SOCIAL DOMAIN

1. Patient currently staying with her son, daughter-in-law and 2 grandsons in a low cost
single storey house.
2. Patient’s daughter-in-law took care of her by:
i. Milk-feeding (Nutren Diabetik) every 3 hours per day
ii. Wipe her body with wet cloth twice per day
iii. Change her diapers whenever necessarily (>3)
iv. Change her lying position every 2 hourly
v. Wound dressing for her bedsore once in every 2 days
vi. Change nasogastric feeding tube once in every 2 weeks
3. Patient’s sister took care of her by:
i. Milk-feeding (Nutren Diabetik) every 3 hours per day
ii. Change her diapers whenever necessarily (>3)
iii. Change her lying position every 2 hourly
iv. Accompany patient when her daughter-in-law went to pick up her grandson
from the school
v. Help to prepare dinner sometimes
vi. Emotionally support the patient and her daughter-in-law

SPIRITUAL DOMAIN
1. Patient is a Buddhist, but not religious.
2. Patient daughter-in-law is a Christian, she encouraged her to belief in Jesus Christ and
even invited the priest to pray for her suffering, but she refused.

FINANCIAL DOMAIN
1. Family income depends on her only son, who works in a printing company.
2. Family income is around RM1000 per month.
3. Patient has her own savings since she was young that can used to cover her medical
expenses around RM1000.
4. Patient bought the low cost single storey house using her own income when she was
young and still working in the factory.
5. Previously, they had applied for government welfare but were not approved as her son’s
monthly income exceeds RM700.
 6. Non-government organizations cancer association provides milk powder and pampers
for them.

ENVIRONMENTAL DOMAIN

Patient is staying in Jalan Teku ( Sibu) with her son's family. They are staying in a low cost single storey
house. The living condition of the house is quite poor. The place is quite dirty and the house is not
maintained well. There is a small living room, three rooms in the house and a bathroom. Patient is in
the last room near the kitchen. The kitchen is not tidy and the whole house is stuffy and hot. The room
is small. All of her medications and milk are kept in the room. Patient is lying on a thin hard mattress.
The ventilation of the room is average. There is one stand fan in the room. The place is quite stuffy and
hot. Thus, her daughter in law will make sure the room door is always open.

They have one motorcycle. Patient’s family couldn’t afford to buy a car. But after the patient is sick, it’s
difficult to bring her to hospital, thus her in law family gave them an old car.

Patient’s family found it hard to bring the patient to hospital and the daughter in law couldn’t rely on
any of their neighbours. According to her, the neighbours are not friendly and none of them visit them.

LEGAL

Not relevant in this case

GENERAL FEARS AND CONCERN OF FAMILY MEMBERS

When spoke to family members, we could detects some of the fears shown by them such as;

 Emotional strained
 Physical demand
 Uncertainty
 Fear of patient dying
 Altered roles in lifestyle
 Finances
 Ways to comfort the patient
 Perceived inadequacy of services
 Existential concern

RECOMMENDED PALLIATIVE PLAN

Aims:
 To improve quality of care provided for patient
 To lessen the suffering on the patient
 To lessen the burden of family members
  To secure patient sense of dignity and respect her wish
 To ensure patient is able to rest in peace
 Ensure patient hydration status and diet is balanced
 Alternate food can be given in blended form
 Continue hypertension and diabetes medication
 Improve ventilation of the room
 Ensure good hygiene by frequent changing of diapers and cleaning body with wet towel

Care for the bedsore

 Education for the caregivers on management and assessment of bedsore
 Frequent repositioning and weight support for better distribution of pressure
 Change to alpha bed or air mattress inflator
 Careful assessment for early evolving wound and must be done for daily basis
 Local wound care which consist of absorbent dressing, local and systemic infection control with
oral antibiotics.

Others

 Frequent massage to improve blood circulation and to prevent muscle atrophy

 Applied compression stocking or placed a pillow under patient legs and keep her legs above
heart level to prevent Deep Vein Thrombosis
 During feeding ensure patient back rest at least 30 degrees and remain in the position for at
least 1 hour after feeding is completed to prevent aspiration pneumonia
 Changing of Nasogastric tube once every two weeks to prevent infection
 To encourage patient to hold strong to religion and pray
 Recommend frequent visit and communication between patient and family members
 Counselling and encouragement for family members
 Frequent home visit by the palliative care nursing
 Financially support from welfare
 Provide opportunities for family caregivers to express their emotion through individual or group
support away from the patient
 Provide information regarding what to expect with the actual death event

MEDICAL PERSONNEL STRESS

The relative youth and high proportions of females among palliative physicians compared with
consultants in other specialties increase their risk of burnout.

Health care professionals working in acute hospital based specialties, in which the aims of treatment are
to cure disease and prolong life, may experience the sense of failure with such patients through having
nothing more to offer them.

CONCLUSION
Palliative care is a multidisciplinary specialty focused on improving the quality of life of patients with
serious illness and their families. Patient centered rather than disease focused .Provides relief from pain
and other distressing symptoms. Prevent and relieve sufferings imposed by disease and their treatment,
achievement of best possible quality of life for patients and their families regardless of the stage of the
disease or need for other therapies.