Goal 1: Ensuring Access to Best Quality of Life

To provide the quality care and effective treatment to the patient, Wilf who suffers from the critical illness with a lot of health problems like hypertension, osteoarthritis, chronic heart failure, mild COPD and Mild Cognitive Impairment, it is important for healthcare professionals to communicate the family members to prepare a plan of care with different objectives and priorities. At present, Wilf needs the palliative care in the form of person-cantered care services for getting the professional medical guidance from the physician along with the effective care from the care provider to get the right treatment for his wellness and quality life. This assessment discusses the short-term and long-term goals as well as the specific goals from the perspective of Wilf’s health safety and wellness through the Medical supervision and involvement of the family in the care support of Wilf (Department of Health and Ageing, 2011).

The first goal of the care plan will be to help Wilf to have access to best quality of the life. In order to achieve this goal, it is important for the nurse or other health care professional to provide appropriate support for Wilf to stay pain free. From the assessment of the medical history of Wilf, it has been identified that Wilf faces health problems like chronic heart disease, Mild COPD, Mild Cognitive impairment, osteoarthritis, and hypertension. Due to the problem of osteoarthritis, the patients suffer from pain in joints, which should be treated by healthcare practitioner. This kind of pain can damage the quality of life and behavior of patient. Second goal of this care plan is to provide care through the medical intervention by the palliative care team in order to ensure relief from pain, stress and symptoms of the complex health problems in Wilf (Stephens, 2018). Educating and consultation can help to enable Wilf to understand that his wife is no longer able to support him. The nurse or other appointed healthcare staff should provide friendly guidance to Wilf to comply with the prescriptions mentioned on different medicines. The health professional should also communicate the consequences that may occur, if he fails to timely take the medicines.

The third short term goal of care plan for Wilf should be to conduct health check-ups and tests of Wilf like blood pressure, heart rate, sugar level etc (Wirtz, Cribb, & Barber, 2006). This will help to prevent consequences arising from hypertension, heart disease and unexpected death with the patient.

Goal 2: Providing Care Through Medical Intervention

The first goal of care plan is that Wilf should be provided psychological treatment (Stone, 2018). It is observed from the analysis of given case that Wilf gets angry and frustrated with Mavis frequently. On basis of these symptoms, it can be said that Wilf is exposed to risk of cognitive impairment disorder. These are also the symptoms of anxiety in a person. The behaviours like anger and frustration should be handled by nursing staff as well as family members through use of different tactics like positive influence on Wilf to stay happy and spending time with family members, reading some books and watching interesting shows (Care Search, 2018). Wilf is also exposed to issue of forgetful. In this context, the memory exercises can be suggested to Wilf.

The second goal of care plan will be to ensure the care setting for Wilf to live in a healthy and supportive environment for feeling pain-free in the life. This can be done through reducing the boredom, anxiety, and distress in his life. The palliative care intervention can be adopted for Wilf for encouraging involvement in different activities that will reduce his boredom, stress, and pain. Example of these activities includes walking, light exercise, playing games with grandchildren, watching T.V. etc. But involvement of Wilf in these activities will depend fully on the free choice of Wilf (The Australian Government: the Australian Institute of Health and Welfare, 2017).

It is very important to support Mavis so that she could stay fit and able to care for herself and her husband. Firstly, Mavis is in the need to get assistance from the home-based palliative care support for better care of Wilf. Mavis should not raise her temper and always work with the cool mind so that she could create a friendly environment for Wilf. Mavis should avoid the heavy works or maintenance of home. This will reduce the physical and mental burden on Mavis. 

Mavis can also get the psychological support from the psychologist in order to stay away from the stress or tension (Dow, et al., 2010). The psychologist can also advise her to create a positive and happy environment for better healthcare for her husband. Mavis can encourage her husband to feel good and live life positively without fear of increasing health concerns and stress. Mavis should spent time on exercise and meditation for getting rid of hypertension. Mavis should also focus on taking balanced food diet by restricting sugar and high carbohydrate (Carlozzi, et al., 2017).

Goal 3: Conducting Health Check-ups and Tests

Mavis is very tense-full and troubled because of increasing health safety concerns of Wilf and now she has not been able to provide longer care support for her husband. Mavis should be professionally advised by the physician to adopt a slow paced approach while performing any work. Mavis should keep careful attention while moving, working, or walking in her daily routines. She should not show any haste because it can result in serious injury to her body. She also should be attentive while serving and caring her husband. This will allow her to avoid situations of frustration/ anger with Wilf (Cortopassi, Gurung, & Pinto-Plata, 2017).

