Healing the Scars Through Palliation
During my palliative course clinical, I encountered a 41 year old male patient in Aga Khan University Hospital. First he came to the emergency with the complaints of hypotension, fever and a decrease in oral intake. The patient was diagnosed with septic shock and pancreatic cancer which had metastasized to the bone.
The patient’s attendant revealed that the patient had first experienced abdominal pain two years back, followed by an Endoscopic Retrograde Cholangio Pancreatography (ERCP) and Whipple procedure later one. His health suddenly deteriorated and he was rushed to the emergency.He was assessed by the doctors and his code was changed from Full to Do Not Resuscitate (DNR) only on medicine.
The patient’s attendent was counselled regarding the poor prognosis of the disease condition, consent was taken to withdraw further treatment and the patient was shifted to palliative comfort care. Life is God’s precious gift to us and death is inevitable, a reality that no one can escape from.All of us have to experience death one day but as a human being, it is our responsibility to help and support each other to pass from one transition to the other, smoothly and peacefully.
The main philosophy or goal of palliative care is to give comfort to the patient and minimize their suffering. (CARE, F. P. O. P. 2002).Initially, I was uncomfortable with this patient because he was in a very serious condition. But with time and the support of faculty members, I gained confidence and was able to communicate with his family. I felt sad because he was only forty years old and tthe sole bread winner of his family which comprised of eight children.
Pancreatic cancer is the uncontrolled growth of pancreatic cells. In USA, it is the fourth major source of cancer death and 227000 deaths per year around the globe. Pancreatic cancer is generally asymptomatic in its early stage and manifests itself in an advanced stage (Li, Xie, Wolff, & Abbruzzese, 2004).Now patient was on palliative care and his code was DNR on comfort. In palliative care, we must take care of two domains, namely; physical and psychological.
Elaborating upon the psychological domain, it is highly essential that the family members of a patient under palliative care, are tended to woth empathy and diligence. Involving them in patient care decisions, talking to them, relieving them of their apprehensions and inhibitions to the best of our capacity.
Literature also says that psychological problems are potentially treatable so we have to treat them so that we can improve the quality of life of the patient rather than further worsening their suffering. (Hotopf, Chidgey, Addington-Hall, & Ly, 2002). Literature also says that family involvement in patient care is very important to maintain quality care and give emotional support. (Glajchen, 2003).
Recommendations:As a nursing intern I helped the staff to administer medications to subside his physical symptoms. Other than that I gave emotional support and taught some coping skills to the family members to alleviate their psychological problems. My opinion is that we should involve families in decision making in order to improve the quality of life of a patient.
Literature also says that family members are a part of the care team. We should to engage them in decision making (Field, & Behrman, 2003).I recommend that we should communicate and listen to a patient and their family actively and therapeutically. We must counsel them and do some mind diversion therapies for psychological support.
Literature also says that being empathetic, showing respect, doing different mind diversion therapies such as music, prayers, showing photographs, writing and remembering of good memories are some coping skills for the patient and their family to ventilate their feelings, improve the quality of life of a patient and maintaining social dignity. (Chochinov, 2006).
Initially, I was very anxious whether I will be able to deal with the dying patients and their families or not. At the end, I was able to interact confidently with such types of patients. I learned many new things as well. Although it was very challenging but I learned that as a nurse, I should provide emotional support to the patients and their families and at the same time, control my own emotions as well.
McDonald, K., & Kong Meng San Phor Kark See Monastery (Singapore).(2003).Preparing for death and helping the dying: A buddhist perspective. Singapore: Kong Meng San Phor Kark See Monastery.
CARE, F. P. O. P. (2002). A Vision for Better Care at the End of Life.
Li, D., Xie, K., Wolff, R., & Abbruzzese, J. L. (2004). Pancreatic cancer. The Lancet, 363(9414), 1049-1057.
Glajchen, M. (2003). The emerging role and needs of family caregivers in cancer care. The journal of supportive oncology, 2(2), 145-155.
Hotopf, M., Chidgey, J., Addington-Hall, J., & Ly, K. L. (2002).Depression in advanced disease: a systematic review. Part 1: Prevalence and case finding. Palliative Medicine, 16, 81-97.doi:10.1191/02169216302pm507oa
Field, M. J., & Behrman, R. E. (Eds.). (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. National Academies Press.
Chochinov, H. M. (2006). Dying, Dignity, and New Horizons in Palliative End‐of‐Life Care1. CA: a cancer journal for
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About the Author: Muhammad Nasir completed his Bachelor of Science in Nursing from The Aga Khan University Karachi in 2015. He is currently interning at the Aga Khan University Hospital Karachi.He can be reached at email@example.com.
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