NR 501 Week 3 Assignment: Concept Analysis Paper
Concept Analysis: Palliative Care
Chamberlain University College of Nursing
NR501 Theoretical Basis
... [Show More] for Advanced Nursing Practice
Concept Analysis: Palliative Care
The role of concept within theory development is to provide guidance, definition of terms and clarification when a concept of interest does not have enough literature, is unclear, or material and studies don’t match; this process is measured as the structural foundation of theory. Once a concept is developed with theory and presented; then can it be described to the real world. Thus, giving a clear understanding of the who, what, when, where and why’s of the proposed analysis that has been formulated (Davis & Foley, 2017). This is vital in healthcare programs because it allows for framework to be comprehended. The nursing concept in this discussion is palliative care; a medical care that is specialized for those who are terminally ill (Center to Advance Palliative Care [CAPC], 2018). Presented by a shared theory context of Bandura’s social cognitive theory and Dorothy Orem’s conceptual model in the analysis of palliative care nursing (Kirkpatrick, Cantrell, & Smeltzer, 2017). This concept analysis paper will discuss the definition of palliative care, provide a literature review, and give defining attributes, antecedent and consequence of the concept. It will discuss the empirical referents, Bandura’s and Orem’s theories, constructed cases, and give a brief conclusion.
Definition/Explanation of Palliative Care
The World Health Organization (WHO) (2018), describes “palliative care is an approach that improves the quality of life of patients and families facing problems associated with life-threatening illness” (p 1, para 1). This is medical care that emphasizes on relieving stressors and symptoms of the illnesses with a goal to giving immaculate assessments and treatments in the early signs of pain and any other complications whether psychosocial, spiritual or physical (CAPC, 2018). In the article by Kirkpatrick, et al. (2017), a collaborated multidisciplinary team is provided with palliative care giving patients and their families a holistic care approach that focuses on the well-being of the whole person. It is the aging population and more people living with chronic illnesses, that brings a 15% increase from prior years, which proposes a greater demand for palliative care in the United States (Hughes & Smith, 2014).
Literature Review
In an article by Senderovich and Yendamuri (2019), conducted a research of dyspnea occurring during palliative care and how it is commonly experienced by many patients. There are 70% of patients who suffer with difficulty breathing during their last few weeks of life. This occurs due to several different conditions such as; malignancy, medications/treatment related causes, infections, chronic end stages disease of kidneys, heart, and liver. There are numerous pharmaceutical medications available to relieve the discomfort of dyspnea, but there is still the concern of side effects and limitations in the delivery methods. Opioids is the first choice of medication; however, it is limited because of the negative side effect and complications of sedation. Another line of medication is the nebulizer/inhalers; however, an occurring problem is the lack of knowledge on proper use. Proper education by medical professionals on the use of inhalers to their patient care can achieve that knowledge. Then benefits of using inhalant medication will increase for the relief of dyspnea in the palliative care setting (Senderovich & Yendamuri, 2019).
Another interesting literature was found on humor and palliative care. A topic not mentioned very often within the healthcare setting but has powerful benefits that are true to the holistic care approach of body, mind and spirit. The authors, Pinna, Mahtani-Chugani, Sanchez Correas, and Sanz Rubiales (2018), indicates that it is humor that aids to building relationships between patients, families and healthcare professionals. Humor allows people to form bonds between each other, build trust and confidence. It also ushers in an atmosphere of relaxation. This article explains that humor breaks the ice, decreases interpersonal distances and reduces fear. Humor among healthcare professionals consolidates relationships, gives confidence, and demonstrates strength to patients and families while breaking barriers of biases (Pinna, et al, 2018).
An additional review shows a statistic of 15 million people experiencing strokes globally and palliative care is desperately needed among those who suffer this devastating illness. When it comes to stroke it is the fifth leading cause of death within the United States. Those who may survive this illness often have sustaining debilitating life long injuries which impact their quality of life (QOL). It is with palliative care as an interdisciplinary approach that purposes to improve QOL from such illnesses. This article discusses the growing concerns of palliative care and end of life (EOL) decisions for stroke patients and recognizing the importance of this type of care for these patients suffering long term injuries (Molidor, Overbaugh, James, & White, 2018).
