Discuss about the Palliative Care Perspectives.
Palliative care is a special type of treatment that is provided to patients undergoing through serious conditions in their health. They mainly help in providing relief to such patients from severe pain and stress. This mainly helps to provide a quality of life care for not only the patient but also for different family members. They are mainly provided by a special group of doctors, nurses and carers who work in association with that of the patient’s own doctor. It helps patients suffering from cancer, congestive heart failure, kidney diseases, Alzheimer’s, Parkinson’s and many others (Sprung et al., 2014). Palliative treatment is mainly helpful in treating pain, depression, shortness of breath, loss of appétit, constipation, difficulty in sleeping and many other symptoms, which often hampers proper life maintenance when being diagnosed by severe diseases and disorders. Researchers have suggested such palliative care to be extremely important for providing relief to the suffering of the patient who are nearing their death stage. This also supports such patients and their families by the comprehensive assessment as well as by the treatment of not only physical but also psychosocial and spiritual symptoms, which are experienced by the patients. When a person approaches towards death, his symptoms need palliation that is more aggressive. At that particular time, palliative care will not only intensify the comfort measure but also support the dying patient’s family (Hui et al., 2014). The essay will therefore mainly focus on the care requirement that are needed for delivering service to end of life care for patients in acute care setting and their families and will highlight the major issues that are faced by nurses while providing such care.
The thesis question will mainly focus on how gathering the knowledge about the correct care requirements can affect the end of life care for people in acute care setting. It will also focus on what are the main issues that nurses face which if known may help in providing better care to such patients.
Palliative care usually accompanies the care that is provided to the patient due to his ailments. The main requirement for providing palliative care for a patient at end of life is proper recognition of the pain and the troubling symptom of the patient by the appointed nurses. They will only be able to plan their intervention for the patient once they are aware of the emotional, spiritual as well as the practical needs of the patient. Once all the important choices of the patient are properly analyzed, the palliative care provided by the nurses will be more fruitful (Gardiner et al., 2014). It is extremely important for the palliative care nurse to identify and thereby carry out the goals of the intervention set up after the analysis. This mainly would involve symptom relief, spiritual comfort, counseling and enhancement of quality life. The nurses need to relieve the symptoms and distress that is affecting the patient at the same time helping them to understand their diseases and diagnosis in a better way. They will help the patient to clarify their treatment goals other options, which are available to them. Besides the nurses, also need to act as an emotional strength to the patient helping them to understand and at the same time support their ability to cope with the patient’s illness (Quill & Abernathy, 2013). The nurses also need to assist the patient in making medical decisions and coordinate with doctors to discuss interventions and the results for providing best care.
It is extremely important for the nurses to avoid making the patient feel that he is nearing his death. Rather she must try her best to make him see the better aspects of the life for which he can live for. Terminal care is required for not only cancer but also for respiratory failure, AIDS, motor neuron disease, multiple sclerosis and many others (Gillian et al., 2015). Therefore, nurses must practice proper communication technique to achieve such goals. Besides, coordination with the multidisciplinary team along with that of the patients’ family members is also necessary. She should try to control the symptoms of the patient for which she might need to be less professional and continue her care even for out of hours. Caring in the dying phase along with providing carer support is also extremely significant. Besides fulfilling the physical requirements, she also needs to provide emotional and spiritual support to the dying patient (Rowe, Fulmer & Fried, 2013). Death will definitely come to all of us and all knows it. However, when it becomes imminent, emotions changes and becomes strong. Patients often tend to know how much time they have in hand, or even may want to be honest with them. Under such circumstances, it is important for the nurse to analyze the patients critically; condition and answer accordingly being honest but at the same time, determining how much should be said to satisfy him without harming his emotional stability.
Nurses while treating patients who are nearing their death face a large number of challenges. One of the major issues is handling intense conditions and important intensified discussions with the patients suffering from severe illness (Beckstrand et al., 2015). Researchers have suggested that nurses and many clinicians often complain about not receiving proper training and education during their courses, which helped them to handle such intense conditions. Studies suggest that only 6% of all conversations carried on end of life issues with patients and family members were mentored by higher authorities in comparison to the 90% cases of invasive procedure training like central venous line placement, arterial puncture and thoracocentesis being mentored by higher authorities (Carter, Levetown & Friebert, 2013). Hence handling such situations effectively often becomes a major concern for them. Another issue faced by them is the application of concept of spirituality with their procedures. After being trained in the procedure for large number of years in science and its advancement in healthcare, it becomes difficult for them to handle conversations of spirituality and emotional strengths in order to handle the patients and his carers effectively. Moreover, it may also result in development of anxiety in the nurse about discussions on death and disease, which is further fueled by interactions with the dying patient (Peters et al., 2013). It may also affect him in other ways like making him remember some similar personal losses that result in developing stronger personal bonds with the patient harming her practice. A large number of ethical dilemmas were found when researchers conducted surveys. It stated that inadequate communication among stakeholders, provision of non beneficial care, different forms of issues with symptom management, autonomy of patient threatened or usurped, use of opioids, challenges faced in decision making and also dilemma in discontinuing life prolonging therapies were the mostly noted (Dilworth et al., 2016).
Though death is an inseparable part of life, death is feared as an illness. Therefore the goal of a nurse in providing a palliative care is to improve the situation where pain and different symptoms of the dying patient are managed providing him both physical and mental support resulting in painless and peaceful situations towards end of life. Therefore, it is very necessary for the nurses to help patients and their family members to determine proper medical and emotional care and in providing correct alignment of the patient care goals with that of the healthcare teams. Establishment of need for medical proxy, resuscitation status and advance directives are the main fundamental foundations of the palliative care at end of life. In order to provide the best quality care to dying individuals, nurses also need to overcome a number of educational, ethical and emotional gaps and challenges to make their practices more prominent so that they can provide the best quality life that a human being deserves before he passes away.
References:
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintosh, J. L., & Rasmussen, R. J. (2015). Rural emergency nurses’ end-of-life care obstacle experiences: stories from the last frontier. Journal of Emergency Nursing.
Carter, B. S., Levetown, M., & Friebert, S. E. (Eds.). (2013). Palliative care for infants, children, and adolescents: a practical handbook. JHU Press.
Dillworth, J., Dickson, V. V., Mueller, A., Shuluk, J., Yoon, H. W., & Capezuti, E. (2016). Nurses’ perspectives: hospitalized older patients and end?of?life decision?making. Nursing in critical care, 21(2), e1-e11.
Gardiner, C., Brereton, L., Frey, R., Wilkinson-Meyers, L., & Gott, M. (2014). Exploring the financial impact of caring for family members receiving palliative and end-of-life care: a systematic review of the literature. Palliative medicine, 28(5), 375-390.
Gillan, P. C., van der Riet, P. J., & Jeong, S. (2014). End of life care education, past and present: A review of the literature. Nurse Education Today, 34(3), 331-342.
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end?of?life care in cancer patients. Cancer, 120(11), 1743-1749.
Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., Hood, K., … & Shimoinaba, K. (2013). How death anxiety impacts nurses’ caring for patients at the end of life: a review of literature. The open nursing journal, 7(1).
Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.
Rowe, J. W., Fulmer, T., & Fried, L. (2016). Preparing for better health and health care for an aging population. Jama, 316(16), 1643-1644.
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M., Michalsen, A., … & Bulpa, P. (2014). Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study. American journal of respiratory and critical care medicine, 190(8), 855-866.
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