Spirituality and Sexuality in Palliative Care

Spirituality and Sexuality in Palliative Care Anjum zahoor Significance of spirituality and sexuality in palliative care According to WHO (2012) â€Å"Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual†. The aim of palliative care is to provide comfort care and support system at end of life, to relieve suffering and cope with problem associated with life changes due to illness. Literature also supported that Palliative care does not depend on prognosis, as the life is at end stage, or cure the disease. But it focuses primarily on anticipating, preventing, diagnosing, and treating symptoms experienced by patients with a serious or life-threatening illness and helping patients and their families make medically important decisions. During my palliative course clinical I encountered with 80 year old male patient admitted with complain of drowsiness, hiccups and upper GI bleed. At Aku he was treated as aspiration pneumonia. During history taking patient stated that, from two days I was feeling weak and unable to move myself. After investigations, reports revealed that he was suffering from bilateral brain atrophy, subdural hygromas and Pleural effusion in left lung. In Four days clinical I observed that his son took care of his father, reciting holy Quran and sprinkle holy water on his face. When I assessed patient’s spiritual Domain, his son verbalized that before hospitalization he was very punctual in his rituals, offered prayers. Due to hospitalization he was unable to perform his rituals. During care when I asked about patient’s memorable day he stated that my memorable day is when me and my wife went to America to meet my daughter .we enjoyed a lot, visited the entire beautiful place and spend good time with my family. Suddenly patient stop conversation and cried. I shocked for a while, elaborating further he mention that he lost his wife. I felt very sad. The moment is very emotional, and my eyes are full of tears. I felt like crying. I felt the pain he was going through from which he can get relief after peace full death. I was very sorry for the absence of his family members, during his last movement who can give at least moral support for him. As a nursing student my responsibility is to provide holistic care to the patient and his family. During care I identified several affected domains, like physical (pain in leg and stomach, drowsiness), psycho-social (death of wife), spiritual (religious), and many others. Here all domains of palliative care are interlinked to each other but I focused on two affected domains: spiritual and sexual. This paper is about issues, intervention, recommendations regarding spirituality and sexuality. I would like to discuss the highlighted domain which was spirituality. Many patients find changes in their spirituality when they are at end of life. Some patients get very closer to God, offer their rituals and find religion as a coping mechanism to enhance their well-being. While some people get confused and stack in spiritual conflicts, blaming God for illness and denied from happening as result they separate themselves from supreme-power. Similar is the case with my patient, because of his illness his religious practice was greatly altered. As patient was CBR and has pain in his leg and right hand. He used to offer regular rituals prior, to his illness and now he is upset as he is unable to do. But he is very satisfied with his God’s blessing. He says that â€Å"God gave me everything, fulfill my wishes, and I am very happy with my life. But now he considers himself unkempt bec ause of urine bag, NG tube. I encouraged patient and his family to reconnect with God. Sulmasy, D. P. (2006). Stated that â€Å"spirituality play a vital role in a person’s coping style. It can also provide a network of social support that promote and to maintain emotional and psychological wellbeing†. As a nurse when I assess patients need, he verbalized that he wants to offer prayers. At that time I provide table covered with clean white clothes, so that patient put his tasbii on it and offer his prayer. Due to his physical illness he does not able to stand so, I encourage patient to offer ritual on his bed and I assist him with physical limitation. I curtain patients bed provided privacy and encouraged patient’s family to recite holy Quran near bed side, and assist to show the direction of kiblah. During feeding his son requested me to give holy water I give. The family really appreciates me and my effect comes fruitful. It makes me so happy and proud. Other highlighted domain was sexuality. Sexuality is fundamental desire for all human being. According to WHO as cited in (Tierney,D.K. (2008). â€Å"Sexuality is the combination of physical, emotional, intellectual, and social aspects of sexual beings in positive ways to enrich and enhance personality, communication, and love†. Most of the health care professionals are hesitant in asking about these issues. Health care provider always address physical, social, psychological domain and many times they neglect the domain of sexuality in their care. As a palliative care nurse it’s my responsibility to provide holistic care to patients so it’s important to discuss the impact of their illness on sexuality. Sexuality is not only about intercourse or not refer to just a physical act but it means identity, gender roles and orientations, libido, pleasure, and attachment. It is experienced and may be expressed through thoughts and feelings and love. It doesn’t matt er patient is so aged, weak or drowsy, but we have to assess patient sexual component. According to Julie (2004) sexuality is a lifelong natural need that is not limited by age, physical appearance, health status, or functional abilities. Referring to my patient’s sexual domain. No doubt patient’s wife is no more, he feel alone and misses his wife, he seems weak or aged but we have to assess patient’s sexual need, his feeling toward it. May be patient wants to meet his daughter share his feeling and emotion with her, gave any advice to them. As a nurse it is not necessary that I help patient to meet with his wife to fulfill his sexual desire, it doesn’t mean that. Delivering physical care also come in sexuality. Moreover, during our palliative course theory session, one of our faculties told us that physical appearance also comes under component of sexuality. If a person is looking well, his self-esteem also improves, while if a person is unkempt, his sel f-esteem declines which ultimately affects patient’s sexuality too. I give fully attention to my patient in care, I give mouth care, bedding, encourage to change clothes. Encourage patient’s family to share his feeling with him. Now a day Palliative care nursing is a very new and fruitful concept. It is started in our country but on a very slow moving and special effort is needed to build up this field. Moreover at organization level we have to work on it. Awareness session, programs are required. So we should conduct session with collaboration of other institution to come close to holistic care during last moment of live. As a student nurse it is our responsibility to assess all domain of palliative care. I would like to share a model that would further enhance our capabilities to understand the qualities of nurses that would help the nurses to play an effective role in palliative care. The model I am discussing isThe Nursing Role Effectiveness Model.This model focuses on the nursing variables such as education and working experience that had a direct impact on patients effective palliative care. If a nurse is well aware and educated about the technical ways of communication with a dying patient, so she can ease his suffering in an effectual manner (Lange, Thom Kline, 2008). Furthermore, health care team should have knowledge about spirituality so that they can identify and fulfill the need of patients by providing them holistic care. It is also recommended that there should be a separate room for patient and family, where they can peace fully performed their rituals. There should a system in hospital policy that provides a spiritual leader. For sexuality it is necessary that nurse should perform a profound sexual assessment and build a therapeutic relationship. It would allow the client to comfortably verbalize his feelings. Moreover, if his family would be there so we would encourage them to spend time with the patient, hug him, kiss him or be intimate with him. Hereother ways of conveying intimacy. Legg, M. (2013). In conclusion, palliative nursing care plays a vital role in terminally ill patients and family to enhance their wellbeing. It is very important component of holistic care and we nurses also play very crucial role in improving condition of patients, providing moral support, which include social, sexual, spiritual emotional and psychological domain. By end of two week of clinical I realized that how much palliative course is important to enhanced or support for patient. In future I will tried my best to help them ,provide a moral care .i used this knowledge in to practice in my community to promote this course. REFERENCE Baldacchino, D.R. (2011). Teaching On Spiritual Care: The perceived impact on qualified nurses. Nurse Education in practice, 11, 47-53. Julie,M. (2004). Sexuality at the end of life.American Journal of Hospice Palliative Care,21. Lange, M., Thom, B., Kline, N. (2008). Assessing Nurses Attitudes toward Death and Caring for Dying Patients in a Comprehensive Cancer Center.Oncology Nursing Forum,35(6), 955-959. doi:10.1188/08.onf.955-959 Legg, M. (2013). What is psychosocial care and how can nurses better provide it to adult oncology patients.Australian Journal of Advance Nursing, 28(3), pp.1-13.. Olasinde, T. A. (2012). Religious and Cultural Issues surrounding Death and Bereavement in Nigeria.Online Journal of African Affairs,1(1), 1-3 Tierney,D.K.(2008). Sexuality: A Quality-of-Life Issue for Cancer Survivors.Seminars in Oncology Nursing,24(2), 71-79. doi:10.1016/j.soncn.2008.02.001 Sulmasy, D. P. (2006). Spiritual Issues in the Care of Dying Patients: â€Å" Its Okay Between Me and God†. Jama, 296(11), 1385-1392. World Health Organization. (2012). WHO definition of palliative care nursing.

