'Mrs. Thomas: Holistic End of Life Care\r'

'Governors university Scenario A brief synopsis of the scenario explored in this make-up leave behind be forthcoming so the by-line observations and detail will have context. The key take aim offs in the scenario explored for Mrs.. doubting doubting doubting doubting Thomas, her married man and family are as follows. Mrs.. Thomas is a johndidate for p bothiative bang; In specifically hospice If she Is given a prognosis of half a dozen months or less. She has suffered breast cancer twice In the by g one and only(a) year.A year ago she had a right mastectomy with removal of five auxiliary lymph nodes, with che giveapy and radiation. Six months ago she had a second mastectomy on her left breast, followed by chemotherapy and radiation. after give tongue to intervention it was discovered that the cancer had metastasiss to her lungs and save surgery is non a feasible option. She has not been taking her annoying medical specialty as she does not want to procure an addictio n occupation. Her anguish has increase and she spends most of the epoch In bed exacting.She had to aim her job, yet has a small stipend via dis competency. She and her married man, a police officer, are struggling to make ends encounter financially Her husband suffers from chronic depression that is be managed by medical specialty, and he is resorting to take his medication often. He is a buy ative and cap open un fussatic anguish go outr however, he Is showing signs of guardianship bestower strain and occupancy stress. In response Mrs.. Thomas Is worried that he Is becoming classical because of the mess of her condition and this In turn Is causing her further suffering. Core family support Is minimal.Mrs.. Thomas close distaff relatives are dead from the really disease that is killing her. Because she is sick, she and her husband no hour desire socialize; she does not cleark servicing from her female friends. Her sons live far a mode, and call often but the y do not pay off to agree her. Mrs.. Thomas is saddened that her sons are not here, but Quality of animation and Health Promotion This think nearly be breatheves that quality of spiritedness is defined psychely for each unhurried. Each single(a) is unique and how they perceive tone and what their brio circumstances are define what is desireed for end of emotional state care.Quality of t peerless during a time when rapacious treatment is no coherenter possible occupys to be foc utilize on comfort fittingness and support of the longanimous, caregivers and family. This deem believes comfort (quality of life) acknowledges the right to be free from unhinge, unless the longanimous chooses to experience main in trade for noetic clarity. It includes the right to not participate in aggressive treatment or in clinical trials if the affected role has no wish to do so. Quality of life to this nurse is serve uping the long-suffering role to do the surpass with the p erspective in life in which the patient role uncoverings themselves.It includes dish come forthing the patient with what he or she perceives as unfinished business and careering the patient reason out this business to the extent possible. Holistic end of life care includes care of all aspects of the patient ( forcible, social and spiritual) and care for those who love the one dying?the family. The family is some(prenominal) blood or non-blood ties this entails; whatever â€Å"shape” of family the patient has at this time. This nurse believes that holistic end of life care encompasses not only physical comfort for the patient but promotion of healthy interactions for the patient with those who love and comfort them.These sensitivities are the goals of this nurse and if employ diligently whitethorn provide the best outcomes for the patient in this time of life. Strategies Four holistic treat goals to begin to improve quality of life for Mrs.. Thomas, her husband and family are the nursing diagnoses: Pain Management, Addressing Anticipatory sorrow and Situational execrable Self-Esteem, as hale as, Altered Family Processes. for the first time one moldiness point a resonance with the patient. By providing an open nonjudg cordial conversation the nurse can encourage an open and realistic converse around what Mrs..Thomas is feeling. By reviewing past life experiences one can make out to know the patient and what interests her and establish trust. This trust is of most importance as all nursing care success depends on creating a police squad effort with the patient. Family involvement in this time take to be proactive to ease Mrs.. Thomas mental state and via this her physical functional ability. Nurseries) A head start conversation with Mrs.. Thomas call for to be around the importance of up forget me drug relief. By bringing the patient to an understanding of how this relief of trouble will improvement those around her, Mrs..Thoma s may be to a greater extent in all comparablelihood to try the medication for said relief. This may be the initial hook with which one can get her to take said medication. The nurse essential put a comprehensive inconvenience history, including frequency, duration and flashiness using a scale dependent upon the patients comprehension of pain doneout her life span. Zero pain for no pain; ten for the worst pain ever. This call gives the nurse a baseline from which to quantify pain vigilance. Her pain has been increasing for the last six months and this nurse would designate that as chronic pain, possibly with acute episodes.Also, the nurse moldinessinessiness ask close to and continue to monitor when said pain is occurring, as well as where and how much. Morning or when? Identifying effectuate factors of pain will financial aid in its long term management. (Nurseries) Pain is what the patient says it is; we as nurses need to accept that premise. Within the realm of pain lie both physical and emotional response. Because Mrs.. Thomas is no longer seeking aggressive cancer treatment, he â€Å"variations of aggressive treatment” pain realise will not be discussed.However, as her disease progresses it is most equivalently that her pain will increase. Which brings up other point?reluctance of the patient to report pain because of solicitude that the disease is worse or that the pain is deserved somehow. The nurse must besides be aware of unmanageable side effects (like hallucination) which if see must be green goddesst with in a government issue of fact fashion and by trying other medication regime. To address pain management with Mrs.. Thomas one must address her fear of addiction. By talking with Mrs..Thomas openly and honestly about the need for pain relief, it is hoped that she is lead to the conclusion that pain management and pain medication abuse are 2 different things. At the end of life, pain medication addiction is not an issue. This idea needs to be gently but openly professed. whiz could point to the relief of stress for her husband if she is not in pain; as well as the physical benefit (and hence mental benefit) of pillowing pain free. If she remains pain free she will be more able to take care of herself and her activities of nonchalant living.She will be able to live in this time instead of living in fear of each daylight. Once she is taking said pain medication it must be monitored, adjusted and changed as needed for optimal effect and to support the ability to participate in activities of daily living to the fullest as possible. Also discussing non-pharmacological comfort criterions like massage and diversionary activities like music is in order. What does Mrs.. Thomas oppose to; what does she like? What kinds of non-pharmacological pain intervention has flirted for her in the past?Ask questions so that she can verbalize these things to help herself. Being able to relax will help her focus her attention. Encouragement of stress management skills and praiseful therapies (relaxation techniques, biofeedback, LAUGHTER, music, aromatherapy, acupressure, acupuncture and touch are a few) helps the patient to actively participate and enhances a sense of control. heating and cold may to a fault help by decreasing muscle spasms and inflammation. Pain makes stress, stress makes fuddled muscles and increases self-focus which, unfortunately, increases pain.As the nurse interacts with the patient it is important that the patient comes up with ideas about care and becomes a proactive ingredient of their healthcare team. (Nurseries) Mrs.. Thomas is also suffering, â€Å"Anticipatory Grieving. This is link up to evil of her physiological health and change in lifestyle. It is interconnected to the knowledge that she is going to die, for real, and most likely soon. This nursing diagnosis is needed because of her change in social activity level, her reluctance to tell her s ons that she needs them?now.It is evidenced by her denial that she does need them and help and support in general from her friends. (Nurseries) Outcomes that are in demand(p) include the patient organismness able to feel her feelings and express them. By doing this she will hopefully come to the place where she is able to take one day t a time and continue her median(prenominal) activities; even planning for the future. Being able to provide that she is dying, understanding and verbalizing the process is a beginning is done, she must feel supported in her grief work. One must beware of debilitating depression, the like of which is indicated by the scenario.To address this the nurse must be candid and direct in asking questions about the patients genius state. (Nurseries) Frequent visiting by the nursing team and care providers, family and social support of friends can help relieve feelings of isolation and abandonment. Her ones need to be contacted with a â€Å"for your tuit ion” talk about coming to see their mom (and dad) and possibly who could be of help with caregivers as it is needed. Mr.. Thomas is also a source to find out about who may be able to help with this care this, as well.The nursing diagnosis, â€Å"Situational Low Self-Esteem” is related to how Mrs.. Thomas feels about her disfiguring surgeries and concomitant treatment side effects (aliped, muscle wasting, and more) as well as feelings of self-doubt and lack of control in her life. It is about the doubt about being accepted by othersâ€of still eyeing a merciful in the world. It is also about her anxiety and fear of her disease process. This is evidenced by her not taking responsibility for self-care (not taking pain medication; crying in bed all day. ) Acceptance of her situation is an outcome that is looked for.She needs to be able to jump mechanisms to cope with her problems and set realistic goals. What coping skills has she used in the past? She needs to be able to participate in her own life by learning to adapt. The nurse can help her through this process by asking proactive questions about how she feels and perceives her world. By getting her to voice where shes at, she will also perhaps start to voice how she can manage. (Nurseries) This diagnosis ties in with the aforementioned, â€Å"Anticipatory Grieving” diagnosis. By formation diagnosis and disease process beginning problem result can occur.By anticipating what can happen, some measure of control can be taken. By works with Mrs.. Thomas and planning how daily activities can be managed, adaptation can occur. (Nurseries) Discussion about her roles in life, as a worker, spouse, and mother and problem solving about how to accomplish her goals for these roles may help abbreviate problems that interfere tit her self- dream up. It may help her to see how she can cluster activities at basis to keep energy but be productive. It may help her to be more able to reach out to those who love her for inclusion and support.The nurse must do it troubles she is experiencing and validate the patients reality; this opens the door to the patient being able to seek measures that are necessary to cope, like counseling, and support groups. The nurse should readily be able to supply information about said resources so as to facilitate the patient in procuring more support. If Mrs.. Thomas is n hospice the social worker of the interdisciplinary team can help facilitate and direct this work; but the nurse must forever and a day continue it during her visits. Holistic Nursing Plan Amongst personized revelation the nurse must explore who may be able to help Mrs..Thomas with her activities of daily living. Her husband is doing the Job, but he is suffering from care giver strain and could use some help. It may be that the people she has cut herself off from socially misfire her and would love the chance to be able to help in some way. Caregivers avenues and their affordab ility need to be explored before they are needed. These interactions; providing pain control, helping with grief and esteem issues, and helping the patient to discover what will work best to live disease state progresses, but before it is needed, preparation for a lesser level of self-care must be addressed.Medicare provides a â€Å"compassionate readjustment” for hospice care for those of any age with a metastasis cancer with a prognosis of six months or less. She needs to apply for this care in the beginning of the nursing visits if she qualifies. To receive hospice care via Medicare she must be entitled for Medicare Part â€Å"A”, be certified as terminally ill and then apply for hospice care. This care would be in her stead. By signing an election of benefits Mrs.. Thomas would be choosing hospice care in topographic point of routine Medicare-covered benefits.Hospice would pay for pain medications and those required by her terminal diagnosis, as well as work included in the palliative plan of care. a great deal the hospice doctor confers with the patients primary doctor and others on the hospice interdisciplinary team are included. (â€Å"Your Medicare benefits,” 2014) Hospice of Kits County provides an interdisciplinary team consisting of the doctor, the patients primary provider and nurse practitioners, sitting nursing care, a medical social worker, a chaplain, a home health aide. Also provided are complementary services, which include massage and music therapies.Volunteers are also enlisted to help with such things as grocery shopping and the like or simply for company. These persons come to the patients home for service. Hospice care differs with regional reporting. Durable medical equipment is also covered, so if Mrs.. Thomas is in need of a hospital bed, oxygen, bedside commode, wheel chair and so on, it will be provided at no cost to her family via Medicare coverage. Grief and loss counseling is also provided. â€Å"H ospice of kits,” ) Providers for home care must be explored as Mrs.. Thomas declines.Often the expense precludes coverage of duties in this way. Exploration of service providers and means of stipend need to be explored as a way to cover Mrs.. Thomas needs as she declines. Medicare covers the cost of a short term inpatient care in a Medicare approved hospice facility, or nursing home if the caregiver is suffering from caregiver strain (for up to five days) or if it is determined by the hospice medico that symptoms must be managed in an inpatient setting. Because Mrs.. Thomas has no Eng term care health insurance this care could be instrumental in providing for her nett days. â€Å"Your Medicare benefits,” 2014) The fourth nursing diagnosis, â€Å"Altered Family Processes” must be addressed for the holistic health of Mrs.. Thomas. This holistic care includes her husband as well as Mrs.. Thomas sons and families. Situational crises can develop when a family memb er has a long term illness. There is a change in roles in caring for a parent and an expect loss of said parent. (Nurseries) Those involved need to learn to express feelings freely and demonstrate individual involvement. This individual involvement must include a problem solving process that promotes suitable solutions for the situation.Mrs.. Thomas sons need to be contacted and requested to attend a family conference. If they are uneffective (because of finances or schedule) to attend then this could be accomplished via phone. They must understand the need of their mother to see them in person and will hopefully comply. The reality of the situation must be broach to them in a caring way. It may be that the Thomas or Mrs.. Thomas can go and check with them for more available for care and support of their mother. verbalize with family members in a caring, respectful manner and providing information both written and spoken helps promote feelings of empathy.It stimulates individual feelings of value and capability in ability to deal the present situation. In answering questions and providing information one can empower Mrs.. Thomas loved ones. Identifying patterns of communication and interaction between family members is an important nursing intervention. It provides information about how active said communication is. It can also identify what problems may exist that interfere with the family in helping the patient and what problems there are in adjusting to the prognosis.Role expectations must be explored and how each individual sees the situation, in sharing these thoughts the family can promote understanding at bottom its unit. Assessing the way members are expending their energy with which to deal with the situation is needed so as to provide guidance in positive focus for the social welfare of patient. Acknowledging the difficulty of the prognosis, as well as, encouraging usurp expressions of anger helps resolution in the stages of grieving. The nur se must remain centered.Stressing the importance f continuing discourse that is open and honest between the family members helps communication to remain open and olibanum facilitates problem resolution. Mr.. Thomas must be educated by the community health nurse as with regards to how anti- depressants need to maintain a certain blood level to be effective. If he is not taking them regularly this will not happen. To help achieve this goal, a pill rap with days on it can be set up; perhaps an alarm set to the said(prenominal) time each day enlisted, so that he can remember to take his medication and thus be better able to function at this time.To provide holistic nursing care to Mrs.. Thomas her needs as a person must be addressed. Physical, social and spiritual realms must be explored. Plans of action to provide for her physical care and the transfer of her abilities must be explored; help must be sought out from the aforementioned sources. Method must be applied via nursing dia gnosis and indications of said diagnosis. Desired outcomes must be planned, as well as nursing interventions to work toward these outcomes. Mrs.. Thomas must be approached with honesty and treated as a human being, with a life, in her time of need.\r\n'