Applying the Four Principles Case Study

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Part 1: Chart (60 points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible.

 

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

●        The physician must ensure that they have done everything possible for the good health of the patient. This also means that they need to wear out all options to makes sure that the health of the patient has improved or his life is prolonged. This happened when James father considered convincing James brother to donate kidney.

●        The patient should not be coerced to treatment that they do not want. Even though there was a perfect match for kidney transplant, it is important that the physician allowed James to have faith in spiritual healing until the time he would think otherwise and consent for a transplant.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

●        James father would have consented to the transplant and convinced his other some to donate one kidney for a transplant, when James life came to very near danger.

●        The physicians needs to do the right thing, which is to ensure that the patient is healed. However, it is also required that the physician listen’s to the patients decision to believe on faith healing as a Christian. Denying them the right to faith healing would be wrong and unfair, however, the right and just thing to do is to convince the patient to undergo a transplant.

Part 2: Evaluation

Answer each of the following questions about how principlism would be applied:

  1. In 200-250 words answer the following: According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

Beneficence is one of the greatest ethical principle which mostly addresses the idea that the action by the physician should be in the manner that will promote the good of the patient. Doing well from the part of the physician is also important especially when it is will benefit the patient. Beneficence however need not to be confused by non-maleficence that states that a physician should not harm a patient.  The principle in regard to the case study means that the physician should have the obligation for him to protect his patient from harm by removing or preventing all parts of bad situations and promoting things that would benefit them.  In the cases study for example, it was the role of Mike to inform the physician that he had decided to make the decision to have his other son Samuel to lose a kidney and not allow the spiritual process since this was something that would be reversed.  Generally as a physician one is expected to see that patient as a whole and to think about the long term effects of the patients. This is because beneficence is centered on ensuring the good for a patient, the difficulty with this is that the principle often lies on the definition of what is good and what that good would mean to the patient.  For some patients, like in the case study, good might also means allowing them to die when their time comes, however to others, goo might mean ensuring the patient has undergone a difficult procedure so that their life is prolonged.

 

 

  1. In 200-250 words answer the following: According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points)

 

According to the worldview Christians must rank the priority of four principles in relation to the health and faith of the individual. In this case, it is important to look at respect for autonomy, non-maleficence, beneficence and Justice as the last principle when everything has been exhausted. This is because in regard to the James story, the patients has the right to make informed decisions regarding the medical care of their patients.  The principle also underlies the demands for the physician to seek consent or ensure there is an informed agreement from the side of the patient before making any investigation or having the treatment take place. Perhaps this principle is as at its most forcible where it is important for the patient to practice their autonomy or when James refused to continue with treatment and rely on their faith in God.  The principle also requires that a patient like James that is suffering from kidney problem has the right to choose whether to consent for kidney transplant or not. The right of choice is also not limited to what others might regard as the right thing to do.  Notwithstanding it exists that the reason to ensure the choice the make about his health is not irrational, should be known or existent. It will however depend on the reason he is coerced to decide and will not be said to be his or should not be respected if it means risking their life. In respect to the condition of James, if the physician had concerns regarding coercion, right medical or treatment practice would ensure there is more time spent to discuss with the patient all the options, including holding on faith so that they can confirm the decision was genuinely theirs.

 

Predictive Analytics, Big Data, And Machine Learning

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Pressure ulcers are still considered as one of the most serious problems that occur in elderly people especially in situations of degenerative diseases. It becomes important to come up with ways nurses deliver care to that type of patient though new technologies in healthcare. With Artificial Intelligence machine learning, physicians can provide predictive analytic models for learning of the generation or degeneration of the condition (Intersystems, 2018). Predictive analytics depends on artificial intelligence where computer are taught how to learn the occurrence or behaviour of a particular medical condition. In many cases this can be helpful to determine the kind of treatment a patient can be put in before they condition gets worse. Machine learning can enable the nurse or physician understand the patient’s pressure ulcers, and apply the required treatment during care to reduce the risk of generation (Intersystems, 2018).  It helps the nurse to evaluate the risk degree with individualized production of pressure ulcer prevention protocol. 


