Holistic Assessment and Care; Standard versus palliative assessment, Holistic Assessment, Framework for the assessment of patients in palliative care, Needs at the end of life, and Pathophysiological changes at the end-of-life.

Holistic Assessment and Care

This guide is about holistic assessment and care. Study it to create excellent essays concerning holistic care and holistic assessment.

Introduction to Holistic Assessment and Care Article

Nurses working in various clinical settings must have the ability to evaluate patients. Assessment is especially important in the palliative care setting to ensure that the patient’s signs are easily controlled and that their dying is as pleasant as possible. This article concentrates on the skills and competencies necessary to assess a palliative care patient effectively.

It starts with an overall view of the distinctions between standard and palliative assessment, then moves on to concentrate on the holistic evaluation of patients in the context of palliative care. The article then goes over a framework for assessing patients in palliative care that is widely used in the UK Finally, the popular requirements and pathophysiological alterations of patients at the end of life are discussed in this article. This article will begin to equip you with the skills and knowledge you’ll need to provide effective palliative care to patients.

Standard versus palliative assessment

What is the difference between standard and palliative assessment?

Nurses working in all clinical settings must have the ability to assess patients. In most cases, evaluation is divided into three stages:

  • The patient is being observed.
  • The patient’s medical history is gathered.
  • The patient is examined physically.

Each of these three steps of evaluation entails interacting with a patient in order to obtain subjective (self-reported symptoms) and objective (measurable indicators) data. This information will be used to: (1) identify the patient’s needs, (2) inform decisions about the type of care the patient will receive, and (3) monitor the patient’s condition while receiving this care, allowing the effectiveness of the care to be evaluated. Assessment serves an essential fourth objective in palliative care: identifying signals that the patient is approaching death and so enabling good death management. In a later section of this article, you’ll learn more about this.

Because it is comprehensive in nature, the evaluation of a patient getting palliative care varies from that of a patient receiving routine treatment. This implies it focuses on knowing the person as a complete person and ensuring that this information is utilized to identify and execute the best possible treatment for each patient. In addition to concentrating on the patient’s medical signs, symptoms, and concerns, as in standard nursing assessment, palliative care evaluation considers the person’s psychological (and emotional), social, and spiritual requirements as well.

Consider the following example of a case study:

Example

Huynh is a graduate nurse who works at a hospice for cancer patients. Marianne, a lady newly hospitalized for treatment during the terminal stages of her metastatic breast cancer, is one of her patients. Marianne’s physical requirements (pain management, dietary assistance, etc.) are assessed, but Huynh also considers Marianne’s:

  • Psychological (as well as emotional) requirements. Marianne is terrified of death and the process of dying. She needs a clinician to explain how she will be cared for at the end of her life.
  • Sociocultural requirements. Marianne desires for her family to remain at her side throughout her treatment. She’d also like to connect with other people who have metastatic breast cancer.
  • Spiritual health is important. Marianne was raised Catholic and exhibits interest in reconnecting with her religion and having chaplain visits from the hospice.

Activity

The West London Cancer Network’s (ND) Guidance Document to Support the Holistic Patient Assessment is recommended reading. This document may be found by searching for its title on the internet.

In your undergraduate nursing program, you’ll learn about standard nursing evaluation in depth. Although the evaluation of a patient receiving palliative care proceeds through each of the three stages outlined above, nurses working in palliative care settings should be aware of a few crucial aspects. The skills and information needed to evaluate a patient receiving palliative care will be the emphasis of this article.

Holistic Assessment

What is holistic assessment?

Nurses working in palliative care settings must evaluate patients holistically, as outlined in the previous part of this article, in order to acquire knowledge of them as a whole person. Nursing assessments, for example, must evaluate a person’s physical requirements.

