Orientation of new graduate registered nurses to the provision of palliative care at workplace

Question

Task: Explain coping strategies that a nurse may use to manage their experiences of grief following the death of a patient. Justify how person-centred impacts on the palliative residents of WSNH care. What is the importance of collaboration and teamwork in the palliative residents of WSNH?

Answer

Coping strategies to manage grief

Among medical workers, the fear of death the patient is common and it is often related to the pessimistic attitude towards caring for the dying patient. Helping a dying patient in their last moment is quite difficult, wherein the huge load of stress is connected with complicated circumstances. The capability to find oneself in the circumstances when the patient dies required support from the family of the individual, along with the inevitability to tackle with one's own emotions (Kostka et al., 2021). In such circumstances of the healthcare system, the newly graduated nurses are the ones that are mostly prone to experience stress, due to lack of experience in terms of dealing with such situations. Therefore, coping strategies are considered an imperative element for nurses to help manage their grief following the death of a patient.

One of the most usually used coping strategies by nurses to manage their grief and emotions after the death of a patient is by sharing and seeking support from colleagues. The study has found that nurses interact or discuss their emotions with other professionals in order to cope with grief, wherein if the atmosphere is unsupportive then the nurses may tend to leave the ward or profession (Agyei et al., 2022). Therefore, if the environment is supportive, the nurses are likely to find meaning in grief experiences, because the opportunity to discuss and share emotional feelings of grief with colleagues and other professionals after the death of the patient provided emotional support to the nurses. Following the death, if the patient, considering leaning on colleagues for support will provide objective insight, wherein sharing and seeking support from the senior and experienced colleague can also suggest coping mechanisms which worked and did not work for them in the past. Therefore, sharing and discussing with colleagues is probably the most effective coping strategy in getting through the difficult death of the patient, as it provides emotional support and the capability to recognize themselves (El-Masri & Metwaly, 2015).

Another effective coping strategy that can be used by nurses in order to deal with grief after the death of the patient is faith and spiritual belief. The study conducted by Khalaf et al., 2017) found that most Jordanian nurses agreed upon the fact that a patient's death makes them feel closer to God while accelerating their spiritual belief and faith. Therefore the spiritual coping strategy is also one of the frequently used strategies by nurses as an effective coping strategy. The nurses who mainly rely on religious belief are able to efficiently address their grief and stress in a purposive and optimistic way using a spiritual coping strategy following the patient's death. Engaging in spiritual practices provides comfort and rest to the nurses and revitalizes their spirits as well. Hence addressing the issue of grief experienced by the nurses because of the patient's death and comprehending the effective coping approaches and strategies is likely to help the new nurses at WSNH to overcome the grief and challenges following the death of patients.

Impact of person-centred care

Person-centred palliative care endeavours to make the complete individual noticeable and prioritise the gratification of existential, psychosomatic, spiritual and social requirements to the same degree as bodily needs. An individual in a palliative care setting is observed as a human being encompassing spiritual, social, mental and physical magnitudes. Both person-centred and palliative care utilise joint decision-making and partnership based on patient narrative along with collaboration and credentials of quality of care for adequate preparation of an individual's outstanding life. Therefore palliative care must be facilitated in an understanding care setting also known as a person-centred setting where the mature individual and the family feel seen, welcomed and concerned by the workers (Bökberg et al., 2019).

Person-centred care must be considered multidisciplinary since it recognises that an individual might necessitate more than one service or professional to assist them with their circumstance. It denotes communicating with persons and recognising and identifying their potential and capabilities to enhance and manage their comfort and health, not simply viewing them as passive recipients of care or victims of the disease. Most individuals want to assist themselves to enhance their quality of life, well-being and health, however, they frequently need professional aid to accomplish the skills, assurance and information to do so(Lee, 2021). The World Health Organisation's framework for formulating age-appropriate communities needs enterprises like hospitals to consult with elder individuals on steps to serve them better which thereby contributes to fostering age-friendly respect, empowering older people and ensuring social inclusion(Department of Health Victoria, 2015).

WSNH must make person-centred practices a part of their work and operation through daily interactions with patients and their careers and family. To implement family members and patients as active care associates, providers can utilise decision aids, engage in appointment agenda-setting, agree on treatment goals and endorse patient self-management policies. The chief principles of person-centred care in clinical care standards are to treat patients with respect and dignity, encourage the participation of patients in decision-making, communicate with patients about their treatment options and clinical conditions and facilitate patients with details in an arrangement that they comprehend so they can partake in the process of decision making. Further in WSNH, a coordinated multidisciplinary team method is vital for enhancing the delivery of care to old age patients. Multidisciplinary care of patients can enhance health outcomes and facilitate more effective use of health resources. Coordination, planning and timely communication between clinicians are vital elements of multidisciplinary care(ACSQHC, 2019). A system-based, integrated approach assisted by WSNH and the network is vital to the delivery of person-centred care. Some of the chief elements of an integrated approach encompass understanding the limitations and capacity of each constituent of the healthcare system across the regional, metropolitan, remote and rural settings, development of clear communication lines between the hospital, primary care, community service and sub-acute and ensuring adequate coordination so that patients obtain speedy access to the best possible care irrespective of where or how they enter the system. As the healthcare sector endures to embrace sounder patient satisfaction along with adherence to quality outcomes and care plans(Heath, 2018).

