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Crucial Role of Nurses in Responding to Patients' Acute Needs

  • 16 Pages
  • Published On: 12-12-2023
Introduction

Nurses are the pillars of the healthcare framework who play crucial roles in providing high-quality care and support to patients thereby promoting their health and wellbeing. Nurses play manifold roles in their practices such as observing patients, assisting doctors to develop an effective care plan, act as a mediator for delivering important information to different healthcare staffs and maintaining effective communication in the workplace (Sekse et al. 2018). This study aims to present a literature review of the roles of nurses in responding to patients’ acute needs. This study will compare the relevant literature, therefore, presenting a comprehensive discussion on how nurses perform an excellent role in determines and responding to the critical needs of patients with complex condition and how nurses can develop an effective care plan to manage the symptom of health condition. This study will determine the ethical dilemmas that nurses face during providing palates care to patients with a life-threatening illness.

In the modern healthcare context, nurses' role is not confined to care delivery to patients rather nurse performs manifold duties such as maintaining transparent information delivery in the ward, interact with patients and their family members, carry out health assessment of patients, lead a team and help the doctor to develop an appropriate clinical regimen for the patient (Mitchell et al. 2020). Under NMC (2015), nurses professionals play crucial roles in assuring that patients are provided with safe and high-quality care that meet their holistic needs of critical patients. in this context the selection of the study is highly appropriate that will provide a new insight into the importance of nursing professionals in relation to playing crucial roles in determines and meeting critical needs of patients. By selecting this topic, this study will highlight the manifold roles that nursing professionals preform in terms of responding to the critical needs of patients and planning their care regimen. Additionally, the study is also useful in highlighting the barriers that nurses face during their practices such as ethical and moral dilemmas.

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Role of nurses in Palliative Care for patients with cancer

Nurses play manifold roles in terms of determining the critical health needs of patients who suffer from malignancy (Sekse et al. 2018). In the UK, oncology nurses are involved in carrying out a physical and psychological assessment of cancer patients in terms of determining their health status. oncology nurses working in the NHS hospitals in England and Wales are not only involved in assessing the health of patients but also providing them with psychotherapy and health education to improve their self-management ability (Ziegler et al. 2018). nurses are involved in carrying out all the necessary physical examination of the patient, gather data on their pre-medical history, genetic disorders and their lifestyles. nurse send all up to date information regarding the patient's health status to the doctors which assists them to develop an effective care plan for the patients based on the current health assessment. While dealing with patient’s who reach the end of their life nurses use polite, friendly and empathetic communication that provides mental and emotional support to patients (Gadoud et al. 2018.). in the UK, oncology nurses are involved in promoting the holistic wellbeing of patients who suffer from life-threatening illness such as cancer by educating them how to lead a systematic and healthy life. here nurses educate patients with cancer about the diet plan, exercises, medication regimen, healthy eating and drinking, as mentioned by Ziegler et al. (2018), through determining the critical need of dying patients’ nurses help doctors in terms of developing appropriate care framework that will not only improve the physical and emotional health of the patients but also improves patient’s quality of daily living.

Roles of the nurse in Palliative care services at home setting and hospital setting:

The research studies showed that some cancer patients want to receive palliative care services in their homes (Dowling et al., 2020). This method is found effective concerning clinical perspectives and also helpful for achieving contentment for patients (Mertens et al., 2019). The approach is considered beneficial to help the patients in achieving physical, spiritual, social, psychological, and economic gains. The study indicated that this method helps patients of cancer decrease financial expenses, reduce the period and side effects of hospitalisation, and in some cases also prevent the need for the patients to be hospitalised. The research study carried out on the cancer patients indicated that receiving palliative care services at home reduced the psychological diseases and their severity among the cancer patients and increase their life quality (Reeves et al., 2020). It was mentioned that the role of nurses was significant for the patients using this method and it reduced the expenses of patients to about 45 percent (Mertens et al., 2019).