Mavis really wants to continue caring for her husband because she has been the principal carer for him. Wilf also expects the care from his wife’s hands but also understands that her wife is currently not mentally fit (facing hypertension) to care for him and maybe an extra burden on her shoulders while she has been facing the health problems in her aging stage. Mavis can get support from an affordable home-based person-centred care staff to help her husband (Cherlin, et al., 2005).

It is important for Wilf and Mavis to keep conversation with their own children, Jenny and David for getting their suggestions regarding the health care concerns. David and Jenny can suggest them for getting the advance care planning with the help of palliative care support. The palliative care staff will assist them in taking the decision for the best care support to Wilf through the residential aged care setting or person-centred care. The palliative care can provide the information on the advance care planning for supporting the life of Wilf with the quality care. The advance care planning will keep him away from psychological problems like stress/tension by reducing anger, anxiety, and aggressive behaviour. The advance care planning will provide the directions for determining that what future health plan will be best and how to implement the plan (Hudson, et al., 2012). The advance care directive will contain a letter or statement of inclusion of the doctor for the preparing the outlines of Wilf’ medical history, his future health plan, life goals, prescriptions/ advice, medical intervention, and the external care support requirements to Wilf for his long-term wellness and safety.  

The conversation could also be held with the children regarding the health improvement of Wilf through the setting of the external care support. There are several government-owned aged-cares or charity-based community cares in Australia that provide the subsidized quality care services for meeting healthcare needs of care recipients. The aged-care service facilities provide the family environment, medical help, and care support from the care service staffs to provide the lifetime healthcare support to assist him to lead a better life with the health improvement through the aged-care setting (Mitchell, 2011).

Goal 4: Providing Psychological Treatment

For this particular case, the conversation should consider the important issues like reduced workload for Mavis. Mavis should follow the physician’s advice to slow down in order to prevent the worsening of her health. David is the elder son of Wilf and Mavis, so he is more appropriate and responsible to take this matter seriously and implement an action plan by consulting or getting information from the palliative care staff. David can request his mother (mum) not to engage in more physical activities or domestic workloads. Rather she should spend the most times of her life with a great deal of comfort and happiness and in the care of Wilf (Palliative Care Australia, 2016). He can also make friendly request his father to control anger, frustration and boredom and to spend time in activities of interest.

It will be important to consider the palliative care like person-cantered care for supporting older life of Wilf for ensuring access to better quality of life. The palliative care is a multidisciplinary approach. The palliative care could be used to get the care support and the additional support at time of old age. But, the main goal of palliative care should be providing the life care support to Wilf so that the mental problems could also be reduced along with the physical health problems (Eagar, et al., 2010).

The principle of respect is related to allowing and enabling the patients to make their self-decisions freely regarding healthcare requirements or medical interventions. But, regarding managing the best interests of the patient safety, the role of the palliative care becomes vital. Application of palliative care can help to provide the healthcare support to Wilf. It is a type of active and supportive care that seeks to maximize the comfort level and quality of life to the person in need. The palliative care support could be provided through the residential aged care facilities or government aged-care centres. It can help to manage the best interests of the Wilf by providing the healthcare support of his own wishes. The application of palliative care will provide better healthcare guidance to assist Wilf for managing his daily life for caring himself by getting consistent information, managing resources, and medications.

Regarding managing the best interests, the palliative care will respect and value the rights and autonomy of Wilf for taking decision for self treatment. But it would be better if the decision is finally made after getting the professional medical advice and consultation with the family members. The palliative care should inform Wilf and his family before any medical intervention or treatment is given to him. The carer requires keeping transparency and accountability in the treatment process by ensuring the right kinds of medication after diagnosing and checking the health reports of Wilf (Entwistle, Carter, Cribb, & McCaffery, 2010).

Goal 5: Ensuring a Healthy and Supportive Environment

Wilf has a particular interest in smoking cigarettes, gardening and playing lawn bawls with friends. The palliative care can provide an expert professional advice to Wilf to quit smoking, only if Wilf wants to quit. Otherwise, there should not be any pressure on freedom of Wilf to enjoy its smoking activity (Naik, Dyer, Kunik, & McCullough, 2009). Family members should be advised to not interfere in freedom and personal choice of interest activities of Wilf like even the smoking, if he is getting rid of tension/ anxiety with this activity. The palliative care can advise Wilf and his family members to follow the safety assessment to keep him away from taking more tension, boredom, and irritation, reducing anger and anxiety. It can help to increase involvement of him more in physical exercising, yoga, and social activities, like watching TV or spending time with grandchildren to get rid of the tension.

The carer should provide effective care with suitable medications on time as per the medical chart prescribed by the physician. The palliative care can guide the carer to follow the safety assessment by arranging fire retardant blanket for the safety of Wilf against fire, clean wearing clothes, and the first-aid treatment in the emergencies (McPake & Mahal, 2017). The person-centred care should be provided to Wilf based on better patient-provider relationship and medical ethics.  

