Reference no: EM132365516

Apply a Palliative Approach in Nursing Practice Assignment -

ASSESSMENT OBJECTIVES - This unit describes the skills and knowledge required to provide nursing care using a palliative approach in care environments such as hospitals, home and community care, hospices and long-term care facilities.

This unit applies to enrolled nursing work carried out in consultation and collaboration with registered nurses, and under supervisory arrangements aligned to the Nursing and Midwifery Board of Australia regulatory authority legislative requirements.

ASSESSMENT TASK 1 - QUESTIONING

You are required to answer all questions correctly.

Questioning:

1. List the principles of palliative care?

2. Explain how the palliative care principles are used to guide a holistic assessment of a patient.

3. Identify and list four (4) factors which are associated to the pathophysiological changes in a patient with a life limiting illness.

4. a. List the pain management strategies for constipation resulting from use of long term medication.

b. When using a syringe driver and intima sub-cut lines for pain management, identify the steps used to administer the medication.

c. Identify two (2) indications and two (2) contraindications for the use of syringe drivers in administration of pain medication.

• Indications:
• Contraindications:

d. Identify two (2) indications for using intima sub-cut lines in each of the following:

• Analgesia
• Prevention of nausea
• Steroid injections

5. In your role in caring for a patient in palliative care, provide an explanation as to how you will meet and respect their lifestyle choices, social, emotional, spiritual and cultural needs.

6. Identify the roles and responsibilities of the Enrolled Nurse (EN) and team members who are a part of an inter-disciplinary team when planning palliative care?

• The role of the Enrolled Nurse (EN) is to:
• Roles of other team members:

7. Describe four (4) the psychosocial issues in palliative care and the impact on the patient's family.

8. Identify six (6) effective and supportive communication techniques and strategies when engaging in conversations with clients.

9. Answer the following questions in relation to a patient who is in their final stages of dying.

a. Explain each of the following and list the legal and / or ethical implications of the implementation of

i. Advanced Care Planning (ACP):

ii. Advanced Care Directives (ACD):

b. Describe your knowledge of the physiology of dying when supporting the patient and family during the patients dying process:

10. Identify the management of the following situations in a patient in palliative care.

a. List the signs of respiratory and swallowing difficulties and the management strategies you would use to ensure the comfort of the patient.

b. List two (2) Hydration and Nutrition requirements of a patient during palliative care and end of life.

i. Hydration -

ii. Nutrition

c. Identify how you manage non - healing wounds of a deteriorating patient.

d. Note the signs of deterioration in a patient and who you would report these signs to.

e. Discuss how you will support the patient's dignity at end of life and after death

• Prior to the patient's passing:
• After death:

f. Describe ethical issues identified during the end of life stage of the patient.

11. Provide a response to the following questions in relation to caring for a patient after death.

a. Identify the legislation and policies and procedures to which you would refer to when managing your own roles and responsibilities in caring for a patient's body after death.

b. List the precautions you would take in caring for a patient's body after death.

c. Identify the various considerations which need to be addressed in caring for the body after death.

d. There are many support services and resources available to provide support the bereavement needs of the family4. List a minimum of two (2) types of support and / or resources you would need to have or have access to:

e. Identify the emotional support you would provide to the family, relevant to grief, loss and bereavement.

12. After all aspects of caring for the patient after death and their family members, provide a response to the following questions in regards to your-self care.

a. List the social and emotional support you would require after a patient in your care has died.

b. Identify the types of internal / external support available to support you.

ASSESSMENT TASK 2 - SCENARIO

You are required to read the following scenario mentioned below and answer all questions.

Scenario -

Ramesh is an 82-year-old strict follower of Hinduism. He has never eaten meat in his life. He was diagnosed with stage IV adenocarcinoma of the stomach and melanoma 2 years ago. Ramesh had several cycles of chemotherapy. He has Cancerous Metastasis in liver and spleen. He has severe malignant wound on his right forearm because of his melanoma. He is on daily dressing change for his melanoma wound. He is currently undergoing palliative care at the Royal Melbourne hospital General Medical Ward.

He has advanced directives clearly stating that he is for comfort care and not for resuscitation in any means if he deteriorates. Please see the attached advanced directives for further information.