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Machine learning involves the use of degree evaluation scales like the Norton and Waterlow scales which can detect areas that are susceptible to pressure ulcers especially for patients that have reached the most severe stages of the illness. By using artificial intelligence, it is also possible to tell the life span for the patient so they can prepare themselves early (Intersystems, 2018). With machine learning, it is possible for the physical to modify the type of care according to recorded factors, change in treatment will then be mobilized  as a comfort message is administered  especially the heels, bony projections among other factors related to pressure ulcers (Saria, 2016).

In summary predictive analytics and machine learning is very important development in medicine and nursing care for pressure ulcer prevention, it will identify the risk factors influence how they occur and how nurses will behave in relation to the causal factor.


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Palliative Care

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Introduction

Palliative care is a type of nursing healthcare whose main focus is to reduce pain and severity of the disease symptoms. Palliative care is a very important aspect of nursing and requires that nurses are equipped with the required knowledge and skills to handle any patient situation. For patients suffering from Chronic Obstructive Pulmonary Disease, palliative care involves both the physical and psychological aspects (Bal Özkaptan & Kapucu, 2016).

Palliative nursing care is hereby critical for patients with COPD because it ensures patient pain and suffering is controlled, and the nursing care acts as a support system when it comes to physical and psychological therapy.

The following report focusses two palliative care nursing strategies namely; psychological support and management of psychological problems and relieving and management of shortness of breath during care.

  1. Psychological support and management of psychological problems

High priority nursing strategy is Psychological support and management of psychological problems. Anxiety and depression is often a common health issue for patients suffering from COPD and if not well managed is bound to have very significant impact on the patient, her family and the development of the condition (Bal Özkaptan & Kapucu, 2016). Anxiety and depression is among the major causes of increased mortality, lengthy stays in palliative care, exacerbation rats and the decrease in the quality of life. 

Among the interventions include the provision of psychological support and management of her psychological problems which could be related to the condition.  During nursing care, it is essential for the nurse to recognize some of the symptoms to come up with a better strategy in assisting the patient in coping with the situation. Also during the nursing care, the nurse will help the patient to practice relaxation through cognitive behavioural therapy (CBT), the nurse can also assist the patient in doing some things for herself like walking to the toilet, taking medication and simple tasks like taking meals and medicine at the required time (Maters, Pool, Sanderman, Wempe, & Fleer, 2017).  When the nurse can administer the proper COPD care for a patient with anxiety and depression, it can have a significant impact on the whole palliative care process for the patient. Other studies have affirmed the importance of psychological intervention among COPD patient in palliative care. 


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Another important intervention is to conduct interpersonal therapy sessions with the patient which will help them to improve their mood through interpersonal relationships. The nurse can show the patient that he can count on their care and support . The main focus here would be to change the patient's thoughts, feelings, and fear about their condition though increase social support and increasing interpersonal function. The nurse needs always to review the patterns of relationship associated with the patient within the nursing care and family; the nurse will then weight the capacity for intimacy in the current relationship (Maters, Pool, Sanderman, Wempe, & Fleer, 2017). It is also important that during this interpersonal relationship, the nurse discusses patient’s treatment plan, what works for them and what does not and what can be done by the nurse to makes the patient is comfortable. When psychological and management of psychological issues is done properly, the patient will be able to deal with events that trigger anxiety and depression, effectively communicate his or her condition and learn to solve problems that are specific to her condition.

The above intervention were chose for Mrs. Brown since it is indicated that she had suffered incidences of anxiety which could  also mean there were underlying psychological issues related to the condition. Her situation was also complicated due to several risk factors associated with biochemical alterations and symptomatology. In any case, as a nurse, there will be no possible consensus on the right approach to psychological screening as to affirm that the patient is suffering from anxiety and depression associated with COPD.

In conclusion, overall focus will be to ensure the patient gains independence while under care and is free to negotiate the support plans and how the patient family can participate in the continued care process.

