Nursing Roles and Professional Attributes in Palliative Care - Essay Example

? Oncology Nurses Perception’s of Nursing Roles and Professional Attributes In Palliative Care September 15, Word Count 2040 Introduction Palliative care recipients are decided by many factors. Palliative care, despite the opinion of many is not simply another word for Hospice. The term encompasses helping an individual be functional, healthy, and independent and as comfortable as is possible despite diseases’ including chronic and debilitating disease such as is frequently treated in the field of oncology. In diseases that are not curable care is always considered palliative care. Palliative health care services for children in the UK are both organized and delivered differently than adult palliative care in oncology (Price, McNeilly, & McFarlane, 2005). Palliative care will usually begin initially at the diagnosis of an incurable disease and continue throughout one’s life (Shaw, 2011). Palliative care will usually involve a multidisciplinary team approach and coordinators will manage and assist with symptoms and pain management along with the other aspects of medical care along with other basic needs such as financing, transportation, medical equipment, respite services for caregivers, counseling and of course easy transition to hospice services should this become necessary. Frequently palliative care is understood or thought to limit opinions available to families and patients rather than helping them to utilize the optimum clinical knowledge and tools available. Rationale 'Oncology Nurses' Personal Understandings about Palliative Care' The rationale for a literature review in palliative care in oncology is heavily supported by the number of new cases expected to be reported yearly; in 2009 alone 1,479,350 cases were expected in the United States (Mahon, and McAuley, 2010, p142). The ultimate goals of cancer treatment fall directly in line for those in palliative care; minimizing effects and alleviating the burdens of this disease. Advances in oncology treatment now means people are living longer with the disease and longer life spans with the disease previously often meant a reduced quality of life; living with the burden of pain, mental anguish and disabilities. Palliative care is now understood to be very distinct from that of hospice care and should be available to patients independent of the prognosis and diagnosis. Cancer patients live with significant burdens and because complex decisions are usual for cancer patients palliative care should be available commonly and routinely to cancer patients. It has become the standard of care for patients with cancer and serious illnesses. Though deficits remain with oncology there are two trends that heavily influence the oncologist’s nurse’s perceptions about palliative care. Many oncology nurses find it difficult to distinguish between palliative care and hospice care and oncology nurses have the unusual opportunity for being trendsetters in oncology palliative care because of the fact that each cancer patient is a good candidate for palliative care. Analysis of Available Literature on Palliative Care in Oncology 'Oncology Nurses' Perceptions of Nursing Roles and Professional Attributes in Palliative Care' Few research studies have explored the perspectives of nursing roles in palliative care (Pavlish & Ceronsky, 2009). Most research is focused on gaining insights about end of life care. Nursing support in palliative care was found to have six dimensions; connecting, valuing, empowering, doing for, assisting in finding meaning, and ensuring the preservation of the patient’s integrity. Nursing responsibilities in the same study were described as providing comfort, responding during the death scene, enhancing personal growth, reacting to anger, enhancing the quality of life during dying, responding to colleagues and responding and interacting with the family in a supportive and professional manner. It was discovered that many nurses felt the most important aspect in palliative care was honesty with the patient which is essential to a therapeutic and trusting relationship. Being attentive to the patient’s individual needs was also consistently emphasized in focus groups used to study the perspectives of nurses in oncology on palliative care. One particular study demonstrated that participating nurse’s definitions of palliative care were for the most part consistent with the palliative care principles. Cancer of unknown primary: addressing the communicative, ethical and medical challenges in clinical practice -- a perspective from palliative care and supportive oncology' Cancer of unknown primary (CUP) is poorly understood though defined as a metastatic cancer for which the primary site is initially undetectable. It is a heterogeneous group of diseases which affect varying anatomical locations. This classification purpose is first to identify possibly curable tumors and secondly to identify a possibly chemo responsive disease. This cancer accounts for 3-5% of all cancers and in this particular focus demonstrates the importance of a timely and considerate approach to the palliative management of this group of patients. CUP is the fourth leading cause of cancer death in the Western United States though despite this the palliative care needs of this particular population have been both poorly assessed and quantified in current literature (Ryan, Lawlor, & Walshe, 2010). Interviews have suggested that the needs of this group differ from those with primary cancers and themes and concerns identified by literature include general uncertainty, lack of understanding of CUP casualty, the experience and frustration of multiple investigations to no avail and because healthcare members often do not know the answers they are unable to provide them to the patient. Because CUP is a common cause of cancer death further study is needed from a