  • The patient’s vital indicators including blood pressure (BP), heart rate (HR), temperature (T), respiratory rate (RR), and blood oxygen saturation (BOS) (SpO2).
  • The patient’s overall health. A patient’s body mass index (BMI), ability to conduct activities of daily living, skin condition, hunger/energy levels, and sleep quality may all be used to determine this.
  • Indicators that show how a patient’s illness is progressing, such as renal function in individuals with kidney failure.

The nurse should also consider the patient’s other needs, such as psychological (and emotional), social, and spiritual. It is critical for nurses working in palliative care settings to establish a patient’s willingness (and, if appropriate, their family’s) to address psychological (and emotional), social, and spiritual matters, as well as to emphasize the significance of doing so. It’s crucial to keep in mind:

  • Psychological (as well as emotional) requirements. As you learned in the last chapter of this module, individuals receiving palliative care may have a variety of psychological disorders, including sadness and anxiety, that may be caused by or comorbid to their palliation. It is critical for nurses to be able to evaluate a patient’s psychological and emotional requirements utilizing the organization’s tools, rules, and procedures.

Activity

You should study the Common Mental Health Problems: Identification and Pathways to Care guideline, or the latest equivalent, published by the National Institute for Health and Clinical Excellence (NICE, 2011). This guideline may be found by searching for its title on the internet.

  • Sociocultural requirements. Because the United Kingdom’s population is so socially and culturally varied, nurses working in palliative care settings must be able to recognize a patient’s socio-cultural demands. Distinct cultures may have different perspectives, values, and beliefs about death and dying; if a nurse is to deliver best-practice, culturally appropriate care, these perceptions, values, and beliefs must be acknowledged and included into the person’s care plan.

It’s crucial to note that palliative care is unfamiliar territory for many cultures, and it’s possible that it’s misinterpreted as “euthanasia” or “giving up” on the patient. A nurse working in a palliative care environment must be able to assist someone from another culture in understanding palliative care, its application, and relevance.

  • Spiritual requirements. Spirituality – or a person’s system of belief and faith, which may be formal (e.g., belonging to a specific religion) or informal (e.g., not belonging to a particular religion) – is closely tied to culture. Many individuals find spirituality helpful in understanding and coping with death and dying. Spiritual leaders (e.g., chaplains, traditional healers, or pastoral care professionals) may visit patients in palliative care, as well as spiritual/religious counselling, worship, or other comparable activities.

Nurses working in palliative care settings must provide patients (and their families, if applicable) chances to address spiritual and cultural matters in a non-judgmental and open way. This might involve, for example, the following:

  • Inquiring if the individual and their family/caregivers have considered, or would want, access to spiritual or cultural leaders, spiritual/religious therapy, worship, or other comparable activities at the end-of-life time.
  • Discussing with the individual and their family/caregiver any cultural, religious, or other rituals they would want to have at or after their death, and ensuring that they are documented in the person’s care plan.
  • If the individual and their family/caregiver so choose, taking the time to listen to them talk about their thoughts and views about culture, spirituality, and death.

Spiritual and religious matters should be openly addressed anytime the individual or their family/caregiver want to bring it up. It’s critical that you approach these conversations consistently nonjudgmentally, that is, that you accept the person’s feelings and beliefs as valid and support them to the greatest extent possible. People’s perspectives, values, and beliefs regarding dying and death may vary greatly from yours; yet, it is critical that everyone’s perspectives, values, and beliefs be respected.

Framework for the assessment of patients in palliative care

What is the best framework for assessing patients in palliative care?

