beliefs about death, dying, palliative care

Answer

INTRODUCTION

The essay has two main parts. The first section is a reflection on the personal beliefs about dying, death and palliative care, experiences of pursuing the unit, and the areas that need some improvement. It incorporates research studies and personal experiences on the idea of death, dying and palliative care. Societies across the world hold varied opinions, and beliefs on the concept of death.  Section two incorporate the case study to deliberate on how nurses would offer holistic care for Sandy and her family factoring psychosocial, physical and spiritual domains. Sandy case study exemplifies the cultural dynamisms that affect palliative care amongst individuals with chronic ailments such as cancer.

1. REFLECTION

PART A

Personal Beliefs about Death, Dying and Palliative Care

Death, dying and palliative care are important stages in any human being lifecycle. Death is one of the emotive issues to face despite the fact that human beings at one point must encounter it at personal or societal levels (Bonsu & Ncama, 2019). I must attest to the fact that death is frightening and nobody of normal mind state imagines the experience. There are various causes of death, including, illness, accidents, suicide and many others.  Currently, death arising from chronic ailments has increased. Many people around the world die out of these disease such as cancer, diabetes, hypertension, heart diseases among many others. The threat of cancer has necessitated for increased creation of awareness and screening to help in its management.

Because I profess Christianity, I also do understand death as a transitional event that would occur to every human. Biblical recording indicate the source of death and explains that those that live accordance with the commandments of the God will die and rise to eternity. Therefore, death is something that we cannot escape from; it must come at some point. I am also privy to the fact that different cultural groups hold different beliefs about death and they engage in different spiritual, traditional, or cultural practices especially when one of their family members dies. For instance, amongst Christians, once a person dies preparations to rest them kick-starts. They organise a religious gathering that leads the procession to laying the dead to his or her resting place. The family members of the deceased receive counselling and encouragement.  After the burial, people mourn for few days and they embark on the daily life hustles.

It is also true that many people remain unaware of the day of their death.  Therefore, nobody can categorically state his or her fateful day. However, in rare occasions, with technology, medics can assess the remaining days for someone to live, especially those with chronic ailments such as cancer. In such cases, the patient has an opportunity to prepare the family members of the death. Palliative care team becomes essential component in the anticipatory grieving. Even though, grieving process may start much before actual death, patients may also grieve for every loss they experience along the journey. For instance, they may grieve for the fate of their children, the failures to accomplish their objectives, and the pain and distress they experience along the journey. For instance, the first loss may be of their future, the loss of seeing their children grow, graduate and get married and so forth. The other loss may be loss of control, loss of their hair, independence, hence reason for grieve.

During grieving, some people may surrender completely to the process while other resist, fight for every bit of autonomous or control, often subconsciously.  Therefore, much pain comes from resistance to give in to the flow of life and to the pain that it might cause. I do not fear death since it is part of cycle of life. I have cared for many people who have died through my hands.  These experiences as awful as they may appear, it is nature. I live knowing that one of the days to come it will be my turn to rest. I do believe that our souls are made of energy and they never cease to exist. I do believe that the physical bodies we have are temporary and the moment we die, as our corpses compose, our spirits live on. These bodies are just shells that allow our souls to accomplish the purpose here on earth.

Reflection on Experience of Undertaking the Unit

The Unit has not been only enlightened me on the issues of death, dying and palliative care  for people with life limiting illnesses, but it has also enabled me appreciate the needs to always be prepared for  death.  The course has introduced to me various concepts in reference to the topic not limited to communication strategies to understand the meaning of the illnesses and the effects it has on individuals. Identifying and acknowledging individuals concerns and source of distress and responding to the same effectively is a role of a nurse.  I have also through unit, got an opportunity, to listen and read stories of different people that have dealt with  life limiting illnesses and this has offered more insights on the management of the same. The unit has also provided an opportunity to engage in constructive discussions with the colleagues, gaining varied opinions and experiences of different people. This diverse knowledge base has widened my knowledge scope on the unit.