The authors, Baik, Cho, and Masterson-Creber (2019), specifies the importance of patients engaging in the strategies and choices made pertaining to their healthcare plans. This is achieved through collaboration and collective choices. A clinical setting where everyone participates with the plans and discusses together the goals and treatments for the best patient outcomes; this process is shared decision making (SDM). The participants exchange information, medical professionals provide the treatment options, and discuss the risks and benefits. This is crucial when it comes to making decisions for the end of life patient because individuals are affected in many ways such as values, cultures, and preferences, SDM helps with these critical care patients in need of palliative care (Baik, et al., 2019).
A home-based palliative care review article addresses the unmet needs of patients and caregivers. This literature review investigates the aspect of unmet needs for patients and caregivers pertaining to communication, psychosocial, practical, information, and spiritual needs. Communication among healthcare professional are frequently reported as unmet needs in this study. The lack of communication brings confusion and uncertainty for patients and caregivers, leading to poor continuity of care because healthcare workers are not being informed of services by other healthcare professionals. The article indicates there remains a concern pertaining to relief of physical, spiritual and psychological suffering within palliative care services. The results of this review show that patients and caregivers report that the dominant unmet need is that of psychosocial and spiritual, then that of the physical need (Ventura, Burney, Brooker, Fletcher, & Ricciardelli, 2014).
MacDonald and Barrett (2016), reference that there is a “link to companionship of animals and the enhancement of human physical, psychological, emotional and spiritual health in the context of palliative care” (p 306, para 7). This literature review suggest that previous studies propose that there are benefits in terms of pain control, psychological distress and less fatigue with companionship of animals. A Loris Face Scale was used in this study for determining mood changes and there was significant decrease (improvement) on patient’s mood when interactions were made with animals. The authors conclude that animals play a vital part in our lives whether they are pets or visited at zoos. It is our human nature that connects are emotional attachment to animals (MacDonald & Barrett, 2016).
Defining Attributes
There will be three defining attributes discussed pertaining to the nursing concept of palliative care. First, there is the attribute of compassionate, nurse’s ability to demonstrate compassion is significant to patient care, it is essential to the healing process and building trusting relationship with patients and family members. Next, is the attribute of the holistic approach that requires teamwork among healthcare professionals. This includes the participation of families, patients and multifaceted therapies to bring about whole care in the body, mind and spirit. The team approach optimizes and incorporates different perspectives to address issues of pain and physical symptoms, assessing functional and psychological needs. Finally, the attribute of realistic/resolute in the delivery of palliative care. This requires planned provision of quality care to meet practical achievements and improve outcomes for patients and family members (Kirkpatrick, et al., 2017).
Antecedent and Consequence
A precursor to palliative care nursing is self-awareness this antecedent mirrors a nurse’s capability to put self in another’s shoes. A nurse’s ability to self-reflect and willfully face own spirituality, values and beliefs about life, death and dying is a valuable aspect in the development of professional healthcare. This recognition is relevant to delivering high-quality palliative care. A consequential benefit in palliative care is improving quality of care to patients and their families within the whole well-being pertaining to pain relief, coping mechanism for the relief of stressors, improving self-esteem, personal and religious relationships (Kirkpatrick, et al., 2017).
Empirical Referents
The two important components that would be measured is hope and comfort level. The tool for measuring hope is the Herth Hope Index (HHI) a device that measures several degrees of hope with a four-point Likert scale that ranges from one to four, strongly agreeing or strongly disagreeing, and a higher score would indicate higher levels of hope and visa a versa for lower scores (Rustoen, Lerdal, Gay, & Kottorp, 2018). An Edmonton Symptom Assessment System (ESAS), can help identify comfort level through a four-point method of scoring pain: none, mild, moderate or severe. The ESAS is a frequently used tool in monitoring and measuring symptoms of distress with palliative care patients (Sprague, Siegert, Medvedev, & Roberts, (2018).
