Mr. Smith is an indigenous Australian that is he belongs to Aboriginal or Torres Strait Islander population. Individuals belonging to this community do not have access to proper medical and healthcare facilities as they are discriminated from other Australian population as they are less educated and have a low socio economic status (Markwick et al., 2015).The culture of Mr. Smith will definitely influence his pain assessment in a negative manner as he is an indigenous Australian and non –indigenous nurses have a different approach of assessing pain in indigenous people due to differences in culture. The non-indigenous nurses are less sensitive to indigenous nurses as they consider them less powerful. Hence Mr. Smith will also be not able to discuss his pain freely with the nurses and the doctors due to a lack of trust among them and low self esteem. Strategies that can be employed to make sure that the pain of Mr. Smith’s is adequately addressed are proper communication with him so that he is able to describe what he is feeling.
There are various tools for the assessment of pain that can be used if he is feeling discomfort. He should be treated empathetically and with courteousness and should be counseled properly so that he can explain the severity of his pain. He has not met his family members that is his wife and children and is suffering from depression and loneliness. The nurses and other healthcare professionals should help him and provide psychosocial care along with palliative care so that he gets well soon.
. As a nurse, I would be quite uncomfortable towards Mr. Smith because of differences in his background and culture. To understand his experience of pain, I will have to gain knowledge about his culture such as history, language, and social life so that hi his provided an effective treatment. There are various concerns I will have to face in caring for him such as it would be quite challenging for me to understand his past history and culture in less time and will have to work to improve his psychosocial health because indigenous people have a low self esteem and are depressed because of discrimination in the society. Mr. Smith will be provided a well balanced diet as he lived on beer and baked beans with n occasional meal at the club that he used to visit with one of his friends. Palliative care will be given to him in a proper manner which is special type of care to that provides relief from both physical and mental pain and stress. It involves the collaborative efforts of various doctors, nurses and other healthcare professionals in helping the patient to manage the health issues and provide quality care (Pratt & Wood, 2015). He will be given a proper counseling and psychosocial care to get rid of emotional health like pain, anxiety, distress and low self esteem occurred due to the health issues. He will also be advised to take precautionary measures to prevent the mental and physical issues like proper rest and sleep intake, taking support and advice with other individuals who suffered with sacral abscess, counseling with a psychiatrist and sharing their feelings that will help them and make them feel positive. Since he is suffering from severe depression so he can also be advised to take have certain antidepressants that is very helpful and can make him feel good about himself.
Code of Ethics for Nurses:
The Code of Ethics for Nurses is developed for the profession of nursing practice in Australia. The code includes that the nurses in the healthcare organizations should provide quality care of nursing to all the individuals irrespective of caste, creed and religion. They should be empathetic and courteous towards their patients and should follow all the ethical values and principles in providing care to them (Halcomb et al., 2016).They should also have excellent decision making skills that will help them to promote the well being of the people.
Code of Professional Conduct for Nurses:
The Code of Professional Conduct for Nurses was proposed on 10th December, 2014.The main objective of this code is to provide guidance to the nursing professionals about their roles and responsibilities to provide care to provide care to the patients in an ethical and effective manner. It includes various values such as the nurses should maintain their dignity and their patients as well. They should provide appropriate health care services by using proper communication skills and ensure patient satisfaction (Grace, 2017).They should take consent from the patient before initiating the treatment that includes the purpose, benefits and the risks involved in a particular treatment.
The Enrolled Nurse Competency Standards involves various laws, acts and policies in relation to the nursing practice. It helps in the provision of nursing care to patients according to the policies and the guidelines of nursing practice. It provides appropriate nursing interventions to patients according to the policy of the organization.
He will be asked about his present issues such as nausea and vomiting. His body temperature, pulse, blood pressure and respiration rate will be recorded as he was suffering from breathing issues. He will also be asked about if he is experiencing pain in any part of the body for proper assessment. b. Mental and Emotional status
He will also be asked about his mental and emotional status to assess his psychological
status such as if he is still suffering from depression, anxiety, sadness, anger or frustration suc as a few questions like, Do you have pain? Are you comfortable? Do you feel down or sad?
He will be asked if he is feeling discriminated as he is an indigenous Australian that is he
belongs to Aboriginal or Torres Strait Islander population.
An Advanced Health Directive is a legal document that is also called as a living will that is used for patients informs the nurses or other healthcare professionals about how to proceed further with his treatment as he is not able to take any decisions related to his health (White et al., 2014).
A Power of Attorney is a paper document that involves the name of a person who can take decisions on the behalf of the patient when he or she is not able to take one. In the case of Mr. Smith, the nurses can contact his family members including wife and children and allow his wife to give the power of attorney in order to make decisions related to his health (Purser, 2014).
