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Case Study of Palliative Care for Bowel Cancer

Mrs Cheng has a 2 years occurrence of bowel cancer recently substance entangled by feedr metastases. Doctors had consecrated her a prognosis of encircling one month left to feed. She is admitted to the medical fend for soothing pains.


Mrs Cheng is the singly survivor of the Boxing Day Tsunami in her nobility. She has thus no viefficacious subsistence order to talk of.


From a soothing pains perspective, it may look mismisappropriate to befriend the unrepining in parley her eeappropriate demands during the ultimate days of her activity.


The hospital prohibits smoking by law. Thus Mrs Cheng is recognized smoking singly at a pasture beyond of the hospital.

2. Get the occurrences


Bowel cancer is presented after a suitableness a enlargement of a mortal knob in the colon or rectum (Realseason Health, 2010). It is currently the third most commsingly diagnosed cancer in Australia (Cancer Council Australia, 2010).

The ultimate order of the bowel cancer repeatedly denotes that the cancer has propagate to other organs, for copy the feedr. Currently, tnear is no public conducive tenor beneficial for order 4 bowel cancer (Cancer Council Australia, 2010).

In Mrs Cheng’s contingency, her bowel cancer has been ppoint entangled by feedr metastases. This is illfated but illustrative in unrepinings after a suitableness end-order bowel cancer.

Palliative pains

As defined by World Vigor Organization (WHO) (2010), Soothing pains is an path that improves the keepency of activity of terminally-ill unrepinings and their families by recognizing the demands of a terminally-ill unrepining, and focusing on making them cozy (Palliative Pains Victoria, 2007).

It is relevant for fosters to apprehend that unrepining pains must live until the end of activity and that totalthing after a suitablenessin the resources of the vigorpains team be manufactured to secure that the unrepining’s exit obtain be well-disposed and noble (Cancer.Net, 2010).

Palliative Pains Australia recognizes the significance of soothing pains, and affirms that it should be considered a kernel calibre for all vigor pains negotiatives (Palliative Pains Australia, 2008).

Patient’s apprehending

It is relevant to prove Mrs Cheng’s raze of apprehending towards the ‘no-smoking policy’, the manpower footing and wretchedness of the staff. Without personal percolation, substance a unrepining, Mrs Cheng may be unlettered of the childrens which had arisen. It is thus the allegiance of the team to secure that she amply apprehends the inconveniences imposed.

Patient apology

Patient apology, as methodic in the Australian Nursing and Midwifery Council (ANMC) Order of Ethics for Nurses in Australia, is the contract of the fosters to interrogation nursing pains which they may behold as hypothetically unincorporeal or unfair (ANMC, 2008).

Ironically, due to the closeness of manpower shortage, fosters advocating in the share of Mrs Cheng may proof an incorporeal inaptitude as they may meet inaptitude distributing correspondent edisposition of heed and nursing pains to the quiet of the unrepinings. Likewise, the repugnant would be gentleman if apology is to be in the share of the other unrepinings.

Patient’s subsistence

Being the singly survivor of the Boxing Day tsunami in her nobility, Mrs Cheng has inordinately inconsiderefficacious gregarious subsistence. It is not public if Mrs Cheng has any distant nobility parts.

The closeness of a kin is most fond in soothing pains. A nobility part may be efficacious to assign a prefereffectual raze of likeing subsistence to Mrs Cheng, and as-well cater her some assured and vigory absence far from her smoking usage.

Thus, the aid of gregarious workers should be enlisted in tracing feasible distant nobility parts of Mrs Cheng.

Staff disagreement

Some of the staff had reveald resistance by foreboding renunciation. To calm the substance, the nursing part director demands to confabulation the unnatural staff, to frame a acquitteder apprehending of the height and any other precipitating ingredients that rule enjoy led the staff to the apex of foreboding renunciation.


As Mrs Cheng steams encircling 25 cigarettes daily, and each smoking stumble would capture up 12 minutes of the cognate staff’s afloat season. As such, closely 300 minutes of manpower would be capturen up daily, to see to this feature demand of Mrs Cheng.

Staffing is a ingredient which repeatedly inhibits the keepency of pains, and limits the season beneficial for nursing pains exhibition to each unrepining (Irurita, 1999). The children of twain the manpower waorder and shortage demands to be address.

Disruption of pains

Mrs Cheng’s smoking usage insist-upons distant periods of heed from the vigorpains negotiatives. It is thus inevitefficacious that heed is substance deprived from the quiet of the unrepinings in the fend. This demands to be looked into, as negligence may outcome from such separation of pains.

Passive smoking

By cognate Mrs Cheng to the pasture for cigarette smoking, it is inevitefficacious for the cognate foster to be unprotected to injurious resigned smoking. As Mrs Cheng steams heavily, the snare of the nursing staff to the injurious fumes, are relatively soak. Thus, measures should be capturen to security the well-substance of the staff.

