Palliative Care Nursing
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.
- 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.
- 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.
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