Disuss about the Worldwide Palliative Care.
The task is about Vera Biggs. Vera is a 76-year-old woman who has been admitted to the facility to receive a palliative care. The patient has been admitted to the palliative care to seek for medical intervention for the painful experiences she is undergoing. 10 years ago, the patient was diagnosed with a breast cancer. Upon the diagnosis, the patient underwent an auxiliary clearance and right mastectomy. This is the intervention that she was given to help in addressing the case of breast cancer she had been experiencing. Later, she underwent a surgical operation called metastases to help in removing the traces of cancer in her breasts.
At the time of her admission to the palliative care, the patient was assessed to be having a complex condition. Her cancerous condition has resulted into a severe anorexia. Meaning, she does not eat well because of a serious loss of appetite. This has led to a great weight loss because of the lack of essential nutrients in the body. Moreover, the patient was observed to be undergoing pains. Cancer has compelled her to undergo many pains that of course make life quite difficult for her. Lastly, the condition has negatively impacted on the patient’s day-to-day routine. It has made her patient to be immobile. She does not have enough strength to freely move around and discharge her normal daily activities like bathing. This is one way through which the illness has limited the patient’s life.
Nonetheless, the patient does not have anyone to adequately care for her. From the records, the patient has two family members who can be responsible for providing her with the necessary care. However, this has not been happening because of the numerous challenges at home. Her only daughter is not available because she lives far away from her. In fact, she has no time to attend to her paining mother because she is caring for her own disabled daughter. Besides, it is quite unfortunate that her 80-year-old husband with whom she lives is not capable of properly attending to her. In fact, he suffers from mild dementia and cannot drive. This leaves the patient with no option rather than seeking for palliative care at the hospice.
Vera’s condition necessitates the provision of palliative care. Palliative care simply refers to the type of medical attention provided to the patients and family members of the patients with life-threatening conditions. The patient should be admitted to a hospice to be given a palliative care. This is a good strategy that will enable her to deal with the pains and improve the quality of her life. A part from helping the patient to reduce the pains and suffering she undergoes, palliative care will play a significant role in reducing the trauma and agony experienced by the patient’s family members (Storch, Starzomski, & Rodney 2013). Palliative care will be essential in addressing the advanced cancer condition because it can relieve all the pains t causes to the patient (van der Steen et al 2014).
Life-threatening illness does not only affect the patient, but the close family members as well. So, after assessing the condition of the patient, ascertaining the severity of the illness and providing the most appropriate intervention, the family members should also be attended to as well (Alliance & World Health Organization 2014). To do so, the patient’s family members should be provided with psychological and spiritual support (Hsu, Coleman, Ross, Johnson, Fishman, Larson & Reid 2012). Meaning, they should be counseled and provided with the necessary encouragement to accept the situation and boldly face it even if it results into the death of their loved one. This implies that the care should not only be limited to the patient alone, but should be extended to her elderly husband and the daughter.
When providing palliative care to the patient, the healthcare providers should ensure that they comply with all the principles of palliative care (Quill & Abernethy 2013). First, the patient and the family members should be ready to affirm life and consider dying as a normal stage in human life. In other words, palliative care should be viewed as an important exercise not exclusively aimed at the prevention of death. Instead, everyone should acknowledge that death is a reality and cannot be escaped (Bodenheimer & Berry-Millett 2009). The only reason why palliative care is provided is to help in the reduction of pain, improving the quality of life and making life much comfortable right before death. This is what should be done to Vera.
Secondly, palliative care providers should be guided by the principle that it neither delays nor speeds death. When a patient is admitted to a hospice, the goal is not to hasten or postpone death. A palliative care patient is supposed to be attended to so as to help in minimizing the magnitude of pain experienced (Gomes, Calanzani & Higginson 2014). Palliative care is provided on the basis that it comfortably comforts a patient to death. So, even if the condition of the patient is deteriorating, the healthcare provider should not fail to effectively discharge his or her duties (Badland, et al 2014. Any case of negligence can result into an earlier death of the patient. When attending to Vera, the palliative care providers should take all the necessary measures to improve the quality of her life without unnecessarily delaying or hastening her death.
The other principle to be applied while proving care to a patient with death-threatening condition is that palliative care should be provided with the goal of relieving the patient from pain and all the other distressing symptoms associated with the condition. When admitted to the hospice, Vera was in great pains. Her cancerous condition had subjected her to lots of sufferings. Therefore, what the palliative care providers should do to her is to ensure that all the pains experienced are eradicated (Ludman & Von Korff 2012). To do so, the providers are supposed to take time to immediately assess her conditions to determine the level of pains before taking the necessary measures to provide her with the drugs, treatment s or any other appropriate intervention.
Moreover, palliative care should be guided by the principle that it integrates the application of spiritual and psychological interventions. Matters related to death are quite metaphysical and can be best addressed by incorporating the element of spirituality. One of the ways of encouraging the patient to accept their condition is to let them know about the reality of death. In this regard, Vera’s intervention should not only be restricted to medication, but should be extended to cover psychological and spiritual therapy in line with her religious beliefs (Di Cesare, et al 2013). Such religious and psychological therapies should also be given to Vera’s family members. It can give them hope and eliminate any psychological distress associated with the end-of-life illness or an eventual death of their loved one.
