Hospice Care Essay

Palliative care is the active holistic care of patients with advanced progressive illness and is intimately linked with end-of-life care for people in the last months or days of life (National Council for Palliative Care, 2017). Around 500,000 people die each year in England and Wales (NICE, 2017) and up to 74% of people say they would prefer to die at home (National Audit Office, 2008), but currently 58% of people die in hospital (National End of Life Intelligence Network, 2010). Common issues in palliative/end-of-life patients such as pain, breathlessness, or seizures (Royal College of Nursing, 2011) are likely to initiate an emergency response from ambulance services. For carers and relatives the lack of community services or 24-hour clinical support often mean they turn to the ambulance service (Parkinson, 2014) This essay will explore the issues surrounding palliative/end-of-life care and the role modern ambulance services can play in facilitating effective care delivery.

Music therapy has proven beneficial to patients with cancer most notably the psychological and physical end-results. More than one million people in the United States get cancer each year (cancer.org). Most have heard or know of someone who has had cancer and the stories of the chemo radiation therapy that goes along with it. Imagine the emotions that one feels when diagnosed with cancer. The patient is ultimately suffering from the whole ordeal physically and emotionally. Music interventions are employed to “alleviate symptoms and treatment side effects in cancer patients” (Cochrane review).

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

The aim of a hospice is to improve the quality of life of the dying

Essentially, Hospice and palliative care focus on managing symptoms when a patient is deemed to have 6 months or less to live and allows patients to live out their lives away from a hospital or nursing home setting. Partially the reason why most people, including me, haven’t heard that much about Hospice is most likely because it is intended for people at the very end of their lives. However, another major reason is addressed in Gawande’s book, and it revolves around the idea that doctors don’t inform their patients every time that Hospice is really an option. Gawande admits himself throughout his book that like most doctors, he is always over-optimistic and focus on the treatment of the disease, forgetting to focus on the idea of just managing the symptoms in cases where treatment would only prolong the inevitable or giving too many choices for families to make. Gawande explains “All-out treatment, we tell the incurably ill, is a train you can get off at any time- just say when”, however other options are often never talked about (2014, p. 187). One example from Being Mortal is the story of Sara Monopoli, who faced an incurable form of cancer at a rather young age. Sara, along with her family and husband, never focused on just symptom management, but rather what new and outrageous treatment can be done

Many terminally-ill patients give up hope when treatments are no longer available to help them and hospice care is given to them as an option. However, hospice care has proven itself to provide the best quality care for the last six months of the dying. The purpose of hospice is to provide the best care for terminally-ill patients at the end stage of their lives. Hospice offer services to support too many aspects a patient’s life such as medical, legal, spiritual care. Hospice includes art therapists, music therapists, and certified chaplains on the palliative team.

According to the National Hospice and Palliative Care Organization, (NHPCO, 2012) in 2011, an estimated 1.65 million patients received services from hospice and an estimated 44.6% of all deaths in the United States were patients under hospice care. In 2001, an estimated 36.6% of cancer patients accessed three of more days of hospice care. The median length of service in 2011 was 19.1 days. 56.4% of hospice patients were female and 43.6% were male. 83.3% of hospice patients were 65 years of age or older, and more than one-third of all hospice patients were 85 years of age or older. 82.8% of hospice patients were white/Caucasian. Patients of minority (non-Caucasian) race accounted for more than one fifth of hospice patients. Today cancer diagnoses account for less than half of all hospice admissions (37.7%). Currently less than 25% of U.S. deaths are now caused by cancer, with the majority of death due to other terminal diseases. The top four non-cancer primary diagnoses for patients admitted to hospice in 2011 were debility, dementia, heart disease, and lung disease (NHPCO, 2012).

Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, 2013). For most nurses, caring for a dying elder (individual aged 65 years and above) is a discrete, time-limited experience that begins with first contact, often in a hospital, emergency room, or long term care facility, and ends with the death itself (Phillips & Reed, 2008).

