These core values enable nurses to do their job effectively and efficiently to ensure patients such as Jane are safe and well treated (NHS England 2018). Within the nursing profession it is paramount that health care professionals view the whole picture with regards to patients, looking at their physiological, psychological, spiritual, and social perspective needs. However, it is also important to look at the patient’s individual culture and cultural background. There are many theorists that focus on this, one theorist is Madeleine Leiningers Theory which focuses on the various cultures which have different caring behaviours and conflicting health and illness values, beliefs, respect for diversity, inclusion and patterns of behaviours. However, it could be argued that personal values, respect, responsibility, and obligation are dependent on the moral attitude of the nurse (Fry, et al 2010).
Managing common physical symptoms is an important objective when completing assessments within nursing care. This is especially important with end-of-life care as a person such as Jane’s condition deteriorates, and her pain may become more intolerable. In palliative care nursing it is common practice for a syringe driver to be set up, this is to very slowly over 24-hour period administer drugs to the patient enabling the patient to be comfortable and pain free (Fallon et. al 2007).
Syringe drivers are commonly used within palliative care without debate (Woods, 2004), however, if a patient is given sedatives and opiates this will reduce anxiety and pain but in COPD patients it may supress the respiratory system, which may speed up the dying process (BNF, 2013). An assessment using the Abbey pain scale (Appendix C) can be carried out to enable the nurses to give the appropriate medication via the syringe driver as well as other methods if required. The Abbey pain scale is a good tool to use when a patient is at the end of their life as they cannot communicate and this tool is compiled from a nurses observations of someone’s pain as it does not differentiate between someone’s distress and pain, but the effectiveness of pain relieving involvement (NHS 2018) There is little evidence to suggest opioids are more effective than the drugs such as paracetamol and/or an NSAID used but it could be argued that by combining opioids with paracetamol and NSAID’s, itcould reduce opioids given thus in turn reducing the adverse side (Regnard and Dean 2010). As mentioned, the patient Jane was admitted to Florence Nightingale hospice for end of life care. She was cared for holistically, which means that her dignity, respect and her wishes were adhered to (NHS 2018). It is crucial that any patient at the end of their life discuss with family and their loved ones about what their wishes and thoughts are when the time comes.
The National Institute for Health and Care Excellence (NICE) guidelines state that the families must be put at the heart of their loved one’s care to enable them to feel valued and involved in their loved one’s care (NICE 2018). This can be a sensitive conversation and talking about this can be an intimate experience. The only way a person’s loved ones can make good decisions for them when the time comes, is if they understand what is important to the person at the end of their life. This is vital as quality of life is different for every person. A study “Patient and Family Satisfaction with End-of-Life Care” was completed by the Stamford school of medicine which found that when a family member or loved one died in a hospice they felt there were fewer concerns and unmet needs of the person that had died whereas family members felt that at home or in hospital the patients’ needs as well as their needs were not met (Stamford school of medicine 2018).
It is felt that the advantages to this assessment tool completed are that it included; head and neck, nutrition, chest, abdomen and pelvis, limbs, skin, sleep, pain, emotional/psychological condition, spiritual beliefs and details of care at home which provides a framework which aims to meet the individual needs of the patient such as Jane. It enables nursing staff alongside other multi professional staff to take a quick glance at the 2 pages of the care plan to gain baseline information. However, it could be argued that although this is a holistic assessment a disadvantage could be that the assessment tool used by the hospice, although it covers most subjects, there is only a small area for nurses to document the information gathered and therefore the information provided is minimal and could benefit from being more in-depth (Chapelhouse et al 2005). To conclude, an assessment plays an integral part of the nursing process and brings about nurse’s legal, ethical and professional accountability. It enables nurses along with other members of the multi professional team to deliver person centred care.
A patient’s physiological, psychological, spiritual, and social perspective needs must be met to enable nurses to care for the patient holistically. However as previously stated this is not always seen as holistic as the patient’s cultural background also needs to be assessed (Fry, et al 2010). This is due to some cultures having different caring behaviours such as, in some culture’s men may make all the decisions when it comes to their wife’s care, i.e. what medication she can have or who can care for her.
With any assessment there are many advantages and disadvantages as discussed in the essay. It can be said that the assessment completed for Jane was holistic and successfully gave the nursing staff a background to what and how Jane wanted to be cared for at the end of her life.
