NRSG374 - Principles of Nursing A Palliative Approach

Assignment Task

Purpose

Students are required to demonstrate an understanding of how theory translates into practical nursing care and how evidence underpins best practice. Each student will review and critique the care given in the Case Study provided according to the ACU End of Life Clinical Practice Guideline (CPG) and provide supporting evidence from current literature, the National Palliative Care Standards, and NMBA or NSQHS Standards.

Students are required to review and critique the care given in a case study. You are not critiquing evidence, the CPG, or the standards. The critique of care is to be based on:

1) Contemporary evidence-based literature and

2) The End-of-Life Care Clinical Practice Guideline (CPG) and

3) The National Palliative Care Standards and

4) The Nursing and Midwifery Board of Australia (NMBA) standards OR the National Safety and Quality Health Service (NSQHS) standards. A critique is not a description of care or the case study.

A critique involves analysing the care, interpreting the care, assessing the care, identifying positives and negatives (what was done well and not so well and why) and offering suggestions for improvement.

Students are to critique four (4) episodes of care. These can be positive or negative elements.

An “episode of care” is any time that care was provided. There could be an assessment, a nursing intervention, a referral to another service, or even an omission of care. Episodes of care can reflect themes, such as communication, assessment, symptom management, cultural/spiritual needs, family needs etc.

Case Study

Gina Owens is a 72-year-old Aboriginal woman, who resides in a rental property with her partner, George, daughter, and grandson in Karumba, a remote community in Northern Queensland. Gina has lived in her same community for her entire life. Gina has recently been diagnosed with rapidly progressive Multiple Sclerosis. She has a history of type 2 diabetes, hypertension, hypercholesterolaemia and smokes 20-30 cigarettes per day. Gina is a retired cleaner and relies on a government pension to support herself and her family. Gina likes to spend time with her community during the day, telling stories and eating together.

Three years ago, Gina had an ST Elevation Myocardial Infarction (STEMI) and required urgent Cardiac Arterial Bypass Graft Surgery (CABGS) surgery at a tertiary hospital twelve hours drive away, however recovered well with support of her family.

Gina has experienced fluctuating symptoms of her Multiple Sclerosis, experiencing decreasing muscle strength in her hands making it difficult for her to feed herself.

Gina is prescribed Riluzole 50 mg BD, Gabapentin 100mg BD, Glycopyrrolate 1-2g TDS, Targin 5mg BD, Metformin XR 500mg BD, Perindopril 5mg mane, Atorvastatin 40mg nocte and Panadol 1gm PRN.

More recently, Gina’s condition has deteriorated, having bradykinesia, significant muscle weakness and altered balance and coordination. This has resulted in her having two falls at home, whilst walking outside in her backyard. Gina is also having difficulty swallowing and has experienced dysphagia and dysphonia. This has led to recurrent episodes of choking and ultimately, aspiration pneumonia.

Gina was transferred via ambulance to a hospital for treatment for her pneumonia. Her family were left back in Karumba. On arrival to the ward Gina asked to call her family; however the nurse was very busy coordinating the arrival of several admissions at the same time. An hour later the nurse came to see Gina and completed a set of observations and commenced IV antibiotics as per the medication chart. Gina queried what the nurse was giving him, with the nurse saying, “it’s medicine to help your chest.” Gina asked the nurse when she could go home to her mob as she wanted to see her healer. The nurse responded that the medication would be what helps to heal her.

Later that day, Gina’s daughter called the hospital asking for an update on her condition and requesting to talk to Gina. The nurse told Gina’s daughter that she would transfer the call through to Gina, however Gina could not reach the ringing phone due to her positioning in the hospital bed and muscle weakness.

As the day progressed Gina’s muscle weakness began to worsen and Gina began to experience pain in her neck, due to her reduced muscle tone. Gina called out to the nurse a number of times as she couldn’t reach and press the nurse call bell. About 20 minutes later the nurse came to see Gina. Gina’s speech had begun to slur as she told the nurse about her pain and asked about her medication. The nurse looked at her chart, which did not have her regular medication charted. The nurse gave Gina 1gm of paracetamol. It was another two hours before the nurse contacted the on-call doctor to write up Gina’s usual medications, and a further hour before the nurse administered Gina her Riluzole, Gabapentin and Targin.

Gina told the nurse she wanted to go home to be with her family. The nurse provided some comfort to Gina and said that she would send a referral to the Aboriginal Liaison Officer in the morning. Unfortunately, the nurse became very busy and forgot to send the referral.

1. Briefly introduce the case and the condition. Indicate that you will critique the care provided against high-quality evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards. Identify the four (4) episodes of care you will discuss in your assignment and the sequence of information to be presented – so the reader knows what to expect in your assignment.

2. Identify the first episode of care you will critique. Indicate if it was a positive or negative element of care. Identify why it was positive/negative referring to high-quality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

3. Identify improvements that could have been made in relation to the first episode of care (what should have been done instead and why), referring to highquality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

4. Identify the second episode of care you will critique. Indicate if it was a positive or negative element of care. Identify why it was positive/negative referring to high-quality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

5. Identify improvements that could have been made in relation to the second episode of care (what should have been done instead and why), referring to high-quality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

6. Identify the third episode of care you will critique. Indicate if it was a positive or negative element of care. Identify why it was positive/negative referring to high-quality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

7. Identify improvements that could have been made in relation to the third episode of care (what should have been done instead and why), referring to highquality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

8. Identify the fourth episode of care you will critique. Indicate if it was a positive or negative element of care. Identify why it was positive/negative referring to high-quality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards.

9. Identify improvements that could have been made in relation to the fourth episode of care (what should have been done instead and why), referring to highquality nursing related/focused evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS standards

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