It’s crucial to note at the outset of this article that there is a range of different frameworks that may be used to evaluate a patient receiving palliative care; nurses working in palliative care settings should be knowledgeable with their organization’s evaluation frameworks. The mnemonic ‘PEPSI COLA’ identifies one of the most prevalent assessment frameworks:

Topics to Consider Questions to Ask
P Physical needs:

  • Symptom assessment.
  • Medication assessment (including side-effects).
  • Identify and cease non-essential treatments.
  • What are your main physical problems?
  • How do these problems affect you?
  • What have you tried to manage these problems?
  • Are you taking your medication as prescribed?
  • What other treatments are you using?
  • Are you using any non-prescribed treatments?
E Emotional needs:

  • Psychological assessment (e.g. depression, anxiety, fears).
  • Understand patient’s expectations of care/death.
  • Coping mechanisms; including attempts to avoid uncomfortable thoughts/feelings.
  • Altered body image.
  • Relationships with others.
  • Disturbed sleep.
  • Is there something that worries you most?
  • Have you recently lost interest in the things you once enjoyed? [Nurses should have the patient explain these interests if they are able].
  • Are you experiencing distress at present? How would you describe this distress? [Nurses may use a tool such as the Distress Thermometer].
  • How do you normally cope with stress?
  • Have you had difficulty coping in the past?
  • What forms of support do you think you have?
  • Would you like to speak to a professional who can provide emotional support (e.g. a counsellor, etc.)?
P Personal needs:

  • Sociocultural background and spiritual background, as described earlier in this chapter.
  • Needs related to ethnicity, language, sexuality, etc.
  • How do you make sense of what is happening to you?
  • What can we do to help with your personal concerns?
  • Would you find it helpful to speak with somebody about these issues (e.g. a support group, patient information service, etc.)?
  • How does your condition affect your ability to meet your personal needs?
S Social needs:

  • Relationships with others.
  • Welfare rights.
  • Carer assessment.
Ask the following questions as applicable to the individual patient:

  • How are you managing at home?
  • How are you managing at work?
  • How are you managing financially?
  • How are your close personal relationships?
  • Is there anyone who is dependent on you?
  • Do you have any legal concerns or issues?
I Information and communication needs:

  • What information does the patient have, and need?
  • Is the patient’s advance care documentation in order?
  • Does the patient understand their plan of care?
  • Determine patient’s wishes for depth of information.
  • Is the mode of communication and language used appropriate?
  • Have you been asked if you would like to be included in correspondence between members of your multidisciplinary team?
  • Do you know who your key worker is, and how to contact them if needed? [If appropriate].
  • Do you feel you have been informed of all the relevant information? Is there anything else you would like to know?
  • Do you know how to access further information when you require it?
  • Have you been informed of the patient support groups relevant to you?
C Control and autonomy needs:

  • Mental capacity to make decisions (as described in an earlier chapter).
  • Engagement in treatment options and plans.
  • Identification of the patient’s preferred place of care.
  • Recap on advance care documentation.
  • [Nurses may use a standard tool to assess the patient’s decision-making capacity].
  • Have you discussed and documented your wishes for your future care?
  • If yes to the above question, where is this documentation located? Who has access to it?
  • Do you have a hand-held copy of your advance care plan/s or patient records (if you would like one)?
  • If your health deteriorated, where would you like to be cared for?
O Out-of-hours needs:

  • Identification of appropriate out-of-hours services.
  • Identification of preferred priorities for care.
  • Transfer information, including ambulance services.
  • Are you (and your family/carer, as appropriate) aware of who you can call for out-of-hours advice and assistance?
  • Do you (and your family/carer, as appropriate) know how to contact services out-of-hours?
  • Do you (and your family/carer, as appropriate) know the transfer services available to you?
L Living with your illness:

  • Rehabilitation support (to promote quality of life).
  • Referral to other agencies.
  • End-of-life care planning.
  • How are you managing your daily living tasks?
  • How is your appetite, mobility, swallowing, communication, diet, sleep, etc.?
  • Have you been informed of the variety of support services available to you?
  • Have you been given the opportunity to discuss your future, expectations, goals, etc.?
A Aftercare needs:

  • Funeral arrangements.
  • Family/carer bereavement risk assessment.
  • Future support of the family.
  • Are there funeral arrangements in place?
  • Do you have information for bereavement services?
  • Are there any additional services your family requires?

(Adapted from West London Cancer Network, ND).

