Describe about The Australian Government for Failing Health and Minimize Suffering.
As the population of Australia ages, an increasing number of the elderly become frail and weak and require specialised care. Even if they do not suffer from a medical condition, the elderly residing at home or in residential care need care and in some cases a constant assistance may be required. As they progress towards the end of life, it is important that the focus of the care team is their quality of life and the transition from life to death be as smooth as possible even as their family members are prepared to face their failing health and minimize suffering. The decision of whether to leave the hospital and spend the last days of the life at home should rest with the aged as far as possible. Effective communication with patient and the family is n important aspect of delivering care. Assessing and managing the patient’s condition is an important aspect of providing care. Coping with the needs of the patient and while preparing the family for a loss and bereavement takes an emotional toll on the care staff.
Specialist palliative care addresses the needs of patients suffering, maximises life and facilitates bereavement and is usually directed at patients suffering from malignant disease. The employment of the key tenets of palliative care for the betterment of the aged under the care of a healthcare team by a general practitioner in conjunction with family members follows the path of a palliative approach. This approach has been promoted by the Australian government department of Health and Ageing. A publication that provides the detailed guidelines for palliative approach in residential aged care was published by the department in 2006 (Palliative care in residential aged care, 2016). (Toye, et al., 2012). More recently, a policy initiative that espouses ‘Living longer living better’ has focussed on the need to provide better services for the aged who are being cared for at home, provision of support to informal carers and bringing the benefits of healthcare systems to aged care.
The residents of aged care facilities may at times develop health conditions due to ageing that may need palliative care even if they have not been diagnosed with cancer. But emotional and physical palliation that is relevant to cancer patients is often found useful in the treatment of age-related conditions. Examples include administration of small doses of opioids may relieve symptoms of aged patients suffering from arthritis (Grbich, et al., 2005). Many aged people prefer to die at home rather than in community settings where they remain separated from the family. A survey has pointed out that of the 800 people studied, 60% were in a hospital on the last day of their life. The objective of a palliative approach is to minimize the need to transfer the aged to a hospital. Physical, mental and cognitive decline are often associated with old age and present difficult challenges to the care -giver. Guidelines on when and how to provide professional help to ease or assist the task of care giving have been provided in the Guidelines for a Palliative Approach for Aged Care in the Community Setting. These guidelines have been approved by the National Health and Medical Research Council and provide detailed resources and information for those engaged in practice (Toye, et al., 2012).
End of life treatment in home care is often a challenge for General Practitioners because through the several ups and downs of the health of the aged person in their care, it is often difficult to determine the kind of treatment that will prolong life and the decision of when to ‘let go’. The adoption of palliative care and a general attitude of acceptance towards patient’s death is a common. The erratic course of the terminal illnesses often make it difficult for the General Practitioners to decide the appropriate point at which the ‘letting-go’ approach needs to be adopted. Help from the palliative care team can help them address this issue better (Sercu, et al., 2015). The best course is adopted in a palliative approach rather than treating the problem focuses on improving quality of life which is more relevant in cases where problems such as dementia occur in end of life stages (Toye, et al., 2012).
An important aspect of the delivery of palliative care is effective communication between the care-provider, friends and family members and the care-recipient. The communication should be two-way and sensitive. All information about the care received by the care-recipient should be shared and the family should be prepared to understand the outcomes expected in palliative care. It is important to understand the concerns of the family and both parties should be able to respect each other’s points of view. The communication needs to focus on the care outcomes and inform the family about the expected responses to the care provisions made to the care-recipient (Effective communication in palliative care, 2016)
Ineffective communication can often jeopardise the delivery of healthcare to the aged care recipients in need of palliative care and lead to unnecessary distress for their family and friends. The family may be left unprepared for the process of dying and may also not understand the complexity of the situation in the absence of proper communication. Anxiety, fear and confusion about the status of the deteriorating health is likely among friends, family and the care givers in a home setting, so preparing them for the end through communication is important. Since treatment is being provided by the healthcare team, relatives and friends may have unrealistic expectations about the outcome. The lack of effective communication makes the family members unable to take informed decisions.