Learning Identified

The opportunity has allowed me to learn many issues including, the concept of death, dying and palliative care. It has also enabled me learn the importance of effective communication in the management of patients with life limiting illnesses.  Currently, courtesy of the unit, I appreciate the principles of effective communication when interacting with people that face life limiting illness and their families.  Getting to connect and build positive relationship with the patient and the family is very critical in helping them overcome their worries and anxieties. Both verbal and non-verbal cues play a noble role on the management of interaction and relationship (Iyengar, Behl,  Pillai & Londhe, 2016). For effective communication, there must be honest, openness and trust. For instance, for Sandy to establish positive relationship with the nurses, they have to be welcoming and remorseful and above all exemplify high levels of professionalism. Empathy and honest must manifest for a long lasting relationship (Ekman & Krasner, 2017).

Identification of various sources of psychological, social and spiritual support for people with life limiting illness and their families was yet another important learning identified. Patients suffering from cancer at advanced stages require spiritual, social and psychological support to enable them cope with the stress. Their families as well requires these support and it becomes paramount that palliative care teams help them with counselling and tips on how to cope with the illness (Iyengar, Behl,  Pillai & Londhe, 2016).

Values and beliefs about dying, death as well affect personal responses and the way people interact with those facing life limiting illness and their families. In our society, people hold diverse beliefs and values about the concept of death and dying. These inclinations and socializations may affect the way patients perceive the disease and death and the way the family as well approach or perceive the concept of death and dying. In a multicultural set up, it become advisable to identify or to appreciate these diversities to enhance cordial relationship.

I have also gained knowledge on matters communications. Nurses have to embrace the most suitable communication strategies that benefit the situations. This comes after assessing the situation and ensuring that the strategies do not pose challenges towards achievement of the objective set. For instance, it is important to appreciate the cultural background of the patients and always use courtesy when communicating or engaging in conversation. Polite word such as excuse me, thank you, pardon, among others are essential to create positive communication relationship. When receiving distressing news, the nurse must understand the communication strategies to employ to help address the stalemate. Allowing the patient time to communicate and speak their mind is important before intervening and providing a response in more objective manner. Communicating with children when a parent has a life limiting illness is also an important aspect in the communication aspect. Children have emotions and the right to know the status of their parents. It is important to be honest and open to them so that they understand the situation at hand.

The unit has also enabled or exposed me to aspects touching on what is required when providing person centred support to patients. It is important to understand sources of distress better reviewed through the Patient Dignity Inventory. This tool allows easy identity of the distress prompting applications of most suitable measure. There is however, some potential barriers that may hinder productive discussions between the health professionals and patients about the distress such as time limitation, personal differences among others, which must be addressed.

Furthermore, the unit has allowed me to learn about support required for persons at the end stage of life. Whether in the hospital, home or hospice settings, persons with end to life concerns must receive appropriate guidance, similar to the family members.  Likewise, Nurses have an obligation to adopt self-care strategies when caring for people with life limiting illness.  Nurses attending to people with life limiting illnesses are prone to mental disturbances hence they require adequate training, and counselling to deal with their psychosocial issues (Iyengar, Behl,  Pillai & Londhe, 2016). Some of the strategies are to appreciate that death is for everyone; it is only that their time has not yet arrived. They must also have enough time to work as a team and be each other keeper.  As I finish, the unit has provided in depth knowledge on entire concept of death, dying and palliative care, which I believe remains essential in my role as a nurse, especially when dealing with people with life limiting illness.

Changed/New Beliefs

Acquisition of new knowledge and experiences through learning shapes the way people think and on how they perceive different things in their lives.  Through interaction with the unit materials, I have changed the way I would interact with people facing life-limiting illnesses. Such people undergo greater pain and distress that nobody ought to ignore. It is very important for the health professionals to be ready to offer their helping hand with professional advice to such people because this could be a game changer as they face their end of life stages.