Conclusion

Overall, it is concluded that Wilf requires the care support and professional guidance under the palliative care supervision. The palliative care could be provided through the aged-care setting of the government healthcare centres. The combined efforts from the family members and medical intervention team could be effective in providing better care support in assisting Wilf to live a better life by ensuring his health wellness and safety. Both short-term and long-term goals can provide the frameworks for the advance care planning and standards for the quality of life by managing the symptoms in his struggled life.   

References

• Care Search (2018). Working with families. Palliative Care Knowledge Network. Retrieved 16/10/18 on:https://www.caresearch.com.au/caresearch/tabid/273/Default.aspx.

Carlozzi, N., Sherman, C., Angers, K., Belanger, M., Austin, A., & Ryan, K. (2017).‘Caring for an individual with mild cognitive impairment: a qualitative perspective of health-related quality of life from caregivers’, Aging & Mental Health, pp. 1-9. doi:10.1080/13607863.2017.1341468.

Cherlin, E., Fried, T., Prigerson, H., Schulman-Green, D., Johnson-Hurzeler, R., & Bradley, E. (2005). ‘Communication between Physicians and Family Caregivers about Care at the End of Life: When Do Discussions Occur and What Is Said?’ Journal of Palliative Medicine, Vol. 8(6), pp. 1176-1185. doi: 10.1089/jpm.2005.8.1176.

Cortopassi, F., Gurung, P., & Pinto-Plata, V. (2017). ‘Chronic Obstructive Pulmonary Disease in Elderly Patients’, Clinics in Geriatric Medicine, Vol. 33(4), pp. 539-552. doi: 10.1016/j.cger.2017.06.006.

Department of Health and Ageing (2011).The Australian Government National Palliative Care Program. Retrieved 16/10/18 on: https://www.health.gov.au/internet/main/publishing.nsf/Content/palliativecare-program.htm.

Dow, B., Haralambous, B., Renehan, E., Meyer, C., Lewis, C., & Lin, X. (2010). Scoping study of health professional education and training in older age depression and anxiety. Retrieved 16/10/18 on: https://www.mednwh.unimelb.edu.au/research/pdf_docs/NARI-education-and-training-in-older-age-depression-and-anxiety.pdf.

Eagar, K., Watters, P., Currow, D.C., Aoun, S.M., & Yates, P. (2010). ‘The Australian Palliative Care Outcomes Collaboration (PCOC)-measuring the quality and outcomes of palliative care on a routine basis’, the Australian Health Review. Vol. 34(2), pp. 186–192.

Entwistle, A.V., Carter, M.S., Cribb, A., & McCaffery, K. (2010). ‘Supporting Patient Autonomy: The Importance of Clinician-patient Relationships’, J. Gen Intern Med. Vol. 25(7), pp. 741-745.

Hudson, P., Remedios, C., Zordan, R., Thomas, K., Clifton, D., & Crewdson, M., Bauld, C. (2012). ‘Guidelines for the Psychosocial and Bereavement Support of Family Caregivers of Palliative Care Patients’, Journal of Palliative Medicine, Vol. 15(6), pp. 696-702. doi: 10.1089/jpm.2011.0466.

McPake, B. &Mahal, A. (2017).‘Addressing the Needs of an Aging Population in the Health System: The Australian Case’ Health System & Reforms, pp. 336-347.https://doi.org/10.1080/23288604.2017.1358796.

Mitchell, K.G. (2011). ‘Palliative Care in Australia’, Ochsner Journal, Vol. 11(4), pp. 334-337.

Naik A.D., Dyer, C.B., Kunik, M.E., & McCullough, L.B. (2009).‘Patient autonomy for the management of chronic conditions: two component re-conceptualization’, American Journal of Bioethics. Vol. 9(2), pp. 23–30. doi: 10.1080/15265160802654111.

Palliative Care Australia (2016).Palliative Care Support and Services in Australia. Retrieved 16/10/18 on: https://palliativecare.org.au/.

Stephens, C. (2018). Hypertension: Causes, symptoms, and treatments. Retrieved16/10/18 on: https://www.medicalnewstoday.com/articles/150109.php

Stone, M. (2018). Goals of care at the end of life. Retrieved16/10/18 on: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291327/.

The Australian Government: the Australian Institute of Health and Welfare (2017). Aged Care in Australia: Overview. Retrieved16/10/18 on: https://www.aihw.gov.au/reports-statistics/health-welfare-services/aged-care/overview.

Wirtz, V., Cribb, A., & Barber, N. (2006).’Patient-doctor decision-making about treatment within the consultation: a critical analysis of models’, SocSci Med. Vol. 62, pp. 116–124. doi: 10.1016/j.socscimed.2005.05.017.