Introduction
Health promotion and support of patients are the two goals of nurses. In the majority of cases, not only patients but also their families are in need of explanations about how to cope with disease-related stress. In the case under analysis, Ali is a 65-year-old man with chronic living disease who, following his religious beliefs, decides to stop dialysis after the second kidney transplant has failed. His family, including a wife and three children, is supportive and agrees with such a decision to remain at home and wait for his eventual death.
The patient is worried about the necessity of his family to observe the deterioration of health; thus, the role of a nursing associate cannot be ignored. In this paper, the discussion of chronic disease and anticipatory grief as the main health and wellbeing issues will be developed to underline the worth of non-judgmental care and communication.
Health and Wellbeing Issues
An understanding of health and wellbeing concepts is significantly challenged when nurses work with patients who know that they could eventually die. According to Naidoo and Wills (2016), health is not only the absence of disease but also a state of physical, mental, and social wellbeing. In Ali’s case, chronic kidney disease influences the quality of his life during the last 20 years.
Now, kidney transplantation and dialysis are not options, and his refusal of further treatment signalises about a high possibility of the condition to be worsened with time. In European countries, the rates of chronic kidney disease have been decreased (Naidoo and Wills, 2016). People get access to supportive treatment and operative interventions to stabilise health and prolong life.
However, there are also communities where religious beliefs play a crucial role. As it is observed in Ali’s family, Muslims believe that illnesses should be regarded as tests from Allah. According to their faith, death is not the end of life, but a transformation of a spirit and salvation, and chronic disease is not a threat but a challenge.
Being one of the critical public health issues, chronic kidney disease affects the lives of millions of people around the globe. Local governments and healthcare facilities focus on the development of cost-effective treatments and practices to support patients and their families, including detection programs, dialysis, and referral guidelines (Neuen et al., 2017).
Still, when a person rejects help because of religious beliefs, no judgments or personal opinions can be given. To be chronically ill means to be ready for regular checkups and evaluations. Not many Muslims find it appropriate to neglect their religion to promote health, and chronic kidney disease may become a serious problem in future.
Another wellbeing issue of this case is anticipatory grief among family members. This type of grief is based on the fact that everyone knows that Ali’s disease damages his health, and his death is coming. The feeling that a family will lose a father in the nearest future may result in a variety of emotional traumas and mental health disorders. Ali demonstrates his worries about the necessity to support and prepare his family. However, the outcomes of such a loss are hard to predict, which makes grief a significant health and wellbeing issue.
Impact of Issues
Both issues affect the patient and his family in several ways. On the one hand, the progress of kidney disease is usually associated with changes in blood pressure, anaemia, weakness, and poor nutritional health (Bello et al., 2017). An individual may be unprepared for health complications, the development of which can be slow, as well as fast. Nurses witness how even the bravest patients who understand the inevitability of their death react differently to the moment when the end actually comes (Anderson, Kent and Owens, 2015).
Kidney disease complications depend on personal characteristics and the presence of other health problems. Anticipatory grief, in its turn, may be regarded as a natural human reaction or a psychiatric disorder (Archer as cited in Gross and Kinnison, 2013). Therefore, emotional changes and behavioural concerns are also expected outcomes of the health and wellbeing issues identified in this paper. A patient or family members can start grieving before the actual death, and that is why the role of nurses and the choice of treatment approaches should promote wellbeing.
Approaches to Assess a Person’s Health
Regarding the situation that is discussed in this case, physical aspects of the patient’s health should not be taken into consideration. Ali is aware of his condition and understands that he would die soon. To promote health, a nurse must focus on emotional and social wellbeing and provide all possible patient-centred services. For example, patient-centred listening and patient-centred communication are the components of psychological care that should be offered to Ali and his family.
Following the main principles of the humanistic approach, people can be driven by various forces, either under or beyond their control (Gross and Kinnison, 2013). Rogers (as cited in Gross and Kinnison, 2013) offered a counselling strategy for nurses to work with patients who cannot improve their health with pharmacological treatments. If a nurse and a patient carry different values, it is a responsibility of a nurse to respect preferences, even if it is hard to agree with this decision. Counselling and communication should not be judgmental or biased because the goal is not to stabilise the condition but to help the family accept the truth.
In addition to the humanistic approach, the Kübler-Ross theory of anticipatory grief needs to be followed. There are five stages of how people understand grief: denial, anger, bargaining, depression, and acceptance (Gross and Kinnison, 2013). Ali’s family should be ready to take all these steps, and the role of a nurse or a nursing associate is to assist and support. It is normal to be angry or ask questions about faith and destiny. With time, new concerns emerge, and new feelings overwhelm the family.
A person’s wellbeing is not only physical health but also emotional stability, and it is necessary not to miss the period when grief turns from a reaction to a disorder. There are many local services and special meetings where people discuss death, its causes, and outcomes. As soon as Ali lives, his family has to be nearby, talk to each other, and cherish the moments they have. However, attention and care should not be obsessive, and nurses may recommend combining different activities.
Conclusion
The role of a nursing associate and any nurse in a family where one of the members is going to die is to support, monitor changes, and become a bridge between healthcare providers and patients. When religious or personal preferences make a patient quit treatment and wait for death, no prejudices or judgments are appropriate.
Instead of thinking of what could be made in the past or in the future to predict the failure, a nurse should think about what can be offered in the present. Following the humanistic approach, active listening strategies, and theories, death due to chronic disease may be understood and accepted with time.
Reference List
Anderson, N. E., Kent, B. and Owens, R. G. (2015) ‘Experiencing patient death in clinical practice: nurses’ recollections of their earliest memorable patient death’, International Journal of Nursing Studies, 52(3), pp. 695-704.
Bello, A.K., et al. (2017) ‘Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action’, Kidney International Supplements, 7(2), pp.122-129.
Gross, R. and Kinnison, N. (2013) Psychology for nurses and allied health professionals. London: Routledge.
Naidoo, J. and Wills, J. (2016) Foundations for health promotion. 4th edn. London: Elsevier.
Neuen, B. L., et al. (2017) ‘Chronic kidney disease and the global NCDs agenda’, BMJ Global Health, 2(2). Web.