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IntroductionIn step with Pakistan economic Survey 2014-15, the extent of change between Pakistan and China has accelerated to $16 billion. China's exports to Pakistan expanded by using ten percentage all through the five years from 2009- 10 to 2014-15.As a end result, China's share in Pakistan's total exports has progressively picked up from four percent in 2009-10 to 9 percentage at some stage in the financial yr 2014-15. The maximum recent milestone completed in this bilateral relationship is the signing of Memorandum of knowledge on the construction of China-Pakistan monetary corridor (CPEC). CPEC is a 3,218 kilometer long path, to be constructed over next numerous years, together with highways, railways and pipelines. The actual anticipated fee of the assignment is predicted to be US$seventy five billion, out of which US$45 billion plus will make certain that the corridor becomes operational by way of 2020. The last funding might be spent on electricity era and infrastructure development. The plenty advertised US$45 billion China-Pakistan financial corridor will skip through the lovely GilgitBaltistan province in the north in an effort to connect Kashgar in China's western province Xinjiang to relaxation of the world thru chinese-operated Gwadar port in the country's south. This mega undertaking is predicted to take the bilateral dating among Pakistan and China to new heights, it's a starting of a adventure which hopes to convert the economic system and help bridge Pakistan's strength shortfall.Present day scenario:According to the Board of funding (BOI), overseas Direct investment (FDI) inflows into Pakistan have multiplied by 74% all through the primary 4 months of the contemporary financial year. Those FDI inflow turned recorded should be $277. 7 million in the month of october Furthermore a significant and only this financing has fallen starting with china done type from claiming China-Pakistan monetary H (CPEC). Out of these parent the power sector were given lion's proportion of FDI, observed via production, financial offerings and communications area. ISLAMABAD: foreign direct investment (FDI) inflows into Pakistan have registered a splendid growth of 74 consistent with cent throughout first 4 months of the contemporary economic 12 months, chiefly because of CPEC, in step with Pakistan Board of investment (BOI). A BOI announcement issued on Thursday found out that Pakistan acquired FDI of $939.7 million up to now in July-Oct 2017-18 that represents a seventy four. Four according to cent boom whilst compared to the inflows recorded in the course of the equal period of the preceding year. Within the month of October 2017, FDI inflows become recorded to be $277.7 million, more than double of the FDI of $one hundred fifteen. Three million in the equal month ultimate 12 months.In keeping with BOI, China becomes the leading investor united states with $631.7 million, up 224.6% from the identical duration in the monetary 2016-17. Chinese language companies invested huge component in their budget in power and infrastructure tasks below China-Pakistan monetary hall (CPEC).The net influx of FDI from Malaysia stood at $107 million in July-Oct FY18, towards $9.four million throughout the same period last year. French buyers accounted for $38.0 million in FDI during the period beneath evaluation. Power zone received the lion's proportion of overseas budget, observed by way of production, financial offerings and communications sector. The inflow of direct investment within the strength area became increased by using a hundred twenty five.4% to $422.4 million in the 4 months of FY18. Those change range fetched $177. 0 million Previously, FDI, contrasted with $31. 4 million a 12 months prior.Telecommunications bounced back as compared to closing yr after inflow of FDI accelerated to $sixty four.9 million opposite to an outflow of $38.three million for the duration of the same period in FY17. The finance region and oil ; gasoline exploration sectors acquired $76.three million and $fifty seven.9 million respectively, at some stage in the 4 months of this monetary year.Brighter FDI prospects are predicted in FY18 as economic system appears to be increasing and paintings on sure electricity generation and improvement tasks below CPEC remains on target. The change range fetched $177. 0 million for FDI, contrasted with $31. 4 million 12 months sooner. The board said it have been closely working with Chinese language experts from country wide development and Reform commission (NDRC) of China for relocation of Chinese language industry into Pakistan and industrialization of unique monetary zones (SEZs) alongside CPEC. 33 gathering of joint attempting institutional (JWG) ahead business participation got to be held for November 9 same time the 7th JCC is predicted to a chance to be held looking into November 21in Islamabad. Large Chinese language investments are anticipated in these special monetary zones, with the intention to be instrumental in attracting FDI from different international locations as nicely, the announcement concluded.BenefitsProfits the CPEC will open entryways will enormous budgetary chances not main to Pakistan Be that as will physically join china should its business sectors for Asia, Europe Also Past. Just about 80% of the China's oil is presently transported starting with strait for Malacca on Shanghai, (distance may be very nearly 16,000 km What's more takes 2-3 months), for Gwadar getting to be operational, those separation might decrease should short of what 5,000 km. Though every last bit dives great Furthermore on schedule, of the 21 assentions looking into energy– including gas, coal Furthermore sun oriented energy– 14 will have the capacity on provide dependent upon 10,400 megawatts (MW) for vitality by Walk 2018. As stated by china Daily, these undertakings might give dependent upon 16,400 MW about vitality inside and out. Similarly as and only foundation ventures worth pretty nearly $11 billion, Furthermore 1,100 kilometer long motorway will be constructed between the urban communities for Karachi Furthermore Lahore,2 same time those Karakoram roadway the middle of Rawalpindi and the Chinese fringe will make totally recreated What's more overhauled. The Karachi–Peshawar fundamental route line will additionally make upgraded on considers train goes during dependent upon 160 kilometers for every hour Toward December 2019. 3 Pakistan's track system will additionally make stretched out within the end unite with China's southern Xinjiang track done Kashgar. 4 An system from claiming pipelines should transport condensed characteristic gas Furthermore oil will additionally make laid Likewise and only those project, including An $2. 5 billion pipeline the middle of Gwadar and Nawabshah will transport gas starting with Iran. 5 oil starting with the center east Might make offloaded during Gwadar Furthermore transported will china through the corridor, cutting those present 12,000 km venture will 2,395 km. It will go about as An span to those new oceanic silk course that envisages linking 3 billion people over Asia, Africa Furthermore Europe, and only a trans-Eurasian one task. At fully operational, Gwadar will Push the investment improvement about pakistan Also ended up An passage for focal Asian countries, including Afghanistan, Uzbekistan, linking Sri Lanka, iran Also Xinjiang will embrace marine transport. 6 over $33 billion worth for vitality base will a chance to be constructed. Eventually Tom's perusing private consortia will assistance allay Pakistan's Ceaseless vitality shortages,7 which consistently sum with In 4,500MW,8 Furthermore have shed a evaluated 2-2. 5% off Pakistan's yearly GDP. 9With pretty nearly $33 billion needed with make put resources into vitality division projects, force era expects a paramount part in the CPEC one task. Through 10,400MW about vitality generating ability may be on make created between 2018 Furthermore 2020 Likewise and only the corridor's fast-tracked â€Å"Early Harvest† activities. 10 the area about Baltistan may be known for its new tree grown foods exports, in cherries, apricot Furthermore apples, CPEC will a chance to be an amusement changer Eventually Tom's perusing opening benefits of the business chances for the region's merchants. This will furnish nearby brokers with favorable element Also assistance them twofold their offers by enormous sparing done cosset for transportation. Presently, fruits would being exported through air-cargo by means of Dubai it might a chance to be speedier and less expensive. In those same Might be sent Toward way to china by means of Xinjiang. Tourism which right now makes up an pitifulness and only our income is accepted with a chance to be raised Eventually Tom's perusing opening from claiming this monetary hall. Those CPEC, a portion believe, will additionally support tourism in the 73,000 square km district. Those area is acknowledged will make An mountaineer's paradise, since it is home with five of the ‘eight-thousands' (peaks over 8,000 meters), and additionally more than 50 mountains again 7,000 meters. It is Additionally home of the world's second most noteworthy crest k2 and the nanga parbat. 11Conflicts between motives those one task encompassed Toward the greater part good faith yet can't a chance to be completely discerned without apprehensions. Legislature of Pakistan (GoP) cases with resuscitate Diamer-Bhasha dam for Indus stream in Gilgit –Baltistan, in the second stage from claiming CPEC, bringing about those processing from claiming 4500MW about power furthermore will serving Similarly as an enormous water supply for the country, which constantly verified Eventually Tom's perusing Asian advancement bank (ADB), Gilgit-Baltistan need the possibility to prepare almost 50,000MW from claiming vitality. Only Bunji Dam, a run-of-the-river task that those ADB need contributed in, need the ability to produce dependent upon 7,100MW power The point when finished. Those inquiry constantly brought up in the psyche of the commoners would At by fabricating hydro tasks Pakistan could securely import vitality. Also will have sufficient to utilize it for its advancement also the reason develop an exorbitant 750km transmission line?.ConclusionThose CPEC shows up with be a essential one task for both the nations. For china it gives a substitute secure course will import vitality Furthermore Figure new businesses for its products Also administrations. To Pakistan it aides counters Indian impact in the region, position itself Likewise a significant travel perspective interfacing Eurasian locale for soutane Asia Also south East Asia What's more gatherings give a a great deal required base to kick begin its monetary development.