Areas Requiring Development and the Techniques

Despite the milestone achieved in management of people with life limiting illness in hospitals, one area that requires further development is increase networking and training programs in palliative case. The values, practice keep on changing, and this requires that changes be also made to keep up with the high level of expectations. This can be developed through rolling up of new curriculum and programs that would allow practising health professionals to get or acquire recent skill and knowledge, especially when handling such cases. Improving training and management of such people will also be essential in ensuring that high quality health care services reach all deserving persons (Law, Levesque, Lambert, & Girgis, 2018). Another area that requires development is periodic screening of patients after the previous screening. This will ensure or reduce the instances of reoccurrence. The suitable strategy to achieve this is through creation of awareness and increasing the number of screening   tools.

PART B

Strategy to Ensure Continuous Development own Self-awareness and Maintain Self Care

As a nurse, it remains prudent to continuously endeavour to develop own self-awareness and maintain self-care.  According to Richardson, Scott, Schüz, Sanderson & Schüz (2017),self-awareness is the ability to understand own personality, including thoughts, and beliefs, strengths and weaknesses, emotions and own motivations.  This allows one to understand other people and detect how they perceive you as well (Heinze, & Williams, 2015). Healthy self-awareness is therefore paramount for a nurse like me to recognise and appreciate the real experiences that other people go through and ensuring that I manage the same from affecting me negatively in the course of expediting my responsibilities. Maintaining self-care promotes positive health amidst difficult situation (Jitender, Mahajan, Rathore & Choudhary, 2017). To have to experience a loved one go through a life limiting illness such as cancer can be so distressing and disgruntling (Law, Levesque, Lambert, & Girgis, 2018). According to Williams, Mowlazadeh, Sisler & Williams (2015) caring for individual with life-limiting illness may be stressful at times. Caregivers may develop stress because of their own fears of death and dying, own identification with a person suffering and own feelings of inadequacy.  One of the strategies for me it therefore to have realistic expectations of the degree of support I am able to offer. As a nurse, I have always learnt to set realistic expectations that I can positively manage to bear.

QUESTION 2

Providing Holistic Care for Sandy and Her Family

This section offers insights from the learning on how best to offer holistic care for Sandy and her family. This discussion encompasses the domains of physical, psychosocial, and spiritual.  To start, the health situation of Sandy affects her and the family-the husband Jack and her two children Billy who is 12 and Jade who is 8 years.  All of them are in need of effective management to avoid any negative effects or mental disorders.

According to Law, Levesque, Lambert, & Girgis, (2018) in end of life, patient’s particular diagnosis does not matter. What matters is the goal of the palliative care team, which is to help relieve patients’ symptoms and help patient, and family that might be hindering the journey to peaceful death. In this case, as a nurse, it is paramount that I demonstrate ability and willingness to interact with the patient and family about deeply emotional issues that face them. It is also important to demonstrate respect and sensitivity for spiritual and cultural aspects of the patient’s life.

In this regard, as the nurse, it is important that I work closely with Sandy and the family. Effective communication becomes critical ingredient to help Sandy appreciate herself and get prepared for her end of life as well as prepare the husband and the family for the loss (Heinze & Williams, 2015).

Physical Domain

As a nurse, I have the responsibility to create a siren environment that will allow the patient and the family members to feel loved and appreciated. Managing effectively the emotional needs and the distress that patient and family members’ experiences during such moment, especially at the stages of illness Sandy is passing through can be a daunting experience (Zou, O’Connor, Peters & Jiejun, 2013). Additionally, it behoves that I create an environment that would allow patients and family members to feel comfortable and safe to relate and to engage in positive communication.  Any barriers to effective communications with the patient and family members must be dealt with amicably, through building of positive relationships built on openness, trust and honest. The therapeutic relationship plays a vital role to patients and families since they mostly rely on nurses for their emotional journey. Since cancer is a highly stressful experience associated with emotional difficulties, it is also important to use validated questionnaires as a tool for routine screening to address the patient’s emotional distress (Satija & Bhatnagar, 2017).

