Care For The Patient Who Is On Palliative Treatment

This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role

Over the past five weeks, I have learned what palliative care really is all about. I found that there were areas that really changed my perspective as well, about what palliative care is. Some of these include, but are not limited to, when palliative care is used, how difficult is can be to get patients the pain management they need, as well as how many different complimentary therapies are available to patients.

The purpose of this assignment is to demonstrate understanding of long term conditions and palliative care. Nursing care in general entails holistic care and collaborative care of individuals of all ages, families, groups and communities, whether sick or well (Royal College of Nursing, (RCN) 2007). Better management of lifelong conditions has been the priority of the National Health Service since the 1990s. When long term conditions are managed well in the community, patients’ can live a quality life without visiting hospital frequently (RCN, 2011). In Britain, six in ten people are reported to be suffering from long term conditions that currently cannot be cured; and these people are often suffering from more than one condition that makes their care challenging. It is estimated that by 2030 the UK will have double the number of people aged 85 years or over, who are living with one or more long term condition (Department of Health, 2014).

Pain is one of the most common and feared complications of cancer. It is exacerbated by stress, anxiety, fatigue, and malaise which accompany advanced cancer. Pain is generally absent in the early stages of cancer, but it is a significant factor as the illness progresses to advanced stages. Cancer-associated pain can arise from a variety of direct and indirect mechanisms including direct pressure, obstruction, and invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation (McCance 2010). Pain is generally accepted as whatever the patient says it is, wherever the patient says it is. Treatment of pain and its associated symptoms is a primary responsibility of the healthcare team. Treatment modalities for pain include the use of opioid analgesics, patient-controlled analgesia, psychological interventions, and preventing recurrence of pain. Reinforcing the reporting of pain by the patient is important, as is a respect for the social and cultural differences with respect to pain perception.

Thank you for the sharing of your personal experience. If I knew, the patient was dying, I would like to contact the patient’s loved one and allow them to have time say goodbye. Death is a process of life. We cannot avoid or run away from it. Therefore, ones need to learn the harmony of life. Grief is unavoidable during the death process. However, if we deal with it well, we can learn and obtain valuable experience on it. Life is sharing and love.

What was once believed to be a form of neglect has resulted in a change in practice with the idea that doing less is more. Culture is an important factor in how care is rendered and thus, the limitations of palliative and hospice care lie within the desires of the family and patients. A thorough understanding of our surrounding demographics helps to ensure a seamless approach to providing care without bias or imposition of ones beliefs. However, just as with all things, providing care for the sick and comforting the dying should be rendered in moderation as to prevent the effects of burn out. Likewise, the same effects occur in the caregivers who sacrifice their responsibilities in order to care for their love ones. Finally, and with some closing thoughts, the writer wishes to express with gratitude the benefit of having taken this course to better understand oneself and others in the realm of healthcare. The lessons learned throughout have expanded this writer's knowledge and understanding of the human desire to make a connection through communication, emotion, compassion, and spiritually - the platform from which this writer wishes to continue seeking further knowledge and

Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).

You have made excellent points. I do not believe that health care professionals neglect to treat patients in palliative care in the correct settings. The care one receives is based on what type of locations they are in. Hospitals and hospice centers often have employees with higher education levels and an increased passion for their job. I believe that health care providers want to ensure that one is comfortable at the end of life. I have visited Alive Hospice here in Nashville and was able to see the the great amount of care they provided to their patients. I have attached a link to their website below. I am curious to know your opinion on why you think one would not receive adequate care at the end-of-life phase.

When reflecting on the past few weeks of clinical experience, there is known to be many events in which I can critically reflect upon in order to improve my clinical practice. During my second week of clinical, I had been assigned with a tough patient. My patient was in his late 50’s, was a chronic alcoholic and was an avid smoker. He has a medical history of COPD, hypertension, and liver cirrhosis resulting from his alcoholic background. However, he had been recently diagnosed with a right-sided stroke. He was homeless as he lived in the motel in town, and had no family or friends to lean on for support. In particular to my personal critical reflection, my patient had signed a DNR with limited interventions. According to his wishes, he requested not to receive any artificial nutrition by tube and refused antibiotics. As a nursing student, wishing to help people recover, this was a specific component in which I could not wrap my head around.

