Chinese Experiencing End-of-life Care

Introduction

The Newman Systems Model has become important in carrying out palliative care. Through analysis of the main features of the model, successful nursing interventions have been carried out, which have resulted in better management of nursing care processes. This study will evaluate how Newman Systems Model applies in China’s nursing care situation.

Case Study

Wu Jintao family is made of four members; Sheng Yu, who is Jintao’s wife; and their two children, namely Wuoy and Xu. Jintao is aged 65 years and has been incapacitated with terminal lung cancer for some time now. His wife, Sheng Yu, had depression problems but she has been undergoing treatment and rehabilitation, thus improving his situation. The two children, Wuoy and Xu, aged 21 and 18 years respectively have relatively good health. Jintao’s family members are firm believers of principles of Buddhism religion, which centers on Four Noble Truths – all beings suffer; suffering is product of desire; to end suffering one has to end desire; and to cease desire is to possess eightfold of paths largely concerning human behavior and approach to life (Matzo and Sherman, 2009). In most cases, Jintao’s family is visited by extended family members and close relatives, especially after Jintao’s health situation became of concern. However, as usual, his health situation is never discussed in his presence and even the medical condition has never been disclosed to him after the family instructed the doctor not to do so. This is because the family remains in conformance with the family aspects of Chinese culture and does not want to bring shame to the family.

After being admitted to the hospital for some time, Jintao made a request to be taken back home where he continue to receive traditional medicine, which in most cases is in the form of herbs, amulets, acupuncture, moxibustion, and many more. From observation, one detects that Jintao’s situation continues to deteriorate, which is life-threatening; however, he remains somehow composed and he reluctantly complains about how he feels. Moreover, family members and relatives have totally refrained from discussing end-of-life issues related to Jintao, as they continue to provide care to him.

Palliative Care in China Context

Medicine, ailing, death, and dying are four components that cannot be divorced from China’s culture, and in greater sense, they have become part of the treatment and disease management process (Boog and Tester, 2008). In China, illness and death, as postulated in Buddhism principles, are natural parts of life. Moreover, health is largely regarded to constitute processes of finding harmony with various internal and external components of the patient (Matzo and Sherman, 2009). Therefore, it is always important for registered nurses to perfectly understand this vital aspect about China when administering end-of-life nursing care in China. These aspects, plus the impact on this family in the case study, will be addressed using the Neuman Systems Model about the four meta-paradigm concepts of person, environment, health, and nursing.

Neuman Systems Model and End-Of-Life Care

Holistic and comprehensive palliative care is the bedrock of the Neuman Systems Model (Parker and National League of Nursing, 1990). The model addresses four meta-paradigms of person, environment, health, and nursing (Parker and National League of Nursing, 1990) about patient situation. The person is identified as the first meta-paradigm, in which case it may constitute an individual, family, relatives, or the community (Parker and National League of Nursing, 1990). Moreover, the person is viewed to constitute an open system that continuously interacts with the environment. In this way, a person can be seen to be client system and possess five variables; physiological, psychological, sociocultural, developmental, and spiritual that in most cases has to be addressed (Parker and National League of Nursing, 1990). The case study presented above involves a family of four members: Jintao, the father; Yu, the mother; and Wuoy and Xu, their children. In addition, there are relatives and close members in this family who pay regular visits.

Physiologically, Jintao suffers from lung cancer that has made him incapacitated in almost all life endeavors. Some of the physiological symptoms portrayed by Jintao include coughing blood, chest pain, and shortness of breath. An immediate action is required. When working as a registered nurse, the first step is to understand the ‘save face’, denial, and secrecy culture of China. As a result, I will invite members of the family to privately discuss the deteriorating conditions of Jintao. Open discussion and communication will be the method to convince members that Jintao needs hospice medication and care as far as traditional medicine may be concerned. Emphasis will be on the procedure of seeking specialized treatment, which should be carried out only with family knowledge and in privacy.