Other physical aspects that Sandy experiences include, pain, shortness of breath, loss of appetite, fatigue and loss of sleep , as some physical symptoms (Chellappan, Rajkumar & Jeyapal, 2017).  Management of these symptoms requires the assistance of a nurse in terms of information and family members. Sandy requires to continue with her medications by taking drugs as prescribed and holistic approaches such as deep breathing to help address some of the symptoms.  It is also important to ensure that she undergoes palliative chemotherapy to help reduce/shrink the tumour that causes pain (Early rehabilitation of cancer patients: An individual randomized stepped-care stress-management intervention, 2018).

Psychosocial Domain

According to Bates, et al., (2018) psychosocial care is important not only to the patients but also to the staff that provides that care.  During cancer journey some patients report unmet significant informational and emotional needs (Wilmont, 2015). Nurses can provide both written and verbal support to patients to help them with proper management of the ailment.  According to Pillemer et al., (2015) psychosocial care /support involve cultural sensitive provision of social, psychological and spiritual care. Nurses play  a significant role in supporting patients such as Sandy  by building dialogue to understand how they view themselves as individual, important aspects to themselves and how relationships with others affect decisions and how they live with such decisions throughout the process of treatment and beyond (Wilmont, 2015). I have the obligation to attend to Sandy as an individual because she requires specific physical, symptomatic, psychosocial and spiritual care.

Studies have indicated benefits of psychosocial care as reducing both psychological distress and physical symptoms through increased quality of life, enhances coping and reduces pain levels and nauseas as well as consequent reduction of demand or utility of hospital resources (Bonsu & Ncama, 2019). One of the important aspects in providing psychosocial care is adopt good communication skills both verbal and non-verbal (Bonsu & Ncama, 2019). Communication with Sandy and Jack the husband requires interactional skills to convey empathy and support and to help them with the information on medications and dealing with the illness and loss. To achieve this, creating a healthy relationship between the care providers with patients based on trust, honest and openness remain key in this process to provide social support for Sandy and her family. Because Sandy is experiencing distress and anxiety, this communication strategies acts as a buffer.

Another nurse role in psychological care is to offer the resources and education tailored to the needs of Sandy. According to

According to Palliative Care: The Gap between Rhetoric and Reality (2015), nurses are supposed to offer or provide information to support putting to consideration factors such as age, gender, the financial status, religious standings among others. In this case, Sandy is concerned about getting the children understand her status and that she will soon be living them. To address these needs, it is important that Sandy consider breaking the information to the children. She must however endeavour to be honest and open with the children to prepare them and let them understand her situation (Popejoy, Pollock, Almack, Manning & Johnston, 2017).  It is also vital to continuously to evaluate Sandy’s psychological wellbeing for immediate action. It is also the responsibility of the nurse to offer basic emotional support (Palliative Care: The Gap between Rhetoric and Reality, 2015) Sandy can also be referred to other palliative care team to for specialised care. For instance, she requires the services of psychologists, therapists and social workers to counsel and guide her. Similarly, the family of Sandy requires these services to be prepared mentally for the loss and the suitable way to deal with the loss of the mother when the time comes.

I must also receive training and supervision on the management and engagement of patients facing end of life care. This is very stressful part of life and it requires a well-trained nurse with the requisite skills and knowledge to be able to guide and ensure that the patient such as Sandy receive the best of services (Palliative Care: The Gap between Rhetoric and Reality, 2015).

It is also important for Sandy to have enough time with her husband far away from children.  They can go out and have a wonderful time with one another, sharing their experiences to refresh themselves. Time out on the weekend would also allow them to assure their love and express optimisms that indeed live will move on and children will receive good care (Jibb et al., 2015).

