QOL assessment of the patient will use dimensions such as the physical activity, psychological, social activity and spiritual well-being. Mike’s quality of life is low with respect to his physical condition. His overall health is poor, the patient’s condition affects is quality of life as he is unable to take care of himself due to increasing weakness. This is indicated by his physical appearance; he is unshaven, his hair is uncombed, his nails are dirty and it has been reported that he refuses to bathe.

Mike’s poor psychological well being is indicated by his anxiety and his negative attitude or sense of helplessness shown when he asks, ‘what’s the point? ’ Mike also has very little social support, he is divorced, does not want his daughter to see him and he does not see his friends anymore. Consequently his is not coping well with his situation evidenced by the way he shouts at the nurse and the fact that he wants to isolate himself both physically and socially.

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Due to the lack of social contact with people, Mike’s spiritual well-being is also poor as he does not seem to have much contact with any spiritual leaders or any form of spiritual practice. In assessing all of these components, Mike’s quality of life is found to be low. Members of interdisciplinary team The most important members of an interdisciplinary team to contact include a medical psychologist and a social worker.

The medical psychologist is of utmost importance because he/she can provide the counseling that Mike needs in order to come to terms with his diagnosis and to be able to learn coping skills that will help him improve his health. The medical psychologist will provide interventions that will hopefully bring about Mike’s psychological well being and hence his quality of life. In this way some of his social needs can also be addressed as the psychologist points out the need for social contact and spiritual welfare. The social worker will be useful for tracking down Mike’s daughter and helping him re-establish his social contacts.

Additional information Additional information that would be helpful in assessing QOL at the end of life includes pain, cognitive functioning or psychiatric co morbidities and fatigue (Douhaiy and Singh, 2001). These two components are important because they have an impact on the coping abilities of the patient (Douhaiy and Singh, 2001). If Mike is very fatigued other psychosocial stresses such as the absence of friends physical inactivity are likely to weigh down more on him. If he has other psychiatric comorbidities for example depression he will have even greater difficulty in coping with the chronic illness (Douhaiy and Singh, 2001).

Role of Nursing in caring for Mike When nursing Mike the nurse has the role of assisting him in adhering to his medication. This can be achieved through teaching him the importance of adherence and educating him on the possibility of side effects. Prompt management of the side effects from the ART will likely improve his adherence as well as help to improve his physical conditions. The nurse also has the role of referring Mike for services that she may not be able to provide for example issues that can be managed by a social worker or a counselor.

Additionally, the nurse has a collaborative role to play that is she needs to collaborate with the physician in ensuring Mike’s health needs are met. Collaboration in this case will involve presenting the nurses concerns about Mike’s health and follow up for this care. Additional information that may be required in caring for Mike includes information regarding his current drug use, his adherence to medications, whether he has developed any side effects and if he is being treated for any opportunistic infections. Creating a safe environment for Mike

The environment can be made safe for Mike by ensuring that he is in room where he can be easily observed. The doors’ room can be left slightly open. To ensure that he gets the right medication, Mike should have a name tag to identify him. Due to his outbursts there is a possibility that he may become violent, thus bed rails can be put up as he remains under close observation. Case study 2: Pain and Suffering The relief of pain is one of the core ethical duties of medical care (Sandra, 2007). This is because unrelieved pain means that the patient cannot enjoy any other human values or goods.

This is very much the case in Madeline Stuart’s case. Pain management is a controversial issue because of the ever present possibility of pain undermanagement (Board of Nursing, 2006; Sandra, 2007). This is common especially because of the assumptions made by health care professionals about pain management. For instance, that pain should not be prevented rather it should be treated, pain is good so that the symptoms of the patient are not masked, the elderly patients always have some amount of pain among others.

The nurse has the role of being the patient’s advocate which means that she has a commitment to the safety, health, comfort and welfare of the patient. In the role of patient advocate the nurse takes the necessary measures to alleviate the pain and suffering that the patient is experiencing. In doing so, the nurse needs to collaborate and consult with the interdisciplinary team to alleviate the patient’s pain. The people on this team will include physicians, pharmacists, massage therapists and experts specially trained in pain management. The nurse may also refer the patient’s case to the ethics committee.

The patient’s pain can be classified as chronic pain. The patient’s diagnosis of end stage cardiac disease and end stage renal disease need to be considered. End stage renal disease is especially important because it will influence the dosage of pain medication that she should get. Giving the patient normal dosages may lead to renal toxicity, making her condition even worse. Concerns that the physicians and pharmacists may have include addiction and diversion of the drugs. These however are not reasons strong enough to deny the patient the necessary pain medication (Sandra, 2007).

The patient Madeline Stuart is German so there is also the possibility that the patient may not be able to communicate her pain and even her wishes effectively. The patient did not have any advance directives. The patient’s daily life is one where she is unable to enjoy her life. She is unable to interact with her family and friends. Additionally she also seems to be about to give up as she is resisting attempts to be transferred to a hospice. The ideal outcome for this patient is that she is able to stay pain free up to the time she dies.

This can be best achieved through the administration of opioid analgesics to manage her pain. One option would be to manage her in the home care agency. The second option would be to transfer her to a hospice care where she can be continued on pain management. The problem with this second option is her desire to remain in the home care agency. The team involved in her care can perhaps engage her family in convincing her to move to a hospice or can provide support for her by offering to assist in her care as she is assigned a health care aide and a nurse to visit regularly.

References Board of Nursing, 2006, Pain Management Nursing Role/Core Competency A Guide for Nurses, available at http://www. mbon. org/practice/pain_management. pdf Douaihy A and Singh N, 2001, Factors Affecting Quality of Life in Patients with HIV infection, Medscape available at http://www. medscape. com/viewarticle/410415 Sandra HJ, 2007, Legal and Ethical Perspectives on Pain Management, Anesthesia and Analgesia, available at http://www. anesthesia-analgesia. org/content/105/1/5. full