There are several ways in which the staff can communicate effectively with friends and family of the care-recipient. A demonstration of a caring attitude that is warm, compassionate and patient create a supportive environment that helps the family to get a better understanding of the situation of their loved one. Mutual understanding between the healthcare team and the family through effective communication can make the experience of providing end-of-life less distressing. But if they are unsure of what is happening regarding the relative’s health, it could be due to ineffective communication (Caswell, Pollock, Harwood, & Porock, 2015). Another study pointed out that large number of care staff and frequent changes affected continuity and had a negative impact on care giving. Low levels of communication between primary and secondary care providers often were viewed in a negative light by family care givers. Greater comfort and reassurance was present and there was a sense of control when communication was better and organisational continuity was maintained (Seamark, et al., 2014).
Several steps can be taken by the staff to show involvement and communicate with the family. Provision of emotional support, active listening to understand the concerns of the family care giver, ensuring that the information has been processed as intended by the listener, because often, anxiety and fear can affect the way the information communicated is understood. Inclusion of the family in providing collaborative care and letting them have their say in issues that pertain to their role in the care giving process. Changes in the health status of the care recipient should be communicated to friends and family in a way that is understood by them. Facilitate their proximity with the aged person in residential care when the end is near, providing references to support services that may be required in the event of bereavement, and an understanding of the loss and the associated grief and sadness felt by the family are all part of the effective communication between the care staff and the family and friends of the aged person (Effective communication in palliative care, 2016).
In a survey of carers four mrkers of satisfaction were considered important. Feeling that sharing of information happened, feeling of inclusion in decision-making about the plan of treatment, feeling that help is available and someone is available during a difficult situation and that the care staff responds to the needs. Majority of home carers reported dissatisfaction with the extent of involvement (Walker & Dewar, 2001).
Diffrent people who suffer from different ailments go through different illness trajectories. People suffering from cancer have a definite terminl stage which is spread over a shorter period of decline in health. Those suffering from cardiovascular disease suffer from intermittent serious episodes spread over a longer period of decline while slow prolonged decline occurs in people with dementia and fraility. Progressive chronic illnesses usually follow an illness trajectory as above but episodic and sudden death is common among people with cardiovascular disease (Murray, Kendall, Boyd, & Sheikh, 2005).
Each patient’s case requires an individual treatment. At times the care-recipient suffers less if all treatment is withdrawn. There may be requests for treatment options from thre patient’s family that the medical team does not believe in. Assessment and management of the patient’s symptoms is an important aspect of providing palliative care alongside treatment for an illness that the care-recipient is suffering from. For example, if a patient is suffering from a progressive neurological disorder, the neurologist can refer the patient for palliative care. The patient can be treated for symptoms, psychosocial issues and spiritual distress. A palliative approach for the treatment of prolonged illnesses that pose challenges such as cognitive decline, behavioral issues and deficits in communication can address issues in order to manage the symptoms. Depression and anxiety are frequently obserbed in ptients with neurologicl disorders but my be left untreated if referrals for palliative treatment are delayed (Boersma, Miyasaki, Kutner, & Kluger, 2014).
As much as I have tried to remain detached from patients while delivering care, the long term care that is often the case while caring for patients in palliative aged care engages me in such a way that I have developed emotional bonds with patients. It is only human to feel and respond to the patient’s plight. While the patients are away from the family they look to us, the care staff to fill in the emotional support that they would hve otherwise received from friends or family. I have often discussed the matter with collegues and we have agreed on the need for some kind of support to be able to deal with loss and grief associted with the death of those in our care. Each one of has different abilities to cope with grief, in my case I find it difficult when the lone and aged spouse who is also at times frail and undergoing treatment for a chronic disease has to be comforted until the family arrives. It has been the subject of many studies that care staff who interact with patients on a daily basis need support to cope with loss of patients when death occurs (Marcella & Kelley, 2015; Durall, 2011; Slatten, David, & Phillips, 2011).
