NURS6711 Palliative Care Practice

Introduction

To add quality life to a patient who is nearing the end of life, the duty of a physician or any healthcare personnel should be communicating with the ailing elderly man or woman and the family, see what goals and the priorities they have and then come up with a plan of care that meets those goals (Stone, 2018). This task discusses by critical thing, the different interventions that a physician should apply in a palliative care for an elderly sick man and his sick wife. To ensure that the quality of life is maintained even towards its end, the family cannot be left out of the care for them.

Goals

Short Term Goals

The first goals and that one I have mentioned is enabling Wilf to have the best quality life (Stone, 2018). To achieve that, as the physician, I should ensure that he lives a life free of pain and weakening the symptoms of her diseases. Considering Wilf medical diagnoses in the past, seems he has had a lot of challenge with heart related diseases; hypertension, mild COPD and PH. Osteoarthritis leads to pain at the joints and that needs to be contained (Sibley, Thompson, Carter & Hurley, 2018). These could lead to a poor quality life considering that his wife Mavis is now ailing and cannot help him like in the past, though she really want to. I should therefore ensure that Wilf’s burdensome symptoms are relieved by giving the best medication. This goal is specific to my discipline as it requires containment of the above mentioned diseases through practices like medication and professional advice.

The second goal should be preventing sudden death, considering the seriousness of Wilf’s condition; with several heart diseases and weakness from Osteoarthritis. Failure to address illnesses with caution could mean unexpected death (Pitcher et al., 2016). The physician, therefore, has a duty of advising Wilf to strictly adhere to the medicine’s prescription and safety now that the wife is not as healthy. I should emphasize on the consequences that come with failure to take medicine as per guidelines. These combined efforts can help keep Wilf alive for a longer time (Arcand, 2015).

Long Term Goals.

Smoking is completely dangerous for Wilf’s health especially because of the heart diseases (“Smoking at End of Life: Does it Really Matter? 2018). For that reason it is a duty of the physician to ensure that Wilf completely stops from this behavior. Considering that Wilf has been so adamant not to stop the behavior, it will really take me a hard time. I should explain and even show Wilf some of the cases of people who have succumbed because of smoking related diseases (Ouyang et al., 2017). I should also advise him that smoking predisposes him to a lung and heart cancer risk. I would also tell him that he really wants to continue doing the things that he likes then he must sacrifice the smoking to have that happy lifestyle. And since smoking is an addiction, stopping requires time. This means I will have to enroll him in a long term rehabilitation program.

The other goal should be helping Wilf psychologically It has been reported that, he has become so forgetful, gets angry quickly and is easily frustrated. Anger and frustration are symptoms of cognitive impairment disorder which he is suffering from (Carlozzi et al., 2017).These are anxiety related symptoms. Forgetfulness requires memory exercises’ and that’s a long term activity. Frustration and anger should be handled using the best practices like telling Wilf to keep happy and accept the fact that he is ill. Having that positive mind and mood is important for philological healing and it favors also the bodily health. Being physiologically healthy will mean that Wilf can take medicine with ease and positivity and that he will enjoy engaging in other simpler activities than those of the past (Carlozzi et al., 2017). It is not good for his health to continue with very physical activities like gardening and the physical lawn bowl games.

What to consider for Mavis’ support

The first support for Mavis should be helping her cope with hypertension (PH). Hypertension or high blood pressure is a serious disease and can reduce greatly Mavis’ support for Wilf (Stephens, 2018). Mavis has actually been advised to slow down; meaning to engage in more physical activities when serving her husband to facilitate her body improvement. For that reason, I should ensure that Mavis takes the medication, engages in regular exercises like walking and jogging, and reduces stress (Barnett & Neves, 2018; Stephens, 2018). That is what will allow her to recover and be able to support her husband.

Secondly, I should advise Mavis to consider getting a house help and a gardener to assist in her care and that of her husband (Aikins & Apt, 2016). A house help will be very important in as far as hygiene and proper diet is concerned. She can also help both Mavis and Wilf in taking medicine or if need be when an emergency come; maybe one of them is very ill. The house-help would assist in all tiresome duties within the house and therefore, Mavis does not have to struggle considering that she has PH and is the principle carer for Wilf.

The recommendations made above on the long-term and short-term goals for Wilf indirectly support Mavis. Since Mavis is greatly concerned about the welfare of her husband, it will be very great support if the physician chips in to ensure that the goals mentioned are achieved. Since we presume that Mavis being the principle carer for Wilf and Wilf being entirely dependent on her, it will be a great relief for Mavis having someone taking care of Wilf’s health. That way, she does not have to be worried of her husband condition so much but will help her in focus on improving her health.

Mavis as the caregiver needs psychological support too (Hudson et al., 2012). It is definitely not easy for her being sickly and her husband the same. It is reported that Mavis is fearful of losing Mavis and that can be traumatizing. During this hard time, supporting Mavis with words of encouragement and in helping her find happiness is also very important for her psychological health (Thomas, Hudson, Trauer, Remedios & Clarke, 2014). Mavis should be advised to engage in simple activities that make her laugh together her husband. Activities that ease anxiety, stress and frustration from disease will ensure that her hypertension is contained and does not lead to even worse conditions like heart attack, stroke among other disorders (Boltz, Chippendale, Resnick & Galvin, 2015). They will also help reduce the fear of losing Wilf or even be like the best moment towards the end of life for Wilf or both of them.

