NSG2ANB : Nursing Assignment : Patient’s Health and Wellbeing Improvem

1.In what way can a multidisciplinary palliative care team continue to support Michael and Ellen in their own home ? (Emphasis on holisitic care , consider all aspects identified in the case scenario - physical , phychological , social , spiritual) 

2. What nursing interventions can you use to assist Michael and Ellen in managing the symptoms associated with Ellen's illness and give rationales for each ? Discuss the types of assessment you would use to access symptoms and how these would/could be managed effectively. Remembering the holistic approach. 

3. As Ellen deteriorate's with her life limiting illness,discuss what would be involved in the care of the dying patient with regards to physical, psychosocial, spiritual care needs and consider what loss and grief impact this May have on Michael.

Answer:

1. Holistic care is one of the important factors associated with patient’s health and wellbeing improvement as in the nursing science, it is said that for human being, the value of whole is much more than that of the sum of fragments. Therefore, by applying holistic care, the nursing professionals are able to provide complete care with respect of physical, financial, spiritual, social and psychological aspect of care. In this case study of Michael and Ellen it has been seen that Michael is unable to take care of her wife alone and is tensed about her health condition as he thinks any accident could happen and degrade her health condition. Both of them are suffering from serious health condition which is affecting their mental, psychological social and spiritual health and hence, application of holistic care will be the best care process which can be applied in the case of Michael and Ellen so that their health condition could be improved and if not, they can lead a stable life.

Holistic care is the process, using which the healthcare professionals can affect the patient and their wellbeing deeply by implementing several aspects in the care process by understanding the need of patient. in case of Michael and Ellen, palliative care has been chosen as the part of holistic care so that understand all the needs of patients and their extent could be understood by determining the patient physical health and emotional wellbeing. While talking about the physical care, both the patients required care and healthcare interventions so that their health condition could be improved. While discussing about Ellen, she is suffering from highly severe Glioblastoma Multiforme and hence, it is causing her right side of the body affected and therefore she is not being able to use her right foot or hand, and dragging herself using her right leg. Further, she has a history of breast cancer due to which she has to go through radiotherapy every 5 years which makes her weaker day by day and hence, her health condition requires continuous support and care. On the other Michael is unable to do so because he also had heart attack few years back which affected his health condition and due to the care process of his wife he have to leave his one and sole source of income which is running in a good state to provide continuous support to his wife. Therefore, palliative care is primary and an appropriate care process using which the continuous care could be provided to Ellen and Michael so that they can improve their health condition.

Besides these, there are several psychological needs both of these patients require for which palliative care will be perfect for the situation. Michael is concerned about his wife and her health condition due to which, he is ready to quit his business and sell it to one of his employees and draw some cash so that he can provide continuous care to her. However, he is also aware of the fact that his business is the only financial support they have and without that they will not be able to survive, hence, in this situation, providing him with psychological support will help him to overcome the situation. On the other hand, the health condition of the patient is such that she is suffering from short term memory loss which is causing her to forget his family and friends. This is psychologically painful for both Michael and Ellen as they both understand the consequences of their illness. Palliative care will be helpful in making the patient calm and help him with continuous mental and physical care so that their pain could be minimized.

Besides these, there are other aspects such as the social and spiritual aspect of the holistic care. There are other care systems in which patients are considered as a machine and only their physical ailment is treated, neglecting the other three aspect of care such as the spiritual, social and mental aspect. As the patient is suffering from such critical health condition, increasing their social gathering and their spiritual needs will be able to help them with secured and peaceful mind and they will be able to relief their mental agony and pain. This will hep to increase their social growth, confidence and discipline and they will be able to understand the need of a social life to overcome their health ailments. Therefore, as per the discussion above, it is determined that palliative care will be the best healthcare need which could be used for the health, mental, social and spiritual condition of the patient as it is able to uplift their confidence and provide them with influence so that they can grow their ability and lead a healthy and stable life.

2. Holistic care approach and assessment procedure are inseparable as both of them are interconnected and require healthcare intervention that can affect the body, mind and to increase the sense of growth, discipline, dignity, hope, autonomy, vigor, therapeutic consultation and others (Khandelwal et al. 2015). In this case of Michael and Ellen, both are suffering from physical and mental ailments and hence palliative care has been suggested as the holistic care process to help them grow their abilities in every aspect. This requires an assessment process so that it could be understood that which care intervention and process should be applied to implement on their case study (Aoun et al. 2013). Hence, for physical assessment both of them will go through an A to G healthcare assessment in which airway, breathing. Circulation, disability, exposure requirement of fluids and c=glucose could be identified. Further her pain assessment also becomes important so that proper medications could be suggests and hence her medical history will be obtained. Further, Michael will also go through the A to G assessment so that his health conditions could be understood (Zimmermann et al. 2014).