The UK’s Gold Standard Framework (2011) suggests that doctors address three essential questions when considering a patient for palliative care:

1. How startled would you be if the individual died within the next several months, weeks, or days?

To help you come up with a response to this question, read the following:

Quote

The answer to this issue should be intuitive, using a variety of clinical, co-morbidity, social, and other aspects to provide a comprehensive picture of deterioration. If you are not shocked, what steps might be done now to enhance the patient’s quality of life and prepare for a probable future decline?

The Royal College of General Practitioners (Royal College of General Practitioners, 2011).

2. Does the patient exhibit any signs of worsening in general?

A patient may be eligible for palliative treatment if a number of essential general signs of worsening are present. These are some of the indicators:

  • Declining activity, accompanied by a reduction in functional performance (e.g., the patient has limited self-care ability, spends more than 50% of the day in bed or a chair, and is reliant on others).
  • The patient has severe comorbidity and/or an illness that is unstable, complicated, and advanced.
  • The patient’s reaction to therapies is deteriorating (i.e., ‘reversibility’ is dwindling).
  • The patient’s options for active therapy are restricted or non-existent.
  • In the last six months, the patient has lost a significant amount of weight (>10%).
  • The patient has had many unexpected or “crisis” hospitalizations.
  • A’sentinel incident’ has occurred in the patient’s life (e.g. a fall, transfer to a nursing home, etc.).
  • A serum albumin level of 25g/L of blood is seen in the patient.

3. Is there any clinical evidence that the patient’s health is deteriorating?

For various illnesses, there are a variety of unique clinical signs indicating deterioration:

  • Cancer Metastasis.
  • COPD: severe disease (FEV1 30% of predicted levels); recurrent hospital admissions due to COPD exacerbation in the previous 12 months; severe shortness of breath (e.g. after 100m of walking); right-sided heart failure; anorexia; pulmonary infection; >6 weeks of systemic steroids for COPD in the previous 6 months.
  • Heart disease: Shortness of breath with modest activity; frequent hospitalizations are symptoms of heart disease.
  • Renal disease: advanced chronic kidney disease; symptomatic renal failure (e.g., nausea/vomiting, anorexia, pruritus, intractable fluid overload; decreased functional status).
  • General neurological disease: progressive deterioration in physical and/or cognitive function despite optimal therapy; dysphagia leading to recurrent aspiration pneumonia, sepsis, breathlessness, and/or respiratory failure; speech problems.
  • Motor neurone disease/Parkinson’s disease/multiple sclerosis: rapid, marked decline in physical status (often with medical complications and dyskinesia, mobility problems, falls, etc.); aspiration pneumonia; increased cognitive difficulties; weight loss; communication difficulties; increased functional dependence; psychiatric problems (e.g. anxiety, depression, hallucination, psychosis – particularly with Parkinson’s disease); dysphagia; poor nutritional status.
  • Stroke: persistent vegetative state / minimum aware state / dense paralysis; medical problems; failure to recover within three months after stroke; cognitive impairment (e.g. post-stroke dementia).
  • Dementia: difficulty to walk without help; development of pressure sores; incontinence (urinary and/or faecal – typically associated with urinary tract infections); reliance on activities of daily life; weight loss; idiopathic fever; decreased oral intake; aspiration pneumonia.

(Reproduced with permission from the Royal College of General Practitioners, 2011).

Needs at the end of life

What are the needs of persons cared for in the palliative setting?

Nursing assessment, as mentioned in the preceding portion of this article, focuses on gathering data to identify a patient’s requirements, guide choices about the sort of care the patient will get, and monitor the patient’s status while receiving this care. Nurses working in palliative care settings must identify the existing and prospective future requirements of a patient receiving palliative care during evaluation in order to plan treatment efficiently.

The kind of sickness a person has, its stage and predicted development, their socio-economic circumstances, the area where they are getting care, and their preferences for treatment will all influence their requirements.

