Acute Myeloid Leukemia is a type of blood cancer that is characterized

Acute Myeloid Leukemia is a type of blood cancer that is characterized by rapid growth of abnormal cells that build up in the bone marrow and interfere with normal blood cells source of this information?. It progresses rapidly and is fatal within weeks or months if left untreated. What was good in this situation was the fact that the disease was diagnosed immediately and palliative care team engaged immediately. What was not so good was the fact that Joel was the only bread winner and his two sons were in secondary and university respectively and depended entirely on him and the fact that he was going to stay long in the hospice. I will focus on the roles and relationships of the dying and the carers within the context of teamwork in palliative care.ANALYSISTHEORETICAL FRAMEWORKAccording to World Health Organization (2003), Palliative care is an approach that improves the quality of life of patients and their families facing life threatening illnesses through prevention and relief of suffering by means of early detection, assessment, treatment of pain and other problems, both physical, psychological, and social. This care is better delivered through an intergrated approach that focuses on the needs of the patient and the family. Check on any other definition and critique.Twycross(1995) further emphasizes on the fact that palliative care should be patient-centered not disease focused, accepts the inevitability of death, is life affirming and should address physical, psychological, social and spiritual concerns and is best delivered by multiprofessional team working in partnership with patients and their families. (Twycross, 1995) I concur because patients present with varied needs in death and dying and a single profession cannot adequately deliver the desired care.Teamwork is defined as two or more people who interact interdependently with a common purpose, working towards measurable goals that benefit from leadership that maintains stability while encouraging honest discussion and problem solving (Manser T (2009).What is your view on this?Health systems are struggling to meet needs of the aging population and the growing needs of clients with multiple and complex health issues. They are also faced with cost constraints, workforce shortage pressure and increasing complexity of required health care knowledge. As a result, there has been a growing need for the healthcare to embrace team-based approaches to healthcare to increase the number and balance of complementary contributions to client-focused care.Engel (2009) came up with a bio psychosocial model of health which in cooperates social, psychological and behavioral dimensions in illnesses and seeks to address inadequacies in the traditional biomedical model of care in which disease, not client, predominates. Engel asserted that a more holistic model of care could be achieved with a shift in focus from doctor-centric service delivery to health care services delivered by team of professionals (Engel 2009). I concur with his approach because clients’ needs can only be met holistically through teamwork.Palliative care teams are composed of clinicians from different disciplines who work in different settings and can act as a link between community, ambulatory and in-patient settings. The team can be composed of physicians, nurses, social workers, chaplains and therapists. The main goal of the team aims at improving the quality of life through pain and symptom management, social/spiritual assessment, understanding of illness and prognosis of treatment options, identification of patient centered goals of care and transition of care. The care constitutes both multidisciplinary and interdisciplinary approaches to holistic care (Tuggey and Lewin 2014). In Joel’s case, a clinical hematologist took the lead role his management. As a nurse, I was allocated as the cancer care coordinator and my role was to oversee and provide clinical advice on the nursing management of Joel, provide education and training to him, his family and the staff concerning the disease process, and to ensure clinical practice and standards were based on up to date evidence of the best practice. A pharmacist provided support on the treatment of the disease, a social work was available to assess and support the complex psychosocial needs of Joel and the family. Due to the extended stay in the hospice and the toxicity of the intense treatment, therapists to include physiotherapy, art therapists, music therapist and occupational therapist were involved in his care. Because of his Christian beliefs, a chaplain was also included in the team to provide spiritual care for him and the family. Multidisciplinary team consists of healthcare professionals of varied discipline and roles working together towards a common goal of providing optimal care for a patient. Physical, social psychological and spiritual needs of the patient and the family are met. (Haugen, Nauck and Caraceni 2010).Interdisciplinary team consists of specialist palliative care team with members contributing from their particular expertise. Teams share information and work interdependently. Leadership is task-dependent, with tasks defined by the individual patients’ situation.Support with literature.The difference between multidisciplinary and interdisciplinary approaches of care is the role collaboration and consensus building present in