The purpose of this project is to write a report on an episode of health care received by a patient with palliative care needs, in which I have already been involved in. It will also demonstrate my potential to meet the learning effects of the module, like the critical evaluation of the plan panorama within which carrying on, palliative or tumors services are shipped and the evaluation of the built in dynamics of service delivery, relevant in patients with palliative care needs and how it has improved the delivery of good care. Integrated care and attention is defined as "the act of making a whole out of parts; the co-ordination of different activities to ensure harmonious functioning" (Marriam Co, C & G. 1998).
In order to adhere to the rules on confidentiality and consent as explained in the Medical and Midwifery Code of professional Carry out (2008) and the guidelines of the University or college, I obtained agreement from the ward sister, to employ a patient's information in my own article. I also asked the patient immediately for his agreement, explaining the purpose of the survey and to be able to protect his anonymity, I'd change his name, not discuss the placement by name and not divulge any identifiable information about him. I've also explained he can withdraw consent at any time. Consent has been noted in the patient's records, from this point onwards I will make reference to my chosen patient as "Phil" and the area as my positioning.
The statement will be organised in parts. Section 1, will bring in the concentrate and composition of the project. Section 2, will give a brief explanation of "Phil", his problems, medical diagnosis, attention needs and who'll be involved in his attention.
Section 3, will discuss three key administration plans, relevant in the care of individuals in the palliative stage of their health problems.
Palliative good care is defined by the globe Health Company (2002) as
An approach that improves the quality of life of patients and their own families facing the challenge associated with life-threatening disorder, through the elimination and alleviation of suffering through early recognition and impeccable analysis and treatment of pain and other problems, physical, psychosocial and spiritual. (www. helpthehospices. org)
My chosen regulations are The Division of Health End of Life Health care Strategy (2008) The National Institute for Clinical Superiority (N. I. C. E) Supportive and palliative treatment services for parents with cancer plus the Liverpool Care and attention Pathway. I am assessing and contrasting the patients experience to insurance plan recommendations and exactly how they have been implemented at a local level. Regulations are detailed by Empty & burau (2007) as an action used by the government, in order to boost, prevent or prioritise to accomplish a finish goal.
Section 4, will contain a synopsis of salient items regarding the guidelines execution, highlighting where areas could be better and make any tips for future practice.
Section 2
Overview of my patient and the episode of care
"Phil" is a sixty five year old male, divorced, lives by themselves within the city and has one boy. He was diagnosed with leukaemia twelve years back in 1997. Alexander, Fawcette & Runcman (2006) illustrate Leukaemia as "a malignant disorder where excessive and extreme of proliferation immature and ineffectiveness of bloodstream cells". You will find two types, serious and long-term Leukaemia "Phil" has serious Leukaemia, Alexander, Fawcette & Runcman (2006) further talk about, Leukaemia is exceptional within the united kingdom and the occurrence can vary geographically, causation is not completely understood but exposure to radiation, chemicals, infections and cytotoxin medication may increase occurrence. People identified as having this type of Leukaemia can live for quite some time after getting treatment.
Phil's Leukaemia was indolent for several years, until 2002 when he received a span of chemotherapy (cyclophosphamide), in 2006 was given more chemotherapy (fludarabine). Then in 2008 he was treated more aggressively with an increased dose of combo chemotherapy (cyclophosphamide & fludarabine). Phil retired at the moment and had continuing to deteriorate until being admitted to the hospital in Apr 09 with a fever where he was treated with intravenous antibiotics, his health dropped further until he was accepted onto my positioning for warning sign control, however Phil changed very rapidly in to the terminal stage. Terminal level is thought as the end period of life, at this time someone's life will normally be in the last days and nights, where someone can maintain the palliative stage for calendar months or years (Kay 2003).
