NRSG374NRSG374: Assessment Task 2: Critique Written

Introduction

After the diagnosis of a progressive neurological condition like Amyotrophic Lateral Sclerosis (ALS), the first responsibility for multidisciplinary teams, family, and caregivers is to think about palliative care (Goutman et al., 2022). The goal of this paper is to critique relevant elements of the CPG and case study whilst upholding the National Palliative Care Standards of NMBA. 

Critique of CPG for case study

The end has come for Tylor Morton, a 40-year-old man who suffered from a number of terrible illnesses. His "Amyotrophic lateral sclerosis" began with discomfort and weakness in his left hand and has progressed via dyspnea, dysphagia, dependence on other people due to loss of movement, and a constant worsening of his physical state (ACU, 2021). Meanwhile, tensions with his wife and family have added another layer of difficulty to Tylor's life. Tylor's decline may be seen in the form of respiratory degradation requiring "non-invasive ventilation," gastrointestinal infections requiring a PEG tube, and constant pain requiring medicine (ACU. 2021). Furthermore, she was not prepared to talk to Tylor's mom or other relatives about his terminal illness. Catherine, Tylor's wife, wasn't blind to the fact that she thinks her husband would never recover from his current state of immobility and return to work (ACU, 2021).

Since Tylor's disabled condition has progressed to a terminal stage, "end of life care" has been selected as the appropriate clinical practice guideline (CPG) to ensure that he receives the highest possible quality of life and the kind of compassionate, family-centered care that will allow him to maintain some semblance of normalcy in the days leading up to his death (ACU Practice guideline, 2021). Clinical guidelines for the treatment of terminally ill patients are best understood as the process of intervening and caring for a patient in their last moments. Guidelines in this CPG address topics such as "options for the treatment of this patient in the last stage," "decision-making," "continue supporting the patient and his family," and "medical, therapeutic, preventative, supportive, and preventive service for the last moment during the last few days of life" (Brizzi et al., 2019).

The diagnosis of Tylor's motor neuron disease (MND) and amyotrophic lateral sclerosis (ALS), which causes paralysis of the arms and legs, speech and breathing difficulties, swallowing difficulties, and advanced muscular problems that can eventually lead to permanent paralysis, is the first and most important step in providing care for him as he nears the end of his life. MND and ALS are progressive neurodegenerative diseases that affect nerve cells in the brain and spinal cord. As described in this case study, Tylor suffered from a similar ailment one that was exacerbated since his wife did not give him the benefit of the doubt (Palliative Care Australia, 2018). In order to provide care for terminally ill patients while adhering to CPG guidelines, RNs may need to take into account some of the NPC Standards. Standard 2 of the palliative care guideline is "developing care planning," Standard 3 is "care for carers," Standard 4 is "providing care," Standard 6 is a "grief report," Standard 8 is "quality improvement," and Standard 9 is "staff qualification and training" in order to provide Tylor with care for his motor neuron disease (Australian Commission on Safety and Quality in Health Care, 2020).  See appendix A

According to this case study, in order to understand Tylor's current condition with ALS, one would need to look at previous records such as his medical history and the reports collected from the palliative team along with the medical officer, also reports from both Tylor's relatives. Additionally, one would need to speak with Tylor's medical officer. . First and foremost, as a certified nurse, it is your responsibility to notify Tylor's loved ones, from his mother to his wife, about his terminal situation and to emphasize the value of providing care centered on the needs of the whole family. Considering his current state of anguish, family pressure and further strain pose immediate dangers to Tylor's life. The pain, anxiety, hunger, weakness, and discomfort levels of Tylor were measured using the SAS tool "Modified Karnofsky Score," "problem severity score," as stated in this case study (Barbetta et al., 2019). Catherine, though, clearly wasn't worried about any of these medical findings. The medical and palliative care teams have only a prognosis and diagnosis of Tylor's illness, and his wife and family are still at odds on how to proceed. For Tylor to get the best possible palliative care, you, as a registered nurse, must take on the additional duty of upholding NPC Standard and other important standards like NMBA's Clinical Practice Guidelines for End-of-Life Care. However, there are competing considerations about where Tylor will remain while he recovers from his injuries: the hospital or his house (Nursing Midwifery Board of Australia, 2016). The fact that he had to decide between taking his IVAB at home and going to a nearby hospital to have a PICC.line inserted for his long-term medicine just added insult to injury.

In addition to addressing these challenges and constraints in diagnosis and therapy, it was crucial to communicate the pathophysiological reactions of this terminally ill patient while using CPG. According to a report from this case study dated March 29. At the end, Tylor's breathing became shallow, short, and laborious; his pulse rate dropped to a dangerously low "5"; his extremities were rigid and cyanotic; and his pupils dilated. It was crucial to have an answer ready for his family at this time so that they may say their goodbyes to him in the comfort of their own home, surrounded by his loved ones, as he neared the end of his life. Tylor's rapid decline into death was mostly due to tensions within his family, particularly those between his wife and his mother and other relatives (Kwan, & Vullaganti, 2022). In light of these dismal circumstances, registered nurses (RNs) must adhere to the NPCS and NMBA in order to address the constraints and contradictions in the profession. Having Tylor's mother and brother visit him as he lay dying was a vital part of providing him with person-centered care.

Elements of the 1.5 CPG must be followed in accordance with the NPC standard 2, "creating care plan," and the NMBA standard 1, "critical thinking and analysis with nursing practices" (ACU, 2021).  See appendix A, The case study revealed various gaps between the ideal of palliative care and the reality of the current NMBA regulations. Tylor's family was not given priority by the palliative care team or the medical officer (Levett-Jones, 2018). Catherine only knew Tylor and Joyce, and she never saw her grandson.

It is a requirement of the standards of practice for registered nurses dealing with terminal care to make sure that their patients have access to painless death. According to the case study, the healthcare providers in question did not adhere to the requirements of NMBA standard 3, "maintaining the capability of practices," which includes the sub-standards 3.3, 3.4, 3.5, and 3.6, and NMBA standard 6, "providing safe quality nursing practices," which includes the sub-standards 6.1. (Palliative Care Australia, 2018). Instead, it may be necessary to keep CPG for end-of-life care in place while also keeping NPC standard 3, which entails "caring for a caregiver," and its sub-elements 3.1, 3.5, and standard 4, which entails "giving care," and its sub-elements 4.1, 4.2, and 4.3. (Riley & Hupcey 2022). 

Furthermore, in order to comply with NMBA standard 6, "grief support," which contains components 6.1, 6.4, 6.5, 6.7, and 6.8, registered nurses could be required to make preparations for Tylor's mother to see her son at the end of his life. This is one of the requirements for the standard. This standard is linked to NMBA standard 6, which is referred to as "safe, appropriate, and responsive quality nursing practice." This standard comprises items 6.5 and 6.6.

Tylor was dying in front of his wife, so he didn't need to make any medical decisions in advance. Following the doctor's orders, Tylor's registered nurses may have to remove the breathing apparatus, tubes, and other pipes that had been introduced into his body, along with any other medications he was receiving (Borbasi, Jackson & East, 2019). According to the data collected and analyzed during this case study, Tylor expressed apprehension about the drugs he was being given and the several tubes and channels that had been inserted into his digestive tract at every stage of the monitoring process. The initial cause of rapid worsening and serious damage was an infection or PEG tube infection. The 20th through the 28th of March were critical for Tylor, and on the 29th he passed away (ACU, 2021). This suggests that within 9 days, his condition had become catastrophic as a result of several conflicting options and obstacles. Before then, his neuro-motor illness, GI infections, dysphagia, and dyspnea all began within a span of 18 months. The most stunning development was that on March 29th, when Tylor breathed his last, no one except his wife, Catherine, was there.