Every individual receiving palliative care will have a unique collection of needs, including those connected to:

  • Symptoms are relieved (e.g. pain, nausea, dyspnoea, constipation, fatigue, etc.).
  • Help with psychological and mental health issues (e.g. anxiety, depression).
  • Information, resources, equipment, financial assistance, and psychological assistance are all available.
  • Support for mobility, self-care and other critical activities of daily life.
  • Support with continence, skin integrity, sleep, communication, sexuality and other functions.
  • Nutrition, hydration, medication delivery, and swallowing assistance are all available.
  • Assistance in selecting a location of care and gaining access to it.
  • Assistance in choosing treatments and obtaining them (including complementary therapies).

It is critical that you be able to determine the patient’s varied requirements throughout your evaluation. This knowledge will be used to make choices concerning the patient’s treatment.

Pathophysiological changes at the end-of-life

What are some of the pathophysiological changes associated with illness at the end of life?

It’s critical to have some understanding of the pathophysiological changes associated with a life-limiting disease when evaluating someone who is getting or will receive palliative care. There are many pathophysiological alterations that are often related to sickness near the end of life:

  • Cachexia is the loss of lean body mass caused by elevated rates of gluconeogenesis (the synthesis of energy by breaking down protein); in severe sickness, this may lead to death (i.e. significant wasting of the muscles and other tissues).
  • There is a lack of energy, as well as severe and chronic exhaustion. Hypermetabolism (an unnatural increase in the body’s metabolic activity) is often to blame.
  • Appetite suppression. This may happen for a variety of reasons, including the loss of taste sensations, changes in a person’s capacity to ingest and digest food, and societal concerns around food intake.
  • Increased apoptosis (programmed cell death); this is prevalent in persons with advanced cancer, organ failure, and neurological illness.
  • Immunological system changes, such as an increase in inflammatory mediators and a decrease in immune function (leaving the patient susceptible to comorbid disease).
    Pain, nausea, dyspnoea, constipation, exhaustion, and other signs and symptoms of progressive organ failure.

All patients nearing the end of their lives will reach the terminal phase of their lives, or the last weeks and days before death. It is critical for nurses working in palliative care settings to be able to recognize when a patient is in the final phase of their illness during their evaluation.

There are many indicators that a person has reached the end of their life:

Holistic Assessment and Care
Pathophysiological changes at the end-of-life
  • To control their indications and symptoms, the patient needs regular intervention.
  • The patient’s health is deteriorating in an irreparable way on a daily basis.
  • The patient is unable to get out of bed.
  • Urine production reduces in the patient.
  • The patient may have a loss of appetite, as well as a dry mouth and trouble, swallowing
  • The patient has severe weakness and exhaustion.
  • The patient loses weight, and in extreme instances, cachexia develops.

While these are essential markers that a patient has reached the end of his or her life, they should not be used in lieu of a customised evaluation of the patient and the application of clinical judgment to the assessment results. For example, simply because a patient with a life-limiting condition has lost their appetite does not guarantee they are approaching death’s last stages. Instead, this might be a problem that can be fixed to enhance the patient’s comfort throughout the palliative time.

Understanding that a person passes through a variety of major phases throughout their death is critical for nurses working in palliative care settings. A person’s health will deteriorate gradually as the body’s processes slow, as shown by signs and symptoms such as:

  • Increased tiredness; trouble waking up and advancing to semi-consciousness.
  • Confusion and disorientation are examples of other neurological symptoms.
  • Swallowing difficulties; a lack of appetite; a desire to ingest food or drink.
  • Control over bladder and bowel processes is lost (in some cases).
  • Restless movements – this might be a sign that the patient is in pain.
  • Cooling on the outskirts (i.e. coolness of the hands, feet, arms, legs, etc.).
  • Breathing rate and depth adjustments.
  • There are times when the patient is semi-conscious.
  • The sufferer withdraws, distancing themselves from people and their environment.
  • Vision-like experiences may be reported by the patient; they are normal and frequent.

