Dying Well And Living Well In Palliative Care For Hypertension

Background Information

Discuss about the Dying Well and Living Well in Palliative Care for Hypertension.

Mr. Tan is a75 years old Chinese who is married and has two sons. His children only make visits during festivals. He stays in a four-room HDB with wife and helper. Previously he worked as a taxi driver. Mr. Tan started smoking at the age of 20, ten sticks a day. He got diagnosed with lung cancer stage 4, nine months ago. Past medical history of Mr. was a diagnosis of Diabetes Mellitus and Hypertension.

He had a right eye cataract surgery done one year ago. The due date for his left eye cataract surgery (put on hold).Currently, the patient is bed-bound and uncommunicative. He is presently on Morphine every 4 hourly PRN for pain and SOB. The patient got discharged from the hospital as the family not keen for further treatment. 

Dying well is as important as living well as it involves asking the question ‘what is a good death?’The Question is answerable through palliative care where there is the end of life care, free from suffering, distress for families, patients, and caregivers. A good death characterizes itself by the patient being pain-free, symptom-free and all decision making done through effective communication. There is preparation for death, affirmation as well as completion of the whole person. The case here involves. As in the case scenario Mr. Tan who is bedbound and uncommunicative a good death for him would be one that is pain-free and surrounded by his loved ones.

In my point of view culture together and spirituality plays a fundamental role in one’s journey through life. Health beliefs get often tied to one’s cultural background, spiritual and religious affiliation. The significance of the essay to identify how to give Mr. Tand good care based on his spiritual and cultural association while relieving him from pain and giving him a right end of life care.

The world health organization (2014) defines palliative care as a strategy that assists in uplifting the lives of the sick in quality as well as their families once faced with a disease that is life-threatening. It gets done through the preventing as well through identification and by identifying and assessing by pain curing together with spiritual, psychological as reducing the extent of suffering and physical problems. Palliative care is a vital health issue among the public as a result of the dramatic rise of aging persons in number. It provides attention to their complex needs. It also provides relief to distressing symptoms (Biswas, Leshabari, & Gebuis, 2015). Age appropriate care is essential while addressing the issues of palliative care. It gives the specialists the opportunity to handle the needs as per the lifespan.

Spirituality and Culture in Palliative Care

Palliative care is essential to the patients due to their complex needs during the dying moments. They suffer from diseases such as arthritis, and dementia which are accompanied by a lot of pain. Significantly, it provides a team-based approach to the needs of patients as well as their families and counseling on death in case it’s needed.  Palliative care never intends to postpone or shorten the lifespan of patients (Beard et al., 2016). It works better for the needs of the sick person more than the family members.

All the healthcare service providers in the world who believe in providing holistic healthcare have risen to realize the vital requirement of palliative health care among aging persons. Nursing care homes offer palliative care to most of the people over the age of 65years. These people consider the nursing homes as the best place to end their life. Developed countries such as England and Spain as well as Australia have most of their aging populations dying in the palliative care homes (World Health Organization, 2014). 

Culture and spirituality mark the most vital measures that define a person’s values as well as the social relation of an individual to others (Matzo &Sherman, 2010). Mr. Tan is a Buddhist maintains his values and beliefs and spiritual stands which affect either positively or negatively the palliative care given. Rego et al, (2016) argue that palliative care having been practiced for a couple of years now, a basic understanding of spiritual and cultural matters are significant when then needs and wants of a dying person become the subject to address. Assessing the cultural background for Mr. Tan ensures that quality palliative care gets treated him. It is essential to offer holistic care to the adults who have cancer.  Culture and spirituality of people go hand in hand. It is a significant dimension for providing quality care. To address the needs of the patient sufficiently, an interdisciplinary team is essential, and each member should actively participate in his or her role. It has proved to be a primary strategy when dealing with the end of life care (Smith, 1996). It is essential to respect and consider the spiritual character of a patient because it interconnects directly with his or her life.

Nurses in all complex and straightforward environments have come to adopt these methods of care to the aging people as they await death. The nurses are prioritizing the issue in their planning strategies (Johnston et al., 2015). They have an essential role to play in this approach alongside the spiritual professionals. It is perfect in nursing homes because it provides ill people with the ability to make decisions on their health status (Saini et al., 2016).

Effective Communication in Palliative Care

Efficient communication with the patient or his relatives is essential during the palliative care process. Conversation is supposed to be at its best during the palliative care process. The interface is a way of sharing information between people with the aim of sharing ideas or clarifying issues to reduce uncertainty.

Excellent communication in palliative care aims to meet all needs of the parties involved which include the family, relatives and the patients that are; spiritual, social, cultural and, physical needs. It should focus on giving out information as per the patient’s preferences whether ill or good. The communication should be based on truth to ensure accuracy. Prognosis, diagnosis, and disclosure, as well as fear of the patient’s health, include the most vital aspects communicated. The health service provider also needs to effectively converse with the patient as well as the relatives of the patient on the disease progression as well as the end of life care (Abney et al., 2014). It’s the role of the health practitioner to explain to the parties the extent of life of the patient and inquire to know the spiritual, cultural and social basis of the patient.

