Termonally Ill Patients Concept Analysis

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

1.1 Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Comparatively, Bailey et al. (2014) studied the effects of implementing interventions to improve end of life care for inpatient veterans. The problem statement was determined to be that end of life care in the inpatient setting was lacking, which drove the aim of the study to improve EOLC and to minimize suffering of the patients (Bailey et al., 2014). The researchers theorized that this could be accomplished if recognition of end of life was increased and if home-based palliative interventions were implemented. Therefore, the team sought to study the effectiveness of implementing staff education of three items: evaluating patients who are actively dying, communicating end of life interventions with patients and families, and implementing home-based best practices for end of life care (Bailey et al., 2014). The purpose here was to improve inpatient end of life care.

Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include

According to American Geriatric Society (2002), chronic pain often associates with older adult. In United States, most of the older adults are suffering from pain in the absence of disease which is clearly not a normal part of aging (Bell et al. 2004). The common chronic pain in older adult is fibromyalgia, gout, neuropathy such as diabetic neuropathy, osteoarthritis and many more (Hiemenz and White 2002). It is estimated that 30% to 50% of older adult has multiple disease and its interaction with body physiologic changes may results in decreased in ability to respond stressors. Chronic pain among older adult has been associated with negative perception that it will lead to impaired in psychological functioning (American Geriatric Society 2002).

You are right, education continues to be the key. We need to make sure our patients and their love ones understand the end of life process, the expected outcomes and their options. At our facility we have an extremely active palliative care team lead by an ARNP. We provide music and pet therapy. The hospital chaplain is also very involved, depending on the patient and family preferences. Patient condition, wishes and available choices are usually discussed in multidisciplinary meetings with patients (when possible) and family members. In the final stages of many terminal illnesses, care priorities tend to shift. Instead of ongoing curative measures, the focus often changes to palliative care for the relief of pain, symptoms, and emotional stress.

M. Carrington Reid, Christopher Eccleston, and Karl Pillemer compiled a systematic review of chronic pain in older adults. Their sources, published during the past five years, were systematic reviews, meta-analyses, high quality randomized controlled trails, and clinical guidelines. They determined that not only is chronic pain a worldwide problem but that geriatric patients often suffer from chronic pain. In order to treat chronic pain a comprehensive geriatric pain assessment must be completed. They also determined that based on the current evidence a multimodal approach should be used including pharmaceutical and non-pharmaceutical approaches to pain management.

Palliative care teams should initiate palliative discussions when a patient is first diagnosed with a terminal disease. Early palliative care consultations provide symptