Motor neuron diseases are severe neurological disorders that affect people and are mainly characterized by the loss of motor neurons (Arora et al.,2022). There are different types of motor neuron disease, but in Tyler’s case, he had amyotrophic lateral sclerosis. ALS is a progressive disorder that affects the nerve cells in the spinal cord and the brain, thus leading to difficulties in muscle control (.Masrori and Van Damme, 2020). People with ALS usually die after two to five years, while others may survive longer, even up to ten years. Therefore, people with ALS require end-of-life care to ensure comfort. The nurses carry out various interventions on the patient to ensure the patient is able to be comfortable and satisfied with the care given. This essay will review the critique of the care given to Tyler. Besides, it will also explain the relevance of various standards, including NBMA and NHQHS, in the provision of end-of-life care.
Review and Critique of the Care given to Tyler
The patient, Tyler, is a 40-year-old man undergoing palliative care due to his ALS, an irreversible disorder. Tyler received end-of-life care as he had reached the point of rapid physical decline before the inevitable death due to the disorder. The goal of care at the end of life is to alleviate symptoms and promote the patient’s comfort. The care is usually patient-centered and holistic, focusing on the interrelationship between psychological, spiritual, and physical issues. Nurses play a critical role when oi it comes to the end of life care. They carry out interventions, including decreasing the risk of injuries due to falls, facilitating communication, and being able to alleviate the pain of the patient (Swanson et al.,2020). Various interventions were carried out in the care of Tyler to help relieve his symptoms and promote comfort. The nurses were able to assess Tyler frequently and address his needs. It is the role of healthcare providers to assess the patient’s needs and fully address them. Patients in end of life care mostly experience symptoms that significantly compromise their comfort. They also may not be able to carry out their activities and thus needs assistance. The nurses caring for Tyler provided nutritional support and pain management and performed pressure area care to ensure the patient was comfortable.
The healthcare providers could also demonstrate collaboration as they cared for the patient. When she found the patient restless, the registered nurse was able to inform the medical officer, who gave information on the actions to be taken. According to Johansen and Ervik (2022), interprofessional collaboration is critical when providing end-of-life care as it helps to ensure that patient needs are addressed.
No family meeting was held upon the diagnosis of Tyler’s condition. Upon diagnosis of an end life condition, the patient and the family need to be informed about it, and a discussion should be held on the type of support the patient will require. The prognosis and goals of care also need to be clearly stated. Patients have the right to information with their families; thus, each finding should be informed. Involving the family in care will help provide the necessary support that the patient may require (Keeley, 2017).
Despite the documentation, some other documentation was not completed, thus assuming a gap in the care. Every diagnosis, procedure, assessment, medication, and various therapies given to the patient must be documented to provide evidence of what was done to the patient. Documentation promotes continuity of care and helps to avoid medical errors that can cause adverse events that may cause disability or even death (Stewart et al.,2019). Consequently, Tyler was not encouraged to write a will. Upon diagnosis of the condition and when providing the end of life care, the patients must be encouraged to write a will. Writing a will help to prevent conflicts that may arise regarding the property of the deceases. Therefore, it is the role of the healthcare providers to encourage the patients at the end of life care to write their wills.
Tyler’s pain was assessed, and the pain medications were administered. However, the pain assessment was not formally completed. When assessing a patient’s pain, health care providers need to use the numerical rating scale so that the patients can grade their pain according to its severity. The process of dying was not discussed with the p[atient. At the end of life care, the nurses need to discuss with the patient the process of dying to prepare the patient psychologically for what he was going to undergo. Discussing the process with the patient also helps to make sure that their needs for the end of life care are known and respected. Additionally, it can help support the family and close friends through bereavement.
Christine, Tyler’s wife, was unable to accept their condition of Tyler and was hoping that after some time, Tyler will be able to regain his health. She could not come to terms with the fact that Tyler’s condition was non-reversible and that he will end up dying. The healthcare providers did not take the issue of denial oof Christine and counsel her to come to terms with the situation. Proper communication with the patient and their family is key as it helps them to come to terms with the situation. It significantly helps in lowering the cases of mental health issues. Various interventions including giving a psychotherapy session to the family helps them to be able to cope up with the situation(Oates and Maani, 2020). Tyler did not want to die at home and wanted it to be in a hospice which did not take place. The wishes of patients in end life care need to be well addressed and fulfilled for the satisfaction of the patient. It is the role of the healthcare providers to discuss the patient’s wish with the family and take appropriate interventions (Brown et al.,2017). This will promote patient satisfaction, and it helps to ensure a peaceful death.
The patient was seen wheezing on 24th March, but no appropriate interventions were taken, and there was just little documentation about the concern (Acu, 2021). Healthcare providers need to take appropriate interventions to address the patient’s needs. The role of palliative care is to ensure the patient is comfortable. Thus, appropriate interventions need to be taken to relieve the symptoms that comp[romise patient comfort. Tyler’s deteriorating condition was not assessed in time, which led to Tyler not being able to achieve his ACD wants and needs. Early assessment of the situation helps to take early interventions and helps in patient planning. The nursing staff did not fulfill the wishes of Tyler. Tyler wanted to see his mother and brother and asked the registered nurse to contact them. The nurse instead asked Christine to contact them without any consideration that they may not be getting along. The nurses need to fulfill the patients’ wishes and apply critical reasoning when making decisions. The registered nurse could have thought of why Tyler asked her to call them and not Christine, her wife whom they have spent the most time.
Generally, from the case, the nurses significantly promoted the comfort of the patient through administering pain medications, doing mouth care, pressure area care, dyspnoea relief where they used CPAP combined with oxygen therapy. They also ensured nutritive support to the patient through peg feeds. Therefore, healthcare providers should work towards promoting the patient’s comfort and ensure that the family is supported to accept the situation. Consequently, nurses must apply the standards of care while caring for the patients and adhere to the code of ethics to ensure patients receive their required care.
Importance of National Palliative Care Standards, NSQHSS, and NBMA and how they influence care
The national palliative care standards significantly promote the vision for compassion and effective specialist palliative care. Palliative care is person and family-centered care provided to the patient whose treatment aims to optimize the quality of care provided (Palliative Care Australia, 2018). The standards bring an insight on why it is appropriate to provide person-centered care while providing palliative care. In Australia, palliative care should be able to address the needs of the patient and their families. Additionally, the care should be available to all individuals with advanced disease with no chances of recovery regardless of their age. It aims at enabling the patient and their families understand that death is inevitable.
The national safety and quality health service stanndards help in protecting the palliative patients and their families from harm and help in improving the quality of the health services provided to them. There are various NSQHS standards including prevention and management of pressure areas, medication safety, prevention of injuries, partnering with consumers and clinical communication (Australian Commission on Safety and Quality in Health Care, 2020). Partnering with the patients and their families when making clinical decisions concerning their health is important as it promotes satisfaction n and comfort in palliative care. Patient and their families needed to be treated well and their dignity and rights be respected. The involvement of the patients in decision making enables them to take part in their own care. In the end of life care, the patients and the families should always be involved in the provision of care. Consequently, most of the patients In palliative care are immobile and spend most of their time on bed lying in the same position which predisposes them to pressure injuries. The nurses in end of life care take appropriate interventions that aim to prevent the occurrence of the pressure ulcers, including frequent turning of the patient.
The NBMA provides various standards for the nurses to apply as they care for the patients. The registered need to think critically and be able to analyze the nursing practice (Nursing Midwifery Board of Australia, 2016). Consequently, the nurse should comprehensively conduct assessments. In the end of life care, the nurses need to apply critical thinking skills when caring for the patients and be able to come up with appropriate interventions that can be able to promote the comfort of the patient (Levett-Jones, 2018). Additionally, when providing the end of life care, the nurses should be able to conduct assessments and determine the needs of the patient and address them accordingly.
Conclusion
Amyotrophic Lateral Sclerosis is a progressive and incurable degenerative disorder that leads to the loss of the motor neurons and with time it leads to death. Amyotrophic lateral sclerosis requires various support in order to ensure the comfort of the patient and ensure a peaceful death (Eljas and Axelsson, 2021). These patients require palliative care and various assistance to meet their needs. The goal of the care is to improve the quality of life for both the patient and their families. There are various standards that guide the type of care provided, including the NBMA and NSQHS.
References
ACU. (2021). Tyler Morton Case Study. https://leo.acu.edu.au/mod/book/view.php?id=4317892
Australian Commission on Safety and Quality in Health Care. (2020). National Safety and Quality Health Service (NSQHS). Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards
Brown, D., Edwards, H., Thomas, B., & Aitken, R. L. (2017). Lewis’s Medical-surgical Nursing Ebook: Assessment and Management of Clinical Problems. Elsevier.
Arora RD, Khan YS. Motor Neuron Disease. [Updated 2022 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560774/
Eljas Ahlberg, E., & Axelsson, B. (2021). End-of-life care in amyotrophic lateral sclerosis: A comparative registry study. Acta neurologica Scandinavica, 143(5), 481–488. https://doi.org/10.1111/ane.13370
Johansen, M. L., & Ervik, B. (2022). Talking together in rural palliative care: a qualitative study of interprofessional collaboration in Norway. BMC health services research, 22(1), 314. https://doi.org/10.1186/s12913-022-07713-z
Keeley M. P. (2017). Family Communication at the End of Life. Behavioral sciences (Basel, Switzerland), 7(3), 45. https://doi.org/10.3390/bs7030045
Levett-Jones, T. (2018). Learning to Think Like a Nurse (2nd Ed). Pearson. 2018
Masrori, P., & Van Damme, P. (2020). Amyotrophic lateral sclerosis: a clinical review. European journal of neurology, 27(10), 1918–1929. https://doi.org/10.1111/ene.14393
Nursing Midwifery Board of Australia. (2016). Registered Nurse Standards For Practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Oates JR, Maani CV. Death and Dying. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536978/
Palliative Care Australia. (2018). National Palliative Care Standards (5th Ed.). Retrieved from https://palliativecare.org.au/standards
Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative. International journal of palliative nursing, 23(12), 577–585. https://doi.org/10.12968/ijpn.2017.23.12.577
Swanson, M., Wong, S. T., Martin-Misener, R., & Browne, A. J. (2020). The role of registered nurses in primary care and public health collaboration: A scoping review. Nursing open, 7(4), 1197–1207. https://doi.org/10.1002/nop2.496.
write