Robley Va Medical Center Critical Reflection

There may be more than meets the eye. Sometime it takes time to talk about the issue to really come out and understand our client. From reading this editorial, I think I will always keep it at the back of my head every time I visit a client. I believe I will ask myself the question: What do you notice? And minutes later, I will asked myself again: What are you noticing now? Perception changes as you continue to talk to your client. Client may be open to you or they may cut you off, but it is important to understand the client. As the clients and their family interact, notice their interactions, and pick up on some of the things they say and things that are happening around the room. Working under hospice, the more we talk to the patient or the family, the more comfortable it become to adjust to them because we are seeing more eye to eye and we are knowing them more than before through the stories they tell us.

This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All

Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

Families can learn to care for their loved ones, making them comfortable, which change to look for. The dying should be given the choice on how and where they will spend their final time. When a loved one is dying they most often choose the memorable location of their home, completely surrounded by their loved ones. At this point hospice nurses and other types medical professions are available at whatever site they feel comfortable with. They provide the care and support not just to the patient, they also bring care to the family as family members struggle with their own lives when they are losing a loved one, someone that were their whole lives. When we think about how we view death, people tend to depict it as dramatic and painful and just plain unbearable. When they are losing a loved one, often family members tend to become simple spectators do to the pain of not knowing how to handle losing a loved one, playing no part in assisting in the comfort to the loved one, in turn leaving everything to the medical staff to help with not just the patient but also to the

Having a dignified approach and respecting elderly patients in a palliative care unit is important because it is enabling them to have control over their care and treatment. This is going to help the patient to feel valued and throughout their last days of life, as they have a choice. (Social care institute for excellence, 2010). By making the patient feel as comfortable and as pain-free as possible, it will help encourage family members to respond in a positive way. This is because they are seeing that their relative is in a comfortable state.

For my last objective I wanted something that I can interpret what i’ve learned throughout this process of palliative care and turning into a physical

    As of late, we’ve become familiarized with the concept of hospice through guest speakers and readings (Class notes, 2016). Through Descendants we learned the importance of advanced care directives and widened our EOL conversation to focus more on family than the patient (Payne). Through another guest speaker and lecture we also talked about expressive therapy and its imperativeness on patient and family care (Class notes, 2016). During our week not in class, we read articles on grief, coping, and social support and it’s importance to communication at the end-of-life, additionally, we saw the five stages of grief after watching the Scrubs episode (Class notes, 2016). Lastly, we closed with potpourri week in which we learned about the different religions/cultures and their views on the afterlife (Class notes, 2016).

It has been a heck of a ride for the past 4 years while on the road to get my degree of Doctor in Pharmacy at Palm Beach Atlantic University. I just finished my last rotation of Pain Management at the West Palm Beach VA Medical Center. The medical center is a general medical, psychiatric and surgical facility. It is a teaching hospital, providing a full range of patient care services, with state-of-the-art technology as well as education and limited research. Comprehensive healthcare is provided through primary care and long-term care in the areas of dentistry, extended care, medicine, neurology, oncology, pharmacy, physical medicine, psychiatry, rehabilitation and surgery. The West Palm Beach VA Medical Center operates a Blind Rehabilitation Center which is the referral center for blind and visually impaired Veterans from throughout the state of Florida. The West Palm Beach VA Medical Center is part of the Sunshine Healthcare Network (VISN 8), which includes facilities in Florida and Puerto Rico.

However, often the nurse will find herself dealing with difficult family dynamics with family members having differing expectations of the type of care that the patient should be receiving, staff conflict over treatment methods or strategies and high workloads. These issues can only compound the stresses on the Palliative Care Nurse and to cope

I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of