The length of time this procedure takes is determined by the person’s health and disease, as well as the sort of treatment they are getting. It might last anywhere from a few hours to many days.

The following indicators of impending death may appear as the patient approaches death:

  • Peripheral circulatory shutdown, cyanosis, (a blue tinge to the extremities).
  • Changes in breathing, such as Cheyne-Stokes breathing (described following).
  • Drowsiness and impaired cognition, including a lack of reaction to stimuli, are common symptoms.
  • Restlessness or agitation that is out of the ordinary.
  • Swallowing difficulties have increased, and upper airway secretions have remained.
  • Hypotension and tachycardia are two cardiac symptoms.

At the end of life, alterations in a person’s breathing are very prevalent, and these changes may be frightening to see. The respiration of a patient often becomes loud and erratic. The patient may breathe via their lips and utilize their chest accessory muscles. Cheyne stoke breathing, in which the individual stops breathing for around five seconds before resuming erratic breathing, is also a possibility. Cheyne stoke breathing is a crucial sign of impending mortality.

It’s vital to note that many patients will have trouble breathing and swallowing throughout the last stages of their sickness. The following are symptoms of respiratory problems:

  • A higher rate of respiration.
  • Cyanosis that starts in the periphery.
  • Flaring of the nose, chest retraction, and/or the employment of auxiliary muscles.
  • Tachycardia is a fast heart rate (increased heart rate).
  • Other breathing noises such as grunting, wheezing, stridor, and/or gurgling.
  • Changes in vigilance.

As previously stated, breathing problems are often accompanied with swallowing problems. It’s critical for nurses working in palliative care settings to be able to recognize the indicators that a patient is having trouble swallowing (particularly if the patient is unable to inform the nurse of the problem). These are some of the warning signs:

  • Coughing on a regular basis
  • The mouth is oozing saliva.
  • When breathing, there are gurgling noises.
  • It takes more effort to swallow.

It’s critical for nurses working in palliative care settings to realize that breathing and swallowing problems are a normal and natural part of dying. Respiratory and swallowing problems should be addressed only if they cause the patient significant distress, (2) they may hasten the patient’s death unnaturally, (3) the patient’s advance planning documentation specifies relevant intervention, and/or (4) a competent patient requests relevant intervention.

Nurses will note the following when death occurs:

  • The act of cooling the body.
  • Disorientation, including the inability to recognize loved ones.
  • Using ‘abnormal’ communication (e.g. the need to say goodbye).
  • As the muscles relax, both the bowel and bladder have incontinence.
  • Secretions in the airways, which may cause gurgling noises.
  • A shift in breathing patterns, including moments when you don’t breathe at all.
  • The pupils are big and fixed, and the eyes are slightly open.
  • Jaw muscles are relaxed, and the mouth is opened.

Nurses should do the following while examining patients who are dying:

Holistic Assessment and Care
Needs at the end of life
  • Avoid any unneeded interventions and be as inconspicuous as possible.
  • Before speaking, speak softly and identify yourself (it’s vital for nurses to remember that hearing is frequently the last of the patient’s senses to fail).
  • Use soft touch and reassuring words with the sufferer.
  • Do not startle or disrupt the patient.
  • Be quiet and helpful rather than judging or criticizing what is going on.
  • If the patient asks it or it is stated in their advance care plan, wet the lips/mouth with a tiny quantity of water, ice chips, or a sponge-tipped applicator.
  • If the patient is incontinent, keep their body clean and dry.
  • Make sure the patient isn’t excessively hot or cold.
  • Provide a supportive and loving environment for the patient’s family, caregivers, and significant others.

It’s vital to note that, even for the most seasoned nurses, dealing with death may be difficult. Nurses working in palliative care settings must look after their own well-being in order to properly care for the well-being of others.