As a result, it is crucial for RNs to understand the emotional and social context of end-of-life care by providing it in accordance with NPC standards 6 (grief report) and 8 (quality improvement) and 9 (staff training and qualification) and their respective elements (9.4, 9.5, 9.6, and 9.7). (Palliative Care Australia, 2018) See Appendix A for details. It's not enough for a nurse to just express sadness at the end of a patient's life or to hand over the corpse to the family (Brown et al. 2017). Conformation in the event of a patient's death is crucial, as is the provision of loss and grief support services, the provision of supporting services to the patient's family, and the release of appropriate documentation, health reports, and death certificates with the consent of the doctor.

Conclusion

It is abundantly obvious, based on these palliative care planning connections with one standard, NMBA for Tylor, that for end-of-life patient ethics and behavioral practices for nurses, it is essential, although reporting loss and grief is not always an easy task. While death is an inevitable part of life, it is not always easy to deal with, especially for those closest to the deceased. Most difficult cases include disputes about medical care and the need to assign blame or make amends between patients and their providers. Ethical considerations must be taken into account prior to releasing the patient to their loved ones, and there must be a clear channel established for the patient to seek out bereavement support services. Here, many inadequacies and restrictions in diagnostic and treatment technique are altered and modified with NPCS and NMBA standard via selecting the appropriate CPG, in this case "end of life care."

References

ACU Practice guideline. (2021). End of Life

ACU. (2021). Tyler Morton Advance Health Directive. https://leo.acu.edu.au/pluginfile.php/4990157/mod_resource/content/3/Tyl

ACU. (2021). Tyler Morton Case Study. https://leo.acu.edu.au/mod/book/view.php?

Australian Commission on Safety and Quality in Health Care. (2020). National Safety and Quality Health Service (NSQHS). Retrieved

Barbetta, C., Allgar, V., Maddocks, M., Ribeiro, C., Wilcock, A., Currow, D. C., ... & Johnson, M. J. (2019). Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: an exploratory pooled data analysis. BMJ supportive & palliative care. https://spcare.bmj.com/content/early/2019/07/11/bmjspcare-2019-001869.abstract

Borbasi, S., Jackson, D., & East, L. (2019). Navigating the maze of research: enhancing nursing and midwifery practice (Fifth edition.). Australia: Elsevier.

Brizzi, K., Paganoni, S., Zehm, A., De Marchi, F., & Berry, J. D. (2019). Integration of a palliative care specialist in an amyotrophic lateral sclerosis clinic: observations from one center. Muscle & Nerve, 60(2), 137-140. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26607

Brown, D., Edwards, H., Thomas, B., & Aitken, R. L. (2017). Lewis’s Medical-surgical Nursing Ebook: Assessment and Management of Clinical Problems. Australia: Elsevier.

Care. https://leo.acu.edu.au/pluginfile.php/4991076/mod_resource/content/1/End

er%20Morton%20AHCD.pdf

from: https://www.safetyandquality.gov.au/standards/nsqhs-standards

Goutman, S. A., Hardiman, O., Al-Chalabi, A., Chió, A., Savelieff, M. G., Kiernan, M. C., & Feldman, E. L. (2022). Recent advances in the diagnosis and prognosis of amyotrophic lateral sclerosis. The Lancet Neurology. https://www.sciencedirect.com/science/article/pii/S1474442221004658

Guidelines-Statements/Professional-standards/registered-nurse-standards-for-

id=3754387

Kwan, J., & Vullaganti, M. (2022). Amyotrophic lateral sclerosis mimics. Muscle & Nerve, 66(3), 240-252. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.27567

Levett-Jones, T. (2018). Learning to Think Like a Nurse (2nd Ed). USA: Pearson. 2018.

Nursing Midwifery Board of Australia. (2016). Registered Nurse Standards For Practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-

Palliative Care Australia. (2018). National Palliative Care Standards (5th Ed.). Retrieved from https://palliativecare.org.au/standards

practice.aspx

Riley, K., & Hupcey, J. (2022). Person-Centered Care Considerations for End-of-Life Care to Persons With Severe and Persistent Mental Illness. Journal of gerontological nursing, 48(3), 11-16. https://journals.healio.com/doi/abs/10.3928/00989134-20220210-04

Appendix

Appendix A: Palliative care standards (5th edition)

(Source: PalliativeCare-National-Standards-2018_Nov-web.pdf)