Construct Cases
A model is an illustrative picture of the essential characteristics of a concept antecedents and consequences which offer to scholars a clear example, which lets researchers gain a better idea of the concept and clarifies the direction of the study (Davis & Foley, 2017).
Model Case
A nurse practitioner (NP) who works in the critical care setting treating terminally ill patients must give a newly diagnosis of Stage IV lung cancer to Mr. Jones whom has been under NP’s care for the last several weeks. Because of his previous admitting diagnosis of active HIV with aids, there will need to be the discussion of chemotherapy treatment vs hospice palliative. A successful generated relationship has been built that established effective qualities of caring, empathy, and trust. This has been very therapeutic and positive for Mr. Jones and his family. The NP has frequently collaborated with all those involved pertaining to his case on a regular basis. Optimizing care regarding his goals, outcomes, physical, psychosocial and spiritual needs, along with making sure Mr. Jones and his family’s concerns were met and answered. Throughout the education and communication process, the NP has demonstrated compassion as if it was themselves facing this same decision.
Borderline Case
Nurse Suzy has been a dialysis nurse at a local dialysis center for 10 years. She has been caring for Mrs. Smith a patient with end stage renal disease (ESRD) stage IV regularly three days a week for her hemodialysis treatment. The last two visit Mrs. Smith has been hypotensive and unable to receive her schedule treatments. Nurse Suzy has developed close relationships with Mr. & Mrs. Smith and other family members since the beginning of hemodialysis treatments. The multidisciplinary team and Suzy have been working closely with Mr. and Mrs. Smith and family throughout the duration of care. A decision to start the process of hospice palliative care was made between everyone involved with Mrs. Smith treatment plans and goals. The next day during hemodialysis Mrs. Smith went hypotensive again unable to receive treatment. Nurse Suzy hadn’t made Mr. Smith aware of his wife’s hypotensive episode or unable to receive treatment. Mrs. Smith’s heart stopped, a code blue was called, after several minutes the time of death was pronounced. Mr. Smith and family were notified and upon arrival Mr. Smith was uncontrollably crying with devastation and unbelief. There was a lack of education and communication on nurse Suzy’s part regarding these episodes of hypotension. Mr. Smith could have been by his wife’s side during those last few treatments if he had known the risks involved in hypotension and no hemodialysis treatments, he feels his wife died alone.
Contrary Case
There is a Jack a 35-year-old man who is frequently admitted to the intensive care unit for drug overdose. This time it is more than just rhabdomyolysis and intubation. He now has bilateral ischemic brain injury and renal failure and an MRI is being performed to determine brain stem involvement. The young man has been seen on several occasions by the multidisciplinary team. However, there was neglect on giving compassionate care, education, communication, and empathy for this patient because he was being treated for addiction.
Theoretical Applications of Palliative Care
A theoretical advancement of a shared theory context of Dorothy Orems’s conceptual model and Bandura’s social cognitive theory for the field of palliative care nursing was presented for comparison. This process offers a context to direct nurses in developing their competence to provide quality care to patients with chronic terminal illnesses. Three concepts of the theory dealt with the nurse’s; self-competence, interventions, and nursing competence. The following shared theories dealt with; palliative self-care behaviors, physical and emotional symptoms, and quality of life. Palliative care deals with the whole person care in the holistic approach of body, mind, and spirit. The study proposes a shared theory to be used as an outline in palliative care, indicating that utilizing this framework can help evaluate the nursing educational programs (Dobrina, Tenze, & Palese, 2014).