In conclusion it emerges that end of life palliative care tht is targetted at improving the quality of life of an aged person in residential care or at home can improve the well-being of the person, the family members and ensure a relatively calm and peaceful end in a dignified manner. The guidelines and updates released by the government of Australia advocate a palliative approach for care of the aged in residential and home settings. The knowledge of specialist palliative care can be employed to treat symptoms of pain and ease the life of frail individuals or those who are suffering from chronic diseases that are non-malignant. Training of medical personnel in making the decision between life prolonging treatment and knowing when to ‘let go’ are important in letting the patient live a good quality of life while alive. Effective communication is important in making the patient and the family involved in the decision taking process so that they feel involved in the various aspects of care provision. Assessment of the patient’s medical condition and management of end of life care are key to reducing the symptoms such as, pain and difficult movement. The emotional involvement of the care staff with the patient and the family and coping with grief when death occurs is difficult to deal with and professional help for dealing with bereavement at the end of long term care is necessary.
References
Boersma, I., Miyasaki, J., Kutner, J., & Kluger, B. (2014). Palliative care and neurology Time for a Paradigm Shift. Neurology, 83(6): 561–567.
Effective communication in palliative care, (2016, October 1). Retrieved from https://www.agedcarecomplaints.gov.au: https://www.agedcarecomplaints.gov.au/…/effective-communication-in-palliative-care
Palliative care in residential care, (2016, October 1). Retrieved from https://www.aihw.gov.au: https://www.aihw.gov.au/palliative-care/residential-aged-care/
Caswell, G., Pollock, K., Harwood, R., & Porock, D. (2015). Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study. BMC Palliative Care, 14, 35 10.1186/s12904-015-0032-0.
Durall, A. (2011 ). Care of the Caretaker- Managing the Grief Process of the Healthcare Professional. Pediatric Annals , 40(5): 266-273.
Grbich, C., Maddocks, I., Parker, D., Piller, N., Brown, M., Willis, E., & Hoffmeyer, A. (2005). Palliative care in aged care facilities for residents with a non-cancer disease: Results of a survey of aged care facilities in South Australia. Australasian Journal on Ageing, 22(4):5-14.
Marcella, J., & Kelley, M. (2015). “Death Is Part of the Job” in Long-Term Care Homes. SAGE Open , 5 (1) 2158244015573912; DOI: 10.1177/2158244015573912.
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2005). Illness trajectories and palliative care. . BMJ : British Medical Journal, 330(7498), 1007–1011.
Rosenwax, L., McNamara, B., Murray, K., McCabe, R., Aoun, S., & Currow, D. (2011). Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. The Medical Journal of Australia, 194(11):570-3.
Seamark, D., Blake, S., Brearley, S., Milligan, C., Thomas, C., Turner, M., . . . Payne, S. (2014). Dying at home: a qualitative study of family carers’ views of support provided by GPs community staff. British Journal of General Practice, 64(629):e796-803. doi: 10.3399/bjgp14X682885.
Sercu, M., Renterghem, V., Pype, P., Aelbrecht, K., Derese, A., & Deveugelea, M. (2015). “It is not the fading candle that one expects”: general practitioners’ perspectives on life-preserving versus “letting go” decision-making in end-of-life home care. Scandinavian Journal of Primary Healthcare, 33(4): 233–242.
Slatten, L., David, K., & Phillips, P. (2011). Compassion Fatigue and Burnout: What Managers Should Know. Health Care Manager, 30(4):325-333.
Toye, C., Blackwell, S., Maher, S., Currow, D., Holloway, K., Tieman, J., & Hegarty, M. (2012). Guidelines for a palliative approach for aged care in the community setting: A suite of resources. Australasian Medical Journal, 5(11): 569–574.
Toye, C., Robinson, A., Jiwa, M., Andrews, S., McInerney, F., Horner, B., . . . Stratton, B. (2012). Developing and testing a strategy to enhance a palliative approach and care continuity for people who have dementia: study overview and protocol. BMC Palliative Care, 11:4. doi: 10.1186/1472-684X-11-4.
Walker, E., & Dewar, B. (2001). How do we facilitate carers’ involvement in decision making? Journal of Advanced Nursing, 34(3):329-37.
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