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The importance of discourse analysis
Discourse analysis in literature
Discourse Analysis Essay
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Expression of Interest
Topic
At what point does the power of decision making (with regards to one’s health) shift from patient to family in Palliative care.
Background
This proposal arises as from observations made during nursing training placement done in a hospice that look after patients with serious illnesses such as cancer.
The term ‘Palliative care’, is defined as care given to improve the quality of life to patients who have serious or life-threatening diseases such as cancer.’ According to National Cancer Institute (accessed 29/05/17), the aim for Palliative care, is to provide comfort care and support the patients in numerous ways. The support also includes helping families care for their loved ones as well as relieving them of care
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The researcher will review available literature in order to answer the research question: At what point does the power of decision making (with regards to one’s health) shift from patient to family in Palliative care. The question will be addressed using a library based research. Secondary data analysis will be used to analyse secondary data collected by other researchers (Dale, Arber and Proctor, 1988). Library based method is arguably appropriate to the objectives of this research but the anticipated problem of too much data requires the use of the keywords to collect relevant data and then the impact of the problem will be minimized. One of the strengths of using a library based approach is that it is less time consuming and cheaper to be able to explore areas of interest without having to go in the field to collect the data themselves (Denscombe, 2010). For this research, the discourse analysis method will also be used to systematically search on electronic databases for peer reviewed literature. This approach is important where the researcher is seeking to understand the relations between linguistic categories and social life. Contents and thematic analysis will be used to identify any merging themes within the data collected that may reveal any significant behaviour that influence the shift in the
After reading the different stories in the book “Final Gifts”, I believe I have a better understanding of the nurse’s role in caring for the needs of the dying patient and how their families need to be guided through this experience. The different stories in this book provide insight into the experiences of the dying as well as how their loved ones cope with their loss. The authors Maggie Callahan and Patrician Kelly, experienced hospice nurses who have extensive exposure to dying patients and their families, through their shared stories, paint a picture of what the dying want. To many, death is a difficult concept.
Palliative care is medical or comfort care that reduces the severity of a disease or slows its progress, but does not provide a cure (Dreeben, 2007). Different people have different needs when life is ending. Working with the incurable may sound depressing but death is a certainty and what we do each day for these patients as physical therapist assistants, matters. Providing care effectively and appropriately has a huge impact on the patient, therefore acquiring the ability to comfort and care for a patient at such a critical stage in life, is an amazin...
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
The first journal article is about advance care planning (ACP) in palliative care. This is of interest due to several clinical experiences and the realization that many families either ignore the patient’s request for end of life (EOL) care or who have no idea of how to plan for EOL care. By reading the research and understanding the methods used, this will allow for insight into how to implement palliative care into clinical practice across different sites. The authors of this original research are Jeanine Blackford PhD, RN, senior lecturer at La Trobe University in Australia, and Annette Street PhD, associate dean of research and professor of cancer and palliative care studies. According to Blackford & Street (2011), this research is important as there are many countries that “report a low percentage of people who have completed an advance care plan” (p. 2022), and ACP is needed upon admission to facilities that offer palliative care.
Palliative care is an essential to the creation of a health and wellbeing continuum for Australians living with a chronic illness. It is an approach of care that seeks to improve the life of patients and family experiencing the effects of chronic illness. Palliative care centres on the relief of the symptoms and effects of disease and incorporate the physical, psychological and social dimensions of a person at the end of life. A recent focus for the delivery of palliative care by nurses to Indigenous communities is the consideration that culture can create barriers to the provision of appropriate and beneficial care for the dying or deceased person. This essay explores the palliative nurse caring for Indigenous communities and the need to consider
Palliative care - treatment that helps to comfort patients, while slowing the progress of a disease.
