Holistic Nursing Care Plan for Terminally Ill Patient

Holistic Nursing Care Plan for Terminally Ill Patient

The objective of this study is to create a holistic nursing care plan for a terminally ill patient. This study will explain how perceptions about quality of life and health promotion might affect care for a dying patient with a lingering illness such as cancer and discuss strategies that could be used in the situation to improve the quality of life for the patient and her husband during this illness.

Holistic Nursing

It is important that the nursing care plan for the terminally ill includes the reassurance that the patient will not be abandoned and that the nurse assist the patient in discussing their care wishes and goals. To assist patients such as the patient in this scenario it is important to understand the concepts and elements of end-of-life care and that the nurse be a skilled practitioner of the nursing arts. The end-of-life care if "patient goal-centered and should be provided for those who have a limited life expectancy." (Norlander, nd, p.3) The National Hospice and Palliative Care Organization states that Hospice:

"…affirms the concept of palliative care as an intensive program that enhances comfort and promotes the quality of life for individuals and their families. When cure is no longer possible, hospice recognizes that a peaceful and comfortable death is an essential goal of health care. Hospice believes that death is an integral part of the life cycle and that intensive palliative care focuses on pain relief, comfort, and enhanced quality of life as appropriate goals for the terminally ill. Hospice also recognizes the potential for growth that often exists within the dying experience for the individual and his/her family and seeks to protect and nurture this potential." (Norlander, nd, p. 4)

The holistic nursing practice is defined as "all nursing practice that has healing the whole person as its goal." (Mariano, 2007, p.64) Holistic nursing care is a caring and healing relationship and values the cultural values and beliefs as well as the individuals' spirituality in the nursing care. Holistic nursing care involves care of the individual's physical, mental, emotional, and spiritual being with a focus on the individual's comfort and relief from pain.

Patient Comfort

Because the patient is terminally ill and is in a great deal of pain one of the first considerations for this patient is relieving her pain so that she is able to function without a great deal of pain. Relieving the patient's level of depression is also of great importance so that she does not spend the end of her life crying in bed as she is doing presently. The nurse should meet with the family members who are reluctant to visit and explain to them that they have a great role to play in the end-of-life care of this patient. The family members should be brought to the understanding that their role is critical.

Patient Emotional Health

Upon relieving the patient of the pain and depression through use of medication, the hospice-care nursing staff will be of great comfort to the patient through simply talking with the patient about her life and about her wishes for her end-of-life care. The patient should be highly active in determining any life support or alternatively lack of life support that she desires to receive. The patient should be assisted in thinking about her wishes for her funeral, the songs and music that will be used at the funeral and what she chooses to wear at the funeral.

Patient Spiritual Health

The patient's spiritual affairs should be addressed as well so that the patient is both emotionally and spiritually prepared to deal with the ending of her life due to the progression of the cancer.

Patient Physical Care

Hospice Care is utilized by many patients who are terminally ill. Hospice Care involves nursing staff coming into the patient's home and assisting them with bathing, dressing, their medication, monitoring the patient's condition, counseling family members about what they can do to make the patient's path of dying easier and more comfortable. The hospice philosophy is stated to be a holistic philosophy, is interdisciplinary in nature, and includes physicians, nurses, social workers, clergy, volunteers, and staff assisting with grief of the family. It is reported that hospice care is "…synonymous with supportive care. Pain management and symptom control is state-of-the-art pain. Volunteers are available for respite care and companionship.

Factors Addressed By Hospice

The hospice team assists with the decisions and challenges that the patient and their family experience on a daily basis. The hospice team assists in identification of strategies for coping. The hospice care team will instruct the patient to do the following: (1) Make an appointment with an attorney to prepare/update a durable power of attorney for financial decisions; (2) Update life insurance policies as needed; (3) Provide family and physician with copies of your advance directive; (3) Review health insurance so you know what is covered and what isn't; (4) Write down important information such as names of banks, where safe deposit keys are, names of attorneys, etc., and share it with someone trusted; (5) Talk with employer about disability and other benefits. (Wuerl, 2013, p.1)

Alternative Care Methods

Some of the alternative care methods that are used with terminally ill patients include energy therapy, biologically based therapies, mind-body interventions, alternative medical systems, and manipulative and body-based methods. These are described in the following table along with examples of the use of each therapy.

Kind

Use

Examples

Energy Therapy

manipulating electromagnetic fields that surround the body therapeutic touch, reiki

Biologically Based Therapies

these make use of elements found in nature

nutritional supplements, vitamins, aromatherapy

Mind-Body Interventions

This makes use of the knowledge that mind can affect the body. It uses positive therapy techniques to help improve overall health art therapy, yoga, music/sound therapy, hypnotherapy, meditation, dance

Alternative Medical Systems

each of these therapies stand on their own as a complete health system homeopathy, osteopathy,

Manipulative and Body-Based Methods

by gentle movement or manipulation of the body in certain therapeutic ways promotes healing and general health

Acupressure, Alexander technique, reflexology

Source: American Holistic Nurse Association (2013)

The holistic nursing assessment is such that provides the patient the opportunity to give thought and to provide direction about their care needs and to work as a partner with their health care team in setting out a plan that has realistic goals. The holistic nursing care plan enables the patient in their own self-care and hands the patient the control, which raises the confidence and self-esteem of the patient. The health care team is able to provide more effective and efficient support and to make decisions based on the needs and wishes of the patient. Since holistic care is a team approach, to health care all views and points of care are included with the mind-body aspect of care being encouraged as well as the spiritual aspect of care. The focus of holistic health care is on the whole person rather on just one aspect of the individuals' care.