...Medical Surgical floor and an Oncology floor have different management skills depending on the staff that care for these patients on a daily basis. Each floor has their own way of conducting the best possible care to the patients and the outcome is the same for each department. Making sure the patients and family have the best possible experience while in the hospital. This all begins at the lowest level employee that is employed on that particular floor. Case Study Proposal Introduction and Preparation Identify the Clinical Problem Early inception of palliative care to direct pain and symptoms offers the benefit to promote good positive life care for patients that are dealing with cancer. The avenue to provide the needs to giving the best palliative care and pain management services fluctuate congruent to the patient and their needs, resources, care giver training, and the hospital setting. This paper will help in describing the management of the Oncology unit in the clinical setting. Collective efforts, planning, support from administrators, and time are necessary in implementing the care needed for the cancer patients and their families (Marchetti, P., Voltz, R., Rubio, C., Mayeur, D., & Kopf, A. 2013). To accommodate this work established by resources, staff, and management different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment of...
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...NU 491: Concept of Palliative Care Physical & Sexual Concerns of Palliative Treatment Scholarly Paper Writing Rozina S. Rashid A diagnosis means twice a heartache, discomfort and worry for a human. When a loved one is stricken with the life threatening illness, every member of the family feels the pain. Life threatening illnesses are marked by fluctuations overtime and the individual suffering from it may experience pain and other symptoms that are not always adequately managed. The individual may have concerned and quarries but unable to ventilate it out. Their care givers often feel stress and burden as the illness progress but they have no support group to whom they share their feelings. In such circumstances, palliative care serves as an intervention to help those. World Health Organization (2012) defines palliative care as, “an intervention that improves the quality of life of patients and their families experiencing intermittent illness, with the ultimate goal being to offer pain and symptom relief, as well as spiritual and psychosocial support.” (Effiong, 2012, p. 01). In my clinical rotation at KIRAN hospital I came across a 20 years old female patient who came to the hospital for her 6th cycle of chemotherapy. 1.5 years back she was diagnosed with Ewing Sarcoma. This diagnosis has not come up in few visits, it took months because of which it was spread towards the chest-wall and the left lung thus she underwent the surgery for the removal of the tumor. Unfortunately...
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...Introduction Palliative care (PC) provides a better comprehensive health care for patients with cancer and their families. Supportive care, pain management and symptom control at the end of life are valuable and common services provided by the PC team (World Health Organization [WHO], 2002). However, there are many challenges and barriers for PC in developing countries such as: health care and public literacy about PC, opioid phobia, policies and regulations to access and prescribe opioid, limited resources and adequate education and training (Bingley & Clark, 2009). The presence of these problems plays a major role in providing suitable and accessible symptom management for many oncology patients. In Saudi Arabia, between 2007 and 2011,...
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...caring for palliative care patients?” Regina Nelson Governors State University Abstract Palliative Care Nurses are at risk of experiencing stressful situations related to symptom management and death. The aim of this paper is to critically examine the current stress nurses face caring for Palliative Care patients. Four Nursing Journals and one Psycho-Oncology were reviewed. There was strong evidence to support that nurse’s experience stress caring for Palliative care patients. Common concerns in the first study were caring for a dying patient; personal level, comfort of the patient, and mediating between patient and family. The second study reported physical and emotional health consequences for nurses who provide hospice and palliative care over extended periods of time. The third study of nursesreported job satisfaction, stressors, coping strategies, and support. The fourth study nurses had 10 themes that conceptualize their work that may enable palliative care workers to remain resilient and effectively buffer or moderate stressful effects. The fifth study reported routinization of care, lack of nursing staff’s availability for emotional engagement, frequent interruptions, quiet afternoons, upbeat and positive culture, and a matter of fact attitude surrounding death and dying ,were all the behaviors that “being with” could not create. Although the report showed nurses able to cope by not “being with” the overall impact is stress related to caring for Palliative care patients...
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...Patients' and End of Life Care: A Multidisciplinary Concept Analysis Jennifer Thompson UTA Analysis of Theories in Nursing Nurs 5327 Ronda Mintz-Binder, RN, MSN, DNP April 19, 2014 Terminally Ill Patients' and End of Life Care: A Multidisciplinary Concept Analysis With an aging population in our country we are facing an increasing number of patients’ that are coming to the end of their lives and are presenting with terminal illness. As life expectancy increases we are seeing more and more patent that are 65 year old and older in need of end of life care. Research and medical developments have provided a vast array of treatment options available to our patients’. After patients’ have exhausted all available treatment options for their disease processes they face the reality that their life is coming to an end. Patients’ near the end choose between quality of life over quantity of life. One service available to terminal patients’ is hospice care which offers palliative care to patients’ at the end of life. Health care providers must be able to face and appropriately care for patients’ with terminal illness and end of life care. At times it may be difficult for health care providers to face or present the truth to a patient that further treatment is futile and end of life care would be appropriate. Advanced practice nurses’ will face terminal illness and it is required of them to be able to sufficiently treat, manage, and discuss end of life care with these patients. It is...
