Hospice Care Plan
Hospice Care Plan Walden University Mrs. Thomas has a history of breast cancer and is status post bilateral mastectomies with subsequent radiation and chemotherapy treatments. She has recently been diagnosed with lung metastasis and further treatment is not recommended by her physician and due toa poor prognosis he is recommending palliative care. Mrs. Thomas has been spending most of her days in her bed crying. She has had very little contact with her sons and their families as they live out of state and she has voiced that she doesn’t want to burden them with her illness.
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Mr. Thomas is attempting to provide for his wife, yet he suffers from chronic depression and is showing signs of increasing depression and often forgets to take his medications. Mrs. Thomas’s physician has made a referral to the local community health nurse to assist Mrs. Thomas and her family. The community health nurse’s role is unique in that she is knowledgeable of the resources available in the community to assist clients and families. The nurse can serve Mrs.
Thomas and her family by assessing the current needs of the family, providing information about available resources that ay be of assistance to the family as well as providing referrals as appropriate for any treatment and care that Mrs. Thomas will require now and in the future in dealing with her terminal illness. Personal Perceptions To Caring for Terminal Patients Caring for terminally ill patients and their families can be a challenging but rewarding nursing experience.
It is important for a nurse to be able to be comfortable with one’s own beliefs about death and dying as well as believing that the quality of life is more important than the quantity of life in order to be effective in elping those that are terminally ill. It has taken many years of professional clinical experience and education in the field of palliative care that has led this writer to be comfortable with the death and dying process. It is a personal belief that death is the reality in life and can and should be a natural process.
A nurse comfortable in great privilege to be able to care for those that are dying and to be able to assist the families at the end of their loved one’s life. It is the belief of this writer that being clinically competent, having the unique ability to be empathetic toward those that are erminally ill and having a positive attitude toward death greatly enhances one’s nursing ability to effectively care for terminally ill patients and their loved ones.
How to Improve the Quality of Life The community health nurse’s first priority and an important first strategy in assisting Mrs. Thomas would be to conduct a home visit in order to perform a comprehensive assessment of Mrs. Thomas’s physical, psychological and social state of wellbeing. It is important for the nurse to plan with Mrs. Thomas as toa suitable day and time for her. It would be valuable to have Mr. Thomas and other family members present as well. The nurse with Mrs. Thomas’s consent could make telephone calls to the sons and their families inviting them to attend.
If they are unable to attend, the nurse could arrange for communication via a speaker telephone call or perhaps a computer generated visit via Skype for instance. It would be important to establish an atmosphere of trust between the nurse and the patient and her family during this home visit. This trust will greatly influence the nurse’s ability to assist the patient and her family. Education would be the key to helping them understand that the nurse’s role would be one of being an advocate for them in avigating the health care system and finding community resources to assist them at this difficult time.
It is important during this first home visit to assess the patient’s knowledge of her disease process as well as her expectations and wishes during the final stages of her life. This conversation as to the patient’s wishes is crucial to the nurse’s success in developing a nursing plan of care individualized to Mrs. Thomas. During the first home visit the nurse would evaluate, educate and discuss community resources that would be of benefit to the patient and her family. It would be mportant to assess the need for short term as well as long term needs during this time.
Over all, the first home visit by the community health nurse should be a time of building trust, providing education and identifying and defining the wishes and the needs of the patient and her family. This first strategy is invaluable in providing Mrs. Thomas with the security of knowing that there is someone who cares about her and will be able to help her through this illness. Encouraging communication with her family is important to ensure that all are knowing about the disease process and er wishes regarding care at the end of her life. This will give Mrs.
Thomas reassurance and peace of mind that she is not alone in her final stages of life and that her wishes and preferences for care will be met. Mrs. Thomas has been experiencing uncontrolled pain which has led to her spending the majority of her time in bed. The second strategy for the community health nurse would be to provide education regarding the importance of pain management which would include the need for the use of medications to manage the pain as well as the proper use of pain medications. This education would also erve to address the fear of addiction regarding her use of pain medication.
It would be beneficial for the nurse to assist Mrs. Thomas to arrange an office visit to her primary physician. Mrs. Thomas is in need of pain and symptom control benefit the patient ensuring that her pain is effectively managed. It is important for the primary physician to remain active in the oversight of Mrs. Thomas’ care with the nurse communicating with the physician on a regular and as needed basis. The third strategy of the community health nurse would be to facilitate referrals to community resources that would be beneficial to Mrs.