  1. relieving and Management of shortness of breathe

High Priority nursing strategy here is relieving and management of shortness of breath. Patients with COPD usually have damage to their lungs that makes it difficult for them to breathe. The shortness of breath will occur since they are using a lot of effort in breathing the air and releasing it out of the lungs. They will require more effort to breath, experience hunger for air, gasp for air and experience heaviness in the chest (Braço Forte & Sousa, 2017).

Among the intervention when the patient experiences shortness of breath is to first of all ensure that she is placed at an airy place, this entails making sure that the environment to which he bed is located is not filled with junk and dust, and that there is easy circulation of air. Since communication is very important in care, the second intervention is to ensure that she can communicate with the nurse through other techniques such as using closed questions when attending to her. Here the nurse can instruct the patient to answer with a shake of the head or a nod as this will allow her to communicate. During this time it is essential that the nurse exercises a lot of patience as this is very important to ensure the nurse does not make assumptions on behalf of the patient (Hussain, Neoh, & Hurlow, 2014). If the patient is strong enough, the nurse can allow the patient to write on the paper or use a flash card as a way to ensure communication about medication, a reminder to go the toilet, change of beddings and progress of treatment and care takes place. Oxygen therapy may also be needed with respect to the severity of the patient as this is also a barrier to communication (Hussain, Neoh, & Hurlow, 2014). 

Also ensure the patient seats or lays in the right position all the time;  since  a patient with COPD experiencing shortness of breath needs to maximize all the respiratory function with minimal physical effort, meaning the nurse needs to ensure the patient is  well supported and stays comfortable (Braço Forte & Sousa, 2017). The nurse should put the patient's pillow on the back to promote his or her posture; they should not be too many as they will restrict chest movement.

In addition to keeping the right posture, the nurse should provide a number of breathing exercises; these are very beneficial to the patient with COPD. Examples of breathing exercise for an elderly patients would include, pursed lip breathing and muscle exercise as this makes the lungs strong. The nurse can teach the patient other controlled techniques for breathing; however this should only be explained to the patient at the moment that they have regained their breath, the nurse should also ensure that they practice this regularly (Braço Forte & Sousa, 2017).  In the event that they are breathless then they will be required to use such a technique in controlling their breathing rate and reduce the discomfort associated with it.  The above interventions were chosen for Mrs. Brown, is it was observed that she was suffering intervals of shortness of breath which is a common condition for COPD patients.

Shortness of breath is a common phenomenon for COPD patients, however physical therapy as the ones discussed above ensure that the patient can manage her condition, whenever moments of shortness of breath occur during palliative care.

Conclusion

Patients suffering from COPD need nursing palliative care since the condition is unpredictable due to physical and psychological symptoms.  Nurses should continuously implement the two high priority strategies. However, the most critical aspect of the two care strategies is negotiating with the patient and finding out from them what can work and what cannot work. Patient family support is also significant during this time, especially in terms of reducing patient anxiety and depression, and management of shortness of breath ensures the patient drifts his thought from the chronic condition and puts more effort towards care.  The above strategies need to be done with a lot of care to ensure that the interventions do not cause harm to the patient.


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Assessment for Evidence-Based Practice and Applied Nursing Research

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Qualitative Research Article: Pain Management in Children

Title of the Article: Valizadeh, F., Ahmadi, F., & Zarea, K. (2016). Neglect of Postoperative Pain Management in Children: A Qualitative Study Based on the Experiences of Parents. Journal of Pediatric Nursing, 31(4), 439-448. doi:10.1016/j.pedn.2016.02.012

Introduction

 The authors of this research article introduce the work well by providing an introduction to the subject which is Pain management. They go on to say that pain management is known as the ‘fifth vital sign' which calls for a holistic approach to management.  In this manner, pain management is about putting in place a holistic assessment an screening, a collaborative care plan between the hospitals and at home. Low interference of the body function, an efficacious treatment that leads to inadequate pain relief among other few adverse effects.  During pain management, the authors show the relevance of being involved and all aspect to pain management in terms of clinical guidelines as they govern their organization and the whole care system.