If Mr. Smith wishes to donate his organs after his death the nurse should inform the organ transplant team of the hospital. The nurses should assess him appropriately and take a written consent from him informing him about the risks involved about the procedure. After the donation of organs he should be provided proper care (Lewis et al., 2015).
5: Suggest alternative strategies (complimentary therapies) other than pharmaceutical pain management that could help Mr. Smith’s pain.
Cognitive behavioral therapy can be provided to patients that would assist in changing their behavior and attitude towards life. The main aim of this therapy is it works only on the issues and the problems and not on the causes of the symptoms faced by the patient. There are many patients who are diagnosed with various diseases and have issues in concentration, memory, thinking, multitasking, learning and organization of new ideas. These issues occur due to the psychological issues they face when they are diagnosed with a disease. Cognitive issues occur because the information is not encoded by the brain and stored in a proper manner (Ehde, Dillworth & Turner, 2014).There are also some alternative therapies that can be used for Mr. Smith to address the pain such as Aromatherapy and Massage therapy. Aromatherapy involves massage with oils and helps in providing relaxation from pain. Massage therapy improves the blood circulation in the body and can be used for Mr. Smith to lower his body pain.
Mr. Smith should be referred to a gastroenterologist in the team since he is suffering from constipation has not had his bowels opened since he was admitted to hospital. Hence, he is undergoing a feeling of discomfort. He is also suffering from mouth ulcers that occur due to constipation and stress. He should be also referred to a psychologist to cure his depression and anxiety as he has been staying alone from a long time. He should be referred to a palliative care team to provide a specialized care in order to get rid of pain and also a physician who will help him to keep a track on his physical health.
7: What support / referral could be offered to Mr. Smith’s family?
The family of Mr. Smith could be asked to visit him and can be made sure by a social worker that they will face the alcohol abuse like in the past as Smith regrets about his misdeeds he had done in the past. They can also be provided financial and emotional support by the counselors of the hospital.
The pathophysiology of Anorexia related to cancer or Cancer Anorexia Cachexia involved reduced intake of food by the patient that lowers the protein and the energy levels in the body due to abnormal metabolism. It has been reported that most of the changes in the body leading to anorexia in cancer are linked to the central nervous system (Ezeoke & Morley, 2015).He should be provided a diet rich in proteins in order to increase the energy level such as meat, eggs and milk.
The pathophysiology of ascites involves abnormal fluid sequestration because of high blood pressure in the portal veins and the lowering of circulation of the volume of blood in the body. This leads to the activation of sympathetic nervous system, aldosterone and renin in the plasma, which results in the retention of water and sodium. This mechanism comes under the underfilling theory. According to the overflow theory, the abnormal condition in the body occurs because there is no proper renal retention of water and sodium (Cavazzoni et al., 2013).He will be advised to exercise regularly, increase the level of potassium and reduce sodium or salt level in the diet, and also lower the amount of alcohol which would help in reducing the blood pressure.
Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate Medicine, 129(3), 366-374.
Cavazzoni, E., Bugiantella, W., Graziosi, L., Franceschini, M. S., & Donini, A. (2013). Malignant ascites: pathophysiology and treatment. International journal of clinical oncology, 18(1), 1-9.
Damania, D., Nandigam, M., Leuva, H., Singh, K., Siegel, R., Khan, Z., & Bachan, M. (2017). Intractable Hiccups-What Else Can We Do?. In A80-B. CASE REPORTS IN SLEEP MEDICINE (pp. A2602-A2602). American Thoracic Society.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Ezeoke, C. C., & Morley, J. E. (2015). Pathophysiology of anorexia in the cancer cachexia syndrome. Journal of cachexia, sarcopenia and muscle, 6(4), 287-302.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2016). Nursing competency standards in primary health care: an integrative review. Journal of clinical nursing, 25(9-10), 1193-1205.
Lewis, V. J., White, V. M., Bell, A., & Mehakovic, E. (2015). Towards a national model for organ donation requests in Australia: evaluation of a pilot model. Critical Care and Resuscitation, 17(4), 233.
Markwick, A., Ansari, Z., Sullivan, M., & McNeil, J. (2015). Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: A cross-sectional population based study. Social Science & Medicine, 128, 178-187.
Pratt, M., & Wood, M. (Eds.). (2015). Art therapy in palliative care: The creative response. Routledge.
Purser, K. (2014). Assessing capacity in the context of testamentary, enduring power of attorney, and advance care directive documents in Australia.
White, B., Tilse, C., Wilson, J., Rosenman, L., Strub, T., Feeney, R., & Silvester, W. (2014). Prevalence and predictors of advance directives in Australia. Internal medicine journal, 44(10), 975-980.
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