Ramesh looks exhausted, tired and weak. He needs assistance with ADLs. He is on regular analgesics. Pain management plan is as follows:

1. Oxycodone 1mg / hour running in the syringe driver.

2. PRN morphine 1mg 4/24. Last given was at 6 am.

3. Panadol Osteo 600mg TDS

4. Fentanyl patch 200 mcg/ 24 hrs.

You are the EN allocated to look after Ramesh this shift. Caroline is the first year nursing student allocated to work with you this shift. Caroline mentioned that she is been here in the medical ward for 2 weeks now. She is the one who helped Mr Ramesh Naidu with his ADL's under the supervision of nursing staff. She requested to look after Ramesh again today. During handover, the night nurse stated that Ramesh appears very weak, grimaced with pain during pressure are care, refused to have dinner last night and hasn't opened his bowels for 4 days.

During your assessment you noticed that Ramesh has severe pain to left upper quadrant, when palpated he grimaced with pain. He stated that he is not hungry and refused to eat breakfast. He looked tired and exhausted. His vitals at 08:00 AM are as follows:

• HR: 118/min
• BP: 95/55 mmHg
• Temp: 36.6'C
• RR: 26/min
• SaO2: 90%

His wife looks very worried and stated that he may be constipated and it me urges to give him something for his bowels.

At 12:00 you noticed that Ramesh started to deteriorate. He started becoming less responsive, only vocalizing, making unusual noises while breathing, moving all his limbs and he started drooling saliva, started hiccupping and his conscious state began to deteriorate. His wife tried to give him some sips of water and he started coughing. You performed a complete set of vital signs on him and it is as follows:

• HR: 60/min
• BP: 85/45 mmHg
• RR: 10/min
• SaO2: 88%

During your assessment Ramesh had an episode of incontinence of both faeces and urine while his family were waiting for you outside the room.

At 12.45 pm Ramesh was examined by the doctor who promptly called a code, consequently Mr Ramesh was transferred to the ICU and placed on a ventilator with isotropic drugs for support. Meanwhile, Ramesh was attended by the palliative care nurse consultant (PNC). PNC requested you to help her while she assesses Mr Ramesh.

Ramesh wife is a witness to all that is going on. She burst in tears and cries inconsolably. Ramesh daughter came to you and said, "I know dad is deteriorating. In our culture we do special prayers during the end of life time. Can you please let us do that to my Dad?". She adds "Do you think he is suffering? Can you please make sure that he is not suffering? He is such a lovely person and I don't want him to suffer" and burst into tears. The nursing student Caroline who was with you the entire shift also started crying. You consoled and advised her to go to staff room with one of your colleagues.

At 1500 HRS, Ramesh died peacefully surrounded by family, friends and his priest.

1. Explain, in no more than 100 words the principles of palliative care as listed in question 1. How will you ensure holistic assessment to Ramesh who is on end of life cancer care.

2. What is the pathophysiology of gastric carcinoma? Identify two needs of Ramesh in this scenario.

3. a. How will you assess this pain and current Pain management plan of Ramesh?

b. Mention two strategies to reduce pain for Ramesh.

c. Ramesh has codeine induced constipation. How do you address medication induced constipation in consultation with RN?

4. Identify the following needs of this patient and explain how this can be respected by you as an EN.

5. Identify your role in this scenario and explain why is it important to work within roles and responsibilities of inter-disciplinary team when planning palliative care?

6. Explain the psychosocial impact of palliative care on Ramesh's wife and family.

7. When Ramesh's daughter approached you to discuss about their spiritual and cultural issues and needs of Ramesh, as an EN how will you handle that situation.

8. Identify two (2) effective communication techniques and two support services you may approach to provide supportive environment and care to Ramesh and his family in this crucial moment of his life.

9. Identify the signs of stages of dying in this scenario. Explain the importance of sharing that accurate information to family.

10. Describe the physiology of dying. Is it important to explain the same to Ramesh's family or carer?

11. Identify the signs of respiratory distress and swallowing difficulties in this scenario. What management strategies you will implement in accordance with Ramesh's ACD?

12. Note how you will manage the malignant wound of Ramesh in accordance with non-healing wound management strategies?

13. What are the signs of deterioration according to ACP or ACD guidelines? When and to whom should these signs be reported?

14. How do you support the dignity of this person while providing care in their end-of-life-stages as well as after death?

15. Identify and reflect on the ethical issues in this scenario. Who is the appropriate person to discuss about this issue according to organizational policies?

