Question

 

Alana Doroppoli is 56 years old. She is an Italian immigrant who has recently been diagnosed with an aggressive form of cancer. Alana is currently being cared for in her own home with palliative care services in home service. Alana has managed all home duties in the past but now finds that, due to the medical treatments she is receiving for the cancer, she is no longer able to manage all the household tasks. Due to tiredness, she is also required to rest for extended periods throughout the day. After six weeks of treatment Alana is bedridden due to the progression of the cancer and the failure of the treatment to halt the disease. Alana is sad as she can no longer cook for and look after her husband and three sons. Alana and her family are also very religious and now Alana can no longer attend her church or take part in community activities connected to her church. As Alana has a life-limiting illness, the health care team plan to make sure her quality of life is maintained as best as possible, and that she is given pain relief when needed. Alana is unable to attend to personal hygiene independently and requires around-the-clock care. The family and the palliative care team make the decision to admit Alana to a hospice facility. They make sure her room resembles her home with familiar photos and her favourite ornaments. They assess Alana and prepare a care plan. Alana also prepares advance care directives when she is first admitted. All team members are made aware of these plans. Alana’s sons say they don’t want their mother to be given morphine but Alana’s doctor explains to the family the benefits of morphine to manage Alana’s pain. The doctor arranges a family conference so everyone is informed and the team can work out how best to support family members and carers. Mai is the day-shift worker. She has only just started working in a palliative care environment. She knows that her job is to provide support to the client, family members and carers by listening to them, getting to know them and respecting their wishes. She provides leaflets to family members and carers about cancer. She also tells them about cancer support groups for family members

1. How can Mai encourage and support the family/carers to discuss spiritual and cultural issues in an open and safe environment within their scope of practice?

2. Identify two examples of care that falls outside the role of the personal support worker in palliative care.

3. How can the palliative care team show Alana and her family empathy and emotional support?

Answer 1

1. Mai should encourage the family members/carers to support the Alana with religious and spiritual belief to cope up with the life. Spiritual well-being may improve the quality of life and reduce the anxiety related to cancer and death. Arrange spiritual support from the medical team and concern about the issues. Spirituality makes Alana the sense of peace and gives meaning to the life.

Spiritual distress may further affect her health condition. Give space to worship and make positive beliefs through the family members and carers. Mai and the team members should listen to the wishes of Alana. Concern about the religious and spiritual needs when planning care and setting goal for this patient. Always respect and respond to the spiritual needs. Make religious leader to speak with the patient and to encourage the patient to cope up with the life.

2.

• The care should focus on relieving pain related to oncology treatment. Provide comfort to the patient. Support psychologically. Assess the quality and intensity of the pain. Administer opioid based on the level of pain. Support and educate the client and the family members about the management of pain. Arrange for non-therapeutic management of pain such as relaxation therapy, meditation, music therapy.
• Treat the reversible causes through proper nutrition and adequate hydration. Discuss with the Alana about the eating-related problem and the alternatives. Explain about the parenteral nutrition and management of weight loss. Arrange a consultation with the nutritionist.

3. Palliative care mainly focuses on the relieving of symptoms and improving the quality of life. Show empathetic to the patient and learn her feeling through the facial expressions. Be empathetic in experiencing a difficult situation. Maintain good rapport with the patient and listen to her feelings and wishes. Try to relieve her stress and provide emotional support. Help in her activities to overcome the fatigue.

Give trust and emotional support to the family members. Give counseling to the family members to handle the situations and need of continuing treatment. Explain about lifestyle changes and its importance. Provide psychological support to overcome the anxiety and the depression. Be interacted with the family members and their presence when caring for the patient. Provide cultural and spiritual well-being. Make positive thoughts on the patient and the family members.