palliative care perspective. The specific needs of this population must be established to create and design the appropriate resources which can be used to target them. ‘Oncology nurses’ perceptions of obstacles and supportive behaviors at the end of life’ This particular research study focused on two questions; what is the magnitude of obstacles to providing end of life care to cancer patients as perceived by oncology nurses, and secondly, what are the supporting behaviors in providing end of life care to cancer patients as perceived by oncology nurses? Goals of this study were to allow educators to better educate and support bedside oncology nurses in delivering end of life care as well as palliative care. Using a self-reporting questionnaire 375 nurses participated after all who were disqualified for some reason or other were removed from the survey data. The highest rated obstacle to providing high quality end of life care to oncology patients was angry family members, which was followed closely by family members being unaccepting and unbelieving of the patient’s prognosis (Beckstrand, Moore, Callister, & Bond, 2009). Dealing with anxious family members and the family members being overly optimistic were also listed in the top ten obstacles. Families also expressed concerns over family members being overly sedated, frequent phone calls from family members for patient updates, and interfamilial fighting about whether or not to stop aggressive treatment ranked ninth. Nurses reported the third ranked obstacle and one that left the biggest impression was being called away from dying patients to care for other patients. This particular obstacle is easily demonstrated through staffing ratios, high patient loads, and lack of time to care for dying patients. Nurses also complained of physicians insisting on very aggressive treatment until patients are actively dying; nurses frequently commented that physicians were hesitant to refer oncology patients at times for palliative or hospice care and because this not being their specialty area were often uncomfortable and inadequate when ordering pain control medication. This study demonstrates the need for appropriate palliative care referrals immediately on diagnosis to be able to work with a team of practitioner’s aware of these many facets of end of life care. Oncology nurses within the UK showed a familiarity with evidenced based practice in palliative care to include dimensions such as exercise promotion (Stevinson, & Fox, 2005). Recommendations included involving social workers and palliative care staff within the oncology interdisciplinary team from the start. Nursing staff and managers can also use these obstacles and supportive facilitated behavior to facilitate discussion and change within their interdisciplinary teams on how oncology care is managed and how quickly palliative care is provided in the patients long term plan of care. 'Reporting Characteristics of Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals' Cancer is a common clinical condition and pain is a common symptom addressed by effective palliative care teams. The effect of cancer pain on a patient’s quality of life is now well documented and understood. Despite the large number of evidence based practice recommendations evidence for analysis of reporting characteristics on cancer pain was not found in palliative care literature (Kumar, 2011). Most studies published on palliative care focused on moral problems, euthanasia, and spirituality. This study reviewed 2600 articles in 19 palliative care journals. 92 were on cancer pain specifically. This study found that the overall reporting of cancer pain was low with the highest to report articles on cancer pain at 19%. This study reveals that there is clearly a need for more research articles on cancer pain in palliative care journals, which allows palliative care support staff access to this information where they can then utilize this to provide higher quality palliative care to their oncology patients. Improving Palliative Care 'Improving Psychological and Psychiatric Aspects of Palliative Care: The National Consensus Project and the National Quality Forum Preferred Practices for Palliative and Hospice Care' In 2007 the National Quality Forum adopted guidelines in their framework for both hospice and palliative care. They adopted a formal definition of palliative care as, ‘family and patient centered care that optimizes the quality of life by anticipating, preventing, and treating suffering, (Ultman, Keene, & Dahlin, 2008).best practices were developed for the hospice and palliative care setting. The national Quality Forum outlined a list of preferred practices for the psychological and psychiatric aspects of care. These practices include measuring and documenting anxiety, depression, delirium and other psychiatric symptoms with the use of standardized scales. The provider should then manage these symptoms in a timely, safe, and effective manner to a level that is satisfactory to both the patient and the family. The psychological reactions of patients should be assessed in a regular and ongoing fashion or order to control and address emotional and functional losses. Because anxiety and depression are such common factors in oncology these standardized assessments should be a part of every palliative care plan in order to meet the needs of the individual in every way possible. An important practice also includes the follow up of care with families by offering services prior to the death of the patient and for a period of 13 months following this. Though this is standard in palliative and hospice care it is a form of treating the individual and the family in a holistic approach that treats all dimensions of an individual. Palliative care treatment providers are afforded the opportunity to provide treatment in such as a manner as to affect the entire quality of life of the cancer patient. Providers