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...preferences around end-of-life care Generally, Latinos often have a strong belief that living with uncertainty is an essential part of life. This mindset shows in their health beliefs and behaviors in major ways. Latino patients are more likely to believe that having a chronic disease like cancer is a death sentence. They may prefer not to know if they have cancer, and may believe that cancer is a punishment from God .Due to their mindset, Latino patients may be less likely to pursue preventive screenings and may even delay visiting a doctor until symptoms become severe. They may avoid effective therapies for cancer and other chronic diseases, especially radical new treatments and invasive procedures (Cateret, n.d). What are the challenges in ensuring those patients (or their surrogates) understand their rights and that their consent is truly informed? The article “Whenever We Prayed, She Wept,” shares the experience of Ms. C, a woman from Central America, who was diagnosed with an acute form of leukemia during her 34th week of pregnancy. Fortunately, she was able to deliver a healthy baby girl, receive chemotherapy after delivery and go into remission. Unfortunately, six months after being in remission, she had a relapse and the cancer resurfaced (Smith et al , 2009).Before being hospitalized, Ms. C lived with Mr. M and allowed him to make medical decisions for her, even though she had not legally appointed him or anyone else her health care proxy. Based on the prognosis...
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...Sedation verses Euthanasia The ethical principle of non-malefiecense is the duty to do no harm. This is promoted by doing three interventions. First intervention is avoiding deliberate harm, risk of harm that occurs during the performance of nursing actions. The second intervention is considering the degree of risk permissible. The third intervention is determining whether the use of technological advances provides benefits that outweigh the risks. The ethical principle of beneficence is the doing or active promotion of good. This is done by providing health benefits to the patients, balancing the benefits and risks of harm, and considering how a patient can be best helped. The ethical principle of Justice is the promotion of equity or fairness in every situation a nurse encounters. The two nursing implications that promote justice are ensuring fair allocation of resources, and determining the order in which clients should be treated. ("Ethical Principles," January 2011, p. screen) There are several nursing ethical arguments on Euthanasia. Those that are against mercy killing have the ethical arguments that euthanasia might not be promoting the patient’s best interest, accepting that it means acknowledging that some people are more important than others, weakening the society’s respect for the holiness of life, and arguing that if voluntary euthanasia were to become legal nationwide, then most probably involuntary euthanasia will be committed at a higher level. The ethical...
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...counseling” and eventually created his death machine and acted in his first assisted suicide ("The real jack," 2013). Prior to becoming a nurse, this author already had very strong feelings in regard to quality of life and end of life issues. Being exposed to long-term nursing home care with my grandmother, and in interactions with my parents, I formed a belief that when a person is no longer able to function independently and comfortably, there is very little value to living for living’s sake only. These early experiences have led me to a belief in strong support of patients and their families rights to make decisions on withdrawal of care, comfort measures, dignity in dying and even as far as supporting self determinate euthanasia for terminally ill patients. I believe that in this regard, people treat animals better than their loved ones. I have found it very “comfortable” and almost easy to help families through the decision making process for withdrawal of care and Do Not Resuscitate orders (DNR). Supporting families and patients in their last minutes has been immensely rewarding. I have great respect for medical professionals and the families that put their trust in those involved in palliative care and hospice. However, these belief systems have provided many challenges in my nursing career as I have dealt with many families who are unwilling to “let go” of a dying family member. The difficulty is in supporting these families as I watch the patient suffer through...
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...Palliative and Supportive Care ~2006!, 4, 399–406. Printed in the USA. Copyright © 2006 Cambridge University Press 1478-9515006 $16.00 DOI: 10.10170S1478951506060494 Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options MARIJKE C. JANSEN-VAN DER WEIDE, M.SC., BREGJE D. ONWUTEAKA-PHILIPSEN, PH.D., AND GERRIT VAN DER WAL, PH.D., M.D. Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands ~RECEIVED June 5, 2006; ACCEPTED August 27, 2006! ABSTRACT Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide ~EAS!, the extent to which the options were applied, and changes in the patient’s wishes. Methods: In an observational study, 3614 general practitioners ~GPs! filled in a questionnaire and described their most recent request for EAS ~if any! ~n 1,681!. Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option ~67%!, and applied most frequently ~79%!, together with radiotherapy, most frequently resulted in patients withdrawing their request. Significance of results: GPs include the availability of palliative options in their decision making when...
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...Bibliography The ethical considerations for euthanasia and physician assisted suicide (PAS) have been debated for decades. As this topic evolves from jurisdiction to jurisdiction, nurses must be prepared to help manage individual cases, as well as participate in shaping the end of life field. If we understand the history of practicing jurisdictions and the evolution of euthanasia and PAS, we can help develop and manage a prudent course of action. Regardless of the nurse’s personal views, this polarizing ethical issue requires a commitment to comprehending the laws of the jurisdiction and adherence to professional responsibilities. Pereira, J. (2011) Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 18, e38-e45. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/pdf/conc-18-e38.pdf The bioethics article offers an extensive body of work that empirically analyzes the effectiveness of boundaries with euthanasia and PAS. The author contends that policy dictates mandatory reporting of euthanasia in practicing countries, but warns of several “transgressions” that occur within the current procedural structure. The main body of the article provides examples and studies to fortify the significant frequency of these transgressions. The slippery slope argument is also addressed. Where by the author documents the historical progression and expansion of the inclusion criteria for those who may be legally euthanized or have PAS...