After the admission and assessment good care plans can be produced whereby Phil's individual treatment needs can be satisfied, Phil's problems are pain, constipation and an over-all unsettled feeling about how is boy is coping with his illness. Involved in his care would be the specialised palliative care doctors, nurses, the spiritual care coordinator and a bereavement counsellor who will support, Phil's only son, who at the moment, has taken periods of University in order to be near to his father, at the end of his life.
SECTION 3.
Policies and exactly how they are applied in the episode of care.
3. 1a Summery from the Team of Health End of Life Health care Strategy (2008)
The Team of Health End of Life Attention Strategy (2008) originated to improve requirements of care across the UK (UK) for those adults at the end stage of life. It aspires to provide frameworks that will guide our health and wellness care system placing great focus on the needs and hopes of the individual and their families. The key aims are, engaging organizations in local areas to become more aware of end of life treatment. It aims to ensure that patients getting close to the end level of life have their symptoms managed to maintain optimal standard of living. It demands the careful diagnosis of needs for folks that are nearing the end level of life, and suggests the utilization of the solo assessment process (SAP). It aims to ensure that services accessed are coordinated to provide seamless care. It aims to ensure that individuals getting close end of life are believed holistically, the alternative approach protects the physical, subconscious, social and religious needs.
The policy's main aim is good for all healthcare providers to adopt and develop the use of the Liverpool good care pathway or an equivalent. Addititionally there is great emphasis on involving and encouraging carers and households, the policy calls for the need to provide information to the carers and family about the person's condition and to support them on the practical and psychological level this is to include bereavement care and attention. The Department of Health End of Life Attention Strategy (2008)
3. 1b How the guidelines have been applied used to my patient
Phil was accepted using an version of the one evaluation process, (SAP), section 3. 36 of the insurance policy supports the utilization of this process. The SAP occurred with the physician, nurse and me, the college student nurse present. It isn't indicated in the one assessment process Instruction for Local Implementation (2002) that the doctor and nurse do this assessment along, but my positioning feel it's a far more effective system when both parties can be found and can nourish back to other members of the team, this also avoids the individual having to do it again their details again.
This posting of information is carried out by the nurse, who admitted the individual, information is passed on during end of transfer handover, where it is attended by nursing personnel and healthcare assistants. The medical staff also talks about his needs with other relevant people who'll be engaged in Phil's attention like the spiritual care and attention coordinator and bereavement councillor and family support team. Multidisciplinary working is covered in the procedures key goals, this is carried out during regular multidisciplinary conferences. Where all gatherings are in attendance that should be involved in patient treatment, during reaching decisions are made regarding who must be engaged and best means of providing good care.
Integrated health care provides patient with the best standard of care, however in order for it to work to the best result again communication and team working has to be a priority, this is supported by Barrett, Sellman & Thomas (2005) who state "the quality of care received would depend upon how effectively different specialists are a team", all these specialists write in the same patient records to share information. The Nursing and Midwifery Council (2008) state good record keeping is one of the most crucial areas of communication and boosts patient care.
Further aims are to ensure pain and hurting is alleviated through skilful sign control, this was carried out by using a combination of analgesic to alleviate his pain and also medication for constipation. Kay (2005) declares that constipation is one of the most frequent side effects of analgesics and patients should be commenced on laxatives from the outset.
Again relating to the plan key referrals, patient and family involvement and support is vital and has been integrated, through, Phil and his boy have been enlightened about his condition and their concerns attended to at all times by personnel. Phil's son is also acquiring counselling and can continue to be offered bereavement counselling after his father's death as stated in the main element recommendations. Luton (1995) expresses if patients and their own families have a knowledge that the symptoms can be handled, dignity is looked after and feel backed by personnel, are better prepared to handle the difficult and psychological time forward.
A further suggestion was to improve the account of end of life treatment. Whilst on location a group of six form students from an area school who are studying health and social attention, asked to invest some time at my placement, to improve their awareness of end of life attention which is part of the course learning.
In accordance to the policy, as well as Phil's health needs the examination also includes his cultural and spiritual needs. Phil has been going to the day centre facility adjacent to my placement, for about six months, it has been a time where he has been able to involve some social interaction away from home and has continued to be offered to attend.
