Part 1 Analysis

1) Mrs. Smith’s basic needs: the physical, psychological, social, spiritual, cultural

There is a direct impact, which makes it impossible not to become her, and their lives intertwined when
Mrs. Smith’s threatening clinical condition along with her chronic obstructive pulmonary disease (COPD),
pneumonia, and diabetes touched her physical, cerebral, social, spiritual, and art- being. In order to
improve the quality of life both for patients and their significant others, the multidimensional needs of
cases should be met through palliative treatment (World Health Organization (WHO), 2020).

Physical Needs:

The infection and chest pain plagued Smith as his health declined. Inadequate management of the
following symptoms led to World Health Organization defined distress for her brevity of breath,
headache and wakefulness. The misfunctioning of the agony and the symptoms ruined her life. The
World Health Organization stated in the year 2020 that for treatment of needless suffering, the patient's
physical symptoms should be diagnosed and treated as early as possible, thereby effective palliative
treatment is only possible. Her method dependence on the ventilator, the nature of the disease would
not allow her to continue her diurnal conditioning, further minimizing her quality and autonomy. This
article highlights the requirement for more anticipatory process of symptom functioning for palliative
care (National Institute for Health and Care Excellence (NICE), 2019).

According to research be Kaasa et al, uncontrolled symptoms such as pain and dyspnea (shortness of
breath) are some of the most distressing aspects of life-limiting illnesses. (2018). In Mrs. Smith, her
headaches and dyspnea have not been treated, leading to a care gap. Timely identification of symptoms
accompanied by efforts to mitigate suffering is a core element of palliative care (Ferrell et al. 2017).

Psychological Needs:

The increasing anger and confusion and disorientation are telltale signs that her sickness is taking a
psychological toll. Mrs. Smith’s intubation which impaired her ability to communicate and her declining
cognitive state likely instilled fear, anxiety and a sense of helplessness. Her psychological unrest was
compounded by early conversations with her coding status and goals of care that she was not included
in, making it impossible to communicate her wants or make informed treatment choices. Psychological
support is a fundamental component of palliative care in helping patients cope with the psychological
ramifications of life-threatening diseases (NICE, 2019).

In palliative care, reducing psychological distress means creating a gentle environment free of moral
judgment, wherein patients feel cared for and validated (Chochinov et al., 2016). Clearer messaging and
more compassion from the healthcare team may have alleviated Mrs. Smith's distress and confusion. In
addition, discussing care goals earlier could have empowered her to make decisions that aligned with
her preferences and values (Sudore et al., 2017).

Social Need:

One of the reason would be the reality that Mrs. Smith, due to her illness, was hospitalized, then in
recuperation, and her general health was rapidly declining so social opportunities were limited due to
her condition. Despite her son and daughter-in-law visiting her each Saturday to ensure she was not
lonely, the clinical team did not communicate well and she was not prepared for the fact that she was
entering a terminal decline. This failure to coordinate likely added to Mrs. Smith's isolation and her
family's emotional burden. Social support is an essential aspect of palliative care as it assists patients
and their families in coping with the challenges of life-threatening diseases (Ministry of Health NZ, 2017).

A study by Gott et al. (2018), is an integral part of palliative care, and family involvement is paramount.
While they require assistance and honest communication from medical professionals, families often
become caregivers and advocates for their family members. Such clinical complexity can lead to only
some members of the family understanding Mrs. Smith’s condition and care plan, leaving Mrs. Smith’
family in the dark with apprehension—as seen in the previous example. According to Hudson et al.
(2017) Family meetings were held regularly, and explanations about the patient's prognosis and
available treatments were provided in detail.

4. Spiritual Needs:

The fear of missing Sunday Mass demonstrates Mrs. Smith's spiritual discomfort since religion carries
tremendous importance to her. The palliative care team failed to provide any spiritual care intervention
which might have provided her comfort during her illness period. Holistic care at Mrs. Smith's hospital
becomes inadequate because spiritual caregiving remains absent thus marking a major care gap for her.
Religion-based support for patients helps them discover purpose in their illness together with better life
quality (Puchalski et al., 2014).

Spiritual care in palliative settings requires healthcare providers to respect and endorse their patients'
personal values together with their beliefs. The nursing staff would have arranged either a chaplain
meeting or religious service engagement support for Mrs. Smith. The research study by Balboni et al.
(2017) demonstrates that providing spiritual care leads to improved patient outcomes which result in
diminished anxiety and lower sadness levels. Mrs. A spiritual elements in Mrs. Smith's treatment would
have enhanced her overall health according to principle.

