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Case Study of Palliative Care for Bowel Cancer

Mrs Cheng has a 2 years history of bowel blight afresh actuality complicated by alarmist metastases. Doctors had accustomed her a cast of about one ages larboard to live. She is accepted to the medical area for booze care.


Mrs Cheng is the sole survivor of the Boxing Day Tsunami in her family. She has appropriately no applicable abutment arrangement to allege of.


From a booze affliction perspective, it may accept adapted to abetment the accommodating in affair her appropriate needs during the final canicule of her life.


The hospital prohibits smoker by law. Appropriately Mrs Cheng is accustomed smoker alone at a garden alfresco of the hospital.

2. Get the facts


Bowel blight is presented with a advance of a cancerous bump in the colon or rectum (Realtime Health, 2010). It is currently the third best frequently diagnosed blight in Australia (Cancer Council Australia, 2010).

The final date of the bowel blight generally denotes that the blight has advance to alternative organs, for archetype the liver. Currently, there is no accepted able assay accessible for date 4 bowel blight (Cancer Council Australia, 2010).

In Mrs Cheng’s case, her bowel blight has been added complicated by alarmist metastases. This is adverse but archetypal in patients with end-stage bowel cancer.

Palliative care

As authentic by World Bloom Organization (WHO) (2010), Booze affliction is an access that improves the affection of activity of terminally-ill patients and their families by acquainted the needs of a terminally-ill patient, and absorption on authoritative them adequate (Palliative Affliction Victoria, 2007).

It is important for nurses to accept that accommodating affliction charge abide until the end of activity and that aggregate aural the agency of the healthcare aggregation be done to ensure that the patient’s afterlife will be peaceful and aristocratic (Cancer.Net, 2010).

Palliative Affliction Australia recognizes the accent of booze care, and affirms that it should be advised a bulk adequacy for all bloom affliction professionals (Palliative Affliction Australia, 2008).

Patient’s understanding

It is important to ascertain Mrs Cheng’s akin of compassionate appear the ‘no-smoking policy’, the manpower bearings and dejection of the staff. Without able clarification, actuality a patient, Mrs Cheng may be apprenticed of the issues which had arisen. It is appropriately the albatross of the aggregation to ensure that she absolutely understands the inconveniences imposed.

Patient advocacy

Patient advocacy, as declared in the Australian Nursing and Midwifery Council (ANMC) Cipher of Belief for Nurses in Australia, is the obligation of the nurses to catechism nursing affliction which they may absorption as potentially bent or actionable (ANMC, 2008).

Ironically, due to the attendance of manpower shortage, nurses advocating in the absorption of Mrs Cheng may acquaintance an ethical bind as they may acquisition adversity distributing according bulk of absorption and nursing affliction to the blow of the patients. Likewise, the adverse would be accurate if advancement is to be in the absorption of the alternative patients.

Patient’s support

Being the sole survivor of the Boxing Day tsunami in her family, Mrs Cheng has awfully poor amusing support. It is not accepted if Mrs Cheng has any continued ancestors members.

The attendance of a kin is best favorable in booze care. A ancestors affiliate may be able to cede a college akin of affecting abutment to Mrs Cheng, and additionally accommodate her some absolute and advantageous aberration abroad from her smoker habit.

Thus, the aid of amusing workers should be enlisted in archetype accessible continued ancestors associates of Mrs Cheng.

Staff disagreement

Some of the agents had approved annoyance by aggressive resignation. To abate the matter, the nursing assemblage administrator needs to account the afflicted staff, to accretion a clearer compassionate of the botheration and any alternative bottomward factors that ability accept led the agents to the point of aggressive resignation.


As Mrs Cheng smokes about 25 cigarettes daily, and anniversary smoker cruise would booty up 12 account of the accompanying staff’s alive time. As such, about 300 account of manpower would be taken up daily, to see to this accurate charge of Mrs Cheng.

Staffing is a agency which generally inhibits the affection of care, and banned the time accessible for nursing affliction commitment to anniversary accommodating (Irurita, 1999). The affair of both the manpower diffusion and curtailment needs to be address.

Disruption of care

Mrs Cheng’s smoker addiction requires continued periods of absorption from the healthcare professionals. It is appropriately assured that absorption is actuality beggared from the blow of the patients in the ward. This needs to be looked into, as apathy may aftereffect from such disruption of care.

Passive smoking

By accompanying Mrs Cheng to the garden for cigarette smoking, it is assured for the accompanying assistant to be credible to adverse acquiescent smoking. As Mrs Cheng smokes heavily, the acknowledgment of the nursing agents to the adverse fumes, are almost immerse. Thus, measures should be taken to aegis the abundance of the staff.

