Palliative Care Case Study Assessment

Assessment overview

This task addresses the following Unit Learning Outcomes:

• LO 1 Discuss the holistic care of the dying person and their significant others, in promoting their quality of life.

• LO 2 Critically analyse ethical and legal issues in end-of-life care.

• LO 3 Plan evidence-based nursing care for the dying person and their family.

Palliative Care for Aunty Betty: A Holistic and Culturally Sensitive Approach

Aunty Betty is a 56-year-old Aboriginal woman from the Kulin Nation who has been living with inoperable breast cancer, which has now metastasized to her lumbar spine. Over the past six months, her condition has deteriorated, and she is now experiencing increased fatigue, difficulties with activities of daily living (ADLs), and breakthrough pain. She has made the decision, in consultation with her family, to forgo further cancer treatments and focus on maintaining her quality of life. Additionally, she has expressed a strong desire to die at home, surrounded by her loved ones. To honor her wishes, a comprehensive and culturally sensitive palliative care plan must be implemented to support her physical, emotional, social, and spiritual needs while ensuring she remains comfortable and dignified during the final stages of her life (Laabar et al., 2022).

The primary focus of palliative care for Aunty Betty is symptom management, emotional and cultural support, and ensuring that her family is equipped to care for her at home. One of the key challenges she faces is pain management, as she is currently on slow-release morphine 100 mg twice daily, but still experiencing breakthrough pain. The palliative care team will need to introduce short-acting morphine (liquid or immediate-release tablets) for fast relief and consider subcutaneous morphine via a syringe driver if she becomes unable to swallow oral medications. Managing her pain effectively is crucial to maintaining her comfort and dignity. In addition to opioids, adjuvant pain relief such as paracetamol or corticosteroids may be required to help alleviate bone pain and inflammation in her spine (Bhatt et al., 2024).

Alongside pain management, fatigue and mobility challenges must be addressed. As Aunty Betty becomes weaker, she may struggle to get out of bed, walk, or perform basic tasks. Providing her with mobility aids such as a wheelchair, walker, and pressure-relieving mattress will enhance her comfort and prevent complications such as bedsores (Eccles & Davies, 2021). Since she is now finding it difficult to complete her ADLs, support from a community palliative care nurse and home care assistants will be essential. These caregivers can help with bathing, dressing, toileting, and repositioning while maintaining her dignity and respecting her cultural preferences (Edemekong et al., 2023).

In contemplating Aunty Betty’s life, it is essential to reflect on other potential symptoms that may manifest toward the end such as difficulty breathing, nausea, restlessness, or the presence of excessive secretions—often referred to as ‘the death rattle.’ For the patient and the family, breathlessness is conclusively one of the most distressing symptoms, though it can be managed with low-dose opioids like morphine, supplemental oxygen (when later stages of disease warrant), and fans to improve air movement. In cases where her sickness or medications cause nausea and vomiting, anti-emetics like metoclopramide or ondansetron can be provided (Speakman et al., 2021). Anxiety and restlessness, prevalent during the final days, can be addressed with low dose benzodiazepines such as lorazepam or midazolam, allowing her calmness and peace. In the event that excessive secretions become a concern, hyoscine butylbromide (Buscopan) injections can be administered to alleviate discomfort (HospiceBuddy, 2024). 

Aunty Betty’s palliative care plan should also address her sociocultural and spiritual dimensions. Ethnically Aboriginal, she cherishes her roots and takes pride in sharing them with her grandchildren. It is important that her palliative care team involves Aboriginal health workers and Elders who can provide culturally appropriate support and guidance. Traditional healing practices, storytelling, and ceremonies should be encouraged to help her feel spiritually connected and at peace (Jessop & Phelan, 2022).

Given that Aunty Betty lives with her daughter, Lisa, and two young grandchildren, the family's emotional and practical support needs must also be addressed. Lisa, as the primary caregiver, will require education on pain management, symptom recognition, and medication administration to ensure she feels confident in providing care. Additionally, the palliative care team should offer respite care services, allowing Lisa time to rest while professional carers temporarily take over responsibilities. A social worker can assist the family with financial support applications, carer's allowance, and funeral planning to ease any economic burdens (Rao et al., 2021). Since young children are in the home, age-appropriate explanations about death and dying should be provided to Katie (4) and Joe (7) to help them process the changes in their grandmother’s condition.

Coordination among healthcare providers is essential to ensure seamless care delivery. The multidisciplinary team involved in Aunty Betty's care will include her general practitioner (GP), palliative care specialists, community nurses, home care assistants, social workers, pharmacists, and spiritual care providers. Regular team meetings will be necessary to assess her evolving needs and adjust her care plan accordingly. A 24/7 palliative care hotline should be made available so that the family can seek guidance and support at any time, particularly during distressing moments (Borgstrom et al., 2021).

In order to allow Aunty Betty to remain at home, an advanced care plan should be prepared that details her preferences about the level of pain relief she wants, the extent of medical procedures she is willing to accept, and where she would prefer to die. Having an ACP will eliminate avoidable hospital admissions and ensure her care aligns with her wishes during the last phase of life. Also, an End-of-Life Care Pathway will be developed detailing the steps for symptom management as she moves into the active-dying phase. Family members will be taught about the signs of death, including reduced levels of awareness, changes in breathing patterns, and social withdrawal, so they can cope better during the final hours (Morrow, 2023).