who keep up to date on training, treatment, and best practices are likely to be the most successful at providing palliative care that is beneficial and crucial to the patient as well as the patient’s family and support system. Promoting not only physical healing but psychological healing will contribute to the overall wellbeing of the individual and also with their level of satisfaction with their care and acceptance of their diagnosis. Conclusion Understanding the principles between evaluation and participatory research can definitely help in the design of future research studies in the UK aimed at improving the palliative health care delivery system within oncology (Froggatt, Hockley, 2011) Intangible areas of palliative care that most often make a real difference to service users were described in one UK study as the quality of the staff, a sense of community and relationships formed between the caregiver and patient (Hyde, Skirton, & Richardson, 2011) The National Council for Palliative Care provides guidance and how it might be used; they estimate only 25% of people actually die from cancer yet 95% of palliative care referrals are for those diagnosed with cancer (Procter, 2012). In July of 2011 the Palliative Care Funding review board within the UK introduced a report that established a new funding system for UK patients needing palliative care services based on the patient needs of the population. The previous system was proven ineffective to meet the needs and in the coming years more people will be dying whose needs are complex and that span health and social care (llis, 2011). References Beckstrand, R, Moore, J, Callister, L, & Bond, A 2009, 'Oncology nurses' perceptions of obstacles and supportive behaviors at the end of life', Oncology Nursing Forum, 36, 4, pp. 446-453, CINAHL Plus with Full Text, EBSCOhost, viewed 15 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=116&sid=ebd46c55-e577-4d93-92b5-d5f213adf6c6%40sessionmgr110 Froggatt, K, & Hockley, J 2011, 'Action research in palliative care: Defining an evaluation methodology', Palliative Medicine, 25, 8, pp. 782-787, Academic Search Premier, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=124&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Hyde, V, Skirton, H, & Richardson, J 2011, 'Palliative day care: A qualitative study of service users' experiences in the United Kingdom', Nursing & Health Sciences, 13, 2, pp. 178-183, CINAHL Plus with Full Text, EBSCOhost, viewed 16 September 2012.Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=20&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Kumar, SP 2011, 'Reporting Characteristics of Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals', Indian Journal Of Palliative Care, 17, 1, pp. 57-66, CINAHL Plus with Full Text, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=6&sid=ebd46c55-e577-4d93-92b5-d5f213adf6c6%40sessionmgr110 llis, J 2011, '[Commentary on] The future of UK palliative care: reflections on the recommendations of the Palliative Care Funding Review', International Journal Of Palliative Nursing, 17, 7, pp. 316-319, CINAHL Plus with Full Text, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=6&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Mahon, M, & McAuley, W 2010, 'Oncology Nurses' Personal Understandings About Palliative Care', Oncology Nursing Forum, 37, 3, pp. E141-E150, Academic Search Premier, EBSCOhost, viewed 15 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=5&hid=109&sid=75f307d8-b555-4125-8882-0b707287c03e%40sessionmgr110 Pavlish, C, & Ceronsky, L 2009, 'Oncology Nurses' Perceptions of Nursing Roles and Professional Attributes in Palliative Care', Clinical Journal Of Oncology Nursing, 13, 4, pp. 404-412, Academic Search Premier, EBSCOhost, viewed 15 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=8&hid=20&sid=75f307d8-b555-4125-8882-0b707287c03e%40sessionmgr110 Price, J, McNeilly, P, & McFarlane, M 2005, 'Paediatric palliative care in the UK: past, present and future', International Journal Of Palliative Nursing, 11, 3, pp. 124-126, CINAHL Plus with Full Text, EBSCOhost, viewed 16 September 2012.Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=20&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Procter, E 2012, 'Collaboration between the specialties in provision of end-of-life care for all in the UK: reality or utopia?', International Journal Of Palliative Nursing, 18, 7, pp. 339-347, CINAHL Plus with Full Text, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=124&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Ryan, R, Lawlor, P, & Walshe, J 2010, 'Cancer of unknown primary: addressing the communicative, ethical and medical challenges in clinical practice -- a perspective from palliative care and supportive oncology', Progress In Palliative Care, 18, 5, pp. 291-296, CINAHL Plus with Full Text, EBSCOhost, viewed 15 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&hid=109&sid=ebd46c55-e577-4d93-92b5-d5f213adf6c6%40sessionmgr110 Shaw, G 2011, 'What is palliative care?', Momentum (19403410), 4, 4, pp. 49-51, CINAHL Plus with Full Text, EBSCOhost, viewed 15 September 2012. Stevinson, C, & Fox, K 2005, 'Role of exercise for cancer rehabilitation in UK hospitals: a survey of oncology nurses', European Journal Of Cancer Care, 14, 1, pp. 63-69, Academic Search Premier, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=3&hid=1&sid=2c4a64f4-a931-4ba3-a44e-94e69536c2c8%40sessionmgr4 Ultman, T, Keene Reder, E, & Dahlin, C 2008, 'Improving Psychological and Psychiatric Aspects of Palliative Care: The National Consensus Project and the National Quality Forum Preferred Practices for Palliative and Hospice Care', Omega: Journal Of Death & Dying, 57, 4, pp. 323-339, Education Research Complete, EBSCOhost, viewed 16 September 2012. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=4&hid=116&sid=a3abcda0-b016-4436-89c1-e81d7dad3fcf%40sessionmgr4 Read More