Integrative Palliative Palliative Care: Team Analysis

As The role of the neonatal intensive care nurse in decision-making: Advocacy, involvement in ethical decisions and communication defines an ethical dilemma, “An ethical dilemma exists when some evidence indicates that an act is morally right and some evidence indicates that the same act is morally wrong, but the evidence on both sides is inconclusive… Thus, an ethical dilemma is not between the good aspects and bad aspects of a situation or between what can be done and what one wishes could be done, but among two or more morally right, but inconsistent, alternatives” (International Journal of Nursing Practice, 109). West Park Hospital states on their tree of ethics that compassion and respect, commitment, advocacy, competency, accountability/ responsibility, professional growth, knowledge, collaboration, and integrity are the roots and branches of a healthy nurse-patient relationship. Not only do nurses have to deal with everyday ethics, but they are also given the responsibility of making life-and-death decisions for patients who don’t have the ability to advocate for themselves. Within the domain of nursing, ethical decisions of all types occur within the job, but the level of education and responsibility that you have acquired determines many of the ethical decisions that one is required to make on a daily basis. Over the years, technological advances have changed the ethical decisions that occur within the job and the way that we handle those decisions. Technology has changed our world in many ways, especially within the medical field- some for the better and some for the worse, and this is very noticeable within a nurse’s daily life. Nurses have a lot of responsibility when it comes to making ethical decisions, but they are not the only ones that are involved in those decisions when it comes to vulnerable

Nurses in specialty care continue to change the health care system to meet the needs of patients regardless of the setting. Hospice and palliative care is an area of nursing specialty care that has grown since the 1970s when it began (Cowen and Moorhead, 2011). Leaders in nursing identify change that is needed and discover ways to make the changes possible. The leadership in nursing brought forth attention for patients with terminal illness. Nurses defined hospice and palliative care, developed core principles, practices, provided education and then pushed for the care to be available in multiple settings (Cowen and Moorhead, 2011). The continued growth in this specialty area of nursing is related to the positive outcomes of patients that have

Before I started this class I thought palliative care was only used as end of life care, or for when a curative treatment was unavailable or had failed. As we learned about the different models of care, and how they have changed over the years, it became evident that the use of palliative care has changed drastically over the past several decades. In the 1800s to 1900s, palliative care was only used once the patient had reached the dying stage, and only included the patient in this care, not their families1. Before taking this course, this is what I thought of palliative care as well. Since the late 1900s though, palliative care has been used in a more proactive approach. From the moment an individual receives a life threatening illness, palliative care begins. This includes caring for the family of the patient as well. This care increases as the patient’s illness progresses, and even continues for the family after the death of the patient. Learning this has really made an impact on how I would like to work as a

My perception of palliative and Hospice care has changed slightly when it comes to communication with the family. I walked into the hospice unit mentally preparing myself to talk with patient families about their loved one and the dying process; this was certainly not the case. The family and the patient did not want to be bothered unless comfort interventions needed to be carried out and there was no conversation to be had about the patient and his situation. This shows that each family is different, each patient is different; and we need to respect and accommodate their unique

Sometimes the transition from critical care to end-of-life care is instantaneous, and the urgency associated with end-of life decisions for these children creates challenges for the nurses providing this care. Therefore nurses whose day-to-day practice focuses on saving lives, a sudden or even gradual change in a child's situation to end-of-life care can cause a disconnect between what nurses routinely do in the ICU setting and what they are now expected to do. Fewer studies could be located that has examined the effects of educational program on nurses provide end of life

Nurses also provide end of life, and post mortem care. When a patient dies, the nurse often grieves alongside the family and helps to provide them with emotional support (Hecktman, 2012). Although the prognoses of childhood cancer have improved drastically over the last 30 years, many children still succumb to the disease. Nurses are the ones who provide constant bedside care, and often “must confront the limits of what medicine can do for people” (Schuster, 2013). This can prove to be difficult and bring on feelings of hopelessness and as though they are not helping their patients at all. Patients can leave lasting impacts on the nursing staff, and when multiple children die while in their care, the nurse may begin to experience cumulative loss. Childhood cancer is the leading cause of non-accidental death for children in Canada, and therefore, pediatric oncology nurses are often exposed to death on a routine basis, with little time to grieve between the deaths. It is imperative that nurses are aware of their stressors and how they respond to stress in order to effectively care for their patients.