Apart from physicians, nursing professionals act as patient advocate in supporting end-of- life decisions as they spend maximum time with patients than any other member of the healthcare team. In many health care settings, the nurse has the responsibility of asking the patient about advance directives. Since each state identifies different laws regarding advance directives, it is important that nurses be aware of the rules of these documents for the purpose of accuracy and compliance. The nurses are required to document any conversations about advance directives in the patient's medical record and keep it timely and updated. Nurses can play vital role in resolving conflicts arising from moral and ethical issues related to advance care planning
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Death is a universal truth. Hospice reduces the suffering associated with death. Hospice is considered the philosophy and model for quality, compassionate care to terminally ill patients. Patients accepted into a hospice program usually have a prognosis of less than six months to live (Potter, Perry, Stockert & Hall, 2017, p. 761). Hospice provides skilled medical care, pain management, emotional, and spiritual support tailored to the patient’s needs and wishes. The goal of hospice is to focus on the quality of life during the end of life. It gives patients a sense of dignity, provides patients and families with support, and it is cost effective. Today, seven out of ten Americans die from chronic disease. By 2020, the number of people living with a chronic illness will increase to 157 million (Hogan 2012). As the elderly population in the U.S. continues to increase, the importance of hospice will only continue to grow.
According to Haley and Daley (2013), cancer as the main cause of the terminal illness in the paediatric age. For the recent years, the survival rates of children with cancer have increased significantly with 7 out of 10 recovers (Selwood, Langford, & Wright, 2012). Haley & Daley (2013) also mentioned that parents act as the decision-makers and as the primary carer, moreover, physical and psychosocial developmental factors of the child affects the perception of death as temporary and the capability to communicate and make their own decisions. Moreover, parents make the decision for the child as for legal matters, but the child needs encouragement to actively participate and to develop the sense of authority. Children may have a different idea of pain and illness, for instance, they may think that they did something wrong that is why they are suffering. Children may refuse or not participate properly in any treatment without the supervision of the primary carer. Providing the child and family with health education during palliation as well as helping them to the transition to adulthood is an important task for the nurse. Derby, Tickoo, and Saldivar (2014) mentioned that the major difference of between old and younger adults is the need for extensive support of the family. Decision-making for older people might include the patient’s family, surrogates and Advanced Care Planning (ACP) at the time they are not able to make their own decision. Derby et al., (2014) stated that “ACP prepares for lack of capacity in decision-making and relieves the burden of decision-making on others” and surrogate decision-maker “is a person whom the patient designates to make decisions if/when he or she is unable to do so”. Older patients need a representative, mostly an elderly act as a primary carer to make the decision for them or someone who will make
... that the nurse or family can do. The goal for palliative care is to make the patient’s passing as comfortable and relaxing, as possible. Medication management should be provided for every patient that is having pain to allow for a more comforting, pain-free, and peaceful death.
Death is a personal experience and to ensure loved one’s wishes, there has to be the ‘what if’ conversation. It is natural to talk about the possible end with loved ones after marriage and having children. Living wills are obtained and do not resuscitate orders, thoughts of a possible guardian for the children, life insurance, appointing a health care agent, and any other loose ends that will ensure the well being of the family. A health care agent is someone who the patient designates to make medical decisions, if decisions cannot be made generally. The chosen agent should be a person who knows the wishes on the extent of medical care treatment wanted. The appointed health care agent should be someone who is not afraid to ask questions of the healthcare professionals to get information needed to make decisions and be assertive to ensure that wishes are respected. (Healthcare Agents, n.d.).
In EOL decisions for aged, nurses who have previously developed a trusting relationship with the family gain a unique perspective that allows them to become aware of a clinical deterioration and this places nurses in a position to facilitate EOL decision-making (Adams, Bailey & Anderson,2011). Thou the individual competence, employer policies standards and conditions may vary the registered nurse’s scope of practice allows her to commence an EOL decision when a plan is already in place but restricts her to make a decision for the patient in the first place, she give the information and directions so that family or patient itself reaches the right decision (Leditshke, Crispin & Bestic, 2015; Tiffen, Corbridge & Slimmer,