The religious coordinator in addition has put in time with Phil responding to any wishes he might have or talking about his feelings regarding his health problems, he only portrayed that his kid received support which he has and he expire at my position. Although he dropped, Phil was also given the chance to access support services that could assist in him to leave prolonged mementos for his kid for example, a storage area box or characters.
My location also supports the utilization of the Liverpool Treatment Pathway as recommended in the policy and it was applied to Phil when it was visible he had come to the finish of life level. The End of Life Treatment Strategy (2008) have been perfectly carried out and my location and has considered the persons needs as well as supporting the family needs.
3. 2a Summery from the National Institute for Clinical Superiority (N. I. C. E) Supportive and palliative care and attention services for parents with cancers(2004)
The Country wide Institute for Clinical Brilliance (N. I. C. E) Supportive and palliative care and attention services for individuals with tumor (2004) advises those who find themselves responsible for the delivery of tumors care about how exactly to ensure their patients, people and carers are well backed the policy has made twenty key referrals. This consists of for example, key staff who are involved in the in the delivery of good care required in people with palliative health care needs, will oversee that the plans guidance has been applied. Patients and their families get excited about decisions about their good care and urged to make their voices read.
The policy advises that a all natural procedure should be adopted in people damaged by tumors have full support literally, emotionally, spiritually and socially. The instruction recommends that patients have access to support groups and also have help and advice regarding money or access to assist with personal needs. The direction advises that systems can be found 24 hours a day and equipment is provided without delay to aid patients to stay at home. (The National Institute for Clinical Superiority Supportive and palliative attention services for parents with malignancy (2004).
3. 2b The way the policies have been applied in practice
The guidance recommends that key staff will oversee that the insurance policies guidance is being implemented. In my own position this is overseen by the head of nursing staff, together with the introduction of medical governance to my positioning, scientific governance is a shape work that monitors attention that is provided, ensures health care is of the highest standard and is evidence based(www. dh. gov. uk). A alternative approach was followed during his good care as mentioned earlier and Phil and his boy were involved with all decisions made regarding his care and attention on introduction, yet when he became semi- conscious, although it was explained to him what care he would acquire, he was no more with the capacity of responding and all decisions were then made by nursing personnel and doctors.
Although some of the advice may have applied to Phil if he had of went home as expected on admission. His health declined so rapidly I can no longer comment on whether some of the policies recommendations were well integrated or not, yet plans were in process for Phil to have a home visit with the occupational therapist who assess his needs at home and any adaptations that might be needed.
Support from day hospice to assistance with personal care and he was to keep to visit the day centre. Day hospice is another of the large array of companies needed when providing look after patients with palliative good care needs. The team have very good human relationships between outside providers and seem to get communicated well during Phil's disorder.
3. 3a Summery of the Liverpool Attention Pathway
The Liverpool Treatment Pathway (LPC) originated by the Royal Liverpool University Trust and the Marie Curie Centre in Liverpool in 1997. Its aim is to bring the style of care used in hospices to all health care setting up. It is an integrated pathway that guilds the health care staff in providing "best practice". Its key aims are to enhance the knowledge of the process of dying also to improve the quality care, sent to patients in the last day and time of life.
The concentration of the LCP is after initial assessment, ongoing evaluation and attention after fatality. This incorporates the spiritual values of the individual, what the individual and their family understand about the illness and what arrangements have been made after fatality. Someone is commenced onto the pathway when it's decided by the multidisciplinary team that the person is dying and also have two or more signals that the team will recognise. These signs are, the patient has become bed bound, the patient is semi-conscious, the individual is only in a position to take sips of drinking water and the individual struggles to swallow tablets.