Another form of palliative care service used to provide to cancer patients include hospice-based services. The hospice-based services referred to the care services provided to the patients who are seriously ill within one day period. However, this service is different from hospital-based services. It was explored that hospice-based services are considered useful in the peaceful death of cancer patients (Lindley et al., 2017). The patients and their families provide the support for solving the physical, psychological or spiritual issues. This form of care provided by the nurses in emergency help to cope up the patients with the severity of pain and also in overcoming the fears of the patients. The study indicated that the model of palliative care assists nurses in enhancing the life quality of cancer patients (Achora and Labrague, 2019).

Ethical and moral issues that nurses face in palliatives care delivery:

Palliative nurses face many ethical challenges during the care delivery. These challenges are as follows:

Obtaining informed consent:

In most of the times nurses who work with patients with life threatening Illness experience lack of cooperation from patients and their family members in terms of applying any treatment or undertaking surgery (Smets et al. 2018). In the UK, nurses working in the oncology ward of NHS hospitals are reported to experience unsupportive behaviour and lack of cooperation from cancer patients and their family members, especially in case of aged patients. As mentioned by McCaughan et al. (2019), the reason behind the non-cooperation on giving informed consent is, that majority of the patients and their family members believe that receiving any additional treatment or undergoing any surgery is full waste of money as there is no hope for survival. In this context, nurses face severe ethical; conflict between the professional ethics and patient’s rights to informed consent.

Conflict between science and spirituality:

Nurses, especially the nursing professionals who work in the palliative ward are more likely to face the ethical dilemmas that develop due to conflict between the professional values of nurses and spiritual beliefs of patients (Costantini et al. 2020). Oncology nurses in the UK are reported to experience many cases in which religious belief of patients and their family members pose bars on applying lifesaving treatment and medical intervention (Smets et al. 2018). Many cancer patients have the spiritual beliefs that they should not undergone any treatment process that can cause blood flow out of their body. Palliative nurses face severe ethical dilemmas while they are obliged to respect the patient’s decision to not undertaking any surgery despite narrowing that surgery is the only option for their survival. In this context n nurses experiences severe conflict between their professional ethics and patient’ to choose their treatment process.

Recourse allocation vs healthcare needs:

Oncology nurses in the UK are reported to frequently face issues of poor resources allocation in the care Freetown that makes them unable to meet patient’s needs (McCaughan et al. 2019). In terms of providing high quality palliative care, nurses must be provided with the resources that are needed to plan and implement effective care regimen to meet holistic needs of patients. In most of the NHS hospital in the UK, nurses fail to provide the care and support that patients with life limiting illness need to meet their physical and emotion needs. There are many cases in which nurses are allegedly changed of providing poor quality care and showing negligence to patients (Sekse et al. 2018). But the actual scenario behind the scene is completely different. The reason behind the poor-quality care is poor resource allocation to nurses that makes them unbe to meet patient’s health needs. Inability of nurses to meet patient’s critical needs cause psychological distress and frustration.

Conflict between autonomy and beneficence:

Sometimes patient’s autonomy can go against the medical ethics that can pose severe ethical dilemmas on nurses. Nurses are involved in checking the effective medicine delivery to patients but the conflict arise if patients refuse to take the medicines (Smets et al. 2018). On the other hand, patient’s autonomy in providing consent to treatment or choosing the care plan can create severe conflict with the beneficence. In many cases patients refuse to undergo surgery or receive the treatment that they desperately need to have a healthy life (Sekse et al. 2018). This refusal poses challenges on nurse’s in maintaining their professional integrity and accountability through ensuring safe care delivery to patients.

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Conclusion

The finding of this review concluded that palliative care approaches have significant impacts on enhancing the life quality of cancer patients. There are different models used by the nurses in providing these services to the cancer patients depending on the needs and requirements of the cancer patients as well as the type of cancers. The review proposed the evaluation of different approaches in palliative approaches and find effective outcomes concerning the improvement of emotional, mental, and physical health of the cancer patients.

