Today's Role of Palliative Care - Essay Example

Essay on Nursing Palliative Care Contents Contents 2 Introduction 3 2. The Communication Process 4 3. Advance Care Planning 5 4. Culturally Appropriate Care 6 5. Epitome and Case for Assessment and Management of Pain 6 6. Assessing and Managing Chronic Conditions 7 7. Psycho-social and Spiritual Support 8 1. Introduction Today, nursing programs are increasingly specializing along with their discourse in order to ascertain their role in delivery of highest level of professional services in the field of medicine. Palliative Care is also one such notion that is aimed for seriously ill people in a community for the implementation of best practices and guidelines. Projects in this reference namely Palliative Care by Department of Health are such programs. Trainings and literature providing best practices are arranged for professionals to implement their rationale. Palliate care is provided by specialists such as doctors and nurses which ensures an extra layer of support through principles and practices. It is implementable for any age and/or stage with serious illness. This is generally provided with curative treatment which has proven to be even more helpful, however for treatment of last stage cancers curative intent is rationally set aside while providing palliative care alone. The concept care started in 2006 in the United States which late matured into a board certified program having specialties in sub-groups of diseases. It is now a multidisciplinary approach for patient care. The terminology differentiates from Hospice Care in certain respects. Palliative Care is given to chronically ill patients and have serious prognosis whereas Hospice Care is given to patients that have less than six months to live if the illness follows its usual course. World Health Organization states that Palliative Care is an approach which improves quality of living of patients and their ambiance who face problems which are life threatening, their prevention, cure and relief involve early identification, apt assessment and their physical, psychosocial and social treatment (WHO, 2009). Palliative Care refers to care which alleviates symptoms and there cure is not possible through simple procedures. It addresses side effects and involves a careful chemotherapy and other relevant measures. It is pertinent to mention here that the term ‘Palliative Care’ involves administration to diseases like cancer, renal disease, chronic heart failure, HIV/AIDS, progressive pulmonary disorders and progressive neurological problems like complicated Schizophrenia. The treatments in above mentioned cases cause psychological, social, spiritual and physical distress. And Palliative Care causes this aggravated condition complex to mitigate. Like emergency care, Palliative Care has its own significance which is substantial. 2. The Communication Process This section deals with the communication process that exists between patients and palliates care nursing. The theory of this specialized care is accessed through a number of journals and publications that have been formulated by professionals. Communication in Palliative Care is a process through which meanings, feelings and information is shared between two parties. They involve non-verbal communication also. Communication is done in varying ways in which context of nursing and the diagnosis initials are of main importance. It is a therapeutic process of interpersonal communication and helps in administration of assistance which sprawls over physical, psychological, spiritual and psychosocial aspects of a disease and patients. The goal of this assistance is to help patients to overcome their distress and ultimately the illness. It is also a qualitative study which uses phenomenological or ground theory by using talking, touching, listening and information giving. This is carefully selected and the concept of this communication mainly carried identification and knowing the patient and his distress. Furthering the information sharing and interaction has nurse-patient and family context. As depicted by National Cancer Alliance in 1996 the identification of deficiencies in healthcare are overcome through family history. Here a step towards psychosocial care is also taken and emotional experience is also noted. Many cognitive therapies are also administered to the patients who are helpful in varying respects. 3. Advance Care Planning Advance care planning in Palliative Care is a highly professional aspect of the program. It has four aspects that are important to be noted before the micro level planning. These aspects are (ASCO, P. 2012): a. Performance status which calculates the abilities and limitation to care for oneself b. Ineligibility of participation during a clinical trial which might end up in limited communication and ultimately hinders easy administration of care in effective manner c. The evidence based treatments are an important part of the advance level planning and if the patient does not receive benefit from previous evidence based treatment investigative communication will have to be performed again d. Assessment of physician about the effectiveness of treatment These aspects are universal and applicable to disease conditions like cancer and other old-age chronic-terminal problems. Note that the assessment method while knowing symptoms is bases on Edmonton Symptoms Assessment Scale (ESAS) with rating points from 0 to 10 (Bruera, 1991). It involves assessing level of depression, appetite, anxiety, nausea, drowsiness, and sensation of well-being. Emotional changes bring physiological and neurovascular changes like change in heart rate, short breath, sweating and fidgeting, etc. Although it is complicated yet professionals are trained for their assessment, diagnosis and management. 