The doctor should brief the patient’s family with their primary style of coping with grief, loss, and bereavement.  Mr. Tan’s family should be well informed on when death is expected, and how they should deal with the loss. In this case, the patients need no more medication, so the family is aware of presumed death. Counseling of the family members done professionally is vital. 

Cases that involve covering the patient from knowing what he or she is suffering from need effective communication and professional handling. The way disclosure of health prognosis is given should be well handled considering the context of the receiver of the sad news.

In the case of Mr. Tan, the health worker should provide the family with the best guidance for the advantage of taking him through an end of the care plan. It will ensure the patient parts with his life with reduced pain and distress.

Palliative care patients are affected by total pain which includes physical, social, physical and spiritual distress and anxiety. Aged people need palliative care because they suffer from significant illnesses accompanied by other diseases such as arthritis, and dementia which are accompanied by a lot of pain.  Their needs at this stage are very complex and in the case of Mr. Tan had a past diagnosis of diabetes mellitus and hypertension. Implicative pain and distress are what Mr. Tan is going through much. He is spiritually distressed, but the addressing of each dimension of stress and anxiety may help alleviate it. Assessing and managing distress should be incorporated into everyday practices. In cases where social distress is reported or found, it only requires subjective measures of guidance such as education, and skills on how to cope with it. Physical pain for Mr. Tan who has cancer which is accompanied by trauma and a lot of pain should get managed. 

Pain Management

Advance care planning, as well as advance medical directives, involve some of the examples of the legal and ethical considerations in palliative care. The former is a process where ill people plan for a time that they can’t make informed decisions or they won’t be able to make any at all through a communication process. As for the case of Mr. Tan who is unable to communicate and make informed decisions, the care involves reflection of what he said earlier, determinations of his values and deliberation of his wishes. ACP should also encompass between Mr. Tan, and or his relatives, health care providers and decision makers concerning his preferences and values as well. There is excellent evidence-based literature about the ACP, but in the case of Mr. Tan, decisions have to be made by his loved ones on his preferences of an end of life treatment taking into consideration his values both spiritually and culturally (Coyle & Ferrell, 2016).

Conclusion

In many circumstances, the aged may be affected by life-limiting illnesses which may be resulting in death. During these moments, the family and the patient need a lot of care. The family should be prepared to accept death as a natural life termination mechanism and also the patient should be taken care.  Instead of adopting the clinical and diagnosis measures, palliative care is the best because it suits the needs of the patient correctly. It gives the family of the old person with a chance to use well the remaining time and have themselves ready for death, through the provision of spiritual, psychological, social and physical support as well as the patient (Brugnoli, 2014).

Using the framework in the essay, Mr. Tan could get the best care for the end of his life. 

References

Abney, L., Burks, A., Pitman, W., Taylor, J., Obert, L., & Kern, N. (2014). Effective communication regarding advanced care planning and end-of-life care options. Women’s Health Care, 2.

Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J. P., … & Thiyagarajan, J. A. (2016). The World report on aging and health: a policy framework for healthy aging. The Lancet, 387(10033), 2145-2154.

Biswas, A. K., Leshabari, K., & Gebuis, E. P. (2015). Living with family at old age. International Journal of Collaborative Research on Internal Medicine & Public Health, 7(10), 186.

Brugnoli, M. P. (2014). Clinical hypnosis in pain therapy and palliative care. Illinois: CH Thomas.

Coyle, N., & Ferrell, B. R. (Eds.). (2016). Legal and Ethical Aspects of Care (Vol. 8). Oxford University Press. https://doi.org/10.1177/1359105316664138.

Johnston, B., Larkin, P., Connolly, M., Barry, C., Narayanasamy, M., Östlund, U., & McIlfatrick, S. (2015). Dignity?conserving care in palliative care settings: An integrative review. Journal of clinical nursing, 24(13-14), 1743-1772.

Lea, E. J., Andrews, S., Stronach, M., Marlow, A., & Robinson, A. L. (2017). Using action research to build mentor capacity to improve orientation and quality of nursing students’ aged care placements: what to do when the phone rings. Journal of clinical nursing, 26(13-14), 1893-1905.

Matzo, M., &Sherman, D.W. (2010).Palliative care Nursing-Quality of care to the endof life (3rd ed.).New York, Springer.

Rego, Francisca, and Rui Nunes. “The Interface between Psychology and Spirituality in Palliative Care.” Journal of Health Psychology, 2016, 135910531666413. 

Saini, G., Sampson, E. L., Davis, S., Kupeli, N., Harrington, J., Leavey, G., … & Moore, K. J. (2016). An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes. BMC palliative care, 15(1), 55.

Smith, J W. “Cultural and Spiritual Issues in Palliative Care.” Journal of Cancer Care

World Health Organization. (2014). Palliative care for older people: better practices.