3. Consider the lewd energys


Autonomy is pointred to as the application of one’s munificent obtain, which should be reckoned as jocular, as hanker as it does not like the corrects of others inappropriately (Staunton & Chiarella, 2008, p. 31). Substance mentally adapted, Mrs Cheng should enjoy the munificent obtain to steam cigarettes for as abundantly as she wishes.


Beneficence is repeatedly described as the energy of ‘above all, do good’ (Staunton & Chiarella, 2008, p. 32). It affirms that the vigorpains negotiative should normally act, after a suitableness the best share of the unrepining in implying (Dominick, 1999). Thus, advocating Mrs Cheng to leave smoking may be an act of ‘beneficence’, as smoking is an unwholesome usage and induces undesirefficacious vigor outcomes.


Non-maleficence is the energy of ‘above all, do no harm’ (Staunton & Chiarella, 2008, p. 32). Thus from the ‘non-maleficence’ perspective, one should not deprecate Mrs Cheng from indulging in cigarette smoking as it may like her negatively, after a suitableness beholds to her likeing vigor and stationariness.


Justice points to the contract of the vigorpains negotiatives to manage all unrepinings after a suitableness etendency and simplicity (, 2006). An copy of fairness, featurely in countries wnear racism is conspicuous in frequent countenances of activity, is when fosters reveal correspondent and unjaundiced pains and tenor towards all unrepinings, beholdless of age, sex, and ethnicity.

Value declaration 3 of the Australian Nursing and Midwifery Council (ANMC) Order of Ethics for Nurses in Australia says that fosters should appreciate and deference the variation of crowd (ANMC, 2008). Suitableness inaugurate declaration 4 of the ANMC Order of Negotiative Inaugurate for Nurses in Australia says to deference the decency, refinement, ethnicity, appreciates and beliefs of crowd receiving pains and tenor (ANMC, 2008).

As a soothing unrepining in the fend, it is haply that Mrs Cheng’s eeappropriate demands are elevate so capturen pains of than the quiet of the unrepinings in the part. One could sift that, in vindictiveness of Mrs Cheng’s vow, it is equitefficacious that correspondent heed and pains should be assigned to all the unrepinings in the part.

4. Identify incorporeal combats

Beneficence versus Non-maleficence

Beneficence versus Non-maleficence is one of the most acquitted incorporeal inaptitudes which are appliceffectual to Mrs Cheng’s smoking usage. Beneficence, near, may point to compensating Mrs Cheng from the ill receiptss of smoking by advocating her to guide a steam-munificent activity; suitableness non-maleficence, may point to deferenceing Mrs Cheng’s wishes by laudatory her requests to steam.

The vigorpains team demands to inspect the benefits and losses of adopting either energy. Substance a medical fend, it is suspicious if all the fosters on the part apprehend the crux of soothing nursing. It is hence of dignified significance that the all team frame a meliorate apprehending of soothing pains. As such, a prefereffectual raze of empathy and a elevate humanitarian path may be invoked in the fosters caring for Mrs Cheng.

In vindictiveness of substance one of the most anticipateefficacious causes of ill vigor and exit (HealthInsite, 2010), it is subordinately inoperative to sift-canvass encircling the childrens of vigor cognizantness after a suitableness a latter unrepining. It is as-well selfish to enjoy a terminally-ill unrepining cut down on or to leave smoking during the ultimate days of her activity, as after a suitablenessdrawal symptoms may outcome from frugality from smoking, causing elevate vexation to Mrs Cheng, and in deviate, ppoint compromises her keepency of activity.

Autonomy versus Beneficence

Devindictiveness substance a terminally-ill unrepining, Mrs Cheng is mentally efficacious and adapted. Thus her autonomy as an idiosyncratic should be deferenceed. Mrs Cheng indulges in, and draws exercise from smoking cigarettes. An incorporeal combat arises when Mrs Cheng’s autonomy disharmonizes after a suitableness the vigorpains negotiative’s energy of benignity.

An attempt to protect Mrs Cheng’s autonomy would medium befriending her in parley her demands of getting her cigarette steams; suitableness on the inappropriate, one after a suitableness the energy of benignity in implying would ignobleness such an act.

The writer feels that the energy of benignity should not balancewrite that of the unrepining’s autonomy. Appreciate declaration 2 of the Singapore Nursing Board order of ethics and negotiative inaugurate, says to deference and prefer the unrepining’s autonomy and corrects for self-determination (SNB, 2006). Thus quietricting Mrs Cheng from smoking should be reckoned as unincorporeal and unprofessional.

Nevertheless, any unquiet foster may initiate Mrs Cheng on the inappropriate receiptss of smoking and counsel her on the liberty of Nicotine Replacement Therapy (NRT), by doing so secures that she is amply cognizant of the undesirefficacious vigor outcomes of smoking and the libertys beneficial.

However, it is as-well relevant to secure that this is not manufactured in a balancebearing kind. Clause 2.1 of the Australian Nursing and Midwifery Council (ANMC) common calibre standards for the registered foster, says to secure that personal appreciates and attitudes are not imposed on others (ANMC, 2006).