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...Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked more often to provide care to patients on their deathbeds (Puntillo et al., 2001). Deciding which ICU patients are actually dying remains an extremely inexact science, and the transition to palliative care is not one easily made. ICU mortality rates are as high as 69% (Puntillo et al., 2001);...
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...Do Not Resuscitate Orders in Pediatric Patients Ethical Issues in Healthcare Abstract Children with terminal illnesses frequently have do not resuscitate orders. Dealing with dying children, and letting them die without major intervention can be hard issues for nursing and other health care professionals to cope with, and can cause an internal ethical dilemma. The seven nursing ethical principles are discussed in regards to do not resuscitate orders, and ethical theory is applied. The ethical dilemma faced by nurses with do not resuscitate order is discussed, and how to resolve it. Do Not Resuscitate Orders in Pediatric Patients Children throughout the United States are diagnosed with terminal diseases daily. Once medical treatments begin to not further the quality of life of the child, discussions will begin with the family to consider a do not resuscitate order. A do not resuscitate order is intended to protect the patient from resuscitative efforts that are not wanted by the patient and family (Baker et al., 2010). As a charge nurse at a pediatric ventilator unit, do not resuscitate status comes into discussion frequently, and it is an uncomfortable topic for some. A do not resuscitate order on a child can cause an internal ethical dilemma for nurses. Children are seen as lively beings, and are supposed to outlive their elders. Also there are many myths surrounding do not resuscitate orders with both family members and members of the healthcare team. Some...
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...Satisfaction with Care at the End of Life Sydney Morss Dy, MD, MSc,Ã wz Lisa R. Shugarman, PhD,§ Karl A. Lorenz, MD, MSHS,§ k Richard A. Mularski, MD, MSHS,# and Joanne Lynn, MD, MA, MS,§ for the RANDFSouthern California Evidence-Based Practice Center (See editorial comments by Dr. Jean S. Kutner, pp 160–162) The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six showed a significant effect. For heart failure coordination of care, only seven...
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...Running head: CANCER PAIN MANAGEMENT 1 Cancer Pain Management Lavon R. Williams University of South Alabama Running head: CANCER PAIN MANAGEMENT Cancer Pain Management Cancer is rapidly becoming a chronic illness, and an estimated that 10 million individuals in the United States are survivors of cancer (Sun, Borneman, Piper, Koczywas, & Ferrell, 2008). According to 2008, cancer statistics from the American Cancer Society, about 2 565,650 people die in the United States from cancer every year. Approximately 1.6 million new cases of cancer are expected to be diagnosed in the United States this year (American Cancer Society, 2012). This is why the health care needs of cancer patients are unique, and many are at risk for developing late or long-term side effects and pain from their primary treatments. These long-term effects may also hinder optimal physical, psychological, and cognitive functioning for patients (Sun et al., 2008). Pain is experienced by 30% to 50% of cancer patients receiving treatment and by 70% to 90% of patients with metastatic or advanced disease. In almost every cancer-related case pain is inadequately managed due to a lack of patient and professional knowledge of optimum management (Sun et al., 2008). This paper will discuss how nurses can help provide adequate pain management in advanced cancer patients. Patient and family needs Support for the patient and family may include education and information, coping skills, counseling and psychotherapy...
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...(DNP) Projects Theses and Dissertations 1-1-2009 The Experience of African American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care Elizabeth Joy Gifford University of San Francisco, lgiffman1@aol.com Follow this and additional works at: http://repository.usfca.edu/dnp Part of the Nursing Commons Recommended Citation Gifford, Elizabeth Joy, "The Experience of African American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care" (2009). Doctor of Nursing Practice (DNP) Projects. Paper 14. This Project is brought to you for free and open access by the Theses and Dissertations at USF Scholarship Repository. It has been accepted for inclusion in Doctor of Nursing Practice (DNP) Projects by an authorized administrator of USF Scholarship Repository. For more information, please contact zjlu@usfca.edu. COMPREHENSIVE EXAM 2 Section I: Introduction Statement of the Problem Although 60% of African Americans in the United States have stated that they would want hospice care when they are dying (AARP, 2003), they only comprise 8% of all hospice enrollees (NHPCO, 2007), despite the fact that they represent 13% of the total population in this country (U.S. Census Bureau, 2008). In fact, hospice care in this nation has always been underutilized by African Americans (Connor, Elwert, Spence, & Christakis, 2008). In the San Francisco Bay Area, among Medicare-certified hospice agencies...
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