Running head: HAT Task 2 1

HAT Task 2
Anita Worley
Community Health Practice
March 27, 2013
Western Governor’s University

A. Personal Perceptions As a Registered Nurse for thirteen years in an acute care hospital setting, I have tended to many dying patients. It is my personal belief that quality of life and health promotion are imperative to the care of the terminally ill patient. Personally, I am a big fan of palliative care nursing. The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with 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.” B. Strategies Improving Mrs. Thomas’ quality of life would comprise of assisting her with her increased level of pain, limited amount of emotional support, and financial concerns. Firstly, Mrs. Thomas’ physical comfort needs addressed immediately. As evidenced by the patient spending large amounts of her day crying in bed, her pain is not under control. As her nurse, I would listen to her fears about addiction, but discuss quality of life versus drug addiction. I would explain how once her pain is tolerable, she will be able to assume a more productive, engaged role in her own life. Secondly, addressing Mr. and Mrs. Thomas’ financial concerns would be my next order of business. Insufficient health care insurance or financial resources can cause excessive worry and concern for the dying patient. Depending on Mrs. Thomas’ life expectancy, she may qualify for Medicare hospice benefits that would greatly decrease their medical expenses. According to the Center for Medicare and Medicaid Services to qualify one must, “meet all of the following conditions: you’re eligible for Medicare Part A, your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less to live if your illness runs its normal course, you sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness. (Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness), and you get care from a Medicare-approved hospice program.” Medicare hospice will pay for physician services, nursing care, social work, medical supplies and equipment, physical therapy, and medications related to symptom and pain control. Lastly, Mrs. Thomas needs a social support system. Unfortunately, having lost her close female relatives and no longer being able to work, her support system has withered considerably. Social support systems can assist in reducing depression and anxiety of a dying patient. The nurse can counsel the patient on reaching out and spending time with her sons. In addition, the nurse can introduce Mrs. Thomas to various cancer support groups; therefore, expanding her social network. C. Holistic Nursing Action Plan A nursing action plan will be beneficial in preparing Mrs. Thomas and her family in light of things to come. Palliative and hospice care focuses on not only the patient, but the family as well. When making a nursing care plan, the nurse needs to involve the entire family. The palliative and hospice care plan is constantly being updated, implemented, and evaluated to meet the needs of the patient. Due to constant updating, assessment of the patient is a large part of the nursing care plan. Frequently, the nurse needs to be assessing pain, fatigue, nausea, anxiety, appetite, wellbeing, and dyspnea.

Functional ability To optimize Mrs. Thomas’ functional ability, her pain must be under control. Once her pain is under control, continue encouraging her to maintain activities of daily living (ADL). Also, inspire the renewing of her previous friendships and increasing communication with her children. Another key factor in optimizing functional ability is maintaining the patient's dignity, self-worth, and personal goals. According to The Journal of the American Osteopathic Association due to the terminal patient’s “desire to remain independent in maintaining their self-care and mobility, they may become concerned about becoming a burden to their family. Patients can slide into depression as they perceive their increased reliance and dependency on others.”
Providing Care Once a patient is too debilitated from a terminal illness, depending on the patient and family’s preference, the patient will decide between in-home hospice care or inpatient hospice hospitalization. According to the American Cancer Society, “Most cancer patients choose to get hospice care at home. In fact, more than 90% of the hospice services provided in this country are based in patients' homes.” Without a primary caregiver or when symptoms are uncontrollable, a patient will go to an inpatient hospice facility. D. Chronic Depression If a family fears a patient is suicidal, it is the duty of the community nurse to report this information to authorities. Mr. Thomas may require inpatient psychiatric hospitalization for proper evaluation of his mental status. Once Mr. Thomas’ medication regime and mental status is stabilized, the community nurse can monitor his mood. Additionally, educate the patient and her husband on the Medicare benefit respite care. Per the Centers for Medicare and Medicaid Services, “You can get inpatient respite care in a Medicare-approved facility (such as a hospice inpatient facility, hospital, or nursing home) if your usual caregiver (such as a family member) needs a rest. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but it can only be provided on an occasional basis.”

E. Sources
American Cancer Society. (2011). Hospice Care. Retrieved March 27, 2013, from http://www.cancer.org/treatment/findingandpayingfortreatment/choosingyourtreatmenttea m/hospicecare/hospice-care-settings
Centers for Medicare and Medicaid Services. (2013). Medicare Hospice Benefits. Retrieved March 25, 2013, from http://www.medicare.gov/Pubs/pdf/02154.pdf
The Journal of the American Osteopathic Association. (2013). Palliative Care: Optimizing Quality of Life. Retrieved March 26, 2013, from http://www.jaoa.org/content/105/suppl_5/S9.full
World Health Organization. (2013). WHO Definition of Palliative Care. Retrieved March 25, 2013, from http://www.who.int/cancer/palliative/definition/en/