how i learned to love football Essay - 1168 Words

Jesse Saunders Prof. Keith Bishop English 101 12/10/2013 â€Å"How I Learned To Love Football† â€Å"Move Over Boys, Make Room In The Crease† Sara Maratta and Felisa Rogers essay is the opposite of one another. Sara Maratta at the age of 14 developed a liking to sports, hockey was Marattas number one sport. Maratta knew hockey inside and out. Her favorite aspect of the sport was the fighting part. It drew her deeper into the sport. Maratta had a passion for the Blue Jackets team, and being her number one hobby whom she supported as a fan. Although women want to be heard in the sports world and want to participate in the games, it is still a man dominated sport. Men feel that the sports world is not for women. Since she was a little†¦show more content†¦Rogers finished all her accounts and then dryed up, while her husband got laid off due to the economy. Rich Rogers, Felisas’ husband decided to take to take charge to help support his family. Rich worked three jobs and with minimal pay supported his family he was so stressed out and was worried that they would lose everything. Then things turned for the w orse, the Roger’s family suffered a tragedy the death of Richs’ mother, and their car crapped the bed. Felisas’ husband was in despair, they had rough times ahead of them. Whenever Rich would talk about football and Brett Favre Richs’ favorite player his face would light up and become happy even for the briefest of moments. Felisa saw this and never gave thought of richs’ emotional status before the hard times hit. Felisa saw the spark of happiness in Rich’s face she started to listen and support her husbands love for football. Felisa found her voice as a wife through sports specially football, reconnecting her relationship with her husband. Felisa found out she liked it. Sara Maratta enters the world of hockey and by doing so discovers her strength as a woman and finds her voice. Maratta states this group did not and have not accepted me as a true enthusiast who has a real comprehension and love for what goes on in the crease. Why? Because I am a woman†.(538-539) Women are finally being recognized in the world of sports. It is still a male dominate sport and women are still looked as sex objects, thatShow MoreRelatedHow I Learned to Love Football Essay1071 Words   |  5 PagesIn Felisa Roger’s article How I Learned to Love Football, Roger discussed how her dislike for sports changed all together with when she had a reason to care about it more. She provided a great background when explaining why she changed her mind about disliking sports, and used a great variety of detail while explaining it. She talked about how as she was growing up she had a strong dislike of all sports. 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Customer Relationship Management (CRM) - 845 Words

RM stands for Customer Relationship Management. It is an approach used to learn more about customers needs and manners in order to develop stronger relationships with them. Good customer relationships are at the core of business achievement. There are many technological mechanisms to CRM, but thinking about CRM in mainly technological terms is a mistake. The more useful way to think about CRM is as a calculated process that will help you better understand your customers’ needs and how you can meet those needs and increase your bottom line at the same time. This strategy depends on gathering lots of pieces of information about customers and market trends so you can sell and market your products and services more effectively. Maintaining customers’ happiness while keeping service costs down: That’s the definitive goal of every customer service executive. 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It is alsoRead MoreCustomer Relationship Management ( Crm )869 Words   |  4 Pageswhat the custome r wants from them. Many companies have come to realize that customers and the service they receive are very important in expanding their brand. Because of that recognition, most businesses of the twenty-first century have developed customer relationship management (CRM) initiatives to better relate to their customer bases. What does customer relationship management (CRM) mean? Kurtz defines CRM as a set of strategies and tools that companies use to learn about customers (Kurtz, 2015