3. Consider the four principles


Autonomy is referred to as the exercise of one’s chargeless will, which should be accounted as acceptable, as continued as it does not affect the rights of others abnormally (Staunton & Chiarella, 2008, p. 31). Actuality mentally competent, Mrs Cheng should acquire the chargeless will to smoke cigarettes for as abundant as she wishes.


Beneficence is generally declared as the assumption of ‘above all, do good’ (Staunton & Chiarella, 2008, p. 32). It affirms that the healthcare able should consistently act, with the best absorption of the accommodating in apperception (Dominick, 1999). Thus, advocating Mrs Cheng to abdicate smoker may be an act of ‘beneficence’, as smoker is an ailing addiction and induces abominable bloom outcomes.


Non-maleficence is the assumption of ‘above all, do no harm’ (Staunton & Chiarella, 2008, p. 32). Appropriately from the ‘non-maleficence’ perspective, one should not forbid Mrs Cheng from indulging in cigarette smoker as it may affect her negatively, with commendations to her affecting bloom and stability.


Justice refers to the obligation of the healthcare professionals to amusement all patients with adequation and candor (, 2006). An archetype of justice, decidedly in countries area racism is axiomatic in abounding aspects of life, is back nurses authenticate according and aloof affliction and assay appear all patients, behindhand of age, sex, and ethnicity.

Value account 3 of the Australian Nursing and Midwifery Council (ANMC) Cipher of Belief for Nurses in Australia states that nurses should amount and account the assortment of bodies (ANMC, 2008). While conduct account 4 of the ANMC Cipher of Able Conduct for Nurses in Australia states to account the dignity, culture, ethnicity, belief and behavior of bodies accepting affliction and assay (ANMC, 2008).

As a booze accommodating in the ward, it is perchance that Mrs Cheng’s appropriate needs are added so taken affliction of than the blow of the patients in the unit. One could altercate that, in animosity of Mrs Cheng’s plight, it is candid that according absorption and affliction should be rendered to all the patients in the unit.

4. Identify ethical conflicts

Beneficence against Non-maleficence

Beneficence against Non-maleficence is one of the best credible ethical dilemmas which are pertinent to Mrs Cheng’s smoker habit. Beneficence, here, may accredit to attention Mrs Cheng from the ill furnishings of smoker by advocating her to advance a smoke-free life; while non-maleficence, may accredit to apropos Mrs Cheng’s wishes by acknowledging her requests to smoke.

The healthcare aggregation needs to counterbalance the allowances and losses of adopting either principle. Actuality a medical ward, it is arguable if all the nurses on the assemblage accept the body of booze nursing. It is accordingly of eminent accent that the absolute aggregation accretion a bigger compassionate of booze care. As such, a college akin of affinity and a added altruistic access may be invoked in the nurses caring for Mrs Cheng.

In animosity of actuality one of the best preventable causes of ill bloom and afterlife (HealthInsite, 2010), it is somewhat extraneous to altercate about the issues of bloom acquaintance with a dying patient. It is additionally apathetic to accept a terminally-ill accommodating cut bottomward on or to abdicate smoker during the final canicule of her life, as abandonment affection may aftereffect from abnegation from smoking, causing added ache to Mrs Cheng, and in turn, added compromises her affection of life.

Autonomy against Beneficence

Despite actuality a terminally-ill patient, Mrs Cheng is mentally able and competent. Appropriately her freedom as an alone should be respected. Mrs Cheng indulges in, and draws amusement from smoker cigarettes. An ethical battle arises back Mrs Cheng’s freedom disharmonizes with the healthcare professional’s assumption of beneficence.

An accomplishment to bottle Mrs Cheng’s freedom would beggarly acceptable her in affair her needs of accepting her cigarette smokes; while on the contrary, one with the assumption of alms in apperception would discredit such an act.

The biographer feels that the assumption of alms should not overwrite that of the patient’s autonomy. Amount account 2 of the Singapore Nursing Board cipher of belief and able conduct, states to account and advance the patient’s freedom and rights for freedom (SNB, 2006). Appropriately akin Mrs Cheng from smoker should be accounted as bent and unprofessional.

Nevertheless, any anxious assistant may brainwash Mrs Cheng on the adverse furnishings of smoker and admonition her on the advantage of Nicotine Replacement Therapy (NRT), by accomplishing so ensures that she is absolutely acquainted of the abominable bloom outcomes of smoker and the options available.

However, it is additionally important to ensure that this is not done in a arrogant manner. Clause 2.1 of the Australian Nursing and Midwifery Council (ANMC) civic adequacy standards for the registered nurse, states to ensure that claimed belief and attitudes are not imposed on others (ANMC, 2006).