Reference list:

Achora, S. and Labrague, L.J., 2019. An integrative review on knowledge and attitudes of nurses toward palliative care: Implications for practice. Journal of Hospice & Palliative Nursing, 21(1), pp.29-37.

Beckstrand, R.L., Collette, J., Callister, L. and Luthy, K.E., 2012, September. Oncology nurses' obstacles and supportive behaviors in end-of-life care: providing vital family care. In Oncology Nursing Forum (Vol. 39, No. 5).

Brant, J.M., Fink, R.M., Thompson, C., Li, Y.H., Rassouli, M., Majima, T., Osuka, T., Gafer, N., Ayden, A., Khader, K. and Lascar, E., 2019. Global survey of the roles, satisfaction, and barriers of home health care nurses on the provision of palliative care. Journal of palliative medicine, 22(8), pp.945-960.

Candy, B., France, R., Low, J. and Sampson, L., 2015. Does involving volunteers in the provision of palliative care make a difference to patient and family wellbeing? A systematic review of quantitative and qualitative evidence. International journal of nursing studies, 52(3), pp.756-768.

Costantini, M., Sleeman, K.E., Peruselli, C. and Higginson, I.J., 2020. Response and role of palliative care during the COVID-19 pandemic: a national telephone survey of hospices in Italy. Palliative medicine, 34(7), pp.889-895.

Dowling, M.J., Payne, C., Larkin, P. and Ryan, D.J., 2020. Does an Interactive, Teleconference-Delivered, Palliative Care Lecture Series Improve Nursing Home Staff Confidence. Journal of Palliative Medicine, 23(2), pp.179-183.

Ferrell, B.R., Twaddle, M.L., Melnick, A. and Meier, D.E., 2018. National consensus project clinical practice guidelines for quality palliative care guidelines. Journal of palliative medicine, 21(12), pp.1684-1689.

Gadoud, A., Lu, W.H., Strano-Paul, L., Lane, S. and Boland, J.W., 2018. A pilot study of interprofessional palliative care education of medical students in the UK and USA. BMJ supportive & palliative care, 8(1), pp.67-72.

Gama, G., Barbosa, F. and Vieira, M., 2014. Personal determinants of nurses' burnout in end-of-life care. European Journal of Oncology Nursing, 18(5), pp.527-533.

Giammalva, G.R., Iacopino, D.G., Azzarello, G., Gaggiotti, C., Graziano, F., Gulì, C., Pino, M.A. and Maugeri, R., 2018. End-of-life care in high-grade glioma patients. The palliative and supportive perspective. Brain sciences, 8(7), p.125.

Gillman, L., Adams, J., Kovac, R., Kilcullen, A., House, A. and Doyle, C., 2015. Strategies to promote coping and resilience in oncology and palliative care nurses caring for adult patients with malignancy: a comprehensive systematic review. JBI database of systematic reviews and implementation reports, 13(5), pp.131-204.

Gómez-Batiste, X., Porta-Sales, J., Espinosa-Rojas, J., Pascual-López, A., Tuca, A. and Rodriguez, J., 2010. Effectiveness of palliative care services in symptom control of patients with advanced terminal cancer: a Spanish, multicenter, prospective, quasi-experimental, pre-post study. Journal of pain and symptom management, 40(5), pp.652-660.

Hannon, B., Swami, N., Pope, A., Rodin, G., Dougherty, E., Mak, E., Banerjee, S., Bryson, J., Ridley, J. and Zimmermann, C., 2015. The oncology palliative care clinic at the Princess Margaret Cancer Centre: an early intervention model for patients with advanced cancer. Supportive Care in Cancer, 23(4), pp.1073-1080.

Kirby, E., Broom, A. and Good, P., 2014. The role and significance of nurses in managing transitions to palliative care: a qualitative study. BMJ open, 4(9).