Among the issues that have been factored will in the introduction is the way that the author insists on the rights of patients to be involved in all aspects of pain management through the governing and organization of all the clinical guidelines related to pain management and the healthcare institutions.  In doing this, the author has been able to identify the purpose of the study which was to determine parents ‘experience on the barriers to optimal postoperative pain management in children

Review of Literature

Review of literature was also done well and looked at the developments in post-operative central management among children. The literature review was also based on background studies especially on the numerous factors that contribute to inadequate pain management among children. In particular, the researchers focussed on organizational factors in pain management that looked at the lack poor access to drugs, limited staff, lack of time to attend to patients and the tasks that came up with competing priorities. The researcher also outsourced information from different studies done in the area of pain management. The literature review was based on studies done between the 1960s to 2017. Among the evidence-based information found in the literature review included healthcare provider related factors that were more focused on the reason patients underwent pain than on the way that pain was managed.  For example, the study looked at the insufficiency in the prescription of analgesics, the fear of poisoning against children and addition and the belief that children usually exaggerate the rate of pain.  The other evidence-based study was based on the prescription of analgesics, where one study identified barriers to communication as one of the challenges caregivers undergo during pain management in children. In particular, the researcher mentioned that children who have no verbal communication skills were the most affected in effective pain management.

From the litterateur review, the authors also identified the lack of knowledge on analgesics of fear of children's addition and the assumption that children always cry like some of the barriers to pain management in children.  This was mainly related to parental care, and it was among the main factors that derailed the treatment of pain. The literature review was done very well and was based on various experiences from hospitals and home care for children undergoing treatment of pain.  Also during the literature review, empirical studies where done on parents perception on how hospitals manage children’s pain. The studies were based on different interviews done in the U.K, South American and other parts of Europe, looking at perceptions of parents in children's postoperative pain management. From the evidence gathered in this literature, the researchers revealed that parents who reported having a limited and passive role in their children management of pain, often felt that caregivers or nurses were the major obstacles in the provision of children postoperative pain management due to lack of communication.

Data Analysis

When it comes to data analysis, it looked at how the researcher went from all the data collected to remaining with only the meaningful insight to the study.  In this study, the analysis was done after completing the interview together with data collection.  The technique here was to analyze content from the interview recordings, where the interviews were transcribed verbatim in support of transcripts which brought out the understanding of the study topic. Other techniques used in data analysis included comparing different codes and grouping them in subcategories by their differences and similarities. After all the abstraction process was complete, the central theme was discovered that reflected the concept of the study area. This method of data analysis was relevant as it ensured that there was the narrowing of the information related to the management of pain among children. 

Methodology

The study was a quantitative type which was based on analysis of different contents from 16 parents that had school children who had undergone an emergency abdominal surgery in the University of Ahvaz hospitals, in Southern Iran.

The sampling method used in the study was purposive.  There are often a lot of benefits in using purpose sampling in quantitative research as it allows from critical case sampling or expert sampling for each area under study.  The researchers also made use of different techniques in collecting data which include semi-structured interviews. Since the study involved children, the researcher ensured that all the interviews were recorded, transcribed and later analyzed.  In evidence-based research, it is always essential to record the interview and data collection process as this helps in ensuring the ethical aspects of the study are taken care of. It also means that all the participants in the study consented and that what the researcher publishes can later be reviewed or clarified through the recorded items. 

  1. Evidence and study outcomes

Generally, it can be concluded that evidence presented in the background, literature review, data collection and analysis supports the study outcomes and implication for future studies. This is because the researchers were able to conduct a background and current trends in post-operative pain management in children.  The study was also able to identify the causes of neglect and provided evidence from empirical studies and recorded interviews. The interviews presented views of both parents and caregivers which influenced the study outcomes. With the study outcomes, future studies can understand the difficulties related to post-operative pain management and reflect it on their patients thus find ways to counter the challenges. 


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  1. Protection of Human Subjects

There was consent written to which the researcher also assured parents that they were not in any way associated with any hospital. There were letters of introduction which were shown to each hospital as part of the protection of human subjects.

  1. Strength and Limitation

One strength of the study is the researchers were able to interview target groups and used the right tool to gather data.

One limitation of the study is that it was done in one location, meaning they were not able to explore other factors related to the management of pain.

  1. Evidence and current practices

The evidence study informs the current nursing practices as it revealed that there is a lot of disregard in healthcare systems, lack of sensitivity from healthcare providers and delay, hesitance in hospitals will affect postoperative management in children. 

Quantitative Research Article: Infections in Hospitals

Title: Esfandiari, A., Salari, H., Rashidian, A., Masoumi Asl, H., Rahimi Foroushani, A., & Akbari Sari, A. (2017). Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders’ Views. International Journal of Health Policy and Management, 7(1), 27-34. doi:10.15171/ijhpm.2017.34

Background/ Introduction

 The research article focussed on the issue of Healthcare-Associated Infections, which continues to pose a huge threat in terms of health and economic development of countries around the world. The paper is based on studies that indicated various causes of healthcare-associated infections, though the authors reveal that there is still very little literature related to Health Associated Infections and measures used in addressing the problem. Through the background, the researchers have tried to provide a background on the problem by looking at data from 1986 -2017. As part of the background, the authors reveal that recent data on Healthcare-associated infections indicate that the United States has 722,000 related cases in acute care hospitals, especially in 2011 which lead to almost 75000 death among hospitalized patients. 

The evidence-based study also reveals that more than half of all Health Associated Infection will occur outside the intensive care unit. From the background of the study, it was found that healthcare-associated infections affect the country's budget where about US$ 33 billion is spent annually. The study also looked at evidence-based from EU which revealed that over 4.5 million people would befall victims t Healthcare Associated Infections which eventually results to about 37,000 deaths in addition to 16 million extra days spent by patients in hospitals. According to the background study evidence it shows that globally, Healthcare-associated infection is a global burden in terms of economic development of countries which is common in five Health associated infections areas like; Ventilator-associated pneumonia ( VAP), Surgical Site Infection ( SSI), Central line-associated bloodstream infection ( CLABSI), catheter-associated urinary tract infection ( CAUTI and Clostridium difficile Infection (CDI). All these representations cost the world about 9.8billion annually, according to the evidence presented by the background study. 

Review of Literature

Concerning the literature review, the researcher used both current and old data related to healthcare infections. The review of the literature was based on published research, news story, and economic related information in healthcare-associated infection. To come up with reliable, evidence-based literature review, the study compared literature from three nations; United States, European Union, and Iran or the number of affected people and its effects in the country's economy. For instance, the researcher's evidence-based literature revealed that Health Associated Infections in Iran account to about 18% resulting in an economic burden in the country of around $150,000 in costs.  Also, the overall death from Health Associated Infections was at 14.8%. This evidence-based literature looks at an empirical study done between 2007-2010).  The literature also revealed reported cases of Health associated infections at 28.9% with the most common being the urinary tract infections. Most infections way is shown to be in intensive care units standing at 12.8% in Iran.

The literature review was also appropriate as it revealed the increasing threat posed by associated health infections which inspired the purpose of this study. The researcher also posted information from a reliable source for evidence like the World Health Organisation, and some of the practices implemented to ensure that there is a reduction in healthcare infections. The studies also revealed some of the causes of infection; however, there is still very little literature on the development of prevention mechanisms making the research topic appropriate for the study.

Data Analysis

As this was an evidence-based qualitative study, the researchers used the MAXQDA10 data coding software. To ensure that everything was captured, the thematic framework approach was relevant which identified five steps; Familiarization, thematic framework identification, index, charting and mapping and interpretation. The evidence-based study was also indicated by recording of information of which two researchers listened to them and gained a holistic view in prevention and control of Health associated infections.

Methodology

The research type used in this study was qualitative. In any case, qualitative research is more exploratory than quantitative research, which made it more applicable to the research topic. This is because the research looked toward gaining an understanding of the reason, causes, and opinions related to health associated infections in hospitals. By using the qualitative study, the researchers were able to provide an insight into the problem thus help in coming up with mechanisms for solutions to the existing problem. It was also appropriate for the researchers to use qualitative research to be able to uncover trends in opinions and thoughts and come up with a deeper understanding of the existing problem or phenomenon.

