Reference no: EM133476964

Case Scenario

Sam is a 73-year-old man with late stage pancreatic cancer. Sam was diagnosed with advanced pancreatic cancer and was referred to the palliative care team. His daughter Cindy 36 years is his primary carer. Sam agreed to have support worker to come his home and assist him with activities of daily living. However, in the past he had some bad experiences and trust issues with medical people when his eldest daughter died in a car accident. Sam was a person that was always able to provide for his family and was struggling to accept that he was no longer able to do this now and, in the future. Sam gradually built a relationship with the palliative care support worker who was able to assist him seek counselling.

When support worker approached Cindy, she verbalized she afraid about future when her father's condition will be deteriorated. Reported not being able to sleep at night and continuous anxiety. The Support worker was also able to consult with the palliative care social worker to establish carer support for Cindy.

After a few months the support worker was visiting regularly to assist Cindy in the care of her father's activities of daily living and she noticed that Sam's pain medication was not managing his pain and reported this to the palliative care nurse. The support worker implemented strategies that Cindy could do to improve management of her father's pain. All of these support needs were documented in the individualised care plan and reviewed for effectiveness and changes to planned outcomes.

As Sam's condition deteriorated the palliative care team started to discuss with him where he would like to die and what things he would like to see happen after his death. Sam stated that he did not want to be resuscitated when his heart failed or any medical intervention to prolong his life and that he wanted to have his favourite football club jersey on when he was cremated. This was recorded and documented in his advance care directive decision and verified by authorised personnel. Sam wanted to be at home for as long as possible but wanted to go to the hospice for his last few days as he did not want to die at home in front of his children and did not want them to visit him at the hospice. Cindy is very upset about it. The support worker could not make decision on what is best for both Cindy and Sam. The support worker thought she was doing what was best for Sam and Cindy as she encouraged Cindy to request Sam's permission to allow her to be with him until he died even though this was not his preference. He died peacefully three days later with only his daughter Cindy by his side.

The palliative care social worker met with Cindy and the younger children the day after Sam's death.

Bereavement support from the palliative team will continue for as long as needed but at present the family are doing relatively well, slowly coming to terms with Sam's death, all knowing they followed his wishes, did all they could to support him and were with him when he died. Bereavement support was also offered to the support worker as she was closely involved with the family throughout the course of Sam's illness and the only person he really trusted.

1. Some of the ethical issues that may arise while working in palliative care? How can support worker respond to those issues? (PC 6.3)

2. What are the five stages of grief? Describe them briefly. (KE4)

3. What are the issues around nutrition and hydration in palliative care? (KE 7)

4. What is advance care directives? Why is it important in palliative care? (KE5)

5. Following are the common care issues at the end stage of life. How can you as a support worker assist client to meet their needs and promote their comfort and quality of life? Pain, dyspnea, dysphagia, anxiety and incontinence

Pain

Dyspnea (Difficulty with Breathing)

Anxiety

Dysphagia (Difficulty with swallowing)

Incontinence