Thomas. The ideal referral would be a referral toa home health agency of Mrs. Thomas’s choice. The primary physician is essentially the gatekeeper to other avenues of the healthcare system and the physician could initiate a referral to home health during the office appointment. Mrs. Thomas would greatly benefit from a home health referral because home health has multiple disciplines that specialize in maximizing an individual’s quality of life and health. These disciplines include nursing, therapies, and social work as well as personal care aides.
The home health nurse would assess Mrs. Thomas’s physical tatus and overall home needs. The nurse would evaluate the success of the pain management regime and provide emotional support and ongoing education to the patient’s needs as the illness progresses. Physical and occupational therapies would provide Mrs. Thomas with recommendations as to exercise and home safety as well as provide any adaptive medical equipment to enhance her overall physical status and provide for her future declining physical status.
The therapies involved in her care would assure that Mrs. Thomas could remain independent and active in her home as long as she could safely manage. Most home health agencies have a social worker available and a social worker could assess and assist with any financial needs or important decisions. The social worker could facilitate communication with Mrs. Thomas’s family as well as identify and teach any coping strategies needed by the patient and her family. Personal care aides could be utilized by the home health team to assist Mrs.
Thomas with any personal care needs such as bathing or other simple household tasks. This assistance would allow Mrs. Thomas to conserve her energy to do other important activities of daily living and those activities that she njoys. Nursing Action Plan The holistic nursing care plan for Mrs. Thomas was developed during the community nurse’s initial home visit and includes all of the strategies as previously discussed. The community health nurse should remain in close contact with Mrs. Thomas and her family to ensure that the needs of the patient and her family are being met.
Home health agencies can provide a myriad of services as the needs of patient and their families arise, but it is critical that the community health nurse continue her oversight of the care of the patient. A weekly phone call or home visit would ensure hat the nurse is aware of any situation that needs additional attention. Mrs. Thomas resides in the suburb of a large city and many cities have organizations including church organizations, Meals on Wheels and others that can assist those with terminal illnesses.
An ongoing evaluation by the nurse is critical to ensure that community resources are utilized to the maximum in order to provide the best care for Mrs. Thomas. It is important for the nurse to assess Mrs. Thomas’s spiritual thoughts as well and having Mrs. Thomas’s minister involved or a referral to a local chaplain would be ideal. The nurse will ensure that the long term needs of the patient are end of her disease process and when she is no longer able to care for herself. Home hospices specialize in end of life care.
Hospice staff includes nursing, physical and occupational therapies, and personal care aides. Home hospices also provide social work counseling to patients and families as well as chaplain and volunteer services. Chaplain services are unique to hospice with the chaplain providing spiritual guidance and support that many patients and their families greatly appreciate during their times of greatest need. Bereavement services are available to assist families after the death of a loved one as well. Should home hospice care not be an option for Mrs.
Thomas, there are inpatient hospices available in most cities that can be of assistance. In summary, the community health nurse would be the key advocate and resource for the patient and her family to ensure that their needs are being met by identifying those needs and providing information and referrals to other support services as the needs arise. Care of Mr. Thomas Mr. Thomas suffers from depression and has exhibited increasing signs and ymptoms due to the stressors accompanying his wife’s illness. It is important for the community health nurse to address Mr.
Thomas’s feelings during the initial home visit. The nurse would educate Mr. Thomas on the importance of taking his medication as prescribed. She could assist in developing a reminder chart or in the preparation ofa pill box to organize his medication regime. Providing the couple with the reassurance that there are many resources in their community that can provide help would serve to greatly alleviate any fears and concerns that they are feeling. It would be important for the nurse to suggest that Mr.
Thomas contact his personal physician to assure that his medication regime is sufficient to manage his depression at that point in time. A referral toa community mental health professional may be warranted. Terminal illnesses and the process of death and dying can be a great time of stress and fear for individuals and their families. It is the community health nurse’s priority to assure that all resources are used as appropriate and that the needs of the family are being met. These nursing actions are the key to assuring that quality of life is maintained during the final stages of one’s life.