The techniques used were both structured and unstructured, for example during sampling, the purposive sampling technique was used as it would be appropriate to identify the study participants to the moment of saturation of. To ensure that there was enough evidence based information, samples were classified where 10 experts from the ministry of health participated in the study; others included 7 staff from hospitals, 7 participants from universities in a Macro, Micro and Meso levels as these are groups of people involved in the prevention and control of Healthcare-associated infections in the country. The tools used for collecting data were semi-structured interviews where the interviewees targeted were key informants and representatives to the country's national committee of Hospital Infection.  On being said that the data analysis and research method used by the researcher was appropriate since the study was not looking at the number of infections or the population but in the causes, implications and what can be done to prevent future occurrences of health associated infections. Another important group that participated in the study to affirm the evidence-based practice aspect included; healthcare professionals, and health technical officers.

  1. Support for the study

The evidence-based approach practiced by the researchers supports the research topic due to the study methodology. There were samples collected with the purpose of finding out the cause and effects of the existing problem, and all the stakeholders were represented.

  1. Protection of Human Subjects

There is no indication of human subjects used in the study, meaning that this was considered. However, cultural consideration was discussed, where the researcher selected only stakeholders from different departments as a way of showing balance and impartiality in the study.

  1. Strength and limitations

One strength of the study is that the researcher was able to compare the collected data, which were indexed under themes and sub-themes. Credibility, transferability, and dependability were also ensured. Because the whole study took 11 months, for purposes of engagement, the reliability of the findings was guaranteed. 

One limitation of the study is that it did not include human experience information from patients who have undergone Health associated infections.

  1. Current nursing practice

The evidence from the study informs the current nursing practice in a manner that it will improve nursing care especially for health professionals working with patients from the intensive care units.


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Palliative Care Nursing

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Introduction

Palliative care is a type of healthcare that is usually focussed in reducing the pain and severity of the disease symptoms.  This makes palliative care a significant aspect to the patient and their families as it leads them to enjoy life easily without suffering until the time of their death. Palliative care is thus critical to these patients as it helps them reduce the suffering and pain brought about by their condition (Nunn, 2014).  This paper analyses two high priority palliative care strategies for the patient with Chronic Obstructive Pulmonary Disease (COPD) (Gardiner et al., 2010).    The incorporation of appropriate high priority palliative care nursing strategies is essential in symptoms management through early identification and assessment and treatment of the pain among other physical and psychological issues that the patient by be undergoing. The following report thus focusses two palliative care nursing strategies namely; psychological support and management of psychological problems and relieving and management of shortness of breath during care.

  1. Psychological support and management of psychological problems

Psychological support and management of psychological problems are among the high priority nursing strategy for patients suffering from Chronic Obstructive Pulmonary Disease (COPD).  During the moment of care, a patient with COPD is bound to experience moments of anxiety and depression due to their condition, which might slow down the process of nursing care and management of the condition (Gardiner et al., 2010). As a palliative patient, some of the psychological problems that he will suffer in repeated incidences will be anxiety and depression which can be complicated due to several risk factors associated with biochemical alterations and symptomatology.  Other factors related to anxiety and depression in this patient will be associated with increased mortality, lengthy stays in palliative care, exacerbation rats and the decrease in the quality of life as the patient continue to lose several body functions (Jeffrey, 2018).  During nursing care, it is essential for the nurse to recognize some of the symptoms to come up with a better strategy in assisting the patient in coping with the situation.


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In any case, there will be no possible consensus on the right approach to psychological screening as to affirm that the patient is suffering from anxiety and depression associated with COPD.  During the nursing care, however, the nurse will help the patient to practice relaxation through cognitive behavioral therapy (CBT), the nurse can also assist the patient in doing some things for himself like walking to the toilet, taking medication and simple tasks like taking meals and medicine at the required time (Jeffrey, 2018).  When the nurse can administer the proper COPD care for a patient with anxiety and depression, it can have a significant impact on the whole palliative care process for the patient. Other studies have affirmed the importance of psychological intervention among COPD patient in palliative care. 