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).

Neonatal Nurse Practitioners (NNP) refers to and cares for newborns in their first 28 days of life. Neonatal nurse practitioners practice advanced skills in order to provide care for healthy newborns, as well as newborns who need individualized attention. These nurses care for premature and sick newborns in many different settings: neonatal intensive care units (NICU), emergency rooms, delivery rooms, or specialty clinics(Nurse). NNP’s level of care enables them to preform multiple duties consisting of: monitoring specialized equipment, providing education to the families of the sick newborns, administering medications, preforming diagnostic tests and other procedures in order to establish a treatment plan for the newborns,

Hospice’s main focus is on the patients and their needs. As shown on www.nhpco.org, the website for the National Hospice and Palliative Care Organization, their vision for patients and families is one where individuals and families facing serious illness, death, and grief will experience the best that humankind can offer (National Hospice and Palliative Care Organization, 1). With this in mind, those who are involved with Hospice work to provide patients with relief from their symptoms and try to lift the weight off of their shoulders, also known as the Palliative Care part of Hospice. Hospice care involves a team-oriented approach, where members of the organization will work together to ensure the the patient, and their family as well, receive compassionate care (National Hospice and Palliative Care Organization, 1). This includes physical care, such as pain management, emotional care, such as relieving stress, and spiritual care. Emotional and spiritual

Children’s hospice care is a form of a palliative care which is provided to children who are expected to live six months or less (). They relieve pain and other symptoms that cause discomfort so that each day can be lived to the full. The families feel being supported emotional, social, practical, psychological and spiritual by the staff. The staff supported families during their difficult time and during the days when there are no longer with their loved ones. They were not alone all the time when they need anything a member of multi -professional team will be there for them for example supporting them with funeral expenses, social fund and ensuring that brothers and sisters are being supported on their grieving moments. A grief specialist

Multidisciplinary team. Palliative care is a consultative discipline led by physician (Billings & Pantilat, 2001). Palliative care requires multi-disciplinary support including buy-in from medical institutions and hospital leadership (Danis et al., 1999). Healthcare providers involved in palliative care include, but are not limited to: anesthesia personnel, chaplains, psychiatrists, internal medicine physicians, palliative care nurses, social workers, psychosocial and psychiatric advanced practice nurses, and hospital administrators (Lynch,

According to the parents, physicians mainly focused on the physical symptoms of the child. Most of the psychological symptoms of both the child and the parent were not acknowledged by health professionals (Theunissen et al., 2007). Despite this result, there have been substantial research conducted to create measures that can gauge the quality and effect of palliative care mostly for adults. However, data collected from these studies may be applied to interventions created to help children with cancer.

“Improved communication is noted as one of the most important factors in enhancing end-of-life care in a pediatric setting” (Hsiao et al., 2007). These factors are beneficial to maintaining the best care for the child. The relationship between hospital staff, the child, and the child’s family is crucial. “Parents have emphasized the importance of receiving honest and complete information from staff, having ready access to staff, and having continuous, caring relationships with compassionate staff “(Hsiao et al., 2007). Along with the parents’ communication with staff, parents feel it is important to have the child communicate directly with the physician when appropriate. They feel “gaining the child’s perspective is critical if there is to be a cohesive relationship among the child, parent, and health care provider” (Hsiao et al., 2007). Also, children who are able and comfortable enough to communicate with physicians benefit

I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of

* Attention to residents’ transition from active curative care to palliative care (with comfort care and symptom management) requires that care team members provide the resident and their families with sufficient information about the transition process to facilitate decision making. This provision of information can reduce residents’ and families’ concerns and increase their satisfaction regarding the appropriateness of a palliative approach.