Should Mrs Cheng accept to abide smoking, her freedom should be admired and preserved, for as continued as she is mentally competent of authoritative her own decisions.

5. Consider the Law

Smoking is banned by law in the hospital. Nonetheless, actuality mentally able, Mrs Cheng should absorb the freedom of authoritative her own decisions. In this instance, accustomed out the act of cigarette smoking, so continued she does not do it aural the hospital.

It is not said if Mrs Cheng possesses the concrete abilities to action herself about in a wheelchair. Nonetheless, should she crave any assistance, it is the assignment of the assistant to abetment her in the aspect of her mobility. Clause 1.2 of the ANMC Civic Adequacy Standards for the Registered Assistant states to accomplish the assignment of affliction appear patients (ANMC, 2006). In Mrs Cheng’s case, a assignment of affliction would absorb accompanying her to the garden for cigarette smoking.

There is no bright ethical or acknowledged bill that protects the absorption of the nurses. However, in Australia, the accent of nurses attention themselves was discussed in a guideline blue-blooded ‘The Responsibilities of Nurses and Midwives in the Accident of a Declared Civic Emergency’.

Owing to the assignment of care, it may be the accountability of the nurses to escort Mrs Cheng for cigarette smoking. Nevertheless, nurses should not be absent to the actuality that they are actuality credible to acquiescent smoker in the process, and booty careful measures, such as donning a face affectation to anticipate accidental and boundless assimilation of adverse effluvium (ANMC, 2008).

6. Authoritative the ethical decision

The biographer believes that Mrs Cheng should absorb her appropriate to smoke cigarettes. As a booze patient, Mrs Cheng’s needs should not be compromised.

It is conceivably apprehensible that the nurses in the medical assemblage feels balked over caring for Mrs Cheng. Apart from manpower shortage, they additionally abridgement specialized ability and appropriately may acquisition adversity in empathizing with Mrs Cheng’s needs. Thus, it is perchance that majority of the nurses would be absorbed to caring added for the medical patients, for whom they are able to cede nursing affliction added confidently.

The administrator should enquire with the booze assemblage of the hospital apropos the achievability of appointment Mrs Cheng to a booze ward, area she may accept added abundant nursing affliction from accomplished booze nurses. By accomplishing so, would concurringly, break the affair of the manpower shortage, and additionally the annoyance amidst the afflicted nurses.

In the accident that a alteration is not possible, the administrator may analyze the achievability of enlisting the advice of a booze volunteer, to tend to this appropriate charge of Mrs Cheng. This would allay the accountability on the healthcare team. There are several booze advance programmes in Australia, one of which is Victoria’s Booze Affliction Program (Victorian Government Department of Human Services, 2007).

7. Document the decision

Documentation is about an basic aspect in nursing care, as it serves as an important apparatus for advice amid associates of the healthcare team. Nurses charge additionally be acquainted that the patient’s advance addendum could be allowable as acknowledged abstracts in the accident of a acknowledged prosecution, appropriately it is important that entries are abridged and absolute (Hansebo, Kihlegren, and Ljunggren, 1999).

Clause 10.2 of the ANMC Civic Adequacy Standards for the Registered Assistant states the accent of nurses to abstracts all forms of communication, nursing interventions and individual/group responses, absolutely and as anon as accessible (ANMC, 2006).

The administrator should accept the albatross of documenting the complaints of the nurses, so as to bigger facilitate an assay of the accessible base causes of the problem. Aloft accession at the ethical decision, credibility agreed aloft by the aggregation needs to be acutely recorded, to ensure that anybody on the assemblage is acquainted of the decision.

Nurses should brainwash Mrs Cheng on the adverse furnishings of smoking, and accept it accurate in the notes. Mrs Cheng’s requests to advance to the garden to smoke should additionally be recorded, additionally for anniversary and every adventure made.

It is additionally important for the assistant to accompaniment that Mrs Cheng has been accompanied by a assistant or certified advance throughout her adventure to the garden; this is decidedly accurate if Mrs Cheng is physically breakable and requires abetment with mobility.

8. Appraisal the decision

Clauses 4.1, 7.6, and 8.1 of the ANMC Civic Adequacy Standards for the Registered Assistant accompaniment the accent of nursing affliction evaluation.

The administrator needs to analysis and appraise agents achievement on a approved basis, to abbreviate any accession of animosity or dejection amidst the associates of the healthcare team. This would additionally accommodate adventitious for blast and aboriginal intervention, and in about-face anticipate issues from ascent to an immitigable state.

Nurses on the area should analysis the assurance and abundance of Mrs Cheng with the booze volunteer, if any. While it is advantageous to accept a advance to see to the needs of Mrs Cheng, her assurance and wellbeing charge not be compromised.

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