Module 10 Patients In Crisis, Grief, And Care For The Dying

Module 10 Patients In Crisis Grief And Care For The Dying Compleme

Write a nursing care plan based on a patient in crisis, experiencing grief, or needing care for the dying. Choose three priority nursing diagnoses. For each diagnosis, include what it is related to (r/t), evidence supporting the diagnosis (AEB), patient-centered outcomes, evidence-based nursing interventions with rationales, and how effectiveness will be evaluated. Include an evaluation tool or rubric. The plan should be detailed and grounded in academic resources with proper APA citations.

Paper For Above instruction

In the landscape of nursing care, addressing the complex needs of patients in crisis, particularly those experiencing grief or facing end-of-life issues, necessitates a comprehensive and compassionate approach. Creating an effective nursing care plan involves identifying priority diagnoses, establishing patient-centered goals, implementing evidence-based interventions, and continuously evaluating outcomes. This paper presents a detailed nursing care plan focusing on three priority diagnoses for a hypothetical patient experiencing grief and nearing end-of-life, with insights into supportive community resources and educational tools.

Patient Profile

The patient is a 72-year-old male with a history of metastatic lung cancer, currently hospitalized for symptom management and end-of-life care. His medications include opioids for pain control, anxiolytics, and palliative care medications. He has a history of hypertension and mild cognitive impairment. The patient reports feeling isolated, anxious, and fearful about death, and expresses a desire to spend his remaining days in a peaceful environment with family presence. No substance abuse or violence issues have been identified. The patient's family is involved but struggles with anticipatory grief.

Priority Nursing Diagnoses

1. Impaired Comfort related to pain, dyspnea, and emotional distress as evidenced by patient reports of pain (7/10), labored breathing, and expressions of anxiety and fear.
2. Anxiety related to uncertain prognosis, fear of death, and inability to control symptoms as evidenced by restlessness, verbalized fears, and elevated heart rate.
3. Impaired Spiritual Well-being related to loss of hope and existential concerns as evidenced by expressions of meaninglessness and disengagement from spiritual practices.

Planned Outcomes

For each diagnosis, outcomes are defined using NOC (Nursing Outcomes Classification) language to ensure clarity and measurability:

• Impaired Comfort: The patient will report a reduction in pain to a level of 3 or below on a 0-10 scale within 48 hours, and demonstrate relaxed breathing and ease in mobility.
• Anxiety: The patient will verbalize feelings of decreased anxiety and demonstrate relaxation techniques, with a reduction in vital signs to baseline levels within 24 hours.
• Impaired Spiritual Well-being: The patient will express a sense of peace or acceptance regarding his situation and participate in spiritual activities or discussions as desired within 3 days.

Evidence-Based Nursing Interventions and Rationales

1. Impaired Comfort

   Administer prescribed analgesics and adjust dosages as needed to maintain pain at a tolerable level. Use non-pharmacological comfort measures such as repositioning, heat/cold application, and relaxation techniques. Rationale: Proper pain management enhances comfort, reduces suffering, and improves quality of life (McCaffery & Pasero, 2017).

2. Address Dyspnea

   Apply supplemental oxygen therapy if hypoxia is present, encourage pursed-lip breathing, and maintain the patient's head elevated. Rationale: These measures alleviate respiratory distress and promote effective breathing (Levitan et al., 2018).

3. Emotional Support

   Offer reassurance, active listening, and empathy. Collaborate with mental health professionals for counseling if needed. Rationale: Emotional support reduces anxiety, fostering a sense of security (Ferrell et al., 2018).

4. Address Anxiety

   Teach relaxation techniques such as deep breathing, guided imagery, or meditation. Administer prescribed anxiolytics cautiously. Rationale: Relaxation techniques can significantly reduce physiological and psychological symptoms of anxiety (Johnson, 2019).

5. Spiritual Support

   Facilitate spiritual assessments, involve chaplain services, and support the patient’s spiritual practices or discussions. Rationale: Spiritual care enhances a sense of peace and meaning during end-of-life stages (Puchalski et al., 2014).

Evaluation of Effectiveness

The effectiveness of the care plan will be assessed using specific evaluation tools aligned with each outcome:

• Pain Assessment: Regular use of Numeric Pain Rating Scale (NPRS) to document pain levels, aiming for a score of 3 or below within 48 hours.
• Anxiety Scale: Employing tools like the State-Trait Anxiety Inventory (STAI) to gauge anxiety levels before and after interventions, targeting a reduction within 24 hours.
• Spiritual Well-being: Using the Spiritual Well-Being Scale (SWBS) to assess patient’s spiritual state, with note of participation in spiritual activities and verbal expressions of peace.

Regular documentation, patient feedback, and observation of behavioral signs will guide ongoing adjustments. Outcomes will be considered achieved when the patient reports adequate symptom management, reduced anxiety, and increased spiritual peace.

Community Resources and Education

In addition to hospital-based care, community resources such as hospice services, spiritual counseling programs, and support groups are vital. Collaboration with these services ensures continuity of care and emotional support beyond hospitalization. An educational tool such as a pamphlet on symptom management, spiritual coping strategies, and available community resources will empower the patient and family, facilitating informed decision-making and shared goals.

Conclusion

Developing an individualized nursing care plan for patients experiencing crisis, grief, or end-of-life issues requires a holistic approach grounded in evidence-based practice. By targeting priority diagnoses, setting achievable outcomes, implementing appropriate interventions, and evaluating progress, nurses can significantly improve the quality of life and emotional well-being of their patients. Integrating community resources and providing educational support further enhances comprehensive care, ensuring that patients and families feel supported and cared for during these difficult times.

References

• Ferrell, B., Coyle, N., & Paice, J. (2018). Oxford Textbook of Palliative Nursing. Oxford University Press.
• Johnson, M. (2019). Relaxation techniques for anxiety. Journal of Holistic Nursing, 37(3), 287-295. https://doi.org/10.1177/0898010118805784
• Levitan, M., et al. (2018). Managing dyspnea at the end of life. American Journal of Hospice and Palliative Medicine, 35(4), 540-546. https://doi.org/10.1177/1049909117734472
• McCaffery, M., & Pasero, C. (2017). Pain: Clinical manual. Mosby.
• Puchalski, C. M., et al. (2014). Improving the quality of spiritual care as a dimension of palliative care: The report of the Consensus Conference. Journal of Palliative Medicine, 17(9), 942-959. https://doi.org/10.1089/jpm.2014.9422