During the final days of Aunty Betty's life, the primary concern is to facilitate a peaceful and dignified passing. The home environment should shift to a quieter, comfortable, and supportive setting that enables her to be within reach of her family. Caregivers and health professionals need to make certain that she is comfortable, settled, and pain-free.(Younis, 2021). 

Funeral services and condolence should be given to the family most especially to lisa and the grandchildren after the demise of aunty Betty. They require to have social stipend for counselling, cultural loss, and spiritual support to assist in their grief. They can help them in the pre-bereavement and funeral arrangements entail that their cultural practises are followed when burying the dead (Best et al., 2023).

In this study, Aunty Betty’s palliative care plan is holistic and requires coordinated multidisciplinary input due to its cultural complexity. She needs to be cared for with a culturally supportive palliative approach which attends to her pain and symptom management, family support dynamics, and cultural identity. If adequate systemic measures to facilitate her comfort, care and companionship of loved ones are provided then her desire to die at home can be realised. This care plan acknowledges the need to respect her culture and makes good use of her resources with reference to her decision.

Assessment Requirements – Brief Summary

The Palliative Care Case Study Assessment focuses on developing a comprehensive, culturally sensitive, and evidence-based care plan for a dying person and their family. The assessment requires the student to:

1. Discuss holistic care for the dying person and their significant others to promote quality of life (LO1).

2. Critically analyse ethical and legal issues in end-of-life care (LO2).

3. Plan evidence-based nursing care tailored to the patient and family’s needs (LO3).

The case study centers on Aunty Betty, a 56-year-old Aboriginal woman with advanced metastatic breast cancer, who wishes to die at home. Key areas to address in the assessment include:

• Symptom management (pain, fatigue, nausea, breathlessness, restlessness).

• Support for activities of daily living (ADLs) and mobility.

• Culturally sensitive care aligned with her Aboriginal heritage and spiritual needs.

• Emotional, social, and practical support for family members.

• Coordination of a multidisciplinary palliative care team.

• Development of an Advanced Care Plan (ACP) and End-of-Life Care Pathway.

• Education of family on care provision and end-of-life signs.

• Ensuring a peaceful, dignified death and post-bereavement support.

Assessment Approach – Mentor-Guided Process

The academic mentor guided the student through the assessment in a structured, step-by-step approach:

1. Understanding the Case and Context

   • The mentor encouraged the student to review Aunty Betty’s medical condition, cultural background, family dynamics, and end-of-life preferences.

   • Key learning: importance of cultural competence in palliative care.

2. Identifying Core Needs and Priorities

   • Pain and symptom management, ADL support, and emotional/spiritual needs were prioritized.

   • Mentor explained the relevance of evidence-based interventions for pain (opioids, adjuvant analgesics), fatigue, mobility, and end-of-life symptoms.

   • Key learning: integrating clinical knowledge with patient-centered care.

3. Ethical and Legal Considerations

   • The student explored autonomy, informed consent, and ethical dilemmas related to forgoing further treatment.

   • Mentor discussed legal frameworks around palliative care and home-based dying.

   • Key learning: critical analysis of ethical and legal responsibilities in end-of-life care.

4. Developing a Holistic Care Plan

   • Stepwise planning included:

     • Symptom relief strategies.

     • Family education and support.

     • Incorporation of Aboriginal cultural practices (involvement of Elders, storytelling, ceremonies).

     • Multidisciplinary coordination (GP, nurses, social workers, spiritual care providers).

   • Key learning: creating a care plan that is practical, culturally sensitive, and patient-focused.

5. Implementing and Reviewing Interventions

   • The mentor guided the student on how to outline monitoring strategies and the role of 24/7 support for the family.

   • The student learned to anticipate end-of-life symptoms and prepare family caregivers.

   • Key learning: proactive, anticipatory planning in palliative care.

6. Advanced Care Planning and End-of-Life Transition

   • Students were guided to document patient preferences, pain management goals, and hospice/funeral considerations.

   • Key learning: ensuring patient dignity and family preparedness during final days.

7. Final Reflection and Outcome Evaluation

   • The mentor encouraged the student to reflect on Aunty Betty’s holistic care outcomes and family support effectiveness.

   • Key learning: integrating theory with practice and evaluating outcomes against learning objectives.

Outcome Achieved

Through this guided process, the student successfully:

• Produced a comprehensive, culturally sensitive palliative care plan addressing physical, emotional, spiritual, and social needs.

• Developed evidence-based interventions for symptom management and family support.

• Applied critical thinking to ethical and legal considerations in end-of-life care.

• Coordinated a multidisciplinary care approach to facilitate dying at home.

• Integrated learning objectives (LO1-LO3) by demonstrating understanding of holistic care, legal/ethical issues, and evidence-based nursing practices.

The final submission reflects not only clinical knowledge but also cultural competence, empathy, and patient-centered care principles, ensuring Aunty Betty’s comfort, dignity, and family preparedness for end-of-life transitions.

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