Intra-stressors, inter-stressors, and extra-stressors can be identified in this case study. Jintao’s age and incapacitated situation constitute major intra-stressors, together with their inability to carry and perform his daily activities. Inter-stressors are accelerated by the fact that his wife Yu has been depressed for a long time and is not yet stable. Extra-stressors originate from the way the larger society expresses stigma to those affected by terminal disease, which forces them to remain silent. All these aspects combine to make the psychological wellbeing of the family unstable, and this can be witnessed in increased fear, anger, anxiety, reluctance to complain, and withdrawal. As a result, psychological instability may affect the physiological functionality of the patient. Basically, the primary step will be to dispel fear and anxiety, which I will achieve through creating open therapeutic communication, empowerment, and expression of love and compassion, and advising members on the best way lung cancer can be managed (Perrin, Sheehan, Potter and Kazanowski, 2011, p.31). Continuous visitation, encouragement, and motivation of members through success stories of lung cancer patients will be appropriate to deal with psychological trauma members may have.

Socio-cultural aspects of the family can be seen to emphasize care for the patient, and opting not to discuss the patient situation. Moreover, the family has numerous relatives with whom they share time. However, the decision-making process is complex, as senior members have to make such decisions. As a way to address this, emphasis on integrating relatives in the process of care, encouragement, and family counseling will be the top priority. Spirituality is another aspect that the family continues to receive through being members of Buddhism. During this time, Buddhism teachings will be necessary, especially concerning life and suffering (Perrin, Sheehan, Potter, and Kazanowski). Family members will be guided on how to appreciate life opportunities and why Jintao is still alive. Such teachings will prepare the family to experience less pain in case Jintao dies. Overall, the family’s belief system will be critical in contributing to the adjustment process of nursing care. Developmentally, Jintao’s children have been affected by their father and mother’s conditions, which have largely affected them. Therefore, another step will be made to conduct therapeutic counseling in order for them to come into terms with the situation.

Environment is another meta-paradigm Newman postulate to be important. Jintao’s family essence of environment is complex and is characterized by the internal aspect of the disease and external aspect represented by culture. Environment exchange operates to influence the client system and as a result, both positive and negative aspects of the culture will be evaluated about their potential or actual outcome to the wider client system (Parker and National League of Nursing, 1990). Another meta-paradigm is health, which can be seen to involve the wellness of the family. Moreover, health functions as continuum and full open system, as it interacts with the environment and when death occurs, the system is closed. As a result, it can be seen that health of Jintao’s family has been compromised by interaction with environment, specifically reluctance to seek hospice medical care. Therefore, the aspects of culture should be addressed, and an integrative model of collaborative therapeutic and educative communication be developed to rectify the existing situation.

Nursing, constitute another meta-paradigm, which essentially operates to ensure a positive outcome for the client system is realized. As a result, the nursing process to be adopted is one that reflects and encourages holistic and comprehensiveness. In this sphere, Jintao’s health situation will be addressed through physiological, psychological, spiritual, socio-economic, and developmental positive functioning. This nursing process will be enriched by encompassing assessment, diagnosis, planning, implementation, and evaluation aspects (Reed, 1993). The overall aim will be to create an optimum and stable adjustment process for end-of-life care.

To help a client system retain, attain, and maintain optimum stability, interventions aimed at each will be vital. As a result, primary, secondary, and tertiary interventions will be incorporated. Primary intervention will include assessing and recommending hospice care for Jintao, through cooperative discussion and brainstorming with family members. The secondary intervention will involve helping Jintao and the family to cope with the situation through therapeutic communication and counseling processes. The tertiary intervention will involve addressing some of the cultural stressors as well as how sustainable they can be incorporated in the palliative care of Jintao. Members and relatives will be educated on how well to participate in the care of Jintao. Lastly, preparing family and relatives psychologically through pain and loss management will be carried out.

Conclusion

The palliative care process in China’s context requires an understanding of the culture of the patient and the wider internal and external environment. More important is the need to apply Newman System Model holistically and comprehensively. At the same time, the entire process of nursing becomes successful through encompassing assessment, diagnosis, planning, implementation, and evaluation aspects in the entire process

References

Boog, K. M., & Tester, C. Y. (2008). Palliative care: a practical guide for the health professional: finding meaning and purpose in life and death. London: Elsevier Health Sciences.

Matzo, M., & Sherman, D. W. (2009). Palliative care nursing: quality care to the end of life. NY: Springer Publishing Company.

Parker, M. E., & National League of Nursing. (1990). Nursing theories in practice. PA: Jones & Bartlett Learning.

Perrin, K. O., Sheehan, C. A., Potter, M., & Kazanowski, M. K. (2011). Palliative care nursing: Caring for suffering patients. PA: Jones & Bartlett Publishers.

Reed, K. S. (1993). Betty Neuman: the Neuman systems model. NY: SAGE Publishers.