I would like to be a hospice nurse practitioner in the future. I worked in the cancer center for two years when I was in Taiwan. Most of our patients were underline with solid cancer which included Nasopharynx cancer, esophageal cancer, gastric cancer, pancreas cancer, colon cancer and liver cancer. The characteristics of solid cancer illness are long-term progression which means their five-year survival rate usually higher than hematology patients. A lot of patients in our nurse station kept in-and-out for more than two years, therefor, we build deep and strong relationship with them. As a result, we not only concerned about patients’ health condition, also we pay more attention on their quality of life. However, being a hospice nurse need professional knowledge background, also they need counseling skills to help patients, family members and caregivers to deal with sorrow and feeling of lost. To be a professional hospice nurse practitioner, there are several counseling skills are very crucial.

According to the Agency for Healthcare Research and Quality (AHRQ) despite the evidence that consistently indicates that palliative care and provision of access to hospice is essential to end-of-life comfort and quality of life in the final stages of terminal illness, it is still not used effectively or sufficiently (2012). In fact, Ctarlson et al., (2010) determined that in spite of the fact that there has been a 41% increase in the total number of hospice service providers in the United States since 2000, that at least 60% of terminally ill Americans still die without the benefit of hospice services. This is because a variety of factors can create an availability gap, or make it increasingly difficult for individuals to access hospice care. These factors generally include: geography, race, age, and socioeconomic capital (Silveira 2011). Each of these factors can be individually examined, as they relate to care accessibility.

Hilliard, R. E. "Music Therapy in Hospice and Palliative Care: A Review of the Empirical Data."

‘Controlled use of music and its influence on the human being in physiological, psychological, and emotional integration of the individual during treatment of an illness or disability’.

On average 1 in 2 Canadians will be diagnosed with cancer in their lifetime (Canadian Cancer Society, Canadian Cancer Statistics 2017). A side effect of a cancer diagnosis is often significant stress. Still, stress is inevitable whether it is a personal or a loved one’s sickness. Stress that is not dealt with or is left to build up can cause many different health problems either with the cancer patients or family members. These health problems include high blood pressure, heart disease, diabetes and more (Mayo Clinic). Music, for many, is a way to cope with these issues because it serves as a relaxation technique that reduces stress levels and anxiety. Abbey L. Dvorak published her peer-reviewed scholarly journal on cancer patients in the

Musical instruments have played many major roles in helping with the construction of many societies around the world today. Many people do not realize what musical instruments have been responsible for and how they have helped shape the world today. There have been many instruments that have helped create and sculpt the world, but one instrument that I want to inform readers about is the trumpet and where it came from, as well as how it has changed over many years. The point that I am arguing is the fact that many people do not know where the trumpet has come from and how it has affected society.

Pain, increased weakness, decreased intake of food and fluid, altered breathing patterns are some physical symptoms often experienced by the terminally ill (Kouch, 2006 as cited in Leow, Drury & Poon, 2010). Treating pain in the terminally ill is very important and challenging for nurses. Therefore, it is important to use both pharmacologic and nonpharmacological methods to reduce pain. The ability of nurses to use music therapy as a nonpharmacological method to manage pain in the terminally ill is a phenomenon of great importance to nursing. Terminally ill in this literature refers to patients with cancer that have six months or less to live and patients that are hospice or are undergoing palliative care. This literature revealed that using a multivariate analysis of covariance (MANCOVA), significantly less posttest pain was reported in the music versus the control group. Cancer patients that listened to soft music in addition to using analgesics experienced increased compared to those using analgesics alone (Huang, Good, & Zauszniewski, 2010). Furthermore, statistical difference was noticed between the groups for mood level and oxygen saturation during live saxophone performance (Burrai, Micheluzzi, & Bugani, 2014). In addition, this research indicated that music may have a more positive effect on females and elderly than younger and more educated males (Chan, Chung, Chung, & Lee, 2008). The