Sample assessment tool -- Observation and demonstration checklist This document is formatted for double-sided printing Candidate Assessment Guide HLT54115 Diploma of Nursing Unit of competency:...

HLTENN010: APPLY A PALLIATIVE APPROACH IN NURSING PRACTICE
Table of Contents
Assessment Task 1    4
Part A – Descriptive Questions:    4
1.    4
2.    4
3.    4
4.    5
5.    5
6.    5
7.    6
8.    6
9.    6
10.    7
11.    7
12.    7
Part B – Case Study Questions    8
Case Study A    8
a.    8
b.    8
c.    8
d.    8
e.    9
Case Study B    9
a.    9
b.    9
c.    9
Case Study C    9
Case Study D    10
a.    10
b.    10
c.    10
Case Study E    10
Case Study F    10
a.    10
b.    11
c.    11
Assessment Task 2    12
Task 1    12
Task 2    14
Task 3    16
Task 4    18
Assessment Task 3    19
Task 1    19
Summary of the Health Information and Clinical Presentation of the Person    19
Summary of Possible Palliative Care Planning and Nursing Intervention for this Person    19
Task 2    19
Summary of Nursing Care Provided to the Person and Outcome    19
Task 3    20
Summary of Nursing Interventions Performed    20
References    21
Assessment Task 1
Part A – Descriptive Questions:
1.
Palliative care embraces integrative, team based, associative procedure that provides end-of-life care services to the patient and their families. This process includes involvement of various healthcare professionals. In order to identify needs of the person in palliative care, nurses should develop a strong relationship with them. Nurses should take time to understand the values, needs and wishes of the patient. They should also provide correct information about the services they are seeking. This would help the healthcare professionals in identifying and providing proper services to them. A nurse may use common assessment tools such as asking follow-up questions, physical examinations such as palpitation and percussion.
2.
Advanced care planning (ACP) is a method of observing, discussing and transmitting information, which helps the individual to decide future healthcare services or treatment for themselves. It is assisted by Statue law and common law in Australia. Advanced Care Directives (ACD) is the formal document that manifests sub assembly of ACPs. Legislation of ACDs is different depending upon the state and territory of the care plans. Various states allow the individual to refuse to particular treatment and assist in expressing their values and wish. Some states allow the individual to choose a decision maker formally. Under some jurisdictions, ACDs are completely independent of the individual. Few states might not have specific laws for ACDs like NSW. Under a law in NSW, patients can opt for a legally bind ACD carrying their wishes and values. The physician is a primary person in notifying the death of a person in hospice.
3.
Spiritual, Cultural and Religious factors can give the patient or the carers’ confidence to ask the healthcare professional for care and services according to their beliefs and services. These factors give meaning to life and hope for the patient. Understanding the culture and beliefs of the patient would help in providing care according to them (Paediatric Palliative Care, 2020). Providing spiritual, religious and cultural care would help in maintain the emotional wellbeing of the patient.
4.
Ethical and legal issues related to palliative care approach:
· Decisions regarding ACDs- sometimes the patient is not allowed to decide or refuse any particular treatment. Deferring the values and wishes of a patient is one major ethical issue in ACDs.
· Conflicts in values or decisions- understanding the values of the person and supporting their decision are one of the major parts of palliative care. Withholding or not considering their values and expectations would lead to a moral and ethical issue.
· Organ donation- organ donation leads to an ethical issue if the person has not registered for it when they were alive. In that case, the right goes to the families of the patients and their decisions should be respected. A physician should help the families in explaining all the information about organ donation process.
· Request for autopsy- Autopsy of a body should only be done with the consent of the family of deceased. It is legally accepted if the cause of death is due to accidents or any criminal violence.
5.
Nutrition and hydration are crucial for body. Proper nutrition and hydration can help older adults in achieving sooner recovery and reducing their visit in hospitals. Small amounts of food and fluids should be provided daily to the patients without using any force. These meals should be highly nutritious. In case of any difficulties in swallowing, fluid intake should be practised in terms of nutrition too. Nurses are the mediator between patient and the physician (Albanesi et al. 2020). Their capability of creating a strong bond with the patient and their families would help in addressing the nutritional and hydration requirement throughout the care.
6.
The administration of analgesic medications using syringe driver and intima sub-cut lines is commonly used in palliative care for managing pain and other unsettling symptoms when other routes of injections are either ineffective or inappropriate. These medications are provided at a controlled rate to control the symptoms (Australian Government, 2020). An enrolled nurse would help in providing information about these analgesics and injections to the patient and their families. They play a significant role in educating patients and their families about the need and the consequences of these administrations.
Some commonly used analgesics are fentanyl, morphine sulphate/tartrate, clonazepam and haloperidol. Indications of syringe drivers are:
· Incompetence to swallow
· Continuous vomiting and nausea
· Excessive weakness
· Unconsciousness and faecal impaction (Cavalcanti et al. 2019)
Contraindications of syringe drivers include:
· Availability of other viable routes
· Denial of permission from the patient or family
· Availability of contradicting drugs to the infused one
7.
Non-pharmaceutical pain management procedures include psychological mediation and use of herbal medicines. Many vitamins and minerals are advised for intake in order to prevent any deficiencies in life limiting diseases. Several practices that have interactions with the mind and body like acupuncture, massages, aromatherapies, hypnosis for stress and anxiety, meditation, yoga, music therapies are also practised in pain management. Various studies have showed that massage is highly effective in reducing symptoms of palliative care such as pain, anxiety, fatigue, nausea, stress and depression (Zeng et al. 2018).
8.
Loss and grief does not only occur because of someone’s death. It might also occur due to series of other losses in a person’s life. These feelings can have a great impact on the physical and mental health as well as economic situation of a person. Hence, it is important to admit these feelings, be vocal about it and dealing with it in a healthy way (Better Health Channel, 2015). An enrolled nurse can help te patients by actively listening to the patient without creating any interference. Nurses can help in coping with grief and provide emotional support to the patients and can even provide medical care if, and when required.
9.
Nurses and other team members are highly susceptible to workplace loss and grief. Since they help in coping the patients with their grief, they are usually attached to the patients and their families. Therefore, a situation like death of a resident might affect nurses and other team members deeply.
10.
Three relevant resources available for those requiring grief and bereavement support are-
· The Australian Centre for Grief and Bereavement: They offer services by specialists particularly for people, who have lost someone close to them and to those who need help. They can also connect the patient to other bereavement services in Victoria.
· The Bereavement Counselling and Support Services- They provide direct counselling depending upon individual circumstances of the person.
· GriefLine- It is an Australia-wide grief helpline that provides free telephonic, online and face-to-face grief counselling services for people.
11.
Nurses play a crucial role in providing efficient palliative care. The availability of nurses around the clock makes them one of the most important parts of the care. They spend maximum time with the patients and build a strong relationship with the patient and family. They continuously watch over the quality and consistency of the care provided to the patients (Sekse, Hunskar & Ellingsen, 2018). They support and educate the patients and their families regarding the services and treatments being provided. Nurses are the multitalented and multitaskers in the palliative care sector and provide a practical as well as ethical direction to their work.
12.
Doctors have a huge responsibility to attend the needs of palliative care system. They provide complete care to the patient. They have skills to manage changes in the condition of the patient. They diagnose and treat the patient and even provide emotional support to the patient and family. They impart emotional support to the patient and family by extending counselling and psychotherapy to cope with the stress and grief (Ramanayake, Dilanka & Premasiri, 2016). Nurses continuously watch over the quality and consistency of the care provided to the patients. They support and educate the patients and their families regarding the services and treatments being provided. They help in building a strong relationship with the patient and family members.
Part B – Case Study Questions
Case Study A
a.
Signet ring cell carcinoma (SRCC) is one of the specific types of Gastric Cancer. The incidence of SRCC is increasing globally. It has two stages: initial gastric cancer that can be exterminated by endoscopy. The other stage, advanced gastric cancer has a worse diagnosis and has lower rate of chemo sensitivity (Machlowska et al. 2019). Due to the encounter of chemo resistance in patients, targeted molecular therapy is considered as a novel method to treat SRCC. It is a very rare kind form of adenocarcinoma, which principally affects the stomach and has a very low rate of prognosis. Alfred would require a proper diagnosis in order to identify the stage of SRCC. Chemotherapy resistance should be checked and Alfred should be provided with proper nutrition and hydration. Healthcare professionals should talk to him and support in coping with the grief and stress.
b.
Functionality and pain assessment should be performed on Alfred. Since Alfred always looks tired, functionality assessment would help in identifying the degree of dependence he needs over the nurse. It is important to determine the degree of dependence so that effective interventions can be planned. Pain assessment would help in determining the type of drug that should be used in the treatment process.
c.
Palliative approach would help in...