[Link] Need:

The case study fails to specify Mrs. Smith's cultural background and therefore palliative care requires
evaluation of cultural elements. The care delivered to Mrs. Smith should have included traditional
customs and rituals from her culture if she maintained ties to any particular religious or cultural
community. There was no recognition of her cultural needs because she received no spiritual support
after her caregiver neglected to fulfill her religious needs. Patients receive culturally sensitive treatment
in palliative care because this approach ensures the preservation of their customs and values (Durie,
1994).

Traditionally in Māori culture the cultural demands may require practitioners to work with Māori
traditional healing practices while also engaging family involvement in healthcare choices. Pōtiki (2016)
demonstrates that Māori palliative care requires medical practitioners to value relationships and
hospitality in their approach according to Māori cultural practices. Treatment plans which incorporate
Māori cultural values need health practitioners to work together with their Māori patients and their
extended families to develop these plans.

b) Life-Threatening Illnesses' Impact on Whānau/Family

The illnesses affecting Mrs. Smith create critical family challenges which generate substantial social
issues combined with emotional and financial problems and psychological stressors. Within Māori
culture the wellness of a group stands paramount so these effects hold special importance within
whānau family bonds (Durie, 1994).

1. Emotional Challenges
Watching a loved one decline causes families to experience an array of emotions that includes
sadness and worrying and feelings of powerlessness. Minimum preparedness for Mrs. Smith's
serious illness condition led the family members to hold irrational optimism while experiencing
confusing emotional distress about her medical care. A vital component of palliative care for
families is emotional support according to Ministry of Health NZ (2017).
Those who care for family members typically experience anticipatory grieving through a
combination of sadness and anger as well as feelings of guilt (Stroebe et al., 2017). Mrs. Smith's
family members probably experienced painful emotional reactions because they failed to accept
her condition properly due to sustaining optimistic beliefs about recovery. Teams delivering
palliative care should provide counseling together with support services to families for managing
their emotional reactions.
2. Financial Issues:
The high hospitalization expenses alongside critical care treatments and medical procedures
cause major financial problems for families. Family members of Mrs. Smith felt distressed due to
the high hospitalization costs which illustrated the economic challenge linked to severe medical
conditions. Palliative care assessment must involve counseling and financial assistance to
minimize these burdens the family faces (NICE, 2019).
Research by Ghesquiere et al. (2015) demonstrates how families of people with end-of-life
conditions face economic problems. Families encountering financial stress because of caring for
a patient represent a common difficulty among other burdensome expenses and lost earning
potential. Mrs. Smith's hospital treatment represents a concern for her family regarding its
financial burden. The care of patients at the end of their lives would benefit from financial
guidance from palliative care professionals who also provide direct assistance to families facing
these challenges.
3. Social isolation
It occurs when care recipients dedicate their attention to their loved ones' needs instead of their
own. Mrs. The stress of Smith's family members might have been increased by a decrease in
social contacts and personal support networks. The Ministry of Health NZ (2017) states that
social support networks are crucial in palliative care because they provide families with the
essential management tools and support.
According to Gott et al. (2018) social isolation becomes prevalent for family caregivers who
deliver direct caregiving. The caretaking attention dedicated to Mrs. Smith likely prevented her
family from maintaining meaningful social connections. Palliative care services should provide
relative ease of access to community resources as well as support groups in order to maintain
family engagement.
4. Stress and Burnout:
Efforts to deal with both caregiver stress alongside burnout occur because of the duties of
caregiving in combination with financial pressures and emotional challenges. The complicated
 care needs of Mrs. Smith presumably caused caregiver exhaustion among her family members
especially her son and daughter-in-law.
Adelman et al. (2014) conducted research which showed that family caregivers experience
severe burnout together with substantial stress levels. Mrs. Smith's family members intensified
their worry because they were unaware of the health and care arrangements. Palliative care
services must provide caregiving families with counseling support together with temporary care
services to assist them manage their responsibilities.

Part 2: Critical Discussion

a) Effectiveness of Pain and Symptom Management for Mrs. Smith

Palliative care team members implemented an inappropriate therapeutic plan for treating Mrs. Smith's
ongoing pain along with her disturbing symptoms. Medical staff ignored her migraines and insomnia
together with shortness of breath which caused avoidable discomfort. Mrs. The therapy for Mrs. Smith
failed to start early enough and perform the proper assessments and treatments for proper symptom
management. Denoting the WHO (2020) that palliative care needs to prioritize symptom reduction along
with pain relief for achieving better patient life quality during treatment. Because the team failed to
address her physical discomfort her freedom as well as her quality of life faced potential risk.