Palliative care was designed as a state of the art measure that alleviated suffering in the patents which allows for better communication to be transpired between the health care team that will alleviate strains for the healthcare members. Clinicians need to be more involved and advocate for consultation based upon identifiable triggers requiring consultation, and elicits feedback from staff about certain interventions. The clinicians acting as an advocate for the patients must remain knowledgeable in recognizing the shift in the patient’s course that indicates the need for palliative care and communicate poor prognoses and outcomes with the patients, loved ones, and offer palliative care when death is prominent. Despite the many barriers identified here, clinician must be champion for palliative care on both hospital, unit, and as well as, on the level of the patient. (Perrin & Kazanowski, 2015)

For most people who are at the final stages of life, a hospice care is where life official ends. Some patients prefer not to die in a hospice care. Some patients are unable to decide where they want to die. For their surviving loved ones, they would make the final decision for their loved one. When family members know that their loved one is dying, their loved one's home is likely where they want to spend their final hours or days in. Caregivers often decide to place their patient in a hospice care where they can passed away in peace.

In the past few decades, the population of the industrialized world has seen an upsurge in longevity due to improved nutrition and medical care. Recent advances in science and technology, such as the discovery of the antibiotics and organ transplantation, ended an era of infectious disease and contributed to an increased lifespan. Unfortunately, their contributions were insignificant or inexistent in curing chronic diseases and terminal illnesses associated with old age and were a factor in prolonging the agony and pain of the incurably ill. The upsurge in the geriatric population led to a higher demand of palliative care units, nursing homes, healthcare professionals, etc., and raised an ethical and legal debate over whether terminally ill

A care case conference is a meeting held between a pt, their family or carer, and the multidisciplinary team. The aim of a case conference is to identify clear goals of care for a pt including review of any advance health care directives, care plans and new health plans. The conference is where issues and questions about palliative and end of life care are raised and agreed upon. Some things that may be discussed eg. Pts condition and if its deteriorating fast, how the progression of illness is going to change, how will nursing; medical and the team manage this progression? Do they know their wishes and if so advanced health care directive, DNR order is implemented or in progression. it is important that those with legal decision-making responsibilities

Palliative care is for patients such as Lorna Hetherington who are facing a life threatening illness. Palliative care is defined by the World Health Organisation as an approach that improves the quality of life of patients and their families confronted with the problems of a life threatening illness, through the prevention and relief of suffering by medical interventions and constant assessments as the illness progresses (Brown & Edwards, 2012, p 158). Implementing a palliative approach is not based on a clinical stage or diagnosis but based on the patients needs. As an enrolled nurse providing palliative care, the aim is to improve the quality of life for the patient, which is more than just pain management, rather a holistic approach is implemented.

Palliative care also referred to as end-of life care (Mosca, Blazer, Wheeler and Abernethy, 2011), is a clinical issue which focuses on treating symptoms, relieving suffering, and providing support to the patient and their family (Hauser et al., 2011). Castro (2015) further defines palliative care as providing comfort through pain relief, attaining a high quality of life and preserving the self-respect and self-confidence of a patient (p. 13). Palliative amputation is a type of surgery described as a component within palliative care that is vital to managing incurable diseases, through preventing and minimising painful symptoms (Mosca, Blazer, Wheeler and Abernethy, 2011). Merimsky, Kollender, Inbar, Chaitchik and Meller (1997) report that palliative amputation is now considered a rare procedure, as it has been replaced with less invasive approaches, including limb-sparing surgery (p. 151). Cancer patients are often the subject of research regarding palliative care, due to the need to be treated with care rather than curative intent (Schofield, Carey, Wein, Love and Nehill, 2006). This paper will address the bioethical principles of autonomy, justice and beneficence in respect to palliative amputation. Despite the focus on cancer patients the principles can be generalised to most palliative patients. Furthermore, the contrasting opinions of whether palliative amputation should be used as a palliative care treatment is also discussed.