interdisciplinary and absent in multidisciplinary care. Each member in multidisciplinary care uses his/her expertise to develop individual care goals while in interdisciplinary care, regular meetings serve as a forum for collaboration and consensus building and each member contributes the knowledge and skills drawn from his/her own unique training and education and build on each other’s expertise (Linda and Emmanuel 2011).Interdisciplinary teamwork is recognized as a gold standard for the management of cancer patients. It represents both a rational and ethical approach to care. It involves healthcare professionals working as a team with the purpose of discussing individual cases and recommending care plans. The approach to care is guided by their willingness to agree on evidence based clinical decisions and deliver coordinated care throughout the cancer care continuum, while encouraging the patient to take an active role in their care. (Tremblay et al2017). It is the desire of the individual patients to be cared for holistically at the end of life according to their wishes, with dignity and respect. Inorder for this to be actualized for both the patient and the family, the care doesn’t rest on a single profession, rather on all those involved in their care, treatment and therapy. As end of life approaches, every individual, whether the dying person or someone close to them is on a different journey. Provision of care at this point is complex, involving a wide range of skills and services from across health and social care. If it is not coordinated properly, it can leave people confused and at times very frustrated, adding to the challenges of preparing for death.Barriers in effective teamwork in a patient with a hematological disease according to research include unique characteristics and pathways of hematological malignanciesdue to fluctuating trajectories, sudden deterioration and death, the close patient/hematology team relationship, lack of role clarity perceived as curative or palliative , late end of life discussions and specialist palliative care team referrals, policy issues and organizational issues that involves distant relationships with primary and specialist practitioners and limitations to information platforms (Mccaughan et al 2018).Challenges identified inJoel’s case included poor coordination between the hematology and the palliative care team. An interdisciplinary team was convened in order to enhance understanding of roles and ensure timely discussions with the patient and the family and also prompt referral to the palliative care team. Effective interdisciplinary teamwork with emphasize to person centered communication is seen as a way of integrating and coordinating care. The dying and their carers are central to the team, not just as recipients of care, but also as participants in it.Regular formal and informal interdisciplinary forums help in fostering collaborations between individuals and their organizations enhancing sharing of relevant, accurate, transparent, concise and timely information hence the team is able to achieve a common understanding and offer quality palliative care (Bainbridge et al 2010). Effective communication aims to address all the needs of the patient, family and the health care team through the holistic approach. The key aspects targeted in communication include prognosis and goals of care, disclosure, patient’s fears and concerns, disease progression and end of life care issues, coordination and integration of care and provision of emotional support as needed. Patient and family centered communication fosters healing relationships, exchange of information, and response to emotions, manage uncertainty, make decisions and enable patient to manageself. Communication results in a more satisfying care and increased sense of wellbeing at the end of life for the dying. It’s critical for a good death because peoples true wishes are heard, understood and followed and their loved ones are left without regrets (Keely MP 2017). Communication enabled the appropriate members of the team to meet the needs of both Joel and the family because the goals of care had to be set from the knowledge that they had acquiredThe care for the dying can be overwhelming and can be painful and confusing for the team (Saunders 2000). The team works in a challenging environment because they meet with death and dying of patients, their own bereavement as well as providing support for the family members. Professionals can’t control death or even know all the answers related to death. FrodeYeng, philosopher, points out the complexity of emotional aspects for professionals and that every person has their own way of dealing with emotions and death depending on cultural and social factors (Ingebretsen and Sagbakken 2016). It’s therefore very important for the team to support its own members. During Joel’s stay in the hospital, I became emotionally attached to the whole family. At times I wished I could do more for him and his family. Mitchell (2011) suggested that to effectively work with palliative care patients and their families, it’s important for the team members to contemplate their own beliefs on the end of life and death.AESTHETIC/ARTISTIC KNOWLEDGEEvidence has shownspthat contribution of art in interprofessional care team enhances provision of patient centered care. Artists improve the quality of life care by providing holistic dimensions of caring, including cognitive and