Ferrell et al. (2017) examined research which demonstrates how a team of specialists delivers maximum
benefit to palliative care symptom treatment processes. Fast interventions combined with regular
assessments and team-based provider interventions become necessary at this point. Better proactive
symptom management would have decreased Mrs. Smith's pain along with improving her overall health
condition.

b) Health Professionals’ Role in Symptom Control

The delivery of complete symptom control requires the essential involvement of health experts. Practice-
oriented care includes psychological analysis as well as social and spiritual evaluation with physical
treatment methods. Healthcare professionals should use the following approach when treating Mrs.
Smith:

• Frequent evaluations of her pain and symptoms.

 Different expert teams worked together to fulfill her complex medical requirements.
 The communication focused mainly on the patient to uncover her individual preferences and
ambitions regarding care.

Professional health workers need to apply their skills for the development of treatment plans which
they then should evaluate and execute and monitor their symptom management results while
conducting necessary reassessments per NICE (2019). Such case requires proactivity alongside patient-
centered strategies in care delivery.

c) Emotional and Spiritual Healing in Palliative Care

Spiritual along with emotional healing stands as an essential element in palliative care delivery. Palliative
care professionals would have helped Mrs. Smith find psychological support to eliminate her anxiety and
fear. The nursing staff should connect her to Sunday Mass religious activities and establish appointments
with chaplains for spiritual care services. I should create an environment where family members could
freely share their emotions and concerns. The identification and treatment of spiritual needs enables
patients to discover purpose in life while experiencing their illness better according to Puchalski et al.
(2014). Palliative care needs to integrate spiritual healing practices along with emotional care services
because it provides complete assistance to patients and their families.

Part 3:

The Function of Medical Professionals in Māori Palliative Care

a) Attending to Māori People and Families

Health professionals must develop cultural sensitivity as a core requirement for providing
appropriate care to Māori people together with their extended relatives. Healthcare providers must
understand two fundamental things about Māori caregiving families. Medical professionals should
include Māori values such as manaakitanga(relationships) and whanaungatanga(hospitality), in their
care planning strategies. Provision of palliative care accessibility must be equal for Māori people.
According to Durie (1994) emphasizes that Māori patient care must include a cultural approach to
deliver the necessary support to Māori patients as well as their whānau members. To deliver
culturally suitable palliative care services health practitioners must work alongside Māori
communities.

b) Importance of Health Literacy and Communication

The Value of Health Communication and Literacy Provision of culturally safe palliative care demands
both health-related expertise and communication skills. Healthcare providers must to:

• The healthcare provider should explain diagnoses together with treatments along with available
care options through easy-to-understand terminology without using medical jargon.
• Help patient’s family members understand both their healthcare situation and planned
treatment approach.
• Every interaction should include respect toward Māori cultural customs and values.

The Ministry of Health NZ (2017) reveals that health literacy stands among the chief elements affecting
Māori health results. Māori patients and their whānau need clear and culturally acceptable
communication from health practitioners to inform their healthcare decisions.

c) Māori Beliefs and Traditions in Palliative Care

Traditional Māori customs along with beliefs deeply affect the practice of palliative care. Two vital
elements include wairua (spiritual dimension) and karakia (prayer). The idea of wairua (spirit) and the
significance of spiritual health. Spiritual customs combined with karakia (prayer) possess the ability to
comfort and heal those who follow them. It is mandatory to adhere to Māori customs as well as conduct
tangihanga funeral rites.

According to Pōtiki (2016) supports how Māori palliative care practice with Māori customs and beliefs
improves the quality of life for Māori patients as well as their whānau. Health practitioners need to work
with Māori communities to protect Māori customs which should be incorporated within care plans.
Conclusion

The story of Mrs. Smith demonstrates the necessity of delivering holistic palliative care that serves
medical and psychological as well as social and spiritual and cultural requirements of life-threatening
patients. A series of gaps in her care include poor symptom management and inadequate pain control
together with insufficient communication between medical staff and her family along with a total lack of
consideration for her mental and spiritual needs. The inadequate care at Memorial Hospital deteriorated
the patient's quality of life and left her household feeling unversed alongside sad when facing her
declining health condition.

The medical problems faced by Mrs. Smith illustrate how serious illnesses affect patients together with
their relatives. The combination of financial troubles with social estrangement and caregiver mental
strain affects families in their coping with threatening illnesses. Thorough palliative care requires
reaching beyond patient care because it must support families in their entirety while providing
knowledge and strengthening while offering complete assistance.

To provide quality healthcare Māori people and their families require culturally appropriate services.
Health practitioners should recognize and respect Māori cultural traditions through their practices
including manaakitanga values of hospitality and whanaungatanga relationships. Health practitioners
should focus strongly on superior cultural safety and health literacy and clear communication to ensure
fair compassionate care for Māori patients alongside their families.

