End of life care may be a challenging situation for a nurse practitioner, the patient, and the family and loved ones of the patient. This is a period of life in which the patient desires physical, psychological, spirituals and even social support from those around him/her including the nurse practitioner. The nurse is also expected to encourage and give guidance to both the patient and the family on how to make informed decisions concerning every encounter at this moment (Vallone, Beunders, & Szmytke, 2017). In our scenario, we have Julia who is at the end of life stage due to the cancer illness she has been suffering for the last four years and her colleague Joyce too is headed to this stage from her illness. This paper, therefore, aims at expounding on the ideal processes to be followed by a nurse to ensure that the goals of Julia and their families and colleagues are met as Julia endures her end of life stage.

The assessment of Julia’s Situation

Julia has had lung cancer for the last four years, and from her story, she entails that she has done everything that the doctor has always prescribed for her, but they have all be in vain. Since she has now decided to let everything go and allow nature to take its place, that does not imply that as a nurse practitioner attending to her some comfort giving medication and screening should not be conducted to her (Vallone, Beunders, & Szmytke, 2017). She deserves a comfortable and well-ending life and therefore, the nurse should ensure that adequate assessment of Julia’s situation is conducted in liaison to the previous treatments she has been undergoing. The evaluation should include the examination of discomfort and pain aspects, distress in breathing, retained secretions, restlessness and possible discomforts that may affect her adversely during this period.

The assessment will help encourage Julia, her friend Joyce and her son Neel. Also, the assessment will ensure that Julia encounters happy and healthy last moments of her life that even if she dies, her friend and her Son will not be affected that much to adjust and regain with normal life afterward. It should also be understood that this is the moment that Julia requires both her family and friend Joyce than ever close to her. The nurse should also encourage his son to drop the idea of attempting further treatment elsewhere since Julia does not want that now and she prefers staying in her house that she loves and prefers to see her friend Joyce just being close to her like she does (Ford, 2016). This will promote active listening to Julia and anything she might want to speak out to them in this final stage.

As a nurse practitioner attending to Julia, it will be ideal to ensure that effective therapy is given to Julia concerning her situation and the stage she is undergoing her life. More significantly, the treatment should also feature both her colleague Joyce and her son Neel so that they can know how to take care of Julia best and even she departs from them at any point, and it will be easy for them to adjust and move on. This will also encourage them to ensure that Julia accepts her life and that she has undergone all her life and should be ready for the next step she is heading to.

However, one of the main barriers that are evident to adequate care for Julia is her close friend Joyce. From the scenario, we can note that Joyce is also sick and this began back in the time when she acquired a knee surgery. Also, due to the aging factor, I believe that whenever she sees her friend Julia undergoing it affects her psychologically and may have a significant impact on the palliative care for Julia (Vallone, Beunders, & Szmytke, 2017). The condition of Joyce may also trigger Julia to have some discomfort whenever she thinks of her and how she’s going to leave her after all the while they have been together.

Description of Julia’s Family

Upon reading the scenario, we can note that Julia does not have such a big family. At some point, she gives us a narration about her father and mother who unfortunately passed away. She also tells us about her ex-husband whom she was once married to and they got divorced after giving birth to one child Neel and since then they have rarely been communicating since they divorced. Since after college and she divorced, the one person that has been so close to her is Julia her neighbor and they have endured and adventured a lot together for the past twenty years ever since they met each other. Therefore, the small circled family of Julia entails Joyce and her son Neel. They have been very encouraging and supporting Julia throughout her medication and treatment until she has decided to let go of everything now.

Two Specific Symptoms of Julia

Give that Julia is in her terminal stage of lung cancer, some of the two main symptoms that may be visible in her condition include difficulty in breathing and fatigue (Leigh, 2014). Due to the illness that she is suffering from and the medication and treatment encounter she has been through, fatigue is one of the symptoms that may be visible at this stage. Also, the issue of difficulty in breathing normally may be evident since her lungs have developed complications from the illness and even her general body strength (Todd & Nash, 2016).

Clinical Interventions for the Symptoms

To effectively mitigate the effects of fatigue on the patient, it will be ideal to counter the factors that may be trying to make the fatigue worse. This may include ensuring a careful balance between activity and rest (Todd & Nash, 2016). Also, to effectively mitigate the issue of difficulty in breathing, it will be ideal for always ensure that sits upright, props herself on a pillow, is leaning on a table, and also, medicine for the reduction of anxiety may be vital to help her have fewer worries among other aspects of medication.

Barriers Experienced by Julia’s Family and Clinical Intervention

One of the obstacles that may be facing Julia’s family is encountering is bearing the experience of farewell and death of Julia and accepting the knowledge of the loss Julia that they are about to meet. Therefore, as a nurse practitioner, an ideal thing to do will ensure that Julia’s family including her friend Julia undergo adequate guidance and counseling that will enable them to have the strength and courage to endure and move on (Whitehead & Carter, 2017). Through this, they will have the strength and courage to allow nature to take its cause for that is a face of life indeed.

