Palliative Nursing Care Plan for Indigenous Australian Patient
This paper presents a holistic nursing case study and care plan for a 68-year-old Indigenous Australian man transferred to a palliative care ward following surgery for a sacral abscess. The paper examines how Aboriginal cultural beliefs influence pain assessment and health-seeking behavior, addresses professional standards for non-judgmental nursing care, and outlines a comprehensive holistic assessment framework. It also covers advance care planning, complementary therapies, multidisciplinary referrals, and the pathophysiology of key palliative symptoms. The second part develops a formal nursing care plan that identifies patient problems, sets expected outcomes, proposes nursing interventions, and describes an evaluation process appropriate to end-of-life care.
- Introduction and Patient Overview: Patient background and palliative transfer context
- Cultural Influences on Pain Assessment: How Aboriginal culture shapes pain perception and care
- Professional Standards and Holistic Assessment: Ethics codes, prejudice reflection, and assessment questions
- Advance Care Planning and Complementary Therapies: Directives, organ donation, and non-pharmaceutical pain strategies
- Multidisciplinary Referrals and End-of-Life Indicators: Referral rationales, symptom pathophysiology, and dying signs
- Nursing Care Plan: Interventions and Evaluation: Formal care plan table, problem list, and evaluation process
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What makes this paper effective
- The paper consistently ties clinical concepts back to the specific patient scenario, making abstract nursing principles concrete and case-relevant.
- It integrates cultural competence throughout, demonstrating awareness that Aboriginal and Torres Strait Islander beliefs about illness and death directly shape nursing practice.
- The structured care plan table clearly aligns nursing diagnoses with expected outcomes and interventions, reflecting standard clinical documentation format.
Key academic technique demonstrated
The paper demonstrates applied clinical reasoning: it draws on referenced professional standards (the Code of Ethics for Nurses, the Code of Professional Conduct, and EN Competency Standards) and pathophysiology to justify practical nursing decisions. Rather than discussing theory in isolation, each concept is immediately applied to the patient's presentation, showing the reader how evidence informs bedside care.
Structure breakdown
The paper is divided into two parts. Part A works through a series of focused clinical questions covering cultural influence on pain, professional ethics, holistic assessment questions, advance care planning, complementary therapies, referrals, symptom pathophysiology, and end-of-life indicators. Part B develops a formal nursing care plan, including a physical assessment narrative, a problem list derived from abnormal data, a nursing intervention table, and an evaluation section. This two-part structure mirrors the real-world sequence of clinical assessment followed by care planning.
Introduction and Patient Overview
The patient is a 68-year-old man who was transferred to the Palliative Care ward from a surgical ward three days ago. He was admitted on January 26, 2013 for removal of a sacral abscess that had been a significant source of pain. Following surgery, his future management was evaluated and it was determined that he would be transferred to the Palliative Care ward, as discharge home was not possible. The palliative care assessment of this patient requires the development of a suitable nursing care plan to address his condition effectively. The nursing plan requires an understanding of the patient's social history, medical history, physical assessment upon admission, and palliative care unit admission assessment.
Cultural Influences on Pain Assessment
The patient is an Indigenous Australian — that is, an individual of Aboriginal or Torres Strait Islander descent. His cultural background has a direct bearing on his pain assessment, given the well-documented role of culture in healthcare. There is a recognized variation between non-Indigenous and Indigenous Australians in their interpretation of death, dying, and other aspects of health and well-being (Queensland Health, 2011). Culture influences his pain assessment because of differences in customary practices between Indigenous and non-Indigenous Australians. In particular, health and well-being are interpreted differently among Indigenous peoples, and hospital admission is often viewed as a place an individual goes to die rather than to heal.
It is important to develop and implement appropriate strategies to ensure that the patient's pain is adequately addressed. This process requires consideration of the impact of geographical and cultural factors on individuals and communities, as well as the barriers these factors create, in order to obtain a detailed picture of the health and well-being of Indigenous Australians.
One key strategy is to address personal and spiritual issues alongside clinical pain management. Aboriginal and Torres Strait Islander people tend to regard factors associated with ill health — such as pain and discomfort — as personal or spiritual matters (Commonwealth of Australia, 2005). Addressing pain therefore requires attention to spiritual concerns and cultural transgression, as these influence the patient's perception of pain. A second strategy involves facilitating discussion between the patient and a health worker or social worker to promote understanding of his current situation and illness. Third, measures should be established to address his current family situation as part of enhancing his social and emotional well-being, which in turn can help manage his pain.
Professional Standards and Holistic Assessment
The patient's social and medical history may generate prejudices and judgements when caring for him. One such judgement is that he may be perceived as violent and stubborn, given his past history of domestic violence and substance abuse. A second is the assumption that he views hospital admission as a place of death rather than healing — a perception common among many Indigenous Australians. Third, his refusal of home help despite being unable to care for himself may lead carers to view him as uncooperative. Fourth, his history of alcohol abuse and heavy smoking may prompt judgements that his condition was self-inflicted.
Several Australian nursing standards and codes are relevant to non-judgmental care in this situation. Value Statements 1 through 7 of the Code of Ethics for Nurses in Australia apply directly. Conduct Statements 1 through 10 of the Code of Professional Conduct for Nurses in Australia also govern non-judgmental practice. The competence units outlined in the EN Competency Standards further regulate nursing practice in ways relevant to this case.
A holistic health assessment should gather information across physical, mental and emotional, and social and cultural domains. The following questions frame such an assessment.
A. Physical health status including pain assessment
i. How would you rate your daily energy levels? ii. Do you experience any headaches, joint aches, or muscle pain? iii. How would you describe your ability to exercise? iv. How would you rate your overall physical health? v. Can you describe your pain for me?
B. Mental and emotional status
i. What is your sense or perception of well-being, and do you feel you meet those standards? ii. How would you rate your overall mental health? iii. What is your level of self-esteem and self-acceptance? iv. How capable do you feel of working with others in a meaningful way? v. How often do you experience difficulties with stress, negativity, anger, emotional numbness, boredom, or depression?
C. Social and cultural issues
i. How would you rate your closest relationships and interactions with friends and acquaintances? ii. Do you actively devote time to your spiritual well-being? iii. What is your perception of hospital admission? iv. How has your experience of pain altered your social life? v. Has your experience of pain affected your sense of belonging to a community or group?
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