Conclusion
The life expectancy has increased over time which means people are living longer with chronic debilitating illness. It is palliative care that provides care to the whole person in a holistic approach to those suffering from numerous diseases. The care requires management of their physical, spiritual and psychosocial needs that is offered through palliative care. The literature review for this concept analysis addresses ultimate goals of palliative care to relieve suffering of body, mind, spirit, and to promote quality of life (Kirkpatrick, et al., 2017). In reflecting palliative care nursing to chronically ill patients it is important to care with compassion and empathy, placing yourself in one’s shoes. Communicating and educating with simplicity and clarification. Incorporating a multidisciplinary approach pertaining to all aspects of care that includes patient and family members. Early initiation of palliative care promotes positive goals and outcomes, giving patient and family members opportunity to engage in care.
References
Baik, D., Cho, H., & Masterson Creber, R. M. (2019). Examining Interventions Designed to Support Shared Decision Making and Subsequent Patient Outcomes in Palliative Care: A Systematic review of the Literature. American Journal of Hospice & Palliative Medicine, 36(1), 76-88. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1177/1049909118783688
Center to Advance Palliative Care. (2018). What is palliative care? Retrieved from https://getpalliativecare.org/whatis/
Davis, A. H. & Foley, A. S. (2017). Using Research to Advance Nursing Practice. A Guide to Concept Analysis. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 31(3) 70-73. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3993352&Journal_ID=54033&Issue_ID=3993308
Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care nursing models and theories. International Journal of Palliative Nursing, 20(2), 75. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=94740528&site=eds-live&scope=site
Hughes, M. T. & smith, T. J. (2014). The growth of palliative care in the United States. Annual Review of Public Health, 35, 459-475. Retrieved from https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-032013-182406
Kirkpatrick, A. J., Cantrell, M. A., & Smeltzer, S. C. (2017). A Concept Analysis of Palliative Care Nursing: Advancing Nursing Theory. Advances in Nursing Science, 40(4), 356. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=126221170&site=eds-live&scope=site
MacDonald, J. M., & Barrett, D. (2016). Companion animals and well-being in palliative care nursing: A literature review. Journal of clinical Nursing, 25(3-4), 300-310. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1111/jocn.13022
Molidor, S., Overbaugh, K. J., James, D., & White, C. L. (2018). Palliative Care and Stroke: An Integrative Review of the Literature. JOURNAL OF HOSPICE & PALLIATIVE NURSING, 20(4), 358-367. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1097/NJH.0000000000000450
Pinna, M. A. C., Mahtani-Chugani, V., Sanchez Correas, M. A., & Sanz Rubiales, A. (2018). The Use of Humor in Palliative Care: A Systematic Literature Review. American Journal of Hospice & Palliative Medicine, 35(10), 1342-1354. https://doi-org.chamberlainuniversity.idm.oclc.org/10.11771049909118764414
Rustoen, T., Lerdal, A., Gay, C., & Kottorp, A. (2018). Rasch analysis of the Herth Hope Index in cancer patients. Health and Quality of Life Outcomes, 16(1), 196. https://doi-org.chamberlainuniversity.idm.oclc.org/101186/s12955-018-1025-5
Senderovich, H., & Yendamuri, A. (2019). Management of Breathlessness in Palliative Care: Inhalers and Dyspnea--A literature Review. Rambam Maimonides Medical Journal, 10(1), 1-7. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.5041/RMMJ.10357
Sprague, E., Siegert, R.J., Medvedev, O., & Roberts, M. H. (2018). Rasch analysis of the Edmonton Symptom Assessment System. Journal of Pain and Symptom Management, 55(5) 1356-1363. doi: 10.1016/j.jpainsymman.2018.01.016.
Ventura, A. D., Burney, S., Brooker, J., Fletcher, J., & Ricciardelli, L. (2014). Home-based palliative care: A systematic literature review of the self-reported unmet needs of patients and carers. Palliative Medicine, 28(5), 391-402. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1177/0269216313511141
World Health Organization. (2018). WHO definition of palliative care. Retrieved from http://www.who.int/cancer/palliative/definition/en/. [Show Less]