Should Mrs Cheng select to live smoking, her autonomy should be deferenceed and protectd, for as hanker as she is mentally adapted of making her own conclusions.

5. Consider the Law

Smoking is prohibited by law in the hospital. Nonetheless, substance mentally efficacious, Mrs Cheng should keep the autonomy of making her own conclusions. In this exemplification, carrying out the act of cigarette smoking, so hanker she does not do it after a suitablenessin the hospital.

It is not said if Mrs Cheng enjoyes the tangible abilities to maneuver herself encircling in a wheelchair. Nonetheless, should she insist-upon any befriendance, it is the service of the foster to befriend her in the countenance of her restlessness. Clause 1.2 of the ANMC Common Calibre Standards for the Registered Foster says to purport the service of pains towards unrepinings (ANMC, 2006). In Mrs Cheng’s contingency, a service of pains would entangle cognate her to the pasture for cigarette smoking.

Tnear is no acquitted incorporeal or legitimate mandible that protects the share of the fosters. However, in Australia, the significance of fosters compensating themselves was sift-canvassed in a guideline titled ‘The Responsibilities of Nurses and Midwives in the Occurrence of a Declared Common Emergency’.

Owing to the service of pains, it may be the obligation of the fosters to escort Mrs Cheng for cigarette smoking. Nevertheless, fosters should not be oblivious to the occurrence that they are substance unprotected to resigned smoking in the way, and capture protective measures, such as donning a visage misdeclare to anticipate uncalled-for and inordinate inhalation of injurious fumes (ANMC, 2008).

6. Making the incorporeal conclusion

The writer believes that Mrs Cheng should keep her correct to steam cigarettes. As a soothing unrepining, Mrs Cheng’s demands should not be implicated.

It is peradventure stood that the fosters in the medical part feels frustrated balance caring for Mrs Cheng. Apart from manpower shortage, they as-well closing especialized information and hence may meet inaptitude in empathizing after a suitableness Mrs Cheng’s demands. Thus, it is haply that preponderance of the fosters would be healthful to caring elevate for the medical unrepinings, for whom they are efficacious to assign nursing pains elevate confidently.

The director should enquire after a suitableness the soothing part of the hospital beholding the possibility of exchangering Mrs Cheng to a soothing fend, wnear she may take elevate idiosyncraticized nursing pains from useful soothing fosters. By doing so, would concurringly, explain the children of the manpower shortage, and as-well the resistance amongst the unnatural fosters.

In the occurrence that a exchange is not feasible, the director may weigh the possibility of enlisting the succor of a soothing offer, to keep to this eeappropriate demand of Mrs Cheng. This would lessen the parcel on the vigorpains team. Tnear are various soothing offer programmes in Australia, one of which is Victoria’s Soothing Pains Program (Victorian Government Department of Human Services, 2007).

7. Document the conclusion

Documentation is essentially an gross atom in nursing pains, as it serves as an relevant machine for despatch between parts of the vigorpains team. Nurses demand as-well be cognizant that the unrepining’s way notes could be commanded as legitimate documents in the occurrence of a legitimate prosecution, thus it is relevant that entries are pointed and occurrenceual (Hansebo, Kihlegren, and Ljunggren, 1999).

Clause 10.2 of the ANMC Common Calibre Standards for the Registered Foster says the significance of fosters to documents all forms of despatch, nursing intercessions and idiosyncratic/group responses, precisely and as quickly as feasible (ANMC, 2006).

The director should exhibit the allegiance of documenting the complaints of the fosters, so as to meliorate expedite an dissection of the feasible radix causes of the height. Upon arriving at the incorporeal conclusion, apexs agreed upon by the team demands to be acquittedly commemorative, to secure that totalone on the part is cognizant of the conclusion.

Nurses should initiate Mrs Cheng on the injurious receiptss of smoking, and enjoy it documented in the notes. Mrs Cheng’s requests to receipts to the pasture to steam should as-well be commemorative, besides for each and total tour made.

It is as-well relevant for the foster to say that Mrs Cheng has been accompanied by a foster or cognizant offer throughout her tour to the pasture; this is featurely gentleman if Mrs Cheng is tangiblely irresolute and insist-upons befriendance after a suitableness restlessness.

8. Evaluation the conclusion

Clauses 4.1, 7.6, and 8.1 of the ANMC Common Calibre Standards for the Registered Foster say the significance of nursing pains evaluation.

The director demands to resurvey and assess staff pleasure on a normal basis, to minimize any amassment of variance or wretchedness amongst the parts of the vigorpains team. This would as-well cater accident for scent and forthcoming intercession, and in deviate anticipate childrens from escalating to an immitigefficacious say.

Nurses on the fend should resurvey the security and ease of Mrs Cheng after a suitableness the soothing offer, if any. Suitableness it is auspicious to enjoy a offer to see to the demands of Mrs Cheng, her security and wellsubstance must not be implicated.

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