It is also important to give suggestions or to refer Sandy to reading materials on breast cancer and other resourceful materials. These materials will help her gain more insights about the disease, gain knowledge and people experiences on the same, hence encourage and engage her. These strategies will help Sandy to remain sober. It is also paramount that the husband reads such materials to gain more insights and to encourage Sandy that indeed, she has fought a good fight and everything is within the control of God. Furthermore, Sandy requires an assurance of regular visits to reassess her situation on the daily basis. The visits will allow the palliative care team to respond appropriately and manage her situation amicably.

Spiritual Support

Sandy and her family require spiritual nourishment to help them gain strength and reassurance that the situation is in the hands of the supernatural being. Sandy has embraced westernised values, but because of the sickness, she is reverting to Hinduism as extrapolated through his changing mode of dressing. As a nurse, it is therefore important to understand the religious beliefs and cultural values a patient and a family upholds to strengthen the same.  This knowledge on Sandy religious beliefs is vital because it helps to administer or manage the situation by borrowing from such values and beliefs.

According to Lee (2019), spirituality should be addressed proactively in hospital settings.  According to Moosavi, Rohani, Borhani & Akbari (2019), spiritual wellbeing is a subjective experience that occurs both internal and outside of traditional religious systems.  Patient’s faith has been found to decrease the patient’s (Moosavi, Rohani, Borhani & Akbari, 2019).  A review by Mishra et al. (2010) established that 98 percent of patients interviewed with advanced cancer believed in God hence spiritually grounded to their faith and religion. They believed that God was in control. In another review by Mazanec et al. (2010), it was established that spirituality was the strongest predictor of social well being and an important predictor of emotional and functional well being in bolstering the quality of life of patients and families suffering from cancer.  In case Sandy experiences spiritual distress, she will be referred to a trained spiritual care provider to help him with the spiritual teaching and encouragement. Similarly, the family of Sandy, which loosely are Christians, will require spiritual teachings and encouragement for them to bear with the situation. For Christians, death is a transition from one state of life to another. Every human being must go through at one point of his or her loves a transition (Mojgan Ansari et al., 2019). Therefore, these teachings hinged on the biblical references are so essential to help Sandy’s family manage the anticipated death of Sandy. It is difficult experience, but it is also an equal important stage in human beings life processes.  It is also important that Jack the husband to Sandy keep the routine as normal for the children to ensure that their minds are not distracted. It is advisable that they start a scrapbook for them to help them start coping with the coming loss. The anxiety that Sandy could be having concerning the wellbeing of her children can be effectively managed through assurances from the nurse and the husband. Jack has to exude confidence that it shall be well with the children. This assurance is also important to help Sandy relieve herself from deep thoughts and about the future of her children.

Family support remains critical at this stage. The fact that Sandy has started changing her dressing mode, it means she is concentrating with her previous religious orientation-Hinduism. She requires the parental love from her parents, which had earlier faded away when she got married in Australia.  Moral support and spiritual support from the parents in India is also essential to prepare her mentally for her end of life care.  Regardless of financial constraints, it is imperative that Jack organises for Sandy to meet with her parents to reconnect with them in terms of spirituality. This spiritual blessing and teachings will definitely help her relief or overcome her guilt.  The moral support from parents will also serve a great deal in her sickness and transition process (Mojgan Ansari et al. 2019)

Conclusion

Nurses rendering end of life care to cancer patients need to embrace psychosocial, physical and spiritual domains as part of their therapeutic quest to offer quality care. The relationships are built through social, psychological, and spiritual care. Effective and quality care has to be holistic and incorporate effective communications strategies.  Serving as a nurse, it is my obligation to monitor and assess the cancer journey of Sandy and address her needs sufficiently.  The family of Sandy is also pivotal in the management of cancer of Sandy. The husband Jack and the children are very crucial and must be trained or educated on the best management strategies to deal with the sickness and the anticipated loss of their mother. Spiritual beliefs and matters faith remain essential in end of life care as it offers guidance, hope and encouragement. Empowering patients through support and education enables them to have some feeling of control.  Use of empathy and reassurance strategies contributes to positive psychological outcomes for patients. They feel supported on a holistic approach, social, psychosocial and spiritual.