Importance of collaboration and teamwork

Figure 1: Advantages of an interdisciplinary team

Source: (Majeed & Bartlam, 2020).

The multi-disciplinary team (MDT) approach appears to be impactful in regard to palliative care to make sure a holistic approach is implemented and professionals are able to provide necessary care to the palliative patient (Majeed & Bartlam, 2020). Patients with palliative illness are already experiencing a difficult situation in terms of emotional and physical strength etc. Therefore, palliative care with MDT appears to be crucial in providing care as per the need of the patient in every aspect as demonstrated in the above figure. For example, a case of an 88 years old lady diagnosed with B-cell lymphoma was admitted to Hospice IPU and was provided with palliative care. It has been found that MDT was not only able to offer care, in fact, but holistic care was also provided enabling her to flourish as she approaches towards end of her life (Majeed & Bartlam, 2020).

On the other hand, cancer is one of the prominent health issues and pain is the most debilitating system among these cancer patients (Yang et al., 2020). Thus, multidisciplinary care teams are provided with access to the clinical severity and symptoms in regard to cancer pain. A multidisciplinary team includes different clinical professionals' rights including physicians, nurses, doctors, therapists etc. Together they provide quality care to the patient compared to a normal team with less expertise and skills. Because of the quality care offered through palliative care to a patient suffering from severe pain most health institutions all over the world have initiated palliative care. For example, the Japanese Circulation Society has recommended a multidisciplinary team for palliative care for a patient suffering from heart failure (Shibata et al., 2021). It is because this multidisciplinary team is known for providing expertise on different psychological and physical distress including care goals and support for future care planning. Also, in palliative care when it comes to aged care there is a need to make a rapid decision which is only possible and effective with a multidisciplinary team.

Considering the advantage of teamwork in palliative care in regards to aged care can be said that the individual skills and experience of each member can contribute positive aspects (Fonseca et al., 2017). Different experiences and skills of professionals enable them in making effective decisions which can lead to offering quality care to aged patients. Across the world, the population is ageing rapidly resulting in an increasingly serious health issue therefore; to meet the need of these people healthcare system is forced to become more effective. Hence, teamwork as a whole appears to be effective to deal with such issues assisting in assessing, planning and evaluating ultimate aged patient care (Larsson et al., 2022). Along with firm effectiveness, teamwork is related to delivering quality and safe care which eventually influences the entire health system of aged care facilities. Unless there is no effective team in the healthcare sector delivering quality care to aged patients in residential facilities is impossible in an effective manner.

References

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Agyei, F. B., Nti, F., Anago, E. K., & Avinu, E. S. (2022). Grief and Coping Strategies of Nurses Following Patient Death at the Konongo-Odumasi Government Hospital, Ghana. Journal of Client-Centered Nursing Care, 8(3), 177–190. https://doi.org/10.32598/jccnc.8.3.434.1

Bökberg, C., Behm, L., Wallerstedt, B., & Ahlström, G. (2019). Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design. BMC Palliative Care, 18(1). https://doi.org/10.1186/s12904-019-0431-8

Department of Health. Victoria, A. (2015, October 5). Implementing person-centred practice. Www.health.vic.gov.au. https://www.health.vic.gov.au/patient-care/implementing-person-centred-practice

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Heath, S. (2018, December 3). 4 Core Principles of Patient-Centered Care, Family Engagement. PatientEngagementHIT. https://patientengagementhit.com/news/4-core-principles-of-patient-centered-care-family-engagement

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Kostka, A. M., Borodzicz, A., & Krzemi?ska, S. A. (2021). Feelings and Emotions of Nurses Related to Dying and Death of Patients – A Pilot Study. Psychology Research and Behavior Management, Volume 14(14), 705–717. https://doi.org/10.2147/prbm.s311996

Larsson, R., Erlingsdóttir, G., Persson, J., & Rydenfält, C. (2022). Teamwork in home care nursing: A scoping literature review. Health & Social Care in the Community. https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.13910

Lee, E. (2021, September 30). Why is Person-Centred Care Important? CPD Online College. https://cpdonline.co.uk/knowledge-base/care/person-centred-care/

Majeed, S., & Bartlam, K. (2020). A case study: highlighting the importance of multidisciplinary working in palliative care for a patient with psychological trauma. https://medcraveonline.com/HPMIJ/HPMIJ-04-00185.pdf

Shibata, T., Mawatari, K., Nakashima, N., Shimozono, K., Ushijima, K., Yamaji, Y., Tetsuka, K., Murakami, M., Okabe, K., Yanai, T., Nohara, S., Takahashi, J., Aoki, H., Yasukawa, H., & Fukumoto, Y. (2021). Multidisciplinary Team-Based Palliative Care for Heart Failure and Food Intake at the End of Life. Nutrients, 13(7), 2387. https://www.mdpi.com/2072-6643/13/7/2387

Yang, B., Cui, Z., Zhu, X., Deng, M., Pan, Y., Li, R., Guo, M., Lu, G., Zhang, X., Guo, L., Huang, Y., & Li, F. (2020). Clinical pain management by a multidisciplinary palliative care team. Medicine, 99(48), e23312. https://doi.org/10.1097/MD.0000000000023312