Family Education Concerning Julia’s Care

From the time of meeting with Julia, there has been a change concerning her condition and thus as a hospice nurse, it will be ideal to the family understand how much valuable the nurse is to them and the efforts the nurse is giving in to ensure full support and under the problematic moment (Leigh, 2014). Also, through therapeutic and guidance and counseling measures will help enlighten them concerning Julia and the progress of her situation. It will good to prepare both the family and the patient psychological about the health condition of the patient and the expected outcomes and how to effectively go about the situation. Through consent and effective communication, the family can be explained in detail the condition and progress of the patient (Whitehead & Carter, 2017).

Again, through therapeutic intervention, the nurse will be able to identify the strengths and weaknesses of every family individual and thus devise an ideal means of breaking any news to the concerning the patient.

Joyce has been Julia’s close friend for long; therefore, the issue of hospice care may be hard for her to incorporate. It will thus be ideal to apply the concept of crisis prevention and ensure continuous caregiver support to encourage and guide Joyce during taking care of Julia and what is expected of her. Also, by spending adequate time with the family of Julia, it will help comfort and strengthen their emotional needs, and they endure the complicated process of grief (Ford, 2016). Knowledge concerning the afterward adjustment and pushing forwards by the family after the death of Julia.

Some of the interventions that may help the nurse in assisting lucy to in the period of Julia’s terminal illness may be through effective communication, guidance and counseling and emotional support. This would have helped in breaking the bad news concerning Julia and other crucial communication prognosis encounters.

Why Early Recognition of Complicated Grief is Paramount to the Family

Julia has been the central figure in the family and even in the life of Joyce; therefore, it will be indeed difficult and hurting to acknowledge that she is going to leave them and even after her death, on how they will move on without her (Leigh, 2014). At this stage, having an intervention of a chaplain or a social work will be ideal to support and encourage both the family and friends of Julia and educate them on how they should live on afterward.

Self Care as a Nurse

Given that Julia’s situation is an awkward moment for the family and friends around her, it will be ideal for the nurse to always concentrate on the needs of the patient and other crucial professional matters that will help the nurse have a code of professionalism throughout the experience (Whitehead & Carter, 2017). It is ideal for the nurse to feel bound to the family and friends of the patient but also, it will be useful to always maintain boundaries as per the nursing code of conducts. The nurse may also encourage family members and friends to ask questions that they feel to about the patient while the nurse educates them effectively to their satisfaction.

Advancing the Profession of Nursing

Through participation and excellent care of Julia’s case scenario, it is a good step for a nurse aspiring to ensure that hospice care for patients with a terminal illness is always professionally handled (Ford, 2016). The scenario also depicts how the nursing and care activities are aimed at promoting quality and well being of the people in the society. Also, through participation in the treatment and care process of Julia’s scenario, the nurse can show the knowledge and skills acquired an how to effectively improve and create excellent experiences to the patients and their families towards the aspect of hospice and palliative care nursing.

Understanding that nursing and healthcare has become transparent, and the quality is measured through the outcomes, it was therefore, ideal to handle and ensure that every aspect in Julia scenario was conducted professionally, and all the required steps and procedures for nursing were applied effectively to both the patient and the family (Leigh, 2014).

In conclusion, the end of the stage of terminal disease like lung cancer for a patient requires a lot from a hospice nurse to both the patient, the family, and friends. As from Julia’s scenario, the case entails what a nurse is required to do to ensure that everything is done professionally from the beginning to the death of the patient and even how the family and friends will move on afterward. The scenario enables a nurse practitioner to have the necessary knowledge of what should be done in the field and how it should be done in an ideal and professional manner. Also through the scenario, we can acknowledge how effective and supportive nurses are to the patients, family, and friends of a dying patient in their end of life stage. Indeed, in collaboration with the IPT concept, the nurse was able to ensure that the patient and the family endured well throughout the entire encounter and even any possible dilemma was effectively solved.

References

Ellwood, J. (2015). Nursing care of the dying patient in the hospital. Caring for the Dying Patient and the Family, 223-242. doi:10.1007/978-1-4899-3376-8_17

Ford, J. A. (2016). The Complexity of Assessment and Treatment for Anxiety in Patients With a Terminal Illness. Journal of Hospice & Palliative Nursing, 18(2), 131-138. doi:10.1097/njh.0000000000000223

Leigh, H. (2014). Chronic Conditions, Lung Disease, Cancer, the Palliative Care Settings, and the Dying Patient. Handbook of Consultation-Liaison Psychiatry, 385-396. doi:10.1007/978-3-319-11005-9_27

Todd, W., & Nash, D. (1998). Disease Management: A Systems Approach to Improving Patient Outcomes. Journal For Healthcare Quality, 20(2), 44. doi:10.1097/01445442-199803000-00011

Vallone, S., Beunders, I., & Szmytke, E. (2017). Lung cancer patient needs in different countries. Lung Cancer Management, 6(1), 1-4. doi:10.2217/lmt-2017-0005

Whitehead, P. B., & Carter, K. F. (2017). A Model for Meaningful Conversation in Serious Illness and the Patient Preferences About Serious Illness Instrument. Journal of Hospice & Palliative Nursing, 19(1), 49-58. doi:10.1097/njh.0000000000000307

 
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