16. What are the legal responsibilities of an enrolled nurse when a patient dies who was under his/her care?

17. Explain the steps involved in death care/ care of body after death in this scenario. Please include standard precautions, respect, dignity, and cultural, religious, spiritual and individual customs in answering this question.

18. Define bereavement care. Discuss the support needs of the family in this scenario. What are the resources available for those who require bereavement care?

19. What sort of emotional support will you provide to Ramesh family in relation to grief, loss and bereavement?

20. As an EN, identify your own needs for self-care and support. Explain how you will implement effective strategies to sustain your social and emotional wellbeing.

21. Identify two (2) ethical implications of Advanced care planning and advance care directives. Explain how those implications can be addressed.

22. How will you encourage Carolyn in this scenario? Explain the importance of professional debriefings in the workplace.

ASSESSMENT TASK 3 - ROLE PLAY

Role Play -

Lan migrated to Australia with her parents Yi Ming and Mei when she was 18 years of age. Lan adopted the English name Amy soon after arriving in Australia. Amy married in her early 20s, had a son Erik and divorced from her husband when Erik was 6 yrs of age. Amy took on the responsibility of raising Erik with the assistance of Yi Ming and Mei.

Amy is now 59 years of age and works full time in a fruit canning factory. She has good friends from her workplace, neighbourhood and community. Amy speaks both English and her traditional language. Amy lives with her son Erik and her mother Mei, who moved in with them after her husband died 12 years ago. Amy's mother Mei is now in her 80's and speaks limited words in English.

Erik speaks English both in and outside of his home with limited ability to speak Amy's traditional language. Erik met Samantha at the engineering company that he works for; they have been dating for the past 5 months.

Recently Erik has noticed that his mother has trouble finding words and sometimes repeats herself during a conversation. He has also noticed that she doesn't seem to be able to concentrate for long and missed paying the phone bill two months in a row, which is very unlike her. Erik asked her about it but she shrugged it off, saying she has been feeling stressed from work.

1. Answer the following question

a. What information specific to Amy, Erik and Mei, would you provide to the medical interpreter, prior to the first meeting at an Aged Care facility?

2. Amy's family makes an appointment with you - Nursing Unit Manager to discuss their concerns about Amy's memory and change in behaviour and the possibility of her being admitted to an Aged Care Facility. Discuss what advice you would give them. Role play your meeting with Amy, Mei and the Nursing Unit Manager.

a. In a group of 4, nominate people to role play Mei, Amy, Erik and the NUM (the medical interpreter will be the Trainer when it is required).

b. Consider the intercultural communication principles when communicating with a person whose second language is English.

c. Outline strategies you would use to:

i. say good morning

ii. discussion about being admitted to an Aged Care Facility

d. At the end of the role play, discuss with the class, the concerns and responses identified:

i. Suggested strategies:

e. Write and submit a transcript of your conversation.

ASSESSMENT TASK 4 - SKILLS ASSESSMENT

DEMONSTRATION OF SKILLS IN SIMULATION LAB

Palliative care and end-of-life care

• One student will be the patient, the other will be the nurse
• The student who is the nurse will demonstrate the care of a patient in Palliative care and end of life care
• The trainer and Assessor will provide information as to where the patient is at for the appropriate care skills to be demonstrated

Care of deceased client (body)

• One student will be the patient (or a manikin can be used for this skills demonstration), the other will be the nurse
• The student who is the nurse will demonstrate the care of a patient once they are deceased
• The trainer and Assessor will provide information as to where the patient is at for the appropriate care skills to be demonstrated

Pain management and documentation in end stage

• One student will be the patient, the other will be the nurse
• The student who is the nurse will demonstrate the care of a patient regarding their pain management in the end of their life stage
• The trainer and Assessor will provide information as to where the patient is at for the appropriate care skills to be demonstrated

ASSESSMENT TASK 5 - PROFESSIONAL PRACTICE EXPERIENCE

The student must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

• undertaken nursing work in accordance with Nursing and Midwifery Board of Australia professional practice standards, codes and guidelines
• analysed health information and clinical presentation of 1 person to reach an accurate conclusion of possible palliative care planning and nursing interventions in consultation with a registered nurse
• provide nursing care using a palliative approach to 1 person in the workplace including performing nursing interventions with the person through the end-of-life stages and professional interactions with the family or carer.

Attachment:- Nursing Practice Assignment File.rar