts.
Answer to question 21
Firstly, Advanced Care Planning (ACP) and Advanced Care Directive (ACD) allows
healthcare professionals to provide health care as per patient’s consent. Person, who take
place in ACP and ACD can release stress easily and can recover soon.
Secondly, ethical implication of these aspects includes making appropriate decision of
healthcare by supporting dignity of patients within a healthcare setting.
Answer to question 22
Caroline can be encouraged by praising for the support she has provided to Ramesh during
the care procedure. Group debriefing can be done where different other senior nurses along
with Caroline can conduct a healthy discussion to motivate her, which can help her to control
emotions. Professional debriefing helps to increase productivity of a person and helps to
control emotions.

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Assessment Task 2: Apply A Palliative Approach In Nursing Practice
Reference list
Buckley, T. (2017). End of life and bereavement care in the intensive care unit: A need for
more quality empirical research. Australian Critical Care, 30(3), 137-138. Retrieved
from:
Journal of pain and symptom management, 49(6), 1088-1096. Retrieved from:
New England Journal of Medicine, 373(8), 747-755. Retrieved from:
Nature reviews cancer, 15(6), 321. Retrieved from:
Contemporary nurse, 51(1), 27-38. Retrieved from:
Current Emergency and Hospital Medicine Reports, 6(4), 141-146. Retrieved from:
Nurse education in practice, 25, 104-110. Retrieved from:
https://www.researchgate.net/profile/Ida_Bjork/publication/316590543_Structured_de
briefing_What_difference_does_it_make/links/5c86b83d92851c831973a17e/
Structured-debriefing-What-difference-does-it-make.pdf
Ryan, C., & McAllister, M. (2017). Enrolled Nurses’ experiences learning the nurse preceptor
role: A qualitative evaluation. Collegian, 24(3), 267-273. Retrieved from:
Journal of pain and symptom management, 50(3), 335-342. Retrieved from:
StatPearls [Internet]. StatPearls Publishing. Retrieved from:
Patient related outcome measures, 8, 71. Retrieved from: