Assessing Pain in Palliative Care

As a team apply the principles of palliative care to complete a holistic symptom assessment using the Symptom Assessment Scale for Geoff.

The patient in the provided case study had excessive pain which developed due to cancer and it impacted the patient’s condition which ultimately resulted in refusal of food and medication due to excessive pain.  The principle of palliative care aims at delivering holistic care to the patient by incorporating the medical practice, nursing practice and also aims at considering the spiritual, social and cultural factors in order to deliver effective support for controlling the patient’s condition (health.nsw.gov.au, 2022). A comprehensive assessment of the patient condition is essential in order to address the needs and to improve the therapeutic relationship which will help in addressing the issue of pain. The symptom assessment scale helps in understanding and measuring the distress symptoms among the patients in palliative care by considering the key signs such as appetite issues, bowel problems, breathing problems, fatigueness, insomnia and nausea. The patient in the provide case study was found to be suffering from unnecessary pain which increased the distressing symptom and resulted in refusal of food and drinking. The patient in this case was anguishing from extreme pain which requires an effective holistic pain management intervention as cancer pain is considered to be one of the physical components which impacts the quality of life.

Discuss and identify how you would assess Geoff’s pain – complete a Brief Pain Inventory form.

The patient in this case was found to be suffering from excessive pain which needs proper care and management. The pain can be assessed with the help of cancer pain prognostic scale which helps in determining the severity of cancer pain from moderate to severe. The predictive formula which can be described with the help of this pain tool include worst pain severity, daily opioid dose, emotional well-being and pain characteristics (palliativecare.org.au, 2022). On the other hand, the pain can also be assessed with the help of brief pain which helps in determining the impact of pain upon the patient’s daily activity. The questionnaire will help in understanding the patient’s pain sensation and implementing intervention. The form will also help in determining information about the present medication, pain relief in the last 24hours and the impact of pain in over-all activity, mood, ambulatory, sleep, relation and quality of life. 

What strategies can your team implement to address the pain?

Strategies to Address Pain

The pain in this case must be recommended with non-pharmacological interventions for lowering the pain such as aromatherapy, cognitive behavioural therapy and relaxing therapy which will help in lowering the patient distress. Effective communication and involvement of the patient’s family will help in providing supportive psychotherapy and it will lower the pain stimulus along with the that the patient must be recommended with opioids such as buprenorphine. Chen et al., (2016) stated that the patient suffering from chronic cancer pain can be provided with aromatherapy for lowering the pain sensation. Syrjala et al., (2014) stated that the cancer pain can be addressed by recommending the patient with proper coping skill training, behavioural approaches and imagery technique which helps in lowering the pain sensation.

What can your team suggest to help Geoff with his constipation?

It is stated that a proper assessment of the patient’s condition must be done in this case and the healthcare professionals must recommend the patient with proper laxatives which includes osmotic laxatives which helps in retaining fluid in the bowel and it enhances the bacterial fermentation. The patient can be provided with stimulants which enhances the peristalsis (canceraustralia.gov.au, 2022). The patient can also be provided with bulk forming laxatives which helps in increasing bulk of stool for easing the passage. Wickham (2017) stated that constipation is one of the most common issues among the cancer patient and it can be managed by laxative management which helps in lowering the constipation.

Complete a Dignity Inventory form for Greg. Using information from the form, create a care plan that shows how you will respect Geoff’s needs in relation to the following: 

	Goal/action	Intervention/rationale	Evaluation
Lifestyle	To improve the dietary plan and inspire to maintain proper exercise.	The patient must be encouraged to consume high fibre food along with food rich in prebiotic and probiotic.	The constipation symptom will be lower. The patient will be able to deal with the changes related to movement due to physical activity.
Social context	To lower the distress symptom and prevent social isolation.	The patient must be recommended with online-social network training.	The online social intervention will help in lowering the issue of social isolation and will help in coping up with the daily challenges by peer support (Owen et al., 2017).
Emotional	To involve the patient’s family and lower the incidence of depression, anxiety. To improve the quality of life	The family involvement will help in providing proper support and prevent the chance of developing psychological disorder	The incidence of depression, anxiety will be reduced.
Spiritual	To address the spiritual wellbeing and consider the patient culture.	The spiritual counselling along with meditation will help in improving the coping strategies.	It will help in improving the quality of life and lower anxiety, depression and feeling of hopelessness (Xing et al., 2018).

Discuss your role and responsibilities as an EN when planning palliative care for Geoff.

Answer- It is determined that the enrolled nurses are directly involved in providing palliative care to older adults by implementing proper care plans for the patient and maintaining a proper leadership skill which helps in ensuring that the patient is receiving adequate care.  The enrolled nurses are also responsible for maintaining proper documentation related to the treatment plan and providing motivation to the patient in order to recover the quality of life (palliaged.com.au, 2022).  It is the responsibility of the nurses to monitor the patient effectively and to implement proper strategies which will help in addressing the pain as it is one of the most distressing situations for the patient.  The enrolled nurses are also responsible for providing medication and non-pharmacological interventions after spiritual care and psychological intervention for understanding the patient need and implementing coping up strategies which will help in addressing the pain sensation (Greer et al., 2018).

1. Identify the other members who may be part of the interdisciplinary team and their roles.

Management of Constipation

Answer- A proper multi-disciplinary approach needs to be implemented for the patient in order to improve the treatment efficacy and implementing proper strategy in order to provide the patient with holistic care.  the interdisciplinary team must consist of registered nurses,  ontologist,  oncology nurses,  dietician,  physician,  physiotherapist  and it is also important to  involve the psychologist and patient family in the care process in order to address the physical and expressive need of the patient and it will also help in improving the quality of life. 

Provide a report that can be conveyed to your teacher on what you would say to Geoff, his wife and children in regards to the stages of dying, as they are asking for information on what to expect with Geoff at end of life.

It is the responsibility of the nurses to inform the patient’s family independent care about the stages of Dyeing which will help in delivering mental support and providing proper coping strategies with the gradual changes. It is highly essential to mention the family with the signs and symptoms which can be considered as the stage of dying.  The nurse must highlight the signs such as social isolation from near and dear one and lack of proper communication, withdrawal of food and gradual decrease in the appetite and it is essential to feed the patient with liquid form in case the patient refuses to eat. Gradual changes will also be observed in terms of sleeping and orientation in the patient with the patient being confused about the time place and identity which might result in distress. The other changes which might also be observed include decreased senses of vision and hearing along with improper bowel movement. The physical changes which need to be noticed by the family member includes skin coloration changes along with that the breathing pattern becomes irregular which indicates the condition of deterioration.

Within your team identify and document the ethical concerns that may arise from Geoff’s case study.

The moral issue which might arise in this case includes- ethical dilemma in considering the patient’s wish as it is found that the patient denied to intake food and medication due to excessive pain. There is a moral obligation to strive to relieve pain and obligation to prolonged life. The patient’s family must also be included in this case but there exists lack of proper decision-making ability to the best interest of the patient (Ferrell et al., 2018).

Planning Palliative Care for Geoff

As a group create a poster to share with the rest of the class about ways to ensure that you look after yourself and your colleagues socially and emotionally when caring for patients facing end-of-life-care.

Include support networks that you may also access for support. Be creative.

The team can be supported by implementing proper interactive session which will help in providing feedback to the peers and improving their practice. A proper stress reduction therapies and relaxation therapies can be implemented as well for improving the mental health and welling. Education and training about palliative care management is also essential for providing quality care. 

At the end of the session participate in a group debriefing and discuss your team’s findings from the case study. Document 5 points that was discussed during the debriefing session.

The Five essential points gained from the case study includes-

• The principle of palliative care aims at delivering holistic care to the patient by incorporating the medical practice, nursing practice and also aims at considering the spiritual, social and cultural factors in order to deliver effective support for controlling the patient’s condition.
• The symptom assessment scale helps in understanding and measuring the distress symptoms among the patients in palliative care by considering the key signs such as appetite issues, bowel problems, breathing problems, fatigueness, insomnia and nausea. The patient in the case study was found to be suffering from excessive pain which increased the distressing symptom and resulted in refusal of food and drinking.
• The patient can be provided with stimulants which enhances the peristalsis. The patient can also be provided with bulk forming laxatives which helps in increasing bulk of stool for easing the passage.
• The family involvement will help in providing proper support and prevent the chance of developing psychological disorder.
• The nurse must highlight the signs such as social isolation from near and dear one and lack of proper communication, withdrawal of food and gradual decrease in the appetite and it is essential to feed the patient with liquid form in case the patient refuses to eat (Zhang et al., 2017). Gradual changes will also be observed in terms of sleeping and orientation in the patient with the patient being confused about the time place and identity which might result in distress.

References

canceraustralia.gov.au. (2022). Bowel problems. Australian Government- Cancer Australia. Retrieved 2 March 2022, from https://www.canceraustralia.gov.au/impacted-by-cancer/physical-changes/bowel-problems.

Chen, T. H., Tung, T. H., Chen, P. S., Wang, S. H., Chao, C. M., Hsiung, N. H., & Chi, C. C. (2016). The clinical effects of aromatherapy massage on reducing pain for the cancer patients: meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2016. https://doi.org/10.1155/2016/9147974

Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National consensus project clinical practice guidelines for quality palliative care guidelines. Journal of palliative medicine, 21(12), 1684-1689. https://doi.org/10.1089/jpm.2018.0431

Greer, J. A., Jacobs, J. M., El-Jawahri, A., Nipp, R. D., Gallagher, E. R., Pirl, W. F., … & Temel, J. S. (2018). Role of patient coping strategies in understanding the effects of early palliative care on quality of life and mood. Journal of Clinical Oncology, 36(1), 53. doi: 10.1200/JCO.2017.73.7221

health.nsw.gov.au. (2022). End Of Life And Palliative care- Principles. Agency for Clinical Innovation. Retrieved 2 March 2022, from https://aci.health.nsw.gov.au/palliative-care/blueprint/principles.

Owen, J. E., O’Carroll Bantum, E., Pagano, I. S., & Stanton, A. (2017). Randomized Trial of a Social Networking Intervention for Cancer-Related Distress. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(5), 661–672. https://doi.org/10.1007/s12160-017-9890-4

palliaged.com.au. (2022). Registered and Enrolled Nurses. Palliaged.com.au. Retrieved 2 March 2022, from https://www.palliaged.com.au/tabid/5572/Default.aspx#:~:text=Their%20role%20includes%3A,care%20teams%20and%20acute%20care.

palliativecare.org.au. (2022). National Palliative Care Standards – Palliative Care Australia. Palliativecare.org.au. Retrieved 2 March 2022, from https://palliativecare.org.au/publication/standards/.

Syrjala, K. L., Jensen, M. P., Mendoza, M. E., Yi, J. C., Fisher, H. M., & Keefe, F. J. (2014). Psychological and behavioral approaches to cancer pain management. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 32(16), 1703–1711. https://doi.org/10.1200/JCO.2013.54.4825

Wickham R. J. (2017). Managing Constipation in Adults With Cancer. Journal of the advanced practitioner in oncology, 8(2), 149–161.

Xing, L., Guo, X., Bai, L., Qian, J., & Chen, J. (2018). Are spiritual interventions beneficial to patients with cancer?: A meta-analysis of randomized controlled trials following PRISMA. Medicine, 97(35), e11948. https://doi.org/10.1097/MD.0000000000011948

Zhang, H., Zhao, Q., Cao, P., & Ren, G. (2017). Resilience and quality of life: exploring the mediator role of social support in patients with breast cancer. Medical science monitor: international medical journal of experimental and clinical research, 23, 5969. doi: 10.12659/MSM.907730