Lastly, palliative care should be based on the principle of activity. Meaning, it should be offered to the patients to support the patient to lead an active life up to the death point. Usually, end-of-life illnesses such as cancer hinder individuals from leading a normal active life. Many such patients are always inactive because the diseases render them unable to do normal activities like walking, talking, bathing and eating (Zimmermann et al 2014). One of the effects of palliative care to Vera is activity. If she gets the services required, Vera should be empowered to be an active individual who can walk and engage in daily activities like bathing (Stajduhar 2011). Should this happen, Vera would be helped to overcome the challenges that limit her from engaging in her normal routine.
Palliative care is a complex exercise that requires the contribution of different players. It is an interdisciplinary activity that requires the cooperation between different experts including doctors, palliative care specialists, general practitioners, general nurses, specialist nurses, personal care attendants, and allied healthcare professionals including occupational therapists, physiotherapists, social workers, psychologists, speech pathologists, dieticians, pharmacists, and spiritual advisers (Wright, Zhang, Keating, Weeks & Prigerson 2014). Each of these professionals should cooperate with one another and work towards relieving the pain and sufferings experienced by the patient. At the same time, they should provide all the necessary psychological support to the family members and other carers (Katon, et al 2013).
When doing all these, the palliative care providers should not fail to incorporate the use of patient-centered approach. This is a good strategy that will enable the patient and family members to receive holistic and satisfying services. The palliative care providers are expected to involve the patient and family members in the decision-making process. However, while doing all these, the patient’s autonomy, value and dignity should be upheld (Austin 2011). When this is done, the patient’s opinion would be sought and respected without any violation. So, since Vera said that she does not want to be resuscitated, all her care providers must respect her wish as long as it meets the required threshold.
The patient’s life-limiting illness has negatively impacted on her and her family members. As a patient, Vera has had to endure a lot of pain. Besides, her normal life has been interrupted because of the limitations imposed on her by the illness. Although her family members do not personally undergo the painful experiences, they are psychologically affected by the illness of their loved one (Pratt & Wood 2015). For this reason, all of them should be adequately attended to by the palliative care providers. While the patient should be given appropriate medical intervention, the family members should acquire counseling services from amongst other specialists, spiritual advisers, bereavement counselors, and social workers (Donato & Segal 2013). So far, the syringe driver and sub-coetaneous morphine interventions recommended by the doctor are suitable for the patient and should not be changed. They can be instrumental in relieving the patient’s pains.
Conclusion
Palliative care is a noble approach that is so important to the life-limiting patients as well as their family members. Since Vera has been diagnosed with breast cancer, she deserves to be taken to a hospice to be given a palliative care. From her medical history, it is evident that the patient has been receiving medical attention for her cancerous conditions. However, the fact that she does not have reliable family members to care for her at home, she should remain in a healthcare facility to be attended to. However, to deliver quality and satisfactory palliative care to her, the care providers should adopt a palliative approach confined within the tenets of patient-centered care as well as interdisciplinary collaboration. This is the only way through which the patient and her family can receive adequate support to endure the painful experiences they are going through.
References
Alliance, W.P., & World Health Organization, 2014, Global atlas of palliative care at the end of life. Worldwide Palliative Care Alliance: Lndon.
Austin, W, 2011, The incommensurability of nursing as a practice and the customer service model: An evolutionary threat to the discipline. Nursing Philosophy, 12, 158-166.
Badland, H., et al., 2014, Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Social Science & Medicine, 111, 64-73.
Badland, H., et al., 2014, Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Social Science & Medicine, 111, 64-73.
Bodenheimer, T., & Berry-Millett, R., 2009, Care management of patients with complex health care needs, the Synthesis Project. Princeton, NJ: Robert Wood Johnson Foundation.
Di Cesare, M., et al., 2013, Inequalities in non-communicable diseases and effective responses. The Lancet, 381(9866), 585-597.
Donato, R. & Segal, L. 2013, Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?. Australian Health Review, 37(2), pp.232-238.
Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D., 2011, Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193-196.
Gomes, B., Calanzani, N. & Higginson, I.J., 2014, Benefits and costs of home palliative care compared with usual care for patients with advanced illness and their family caregivers. Jama, 311(10), pp.1060-1061.
Hsu, C., Coleman, K., Ross, T.R., Johnson, E., Fishman, P.A., Larson, E.B., & Reid, R.J., 2012, Spreading a patient-centered medical home redesign: A case study. Journal of Ambulatory Care Management, 35(2), 99-108.
Katon, W.J., et al., 2013, Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine, 363(27), 2611-2620.
Ludman, E. & Von Korff, M., 2012, Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Archives of General Psychiatry, 69(5), 506-514.
Pratt, M & Wood, M. eds., 2015, Art therapy in palliative care: The creative response. Routledge: New York.
Quill, T.E. & Abernethy, A.P., 2013, Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), pp.1173-1175.
Stajduhar, KI, 2011, Chronic illness, palliative care, and the problematic nature of dying. Canadian Journal of Nursing Research, 43(3), 7-15.
Storch, J., Starzomski, R., & Rodney, P., 2013, Re-framing end of life decision making. In J. Storch, P. Rodney, & R. Starzomski (Eds.). Toward a moral horizon: Nursing ethics for leadership and practice (2nd ed., pp. 333-357). Toronto: Pearson-Prentice Hall.
van der Steen, J.T., et al., 2014, White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 28(3), pp.197-209.
Wright, A.A., Zhang, B., Keating, N.L., Weeks, J.C. & Prigerson, H.G., 2014. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ, 348, p.g1219.
Zimmermann, C., et al., 2014, Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), pp.1721-1730.
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