Conclusion

The skills and expertise required to successfully evaluate a patient receiving palliative care are discussed in this article. It starts with a review of the distinctions between standard and palliative evaluation, then moves on to a focus on the holistic assessment of patients in the context of palliative care. The article goes on to provide a paradigm for assessing patients in palliative care that is commonly utilized in the United Kingdom (UK). Finally, the common requirements and pathophysiological changes of patients near the end of life are discussed in this article. This article will begin to provide you with the skills and information you’ll need to provide excellent palliative care to patients.

Frequently Asked Questions (FAQs)

1. What is a palliative assessment?

Because it is comprehensive in nature, the evaluation of a patient getting palliative care varies from that of a patient receiving routine treatment. This implies it focuses on knowing the person as a complete person and ensuring that this information is utilized to identify and execute the best possible treatment for each patient. In addition to concentrating on the patient’s medical signs, symptoms, and concerns, as in standard nursing assessment, palliative care evaluation considers the person’s psychological (and emotional), social, and spiritual requirements as well.

2. What is a holistic approach to assessment?

Nurses working in palliative care settings must evaluate patients holistically, as outlined in the previous part of this article, in order to acquire knowledge of them as a whole person. Nursing assessments, for example, must evaluate a person’s physical requirements.

3. What are the needs of palliative care patients?

Every individual receiving palliative care will have a unique collection of needs, including those connected to:

  • Symptoms are relieved (e.g. pain, nausea, dyspnoea, constipation, fatigue, etc.).
  • Help with psychological and mental health issues (e.g. anxiety, depression).
  • Information, resources, equipment, financial assistance, and psychological assistance are all available.
  • Support for mobility, self-care and other critical activities of daily life.
  • Support with continence, skin integrity, sleep, communication, sexuality and other functions.
  • Nutrition, hydration, medication delivery, and swallowing assistance are all available.
  • Assistance in selecting a location of care and gaining access to it.
  • Assistance in choosing treatments and obtaining them (including complementary therapies).

4. What are the physiological signs and symptoms of a patient at the end of life?

There are many indicators that a person has reached the end of their life:

  • To control their indications and symptoms, the patient needs regular intervention.
  • The patient’s health is deteriorating in an irreparable way on a daily basis.
  • The patient is unable to get out of bed.
  • Urine production reduces in the patient.
  • The patient may have a loss of appetite, as well as a dry mouth and trouble, swallowing
  • The patient has severe weakness and exhaustion.
  • The patient loses weight, and in extreme instances, cachexia develops.

Reference list

Faull, C., de Caestecker, S., Nicholson, A. & Black, F. (Eds). (2012). Handbook of Palliative Care (3rd ed.). Hoboken, NJ: Wiley-Blackwell.

Matzo M. & Witt Sherman, D. (Eds). (2010). Palliative Care Nursing: Quality to the End of Life (3rd ed.). New York, NY: Springer Publishing Company.

Royal College of General Practitioners. (2011). The GSF Prognostic Indicator Guidance: The National GSF Centre’s Guidance for Clinicians to Support Earlier Recognition of Patients Nearing the End of Life. Retrieved from: http://www.goldstandardsframework.org.uk/cd-content/uploads/files/General%20Files/Prognostic%20Indicator%20Guidance%20October%202011.pdf

Royal College of Nursing. (2013). Dealing With Death and Trauma. Retrieved from: https://www2.rcn.org.uk/newsevents/congress/2013/agenda/13-dealing-with-death-and-trauma

West London Cancer Network. (ND). Guidance Document to Support Holistic Patient Assessment.  http://www.goldstandardsframework.org.uk/cd-content/uploads/files/Library,%20Tools%20%26%20resources/PepsicolaHPAguidancedocument.pdf

Wilson, J. & Kirshbaum, M. (2011). Effects of patient death on nursing staff: A literature review. British Journal of Nursing, 20(9), 559-563.

Holistic Assessment and Care

 

 

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