4. Culturally Appropriate Care Societies have different psychological constructs and culture is defined as ‘what we are’. This definition when seen through the lens of norms, folkways, taboos, haves and have not, etc. become the wholesome picture about the culture. Religion then plays an important role in defining culture which lies at the hearth of any culture. In multi-ethnic societies sub-cultures are obvious to exist therefore it is important to note following aspects through the process of communication (Dunne, 2005). a. What is traditionally known to patient (what is ‘I don’t Know’) b. Fear of getting blames (as commonly seen in case of HIV/AIDS) c. Emotional response of patient (Anger, Silence, Tears, etc.) d. Medical Hierarchy (Response to the procedures) e. Anxiety and Existence of Death Instincts f. Fear of untaught It is therefore important to keep a close eye on the culture related responses of the patient which might increase or diminish mental and psychological distress of a patient. The level of spirituality of a patient is also important to assess. Cultures are steers by deep rooted religious mobilization of patients. If the level of self-contentment is noted during communication step, it will help in fomenting positive psychological disposition in patients suffering from chronic illness. 5. Epitome and Case for Assessment and Management of Pain As discusses the ESAS method of assessment has eight visual based point scores. The Visual Analog Scales (0 to 10) indicate problems that cause physical, psychological, psycho-social and spiritual distress. The role of patient in this assessment is important along with the engagement of family of the patients (Bruera, 1991). Some of the examples in communication for assessment and management procedures are discussed in this section. In Aged Care services are not effectively explainable in first clinical interaction; the recipient is explained about the nature and its relationship to end of life care. The changing care needs, timeframe and professional support services are presented so that decision about delivery of the care might be taken (Health.gov.au, 2014). The standards for delivery of care which are expected are also explained with the prognosis of physical and mental changes that might occur during the course of the program. The effectiveness of the program is gauged with the help of standardized extrapolation of prognosis. Re-assessment is also important which occurs time to time. The responsibility is to share specific types of information and the documenting of changes is dome during the care plan. In next section the management issues and its procedural steps will be discussed. 6. Assessing and Managing Chronic Conditions Assessment and Managing of Chronic Conditions in a pose operative pain management is taken as moot point to comprehend the concept of palliative care. Note that the 70% of the surgery patients experience varying degrees of pain which are divides as (Borda, 2009): a. Moderate b. Severe c. Extreme Under estimation of postoperative pain causes distress, mortality and morbidity in patients. Thus importance of pain is important in assessment and management in patients. Old age patients according to Age-Action table will lead to terminal distress and non-recoverable attitude of the subject patient. The assessment table are consulted in each complication with varying care administration, few complications are a. Stress response to surgery b. Cardiovascular Complications c. Respiratory Complications d. Musculoskeletal Complications e. Gastro Intestinal and f. Psychological Complications (emotional responses like resentment, anger, neurovascular changes like palpitation, sweating which can cause hypoglycemia and various problems) Aims of effective postoperative pain management are to improve comfort and satisfaction, reduction of morbid thoughts, promotion of rapid discharge from hospital and facilitation of functional abilities (recovery). It is important for the health professionals to conduct pre-operational evaluation especially in old age patients so that proper measures might be adopted for pain management in post-operation scenarios. It is equally important for professionals to segregate their roles and responsibilities during planning and assessment procedure (Health.gov.au, 2014). A team of professional nurses which are eyes and ears of any care program must be specialized in getting maximum information. 7. Psycho-social and Spiritual Support As discussed in cultural context, the psycho-social and spiritual support section will address the effectiveness of this cognitive element in palliative care. Psycho Social support is usually extracted from the up-bringing and mental construct of an individual. Family histories and interaction during communication process play an important role. Spirituality is actually an aspect that is instigated during distress conditions and can be an output of human concept about life and spirit. In religious societies it has been seen that suicide rate, according to Emil Durkheim, is lower to that of Atheist societies. Thus spiritual support is a way to mitigate those aspects which are usually troublesome and may make patient a dejected case with rejecting attitude. Thus it is important for patients that are terminally ill to show sign of a better will and helping themselves along with medication and care. The case of sports men that are spiritually strong and have psycho social construct with better will power have even recovered from blood cancers after chemotherapies. This epitome is one such perfect example of psycho-social and spiritual support administered to construct positive cognition by a patient’s rational will and ambiance. Work Cited ASCO (2012), American Society of Clinical Oncology, Five Things Physicians and Patients Should Question, Choosing Wisely: an initiative of the ABIM Foundation (American Society of Clinical Oncology) Borda, P. (2009). Guideline on Pain Management. [online] Available at: http://European Association of Urology 2013 [Accessed 17 Aug. 2014]. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients Journal of palliative care 7 (2): 6–9. PMID 1714502 Dunne K (2005) Effective communication in palliative care. Nursing Standard. 20-13, 57-64. Date of acceptance: June 3 2005. Health.gov.au, (2014). Department of Health | Industry Feedback Alert - Effective communication in palliative care [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-feedback-alert-palliative-care.htm [Accessed 17 Aug. 2014]. WHO. (2012), WHO Definition of Palliative Care World Health Organization Read More