As the physician, I should have an appointment with Mavis and Wilf’s children (David and Jenny). It is good that it is reported that both love their parents and have been supportive in the past. They have also recently proved that they really want to help towards the condition of their parents. That way, the children will not hesitate to get a house-help for Mavis and Wilf or even consider taking both of them and living with them. If not that, I should emphasize that they pay them random visits to look how they are faring health-wise. I should emphasize on the importance of a family towards palliative care and end of life for the aged (Virdun, Luckett, Davidson & Phillips, 2015). I should also make them know that Mavis requires support if she really means supporting her husband, now that she is also ailing. Facilitating proper nutrition for their parents is also important for Mavis as it seems that she had been the breadwinner in the recent past.

Conversation between Family and Health Care Providers

Since most of the hospitals and healthcare environments are designed for purposes mainly on treatment and cure of diseases, it is important to consider appropriate care for patients who are towards the end of life in other environments with access to better quality life (Caswell, Pollock, Harwood & Porock, 2015). It has also been studied that there is a poor communication between physicians and relatives (Cherlin et al., 2005). An effective communication should be incorporate in a good palliative care program.

The senior clinician is the one in charge of serious conversations but lower ranks clinician can take part in practice based conversations and therefore both ranks should take care of this talk with David and Jenny (Caswell, et al., 2015). Since death is expected or may result, the most preferable candidate for this role is the senior physician. That however, should not prevent a nurse and a less senior clinician from taking part in the conversation because of their supportive roles in explaining matters to do with practice and giving clarification when needed (Caswell, et al., 2015).. The conversation often comes with bad news sometimes and it is a difficult task considering that the hospital environment is not always private plus the little time available to engage in a lengthy conversation and establish a firm relationship with them.

For this particular case, the conversation should revolve around matters like the reduced workload for Mavis which means providing a house help or taking both Mavis and Wilf to their home and living with them. This, as discussed earlier is important particularly for Mavis who has been lately identified to be suffering from hypertension and the principle carer for Wilf. The clinician should emphasize on the need of Mavis slowing down to prevent worsening of her health and that therefore requires support on household chores and garden works. The nurse should emphasize that it is even better when they live with their parents because that is a better and more efficient as far as emergencies are concerned. The grandchildren, living with their grandparents is also a psychological relief for both Mavis and Wilf. That ensures their happiness and consequently reduced stress and anxiety.

Another conversation that the physician need to consider is a little more serious as it touches on death. Wilf, because of his condition and the fact that he has been having mood swings; from anger to frustration, should not be involved in the conversation of how he wants to end his life (Hickman, Keevern & Hammes, 2015). However, Jenny and David should be asked about it since they can cope with it easier. The physician should enquire on how the two would want their father to live up to his last breath. This is also not an easy task since either Jenny or David or both of them would not be willing to have that kind of conversation. Therefore, the first thing to do is assessing whether they have wishes to discuss about death and the particular time they should do that (Caswell, et al., 2015).  The most preferable party for this conversation is the senior physician.

The rehabilitation therapy palliative care of Wilf because of his smoking behavior should also be a theme of discussion (Cortopassi, Gurung & Pinto-Plata, 2017). The clinician should explain to both Jenny and David that a better quality life will only come when Wilf completely stops smoking. The physician should also emphasize that smoking will deteriorate his condition considering he suffers from several heart diseases, puts Mavis at a risk of getting diseases too, and might also lead to additional diseases like lung cancer which is common with the elderly (Gajra et al., 2018). The doctor should emphasize that because previous attempts have all failed in stopping the smoking behavior, rehabilitation can change. The conversation should involve how Jenny and David will persuade their father in enroll to a rehabilitation institution. Emphasis, however, should be put so that the rehabilitation chosen provides care considering other health issues with Wilf.

Managing Wilf’s Safety and Interests in Decision Making

In  decisions relating to a patient’s care, the role of the clinician and the nurse is to look for other disciplines that can apply in giving that care and so that the whole treatment process is transparent (Hebert, Moore & Rooney, 2018). The decision as per a patient’s health should be ethically made (Olsen, Swetz & Mueller, 2010).

Wilf has a particular interest in smoking cigarettes, gardening and playing lawn bawls with friends. Whereas his health condition has made it difficult for him to engage in the last two mentioned activities, Wilf cannot stop smoking. But still, his health condition is not good for smoking. However, because he does not ran out of breath doing it like he does on the others he cannot stop using cigarettes. Nevertheless, the physician should understand that smoking is an addiction unlike the others and therefore it could not be Wilf’s intention to continue with the behavior but he has failed to get over it.

The best way to manage Wilf’s safety is by seeking what he has to say about his smoking behavior. I should engage him in a conversation to discuss about it and if he hints that the behavior is an addiction, then I should seek his stand about rehabilitation. That will ensure that I do not dictate his recovery. Finding out whether he has tried other means to recover is equally important.

I can also involve Mavis and the children (Jenny and David) in the decision and if Wilf cannot make a decision of his own (Holroyd-Leduc et al., 2016). I should seek the relative’s stand regarding rehabilitation therapy palliative care. I should take an advising position and not a dictating one and if I notice that the patient’s side is making the wrong approach I can only warn them. When the family wants one thing and the patient wants another, it is to consider the patient’s decision since he is the one the decisions affect most.

Conclusion

Wilf can still have a quality life if he allows to be helped. A physician’s interventions can lead to successive palliative care for Wilf. A combined effort of the healthcare team, Mavis who is the wife and the family (Jenny and David and their children) can lead to a happy end life of Wilf. Wilf should however make the difficult decision of keeping of smoking of cigarettes so that the medical intervention is not pulled back. That way, the short-term and long-term goals set at the beginning will be achieved.

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