Comprehensive account of working and interacting with others In the area of palliative care. The author of this essay is a Health Care Assistant for three years and works as a member of a Hospice Home Care Team. For the purpose of this assignment the author will outline a selection of evidence of their work and interaction with their Palliative Care Clients and the Palliative Care Team. For the privacy and dignity of the client we will refer to the client as John (an alias) and me as the author or HCI (Health Care Assistant).
John is a 78 year old single man who has retired from farming. John has a nephew, Tom (name changed to protect his identity) who works at the farm everyday although he lives a few miles away. John is a very happy and Independent person; he has many good neighbors who stop in regularly to visit. John was diagnosed with stage 3 Prostate Cancer 4 years ago. The client has undergone treatment however the cancer has spread and tumors have developed in the groin area. John underwent surgery to remove the tumors and contracted MRS. while recovering in hospital.
The MRS. has prevented the surgical area from healing completely and as John’s HCI it Is my responsibility to change his dressings overall times per week. The client Is terminal and Is currently receiving Palliative Care in his home. The Palliative care team consists of John’s nephew Tom, the local GPO, oncologist consultant, Palliative Care Nurse and the HCI. The nephew, Tom, is largely responsible for ensuring that John makes it to his medical appointments and caring for his daily needs. Tom is very busy with farm work and as John’s health has deteriorated he is becoming more reliant on certain members of the Palliative Care Team.
Although John’s local GPO and Oncologist Consultant are members of the Care Team, they are not involved In the daily care of him. The Palliative Care Nurse Is calling in on John once a week and more if necessary. The nurse communicates with the HCI regarding John’s daily care. The HCI is the one member of the team that has daily contact with John and Tom. The HCI keeps a close eye on John’s physical and emotional health. John has been suffering from depression lately and the HCI has communicated her concern to the Palliative Care Nurse.
As part of her daily care of John, the HCI has made It a priority to actively listen to John and his sadness over his diminishing ability to care for himself. I make It a point to sit facing John and making ye contact with him, when he becomes very upset I lightly touch his hand and ask what I can do for him. An important aspect of caring for the dying is to Listen. (Kibble Ross, 1969) Clear Awareness of need to treat others with respect and sensitivity. As HCI, I have communicated my concerns about John’s depression to the Palliative Care Nurse and have stressed how much his personality has changed.
By actively listening to John and his feelings of helplessness, I never diddles John’s feelings but rather encourage John to complete personal tasks which he is capable of completing. John can no longer stand without the assistance of his walking frame, this makes shaving in the morning difficult and John is quite particular about his appearance. John feels better about himself when he is clean shaven and dressed for the day, ensuring that John’s dignity remains Intact is extremely Important. I have discussed an alternative to shaving at the bathroom sink with John.
John has a desk have the desk in his bedroom and everything necessary for him to shave at his desk with a mirror stand. John’s feelings of inadequacy about caring for himself have been improved and he feels more independent. The HCI empowered John to make his decision and thereby improving his emotional self worth. Effective reflection on personal interaction/communication with dying person and family. During John’s care, especially as his health deteriorated, there was a concern from both and John and his extended family that John is kept comfortable and his pain minimized.
John was fearful of the pain associated with dying from Cancer. These feelings were communicated to me the HCI in a conversation one day while John was being assisted with his dressing. His sister had died of Lung Cancer 30 years before. At the time of her death, pain management and hospice care were not s evolved as today. I listened to John and reassured him that Palliative Care both at home or in a hospice had changed immensely over the past 30 years and that his comfort and needs would be fully met.
Tom was also concerned that his uncle was becoming more agitated and upset about being in unbearable pain. The HCI communicated both in writing and in a meeting with the Palliative Care Nurse and GPO about these concerns. We talked about John’s failing physical health and how this was affecting his emotional state. After consulting with Tom it was decided that the HCI would stay with John from 10:00 pm until 8:00 am and a family member would e there to spend the morning and afternoon with John. Tom explained to the Nurse and HCI that John was most agitated and uncomfortable during the night.
It was suggested by Tom that if John didn’t feel that he was alone during the night he may feel more secure and his fears might be lessened. It was agreed that we would discuss the situation after 4 nights and reflect on John’s response to the additional care. Out of respect for John the plan was discussed and he was happy to have a career there at night and that if he was experiencing any discomfort there would be a professional there to ensure he was kept comfortable. The Palliative Care Nurse after consulting with John’s GPO spoke to John about using a Morphine Patch in addition to the pain medication he was taking orally.
It was explained that this would provide a consistent flow of Morphine into John’s body and thus keeping any discomfort or pain too minimum. John could take additional pain medication when the need arose. During John’s last week of life he was surrounded by family and friends, nieces and nephews took turns staying at John’s house at night in addition to the HCI. While tending to John’s personal hygiene I would speak to John about what ties I was performing, respecting him and protecting his dignity at all times.