social engagement and a meaningful interaction. Artists presence in interdisciplinary teams provide a cost-effective and welcome resource for clinical staff and builds a culture in which creativity and interdisciplinary collaboration are highly valued and activated. Art in health encompasses a wide range of forms including visual, literary and performing arts. They enhance the aesthetics of the environment and give patients, family members and staff valuable opportunities for enjoyment, relaxation, expression and connection. Arts demonstrate significant improvement in the quality of care and specific patient outcomes. Patients report enhanced sense of control, self-awareness and social relationships and reduced anxiety in relation to participation in art programs. Evidence has shown that Music reduces pain control and tolerance. Visual arts have shown to offer non-verbal communication. Artists have been proved to offer valuable component in interprofessional healthcare teams. (Sonke, Pesata and Pole 2017). Joel was introduced to a support group during his stay in the hospital. The group participated in painting with the help on an art therapist which helped them divert their minds as they shared their experiences. A music therapist also participated in their care. Joel was able to divert his thoughts from the stress of his diagnosis while paintingand continued the same on discharge.ETHICAL/MORAL KNOWLEDGEPain, symptom management, psychosocial care and end of life issues in palliative care should be managed in an ethical manner. The cardinal ethics of Autonomy, Beneficence, non-maleficence and justice should be followed. The palliative care team is called to carry out their responsibilities with honesty and dignity (Mohanti 2009)Palliative care teams are normally faced with ethical dilemmas in end of life care such as decisions related to place of care and death, therapeutic interventions for symptom control, withholding/withdrawing treatment, truth telling and also decisions considering patients autonomy and self-determination, justice and resource distribution (Pereira 2011)Building trust between the team, the patient and the family is vital in resolving ethical issues. Inco-operating beliefs, values and goals in a care plan for individuals demonstrates the principle of respect in ethics. I brought up the subject of advance care planningin my continuous education to Joel and family due to the complexity in the treatment if his disease. He preferred the team to focus on him getting better and going back to his family. His wishes were respected.PERSONAL KNOWLEDGEAs a nurse in my practice, I have come across many patients requiring end of life care. The code of conduct for nurses counsels the nurses to “foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain and support a dignified and peaceful death including the support of the family during and after death”. This is best provided through the collaborative practice of an interdisciplinary team to meet the physical, emotional, psychosocial, cultural and spiritual needs of the person and their families. I have seen many patients die without much involvement of teamwork because of lack of the know-how on palliative care. With the knowledge I have learned, I know now how I could have competently participated in taking care of these patients and their families.SOCIO-CULTURAL KNOWLEDGEConsidering socio-cultural aspects in palliative care can help the team to analyze if the intervention will succeed in a specific socio-cultural context. Palliative care teams need to have a level of cultural competence when caring for people from different cultural backgrounds and the knowledge of when and how to consult for further cultural expertise when required. Beliefs, values and traditional health care practices are of relevance in end of life care. Krakaueret al (2002) notes that culture is particularly important in shaping attitudes about dying, death and end of life care preferences. The health care team must recognize that the basic values principles and assumptions of medicine and bioethics are themselves culturally determined and may be alien to patients from different cultural backgrounds. Cultural competence according to Lickiss(2003) includes communication issues, modes of decision making that is when to involve the patient and family, the role of advance care planning, conceptions about the disease that is meaning of pain and other symptoms, ways of conceptualizing death and dying in relation to the rest of life, customs surrounding death, burial or cremation and bereavement, attitudes to medicine and nutrition, privacy issues, spiritual matters to include religious issues and rituals. Cross cultural competence should start with an attitude and genuine interest of the individual team members in experiencing, conversing about and participating in ongoing learning opportunities about diverse cultures (Cohen and Palos 2001).CONCLUSIONTeamwork is a complex but essential component of palliative care. The needs of persons with life threatening illnesses vary overtime requiring a holistic approach to care. For this to be achieved, different models of teamwork, that is, both multidisciplinary and interdisciplinary approaches must be employed. The patient and the family form part of the team to help develop the goals of care. Support your conclusion with literature or theory from your text.ACTION PLAN

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