The best nursing strategy here will be to conduct interpersonal therapy sessions with the patient which will help them to improve their mood through interpersonal relationships. The nurse can show the patient that he can count on their care and support (Bowen, 2014). The main focus here would be to change the patient's thoughts, feelings, and fear about their condition though increase social support and increasing interpersonal function. The nurse needs always to review the patterns of relationship associated with the patient within the nursing care and family; the nurse will then weight the capacity for intimacy in the current relationship. It is also important that during this interpersonal relationship, the nurse discusses patient’s treatment plan, what works for them and what does not and what can be done by the nurse to makes the patient is comfortable (Bowen, 2014).

The overall focus will be to ensure the patient gains independence while under care and is free to negotiate the support plans and how the patient family can participate in the continued care process. When psychological and management of psychological issues is done properly, the patient will be able to deal with events that trigger anxiety and depression, effectively communicate his or her condition and learn to solve problems that are specific to his condition. 

  1. relieving and Management of shortness of breathe

Relieving and management of shortness of breath is another high priority strategy for a patient with COPD under palliative care which requires a thorough assessment and measurement of various observations so that the nurse is in a position to understand how the patient is managing his or her breath and causes for challenges (Nunn, 2014).  The first strategy will be to make observations of the patient COPD status with the help of a physician; during this time the nurse will record and observe the breathing patterns of the patient. It will also be essential to document the patient's Color, like the blue discoloration of the skin and the mucous membrane which can be seen from the earlobes, lops, fingers and, mouth, all of this will be signs of lack of oxygen (Bowen, 2014).  After this, the nurse will then implement several strategies to ensure that the patient remains at the most comfortable position possible.

In most cases, a patient with COPD will suffer intervals of shortness of breath which may at times affect his speech. It is essential that the nurse uses closed questions when attending to him, the nurse can instruct the patient to answer with a shake of the head or a nod as this will allow him or her to communicate. During this time it is essential that the nurse exercises a lot of patience as this is very important to ensure the nurse does not make assumptions on behalf of the patient (Hussain, Neoh, & Hurlow, 2014). If the patient is strong enough, the nurse can allow the patient to write on the paper or use a flash card as a way to ensure communication about medication, a reminder to go the toilet, change of beddings and progress of treatment and care takes place. Oxygen therapy may also be needed with respect to the severity of the patient as this is also a barrier to communication (Hussain, Neoh, & Hurlow, 2014).  The other strategy will also be to ensure the patient seats or lays in the right position all the time;  this is because  a patient with COPD that is experiencing shortness of breath needs to maximize all the respiratory function with minimal physical effort, meaning the nurse needs to ensure the patient is  well supported and stays comfortable. For example, the nurse should put the patient's pillow on the back to promote his or her posture (Jeffrey, 2018). Also, the number of pillows should be monitored since when they are too many can cause the patient to sink in them and restrict chest movement.

In addition to keeping the right posture, the nurse should provide a number of breathing exercises; these are very beneficial to the patient with COPD. The nurse can teach the patient different controlled techniques for breathing; however this should only be explained to the patient at the moment that they have regained their breath, the nurse should also ensure that they practice this regularly (Jeffrey, 2018).  In the event that they are breathless then they will be required to use such a technique in controlling their breathing rate and reduce the discomfort associated with it.

During the shortness of breath incidences, it is essential that the nurse ensures the patient hygiene is kept all the time, since COPD patient with shortness of breath usually gets discouraged from going to wash; thus the nurse should discuss with the patient the best way to cope with the physical condition and the help they may require therefore. The nurse can also provide the patient with oxygen during bathing to ensure they are as comfortable as possible.

Conclusion

Patients suffering from Chronic Obstructive Pulmonary Disease (COPD) are in constant need for nursing palliative care since the condition is often unpredictable when it comes to the physical and psychological symptoms as the ones discussed.  The nurses should continuously implement the two high priority strategies. However, the most critical aspect of the two care strategies is negotiating with the patient and finding out from them what can work and what cannot work. Patient family support is also significant during this time, especially in terms of reducing patient anxiety and depression, since interpersonal communication ensures the patient drifts his thought from the chronic condition and puts more effort towards care.


Read PDF : Palliative Care Nursing