Reference no: EM133623054

Deliver care using a palliative approach.

Assessment activity 1

Palliative Care is the approach that improves the quality of life for patients and their families and friends facing the problems of life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
It has three forms end of life care, specialist palliative services and a palliative approach

1. Define a palliative approach and outline how it is different from a curative approach.

2. A palliative approach should be implemented:
a. When the client's needs are holistic and required over time, not just at the end of life.
b. When the relatives request it
c. When the maintenance of quality of life and comfort is vital
d. Both A and C

Assessment activity 2
Danielle has chronic lung disease and finds it difficult to participate in any activities that are offered to her. Her family are fiercely protective and demand that she is not bothered with requests to be involved in any activities at all. Danielle likes to attend church when she is able to, and has up until recently been attending the Irish club on a Sunday afternoon for poetry reading. She has not attended either activity for the last two weeks as she has had a chest infection and has felt too weak to participate. She is currently on antibiotics to relieve the flu like symptoms. A case conference is held to discuss Danielle's ongoing support and care needs and the families wishes are noted. You are concerned as you feel that Danielle does not have the energy to input into the case conference and you are sure that she will want to return to her activities when she is well enough. She does not have an Enduring Power of Attorney but she does have an Advanced Health Directive indicating that she wishes to undertake antibiotic therapy for chest infections, however she does not want to go to hospital to die.

Danielle has a double dose of antibiotics and is improving. She now wishes to return to her church services and poetry reading activities, however her care plan states that at the families request she is unable to do so.

1. Outline a discussion that you might have with your supervisor to assist Danielle to return to these activities against the families wishes.

2. What role would an Enduring Power of Attorney play in this decision making process?

3. You explain to Danielle that her family have requested that she doesn't attend any activities and confirm that she agreed to this during the case conference. She is annoyed that this was allowed to happen when she was so ill as these activities support her cultural and spiritual preferences and confides in you that her family are not aware that she has any religious beliefs nor that she has connected with the poetry group as she feels connected with her first husband, who was not the father of her children, and was not accepted by the rest of the family, when she hears the poetry being read. What is your response?

4. Once Danielle has confided in you about the connection with her first husband you suspect that she may be feeling some loss regarding this. You also think that the family need to be advised of her wish to reconnect with these social experiences as they have special significance to her. Outline your thoughts regarding discussion that should take place between Danielle and her family to ensure that Danielle's wishes are restored and that the information is dealt with discretely.

5. Outline communication strategies that you might use to ensure that Danielle feels comforted and heard during your conversation.

6. Outline your thoughts on ways that you might facilitate an open discussion regarding this issue between Danielle and her family, ensuring that you maintain her privacy and confidentiality

7. Danielle's Advanced Health Directive states that she wishes to have regular pain relief to ensure that she is as free from pain as possible. She talks to you about the fact that she has breakthrough pain and to control it she has an analgesic rub that the doctor has not prescribed and does not appear in her care plan. It is an over the counter medication and you know that she used to apply it herself when she was able. What would you do? why?

8. You report the breakthrough pain to the medication nurse and she says that Danielle has had her prescribed dose and cannot have anymore. You go back to tell Danielle and notice that she is grimacing and clutching the bed covers. You return to the medication nurse and she states that she is unable to do anything as she does not want to be responsible for Danielle becoming addicted to pain medication. What do you do?

9. Document the above scenario below

Danielle Johnson

10. List three types of alternative pain therapies that you might utilise.

11. Why is it important to identify and monitor the effects of pain relief?

Assessment activity 3
You are a worker at an aged care facility called Hillside. One of the people you care for is Mr Jones. Mr Jones has episodes of short term memory loss and confusion related to diagnosis of dementia. He has been living at Hillside for several years. He has regular visits from his family and also has friends visit occasionally.

Recently Mr Jones has been very unwell and was recently in hospital for pneumonia. During this time certain tests were performed and he has been diagnosed with bowel cancer in a very advanced stage. Since then his condition has deteriorated significantly and as a result his care plan is in need of reviewing. The medical specialists have told him and his family that he may only have a few months left to live.

Since he returned to Hillside he has been unable to attend the Anglican Service and this has agitated him a little. He feels out of touch with his pastor and would like to have the opportunity to be taken to a service or have the Pastor visit him.
Mr Jones has also been unable to have his meals in the dining room and is now required to be fed by a carer in his bedroom. However he is able to give himself a drink if the cup has a straw.