The LCP also offers help with areas such as indication control, prescribing medication which may be needed, stopping other treatments that are no more required, providing comfort for example mouth area care. This records is usually to be filled out every four hours. The policy concentration would be that the patient's symptoms are managed and four key drugs are administered (www. mariecurie. org. uk). Kay (2003) areas, that patients will receive Morphine for pain, Midazolam to regulate agitation, Cyclizine for nausea/vomiting and Hyoscine that regulates secretions or an similar medicine to the same impact by the end level of life.
3. 3b How the policy has been applied to my patient in practice
Phil was admitted for indicator control of pain, on entrance he was fully mobile, he was eating small amounts and coherent. However his health deteriorated speedily, within days and nights he needed support of two people when getting in and out of bed, over another five times he had not been eating, he could no longer talk and could not swallow his medication, as mentioned in the coverage these are the signs that he has entered the terminal level. It was decided by one of the doctors and a staff nurse that he was now in the terminal stage and the LCP should be employed. Among the doctors and an employee nurse went jointly, the doctor took the lead when explaining to Phil and his son what changes were developing. The personnel nurse stayed after the doctor left to support both Phil and his child.
My position has a leaflet describing the symptoms of the finish phases of life that was given to Phil's boy. Providing information is one of the policies main aims and as stated previously knowledge can better put together patients and their own families for the end periods of life. Phil was reassessed at this time and the LCP was now the one paperwork that was to be filled out. The LCP is an extremely structured plan that may be altered in a few ways to give a more specific approach, yet I did not see it being changed at all regarding Phil's care and attention or any other patients whilst on position.
The LCP will provide an successful checklist, however after the initial assessment I sensed the good care became simply a ticking box exercise and since Phil was now semi- conscious the only real time nursing personnel proceeded to go into his room was to provide comfort and on occasions the time got lapsed following the four hour advised time explained in the policy, this view is reinforced by Kelly (2003) who claims:
that good care of the dying may be standardised to such a degree that the truth is reduced to a flow diagram and palliative health care is simply a series of boxes to be ticked be professional good care givers.
However Taylor (2005) declares that if the LCP execution is completed by health care professional that are fully trained in palliative care and attention and the utilization of the LCP the documents may be used to its full probable.
Phil was also prescribed the suggested medications and died peacefully with his child by his part. After death health care is also a goal of the coverage and soon after he previously died a member of staff told Phil's boy that nursing personnel would clean and dress his father also asking if he had expressed any wishes and to contact his chosen funeral director, and Phil's son was presented with as much time as he wanted to spend along with his father. Before departing my location Phil's son was given the phone quantity of the bereavement counsellor. After Phil's boy has remaining the funeral director is contacted again by one of the medical staff to accumulate the body.
Conclusion
This statement has covered guidelines that are being used in people with palliative care needs, the overriding subject matter from all the procedures is, support of patients their carers and young families, the need to approach attention from a holistic aspect, within the person's physical, emotional, social and spiritual needs. For patients to be engaged in decision making and be up to date about their treatments and the good care they will get. All the policies require a high standard of good care delivery for folks with palliative treatment needs and end of life treatment. The policies try to ensure that patients approaching the end stage of life have their symptoms were able to maintain optimal standard of living until fatality.
This positioning has taken place in a palliative care product and whilst writing this part I am very aware that my location area offers a very high standard of care that applies most of the principles of each policy. The Section of Health End of Life Care and attention Strategy (2008) says that the principles of the plan should be offer to all dying patients. However, within my time spent on the ward there is only ever before one patient accepted for end of life attention that didn't have tumor, to which staff commented on why she was here. So that it seems that cancer tumor patients are part of a privileged group when achieving the end of life.
For future practice I would suggest that the LCP has a section that will require nurses to check on patients more regular, never to provide any care and attention but reassure patients and their own families their needs are being attained and staff are always readily available. I would like to see all patients with palliative health care needs be offered the same quality of health care as cancer tumor patients receive at a hospice. Yet I am aware that providing this standard of health care to all or any people would over stretch out the already limited available resources. Yet my own philosophy of health care is not influenced by money but providing the best look after my patients no matter illness.
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