The interventions which will be applied in the palliative care process for both of them especially for Ellen will be providing continuous care to her. As her right portions are being inactive she will be provided with mobility wheelchair so that she could be easily taken to anywhere at her home as she loves to roam around in her house. Further she will be supported to her activities of daily life so that she could be provided with self confidence and dignity. Her medications will be assessed and for this help of a physician will be taken so that her medications could be verified and then on the basis of prescription all the medicines will be provided to her daily (Aslakson et al. 2014). Hence, it is an important physical intervention which could be taken under the palliative care holistic approach so that the patient could be helped with their needs in the physical aspect of palliative care. Further in the patient condition, it could be clearly understood that both of them are under mental pressure and agony more than their physical needs and hence, they require mental interventions to calm their thoughts, their negative perceptions and agony. In this aspect the healthcare professionals providing palliative care to the patient and her husband should conduct an educational session with them so that they can understand their disease from a closure perspective and help the professionals to make it improved. Further they will be indulged in effective communication so that they can share their pain and agony with the counsellor who can resolve their issues by providing them with easy and applicable interventions. Harding et al. (2012) has also provided research acknowledgement to the interpersonal communication as a string intervention in influencing patients to take care of their health. Therefore, indulging in care process will be helpful in maintaining health condition of the patient. further, the patient will be provided with activities such as gardening, painting and other craft works so that while working on these activities she can be free from all the negative thinking. Michael will also be provided with counselling so that he can continue with his business as will  keep him busy and free from other negative thinking about his wife’s health and he will be able to work efficiently for the health development of his wife (Aslakson et al. 2014).

Further, to improve their social health and spirituality, they will be asked to join the local social gathers or roam in the nearest park in the evening so that some quality time in the local vicinity with neighbors can help them overcome their illness and understand the importance of social gatherings in life. In a research study by Zimmermann et al. (2014) in was mentioned by the researchers that social gathers help critically ill (physically and mentally) to understand the critical nature of society and their inner peace about their situation increases that help them to improve their health. However, in this case being health professionals their autonomy and privacy should be respected as many people are not comfortable communicating with other. Therefore, after communicating about this intervention with Michael this intervention will be applied on the patient so that they can help each other in overcoming their mental condition. Further the evaluation of these interventions will be done by assessing the health condition of the patient and their improvements. After two to three months of the application of the intervention, all the assessment tests applied before will be conducted again so that complete physical and mental health could be assessed at once (Aslakson et al. 2014).

3. The health condition of Ellen is deteriorating everyday and hence, her care process should be inclusive of health condition. There is a big impact of death in this society and the person who lose their loved one’s suffered from mental pressure grief and agony. Therefore, in the care process of Ellen who will be dying in some months, they will be provided with spiritual care and by the help of the spirituality they will be made comply with the truth of life and will be provided with the truth that death is constant for every individual and hence, provide as much affection and care they could provide to their lobed one’s so that they do not suffer from grief and agony. Therefore, this will help them to understand their condition and their pain will be decreased while going through the grief and agony. Therefore, it is the primary role of the palliative care health professionals to provide the patients with care. Further, as per the physical needs, her pain will be the first priority of the patient as she is going to leave the world in few months. Therefore, she will be asked about her needs, her desires and then for those desires required interventions will be provided to the patient. this will be the aspects which will be added to the deteriorating health of the patient Ellen and her limiting health illness. Besides these, Michael is about to leave his business so that he could provide  care to Ellen, hence he will be informed about the health condition of Ellen and will be asked to not to sell his business as after the death of his wife, he will be requiring his business to keep himself busy and active so that he can forget about his loss and pain. Therefore, in palliative care, there is a different approach for patients approaching death and aims to provide them enough mental peace so that after their death their loved one’s can spend their life peacefully.

References:

Aoun, S. M., Bentley, B., Funk, L., Toye, C., Grande, G., & Stajduhar, K. J. (2013). A 10-year literature review of family caregiving for motor neurone disease: moving from caregiver burden studies to palliative care interventions. Palliative medicine, 27(5), 437-446.

Aslakson, R., Cheng, J., Vollenweider, D., Galusca, D., Smith, T. J., & Pronovost, P. J. (2014). Evidence-based palliative care in the intensive care unit: a systematic review of interventions. Journal of palliative medicine, 17(2), 219-235.

Harding, R., List, S., Epiphaniou, E., & Jones, H. (2012). How can informal caregivers in cancer and palliative care be supported? An updated systematic literature review of interventions and their effectiveness. Palliative medicine, 26(1), 7-22.

Khandelwal, N., Kross, E. K., Engelberg, R. A., Coe, N. B., Long, A. C., & Curtis, J. R. (2015). Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Critical care medicine, 43(5), 1102.

Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., ... & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.