Koutsopoulou, S., Papathanassoglou, E.D., Katapodi, M.C. and Patiraki, E.I., 2010. A critical review of the evidence for nurses as information providers to cancer patients. Journal of Clinical Nursing, 19(5‐6), pp.749-765.

Lalani, N., Duggleby, W. and Olson, J., 2018. Spirituality among family caregivers in palliative care: An integrative literature review. International journal of palliative nursing, 24(2), pp.80-91.

Lindley, L.C., Herr, K.A. and Norton, S.A., 2017. The role of hospice and palliative care nurses in quality improvement. Journal of Hospice & Palliative Nursing, 19(2), pp.160-165.

Mahon, M.M. and McAuley, W.J., 2010, May. Oncology nurses' personal understandings about palliative care. In Oncology nursing forum (Vol. 37, No. 3).

McCaughan, D., Roman, E., Smith, A.G., Garry, A.C., Johnson, M.J., Patmore, R.D., Howard, M.R. and Howell, D.A., 2019. Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study. European Journal of Oncology Nursing, 39, pp.70-80.

Meier, D.E., 2011. Increased access to palliative care and hospice services: opportunities to improve value in health care. The Milbank Quarterly, 89(3), pp.343-380.

Mertens, F., De Gendt, A., Deveugele, M., Van Hecke, A. and Pype, P., 2019. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. Journal of Clinical Nursing, 28(19-20), pp.3680-3690.

Mitchell, S., Maynard, V., Lyons, V., Jones, N. and Gardiner, C., 2020. The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic. Palliative Medicine, 34(9), pp.1182-1192.

Oishi, A. and Murtagh, F.E., 2014. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliative medicine, 28(9), pp.1081-1098.

Raphael, D., Waterworth, S. and Gott, M., 2014. The role of practice nurses in providing palliative and end-of-life care to older patients with long-term conditions. International journal of palliative nursing, 20(8), pp.373-379.

Reeves, E., Liebig, B. and Schweighoffer, R., 2020. Care Coordination in Palliative Home Care: Who Plays the Key Role?. International Journal of Integrated Care, 20(3).

Reinke, L.F., Shannon, S.E., Engelberg, R.A., Young, J.P. and Curtis, J.R., 2010. Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses. Journal of pain and symptom management, 39(6), pp.982-992.

Schroeder, K. and Lorenz, K., 2018. Nursing and the future of palliative care. Asia-Pacific journal of oncology nursing, 5(1), p.4.

Sekse, R.J.T., Hunskår, I. and Ellingsen, S., 2018. The nurse's role in palliative care: A qualitative meta‐synthesis. Journal of clinical nursing, 27(1-2), pp.e21-e38.

Sekse, R.J.T., Hunskår, I. and Ellingsen, S., 2018. The nurse's role in palliative care: A qualitative meta‐synthesis. Journal of clinical nursing, 27(1-2), pp.e21-e38.

Siouta, N., Van Beek, K., Van der Eerden, M.E., Preston, N., Hasselaar, J.G., Hughes, S., Garralda, E., Centeno, C., Csikos, A., Groot, M. and Radbruch, L., 2016. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC palliative care, 15(1), p.56.

Smets, T., Pivodic, L., Piers, R., Pasman, H.R.W., Engels, Y., Szczerbińska, K., Kylänen, M., Gambassi, G., Payne, S., Deliens, L. and Van den Block, L., 2018. The palliative care knowledge of nursing home staff: the EU FP7 PACE cross-sectional survey in 322 nursing homes in six European countries. Palliative medicine, 32(9), pp.1487-1497.

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Ziegler, L., Bennett, M.I., Mulvey, M., Hamilton, T. and Blenkinsopp, A., 2018. Characterising the growth in palliative care prescribing 2011–2015: Analysis of national medical and non-medical activity. Palliative medicine, 32(4), pp.767-774.

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Professional conversation (interview transcript)

1. What is your current designation in your placement?

I am currently working as a student nurse in palliative care

2. What type of patients you are dealing with?

Being a student nurse, I use to help the senior nurses and health professionals to deliver the high-quality End of Life care to cancer patients who reach at the end of their life.