It takes a huge effort for Mr Jones to take showers, but he does prefer this to a bed-sponge. Mr Jones would prefer to have the choice each day depending on how he is feeling. Mr Jones also finds it difficult to read to himself and is a little annoyed at this small loss of independence. He prefers not to read rather than have someone else read his books to him. However, he still likes to play chess with his grandson who visits most weekends and has started listening to talk back radio as he says it takes his mind off what he can and can't do.

The family is worried that his dementia may worsen as he becomes more ill. Mr Jones does have a will but it is out of date. His eldest son has suggested that he take over the role of guardian so he can make the end of life choices on behalf of his father. But, Mr Jones' daughter believes that Mr Jones is still able to make his own end of life decisions and should be given the opportunity to do so.

Mr Jones and his family have had wonderful support from the medical professionals involved and have chosen to take a palliative care approach to Mr Jones' care. However some of the family members disagree on what this means and how they can be involved.
As the main worker for Mr Jones, you have been asked to work with him and his family to help ensure that a palliative approach is taken with Mr Jones

1 Outline why it is important that Mr Jones' holistic needs are considered as a component of his ongoing person centred care, not just in terms of palliative and end of life care.

2 As Mr Jones' affairs are not in order there are steps that must be taken to assure that his rights are protected. What advice would you give to the family, after discussion with your supervisor?

3 The family request a case conference to discuss their father's needs. Identify two areas of discussion that you would undertake to ensure that they understood the meaning and importance of adopting a palliative approach to care.

4 Mr Jones is visited by a friend on a regular basis. He shares with you that they have had a "special friendship" on and off since the death of his wife, and that his family is unaware of the depth of the relationship. You have heard other staff gossiping about the possibility that these two are more than friends and feel that you need to discuss this as a matter of urgency to protect both Mr Jones and his family, as you believe that it is Mr Jones right to retain or share this information from his family.
a. Who would you discuss this with?
a. You are feeling uncomfortable with the idea of the "special friendship" What do you do?

5 Why is it important to show empathy and provide emotional support when discussing issues with both Mr Jones and his family?

Assessment activity 4

Alec is a client living at home. He has a terminal illness and does not wish to die in hospital. His family are adamant that they do not want him to die at home as his wife is elderly and may not cope with the memory of his death in the house where she will be living alone. Alec's wife Alice has not expressed an opinion as every time she tries to speak one of two family members, who have very strong feeling on the matter, answer for her.

1 What would you do?

2 Alec is becoming weaker and there are signs that the end of his life is getting closer. You offer extra support in the form of hospice care however he refuses. How would you ensure that his wishes were upheld?

3 Why is it important that Alec and Alice's wishes, including changes to the care and support and cultural needs and decision making processes are clearly identified and documented on the care plan?

4 Alec has specific rituals outlined in his terminal wishes, this includes Alice assisting with the preparation of the body. Why is it important to know whether Alice is comfortable with this and that Alec has full disclosure regarding her ongoing comfort?

5 Outline two signs of Alec's imminent death and your response to the observations of these signs.

6 Outline your response to the support needs of the family after the death has occurred.

7 Maintaining the dignity of the client during the dying process and immediately after death is important. How are you able to do this?

Short answer questions

1. Outline the influence of the Advance Health Directive and Enduring Power of Attorney in your role, and the supporting care planning for the client

2. Why is it important to ensure that you are working within the policy and procedure of the service as well as your scope of practice when implementing the clients advanced care directive?

3. The changing needs of the client, and the attitudes and impact of family inputs are important at the end of life, particularly during decision making. Who should be involved in the discussion anc documentation regarding the end of life care?

4. There are schools of thought that providing pain relief to clients more frequently under a "PRN or whenever necessary" order as their pain levels increase may hasten death. What are your thoughts on this statement particularly where the Palliative Care Guidelines state that a person must be kept as pain free as possible in the palliative and terminal care stages of the life?

5. Why is it essential that you recognise your grief response and manage it during terminal care of the client, and seek bereavement care and support for your personal feelings of grief?

6. Identify two grief support services that are available to you should you require for your personal feelings of grief.

7. Kubler Ross identified five stages of grief that have no specific order. What are they?

8. Identify three alternative pain relief strategies that may be utilised during palliative and terminal care.

9. Hydration and nutritional requirements should be observed at all times during palliation in order to:
a. Assure the family that life will go on for as long as possible
b. Meet the wishes of the client under their Advanced Health Directive
c. Ensure that maximal condition and comfort of the client is maintained
d. Both b and c