As HCI, I had cared for John for several months and was aware of his fear of being alone; during his final week I made my presence known to him during the night when he would become agitated. Sitting holding his hand and speaking softly to him, reassuring him that I was there, that he was not alone, brought comfort to John. I also encouraged the family members to sit quietly with John either holding his hand or wiping his brow with a cool damp face cloth. One member of John’s family, a niece had a tendency to speak in front of John about his deterioration.
In a very thoughtful and respectful manner I spoke quietly to the niece explaining to her that although John appeared to be unconscious we should refrain from speaking about him in his comforted by their presence. The family was very caring and the niece was very fond of her uncle. Her concern for his care made her actions understandable but it was important that John’s room remain peaceful and calm. The last 24 hours of John’s life were very peaceful. The nieces and nephews of John were present during those last hours and two nephews were with him when he died.
The family was very close knit ND extremely appreciative of all the support that had received from the Palliative Care Team. Reflecting back on John’s final days, I felt that John’s greatest fear of being alone and his pain management were handled extremely well. By working with Tom and other family members, the Palliative Care Team was able to care for John in a caring and supportive manner. With attentive listening the HCI, who spent the most time with John, became aware of John’s fears and worked with the Palliative team and John’s family to improve the quality of John’s life and keep communication open and focused on John’s care.
Clear awareness of role of other members of the healthcare team. The healthcare team consists of the client’s local GPO, Specialist Consultant, Palliative Care Nurse, Health Care Assistant and the client’s family. The local GPO is the diagnostician, provider of prescriptions, and the person who initializes the clients care within the healthcare system. The GPO will refer a client too specialist consultant for further tests and treatments. The consultant will offer treatments and communicate the findings with the local GPO.
A Healthcare Assistant works under the direction and guidance of the Palliative Care Nurse. The Nurse can administer the medications that doctors prescribe and offer guidance and help with solutions to difficulties encountered in the care of clients. The HCI and Palliative Care Nurse work closely together and communication between the two is vitally important. The Family of the client is the most important participant in the client’s care; their assistance in caring for the client is crucial.
It is important to include the family in the care plan of the client, respect their emotional needs and above all else respect their right to privacy. The Nurse and pharmacist are the main sources for information regarding dedications prescribed and how they may interact with one another. Family members with questions regarding medications should be referred to the GPO, Nurse or Pharmacist. Communicated/Supported family after their loved one has died. Having known John for several months I attended his wake and funeral. I had become fond of John and his friendly nature.
I have stopped in to say hello to Tom and his family in the weeks after John’s death to see how they were doing. I always have leaflets and contact numbers for Bereavement services and counseling in the event that I feel they might be useful for the family. Tom seems to be getting on fine and although he mentions how quiet the house feels now that John is gone and he misses the great banter the two had every morning, he appears to be handling his grief well and I let him know that if we can offer any assistance to please call. Conclusion.
This assignment has been beneficial to my learning by providing me with an opportunity to reflect on a series of events while caring for a client during his final 3 months of life. I understand that by paying close attention to the client and by listening to their concerns I can make important decisions about the care of my achieved this by using active listening skills and taking the time to engage on a personal level with my client. The Hospice movement plays an important role in the community, caring for the terminally ill. The Hospice movement believes in the idea of the patient as a family unit and not as an individual.
The hospice movement is deeply rooted in holistic care; the spiritual, physical, psychological and social care. A Hospice provides expert medical care, highly skilled and confident nursing care with an emphasis on experienced use of drugs. In Ireland, a hospice is considered a centre of excellence for palliative care. The act of dying is a personal and unique experience; therefore the caring for those dying should be unique and personal. Holistic care is patient centered and is all about the needs of the patient and their family.
Tending to their spiritual and social needs, getting to know the patient as a whole rather than Just providing for the physical needs improves the quality of care. (Luke, Austin, Caress & Halest, April 2000) Ronald of Advanced Nursing, Volume 31, Issue 4 pages 775-782 April 2000) The Importance of “knowing the patient”: community nurses constructions of quality in providing palliative care. In order to meet the client’s needs and maintain a high standard of care it is essential that all members of the palliative care team communicate with one another.
More importantly it is essential that communication be open and honest with the client and their family, making sure to actively listen to their needs and concerns and act in their best interest. Working in Palliative Care can be very draining emotionally and you need to be secure in your own emotional self regarding death and dying. When caring for other people in their hour of need it is crucial that as a career I am taking mime to mind myself both physically and emotionally.
Working in Palliative Care, while it can be draining is also very fulfilling. I take great satisfaction in caring for a person up until life ceases and hopefully somehow ensuring that they have had a peaceful death. Although it can be sad, caring for someone dying is a privilege. In the future I would like to be more knowledgeable about how you can offer comfort to someone. Communicating with a person who is dying and responding to their difficult questions I believe is an area where I could greatly improve.