3. How many years you are in this profession?

This is my first placement as a student nurse in palliatives ward in which I am working from last 6 months.

4. What kind of role you do in your placement as a student nurse?

As a student nurse in palliative care, I use to perfumer manifold roles such as observing patient’s health status, by monitoring their BP, oxygen saturation, heart rate and pulse, informing doctors and senior nurses if there are any serious charges in these parameters and monitor the right quantity and dose a appropriate medicines are given to patients. as mentioned by Sekse et al. (2018), student nurses play crucial roles in assisting the doctors and senior nurses to provide the high-quality end of life care to the patients suffering from the life limiting illness.

apart from assisting senior nurses, I use to perform other functions such as maintaining effective information delivery system in the palliative ward to deliver all the up-to-date information regarding patient’s health to doctors and senior nurses. as opined by Mitchell et al. (2020), student nurses working in the palliative care are obliged to develop transparent and effective communication among patients, health care professionals and nurses thereby act as the important mediator of delivering all information among them.

I use to make regular interaction and friendly communication with cancer patients and discuss about their current physical and psychological health status, their pain, the usefulness of the ongoing medicines and their complaints or queries regarding the entire treatment process. according to Ziegler et al. (2018), student nurses in palliative care need to maintain transparent and friendly communication with the patients in terms of obtaining clear information about their needs, pain and preferences that can improve the quality of palliative care. I also interact with patient’s family members to obtain data regarding patients’ pre-medical history, any additional health issues, personal and professional life, genetic history of cancer and patients’ preferences and choices

I use to assist senior nurses to provide health education to patients to promote effective health literacy in them. here I work under the direction of senior nurses to provide health information to patients regarding how patients can manage and control their health. I use to provide advice to patients regarding how to improve their lifestyle, health behaviours and living standard to live healthy life. under the direction of senior nurses, I provide health promotion leaflets to patients, which can improve their knowledge about their own health condition and teach them how to manage the health condition interpedently and live a healthy life.

I also form the electronic health records (EHR) of patients by entering all their health-related database into the excel and store them by using proper authorised password. I always make sure that the data that I obtain regarding patient’ health status on regular wise are accurate and genuine thereby eliminating chances of any manipulation of data.

5. What is the approach that you use in terms of carrying out effective patient-management?

The approach that I have used in managing patient’s health condition is continuous assessment and monitoring of the illness. as stated by Gadoud et al. (2018), through ongoing assessment and monitoring of patients suffering from the life-threatening illness, care professionals can determine the health needs of patients and evaluate the usefulness of the care plan. For carrying out effective assessment and monitoring of the health condition on regularise, I use the PEPSI COLA model under the direction of my seniors. Through using this model, I determine the following elements

  • Physical
  • Emotional
  • Personal
  • Social support
  • Information and communication
  • Control and autonomy
  • Out of hours
  • Living will illness
  • Aftercare

By considering all these above-mentioned elements I am able to analyse the social, psychological and physical needs of cancer patients that need to be met accordingly to improve their quality of living. As argued by Ziegler et al. (2018), while dealing with a cancer patient nurses must consider the holistic needs of patients rather than focusing on only physical needs. Through using this tool, I ensure that while delivering care to patients their autonomy and rights to confidentiality, dignity, privacy are respected accordingly. Based on this tool I use to communicate regularly with the cancer patients and record the information about their current health status (BP, oxygen saturation level, Heart rate and Pulse), any pain or health issues they face, any deterioration or serious changes in their physical health and their ongoing medicines. As mentioned by McCaughan et al. (2019), nurses play critical roles in medicine management in which they ensure that right dose of appropriate medicines are given to patients. Based on the tool I also provide health information to patients in terms of improving their self-management skill which can assist them to make effective changes in their lifestyle and diet to have control on their own health and wellbeing.


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