In Conclusion,Palliative care maintains patient control through preserving self-reliance together with
dignity and life quality while supporting families completely. Symptom therapy alone does not represent
the core objective of this approach. The delivery of physical alongside emotional and social and spiritual
and cultural care through patient-led proactive methods enables healthcare professionals to fulfill this
objective. Palliative care reaches its purpose of quality life improvement for terminally ill patients
through holistic support for both patients and their families.

References

1. World Health Organization. (2020). Palliative Care. Retrieved from [Link]

room/fact-sheets/detail/palliative-care

 This WHO fact sheet provides a comprehensive overview of palliative care, including its
definition, principles, and global importance.

2. Ministry of Health NZ. (2017). Palliative Care and End of Life Care Plan. Retrieved
from [Link]

 This document outlines New Zealand’s strategy for improving palliative care services, with a
focus on equity and cultural responsiveness.

3. Durie, M. (1994). Whāiaora: Māori Health Development. Oxford University Press.

 This book explores Māori health models and the importance of cultural values in healthcare. For
more information, visit Massey University’s profile on Māori health.

4. Pōtiki, T. (2016). Māori Perspectives on Palliative Care. Journal of Indigenous Wellbeing, 1(2), 45-
52. Retrieved from [Link]
• This article discusses Māori perspectives on palliative care, emphasizing the importance of
cultural practices and whānau involvement.

5. National Institute for Health and Care Excellence (NICE). (2019). Palliative Care for Adults: Strong
Opioids for Pain Relief. Retrieved from [Link]

• This NICE guideline provides evidence-based recommendations for managing pain in palliative
care.

6. Puchalski, C., Vitillo, R., Hull, S., & Reller, N. (2014). Improving the Spiritual Dimension of Whole
Person Care: Reaching National and International Consensus. Journal of Palliative Medicine,
17(6), 642-656. Retrieved from [Link]

• This article highlights the importance of spiritual care in palliative care and provides a framework
for integrating it into practice.

7. Ferrell, B., Twaddle, M., Melnick, A., & Meier, D. (2017). National Consensus Project Clinical
Practice Guidelines for Quality Palliative Care. Journal of Palliative Medicine, 20(12), 1301-1305.
Retrieved from [Link]

• These guidelines provide a comprehensive framework for delivering high-quality palliative care.

8. Chochinov, H. M., Kristjanson, L. J., Breitbart, W., & McClement, S. (2016). Effect of Dignity
Therapy on Distress and End-of-Life Experience in Terminally Ill Patients: A Randomised
Controlled Trial. The Lancet Oncology, 12(8), 753-762. Retrieved
from [Link]

• This study examines the impact of dignity therapy on psychological distress in terminally ill
patients.

9. Sudore, R. L., Lum, H. D., You, J. J., & Hanson, L. C. (2017). Defining Advance Care Planning for
Adults: A Consensus Definition from a Multidisciplinary Delphi Panel. Journal of Pain and
Symptom Management, 53(5), 821-832. Retrieved
from [Link]

• This article provides a consensus definition of advance care planning and its importance in
palliative care.

10. Balboni, T. A., Balboni, M., Enzinger, A. C., & Gallivan, K. (2017). Provision of Spiritual Support to
Patients with Advanced Cancer by Religious Communities and Associations with Medical Care at
the End of Life. JAMA Internal Medicine, 173(12), 1109-1117. Retrieved
from [Link]

 This study explores the role of spiritual support in improving end-of-life care for patients with
advanced cancer.

11. Kaasa, S., Loge, J. H., Aapro, M., Albreht, T., & Anderson, R. (2018). Integration of Oncology and
Palliative Care: A Lancet Oncology Commission. The Lancet Oncology, 19(11), e588-e653.
Retrieved from [Link]
fulltext
 This commission report highlights the importance of integrating palliative care into oncology
practice.

12. Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning Health-Care Professionals: Bereaved
Persons Are Misguided Through the Stages of Grief. OMEGA - Journal of Death and Dying, 74(4),
455-473. Retrieved from [Link]

 This article discusses the complexities of grief and the need for tailored support for bereaved
individuals.

13. Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014). Caregiver Burden: A
Clinical Review. JAMA, 311(10), 1052-1060. Retrieved
from [Link]

 This review examines the burden experienced by caregivers and strategies to support them.

14. Ghesquiere, A., Haidar, Y. M., & Shear, M. K. (2015). Bereavement and Mental Health: The Role
of Social Support. Journal of Social Work in End-of-Life & Palliative Care, 11(3-4), 281-293.
Retrieved from [Link]

 This article explores the role of social support in mitigating the mental health impacts of
bereavement.

15. Hudson, P., Trauer, T., Kelly, B., & O’Connor, M. (2017). Improving Support for Family Caregivers
of People with a Life-Threatening Illness: A Systematic Review of Interventions. Palliative
Medicine, 31(5), 394-405. Retrieved
from [Link]