Discuss about the Structure Based Discovery of Opioid Analgesics.
Palliative care is a special kind of medical care given to the patient who are suffering from critical diseases such as cancer. It is given to patient to improve the quality of life as early as possible. It addresses the patient as a whole rather than their diseases and its primary goalprovides support to both patient and its family (Aslakson, Curtisand Nelson2014).Some specialized person who has undergone special training and certification in palliative care usually provides this care. These include a multidisciplinary team consists of doctors, pharmacists, registered dietician, social workers and also nurses. In the given case study,a patient named Tom of 55 years of ageis suffering from advanced lung cancer and multiple metastases. He was admitted to hospital after falling down on the floor. Though he was able to talk to nurse, but he was facing trouble in breathing and also suffering from lot of pain. Hospital engaged Aboriginal liaison officer, Nancy tocare for himand escaping him out from these life-limiting conditions. This essay will provide an evaluation of the ethico-legal and clinical issues of this case study. This will also establish some goals of palliative care and describe about palliative assessment tool, communication and pharmacological issues and patient nurse relationship.
The end of life carestrategy endorses high quality care for patients during the end of their life. It focuses on raising public awareness with respect to incidence of death. In the given case study, Tom hadreturned from his country to hospital for end of life care due to further deterioration of his health condition. He was suffering from advanced lung cancer with multiple metastasis. Recently he was experienced a severe pain and trouble in breathing. His family was concerned and worried about his poor health condition. One of the nurse named Sarah suggested some pain reliever but he refused to take this. He mentioned that his aunty Joyce after taking morphine became drowsy, lost her ability to speak and died the next day. Later on, the nurse made her understand the factthat small amount of Morphine will help him to manage his pain and breathing without making him drowsy. After his consent, her daughter Carina arrived to hospital, claims herself as the power of attorney. Power of attorney is a legal document that has been given to one person in the power to perform or act on behalf of another person. This is widely used in case where a person is disable, may be due to poor health condition and cannot make decision by his own (WALES2015). In this case study his daughterwanted to stop the use of morphine, and told nurses to change this to something better. Jimmy, who is the son of Tom, confirms that his mother is Tom’s enduring guardian. An enduring guardian is someone whom the patient can appoint for making lifestyle, health and medical decision on hisbehalf. An enduring guardian may also decide the place the patient should live, what services to be provided and what medication to be taken (Tsohet al. 2015). Both enduring guardian and power of attorney are complementary documents that are made separately or sometimes together. Patient will decide whom he wants to have the authority.He also mentioned that his father did an advanced care paper that take priority over enduring guardian.This pointed out legal and ethical issues in decision-making.The process of advanced care planning help to plan medical care in advance based on the assumption that patient will become too sick to make his own decision (Carter et al.2016). This scenario results in a conflict and a matter of obvious distress to the rest of Tom’s family along with Tom’s health condition.
Clinical issue that raised was based on the usage of Morphine that is an opioid analgesic. Tom was suffering from pain and nurse suggested him to take a pain reliever like morphine. His daughter wanted to stop the medication due to some known side effects of Morphine. These include shallow breathing,slow rate of heartbeat, stiffness in muscle, trouble in swallowing, appearance of seizure, drowsiness and severe weakness (Mangliket al. 2016). Moreover, Tom is suffering from advanced lung cancer and these side effects will affect him more in future.
There is an important role in shared decision-making. This enables a healthcare professional to participate jointly in making decision based on health. It is used as a trademark for good and healthy clinical practice. This is most applicable to the case where there is uncertainty in choosing the right option (Hoffmann and Tooth2017). In case of Tom, this shared decision making process had imparted a positive effect in his treatment. They consult jointly and discuss about the benefits and harm of the medicine considering the value of patient, his preferences and circumstances.
Palliative care service generally addresses the issues related to physical, psychological, social and spiritual factors of a patient’s disease. Palliative care community of Australia acknowledges the sensitivity of end of life care. It also identifies the necessity of cultural awarenesswhile giving services to aboriginal people(Rogers and Student2017). In this case study,health professionals should understand the needs of Tom and increase knowledge of palliative care among them. Several factors play a role in accessing palliative care services among aboriginal patientor their family carer. One of the main issue is palliative care professional are non-indigenous. This often serves as a difficulty for aboriginal patient to develop a trusting and personal relationship with healthcare professionals.
Goals involve in developing this care service firstly includes communicationswith the patient (Bernacki and Block 2014). Before introducing all the facilities to them, health care professionals should make possible face-to-face interactions withTom as well as with his family carer. While making contact, health professionals should be aware of the Tom’s preferences about the mode of contact. Second goalis to discuss regarding care management (Schenkeret al2015).This will discuss about who will take in the role to provide care to their health in detail. Care should be well timed and should be delivered in a co-ordinate fashion. Another goal is to be flexiblewhile giving services. Services should be flexible in terms of borders and boundaries applied to those programs. Last goal is to build relationship among palliative care service professionals and Tom along with his family members in order to reduce barriers for accessing proper care.
Patient’s Goals of care determination is the crucial principle for palliative care services.The course of action to be taken also follows a goal-care plan.First goal of care is creating an environment that has privacy and minimal level of interruptions. This will enable health professionals to listen patient properly all through the palliative care process.Second goal taking actionto explore patient’s story as a whole. This will help to learn about their priorities and values. Third goal is to determine the knowledge of patient and family members regarding the present health condition of the patient. Forthaction of goal-plan should discoverwhether family and patient have any hope, worries and concern about the disease. Professionals should enquire patient’s inner strength and family’s support systems as well. Fifth goal is to set a realistic approach to achieve the goal. Other actions involved making responses empathetically, arranging an alternative plan and reviewing and responding to patient’s need periodically.
Palliative assessment give priorities to patient and his family’s issues and concerns. Palliative care assessment tools facilitated assessment that include illness history. This is assessed by reviewing patient’s disease course and summarizing previous treatments and previous responses of patient. Secondly physical symptoms assessment should be done by examining patient’s physical condition. This can be used to confirm illness history findings and to analyze the response of patient’s goal of care. Third assessment key is the assessment of psychological symptoms of patient that investigate about emotions, mood, cognitive state and unresolved issues(Grassiet al. 2015). Another assessment is done on decision-making capacity of the patient and social assessment to evaluate various social circumstanceslike family, community and environment that are disturbing the patient (Aounet al. 2015). One more assessment tool is done on the basis of some spiritual factors like patient’s faith and religious beliefs and practices. Some practical needs such as domestic and residential needs should also be assessed to identify the change of these needs with the progression of the disease. Communication issuesare a major problem faced during palliative care process. The quality of this communication always require special skills of professionals. Many professionals avoid end-of-life discussions as they are overstrained. Both health professionals and patients are sometimes uncertain about this discussion process. Moreover, medical professionals avoid such discussion due to high emotional impact that creates a burden for them. They should initiate a sensitive way to make such end-of –life communication (Galushko, Romotzkyand Voltz 2012).Pharmacological issues are also a part of initial palliative care. Palliative treatment of symptoms like pain, anxiety, depression, restlessness and nausea requires administration of drugs and has been reported to have significant side effects. Patient suffering from these symptoms have to undergo medications for their relief. Medicines like opioids, neuroleptics, corticosteroids are prescribed for initial palliative care. These drugs have many side effects. One study with oncogenic patients was conducted where palliative care was provided on symptoms like constipation, urinary retention, pain andvomiting. Many side effects were observed like respiratory depression, hypotension and drowsiness amongst patients (Taniguchi et al. 2015)These are the basic pharmacological issues arises during palliative care.
Conclusion:
From the above discussion this can be concluded that proper approach to palliative care can partially help Tom to overcome his ill health condition. Though some legal and clinical issues raised in this case study yet shared decision-making process helped them to sort out from these issues. Lastly, some points on palliative assessment tools and goals are mentioned that that will help health care professionals to give proper care to patients.
References:
Aoun S, Toye C, Deas K, Howting D, Ewing G, Grande G, Stajduhar K. Enabling a family caregiver-led assessment of support needs in home-based palliative care: Potential translation into practice. Palliative medicine. 2015 Dec;29(10):929-38.
Aslakson, R.A., Curtis, J.R. and Nelson, J.E., 2014. The changing role of palliative care in the ICU. Critical care medicine, 42(11), p.2418.
Bernacki, R.E. and Block, S.D., 2014. Communication about serious illness care goals: a review and synthesis of best practices. JAMA internal medicine, 174(12), pp.1994-2003.
Carter, R.Z., Detering, K.M., Silvester, W. and Sutton, E., 2016. Advance care planning in Australia: what does the law say?.Australian Health Review, 40(4), pp.405-414.
Galushko, M., Romotzky, V. and Voltz, R., 2012. Challenges in end-of-life communication. Current opinion in supportive and palliative care, 6(3), pp.355-364.
Grassi, L., Caruso, R., Sabato, S., Massarenti, S. and Nanni, M.G., 2015. Psychosocial screening and assessment in oncology and palliative care settings. Frontiers in psychology, 5, p.1485.
Hoffmann, T. and Tooth, L., 2017. Shared decision making. Evidence-Based Practice Across the Health Professions-E-pub, p.337.
Manglik, A., Lin, H., Aryal, D.K., McCorvy, J.D., Dengler, D., Corder, G., Levit, A., Kling, R.C., Bernat, V., Hübner, H. and Huang, X.P., 2016. Structure-based discovery of opioid analgesics with reduced side effects. Nature, 537(7619), p.185.
Rogers, A. and Student, M.N., 2017. A Cultural Safety Perspective on Palliative Care for Indigenous Peoples. https://www.nbhpca-aspnb.ca/education/conference_congres/congres_2017_conference/2017-04-27_Rogers-Amanda_A-cultural-safety-perspective-on-PC-for-indigenous-peoples.pdf
Schenker, Y., Arnold, R., White, D., Chu, E. and Rosenzweig, M., 2015. Care Management by Oncology Nurses to Address Palliative Care Needs: A Pilot Trial to Assess Feasibility, Acceptability, and Perceived Effectiveness of the CONNECT intervention (SA516-C). Journal of Pain and Symptom Management, 49(2), pp.394-395.
Taniguchi, S., Martins, R.M., Vogel, C., Ropero, J. and Mason, R., 2015. Initial palliative care drugs’ side effect. European Psychiatry, 30, p.1507.
Tsoh, J., Peisah, C., Narumoto, J., Wongpakaran, N., Wongpakaran, T., O’Neill, N., Jiang, T., Ogano, S., Mimura, M., Kato, Y. and Chiu, H., 2015. Comparisons of guardianship laws and surrogate decision-making practices in China, Japan, Thailand and Australia: a review by the Asia Consortium, International Psychogeriatric Association (IPA) capacity taskforce. International psychogeriatrics, 27(6), pp.1029-1037.
WALES, N.S., 2015. Enduring Powers of Attorney.
https://www.diamondconway.com.au/wp-content/uploads/DC-InfoSheet-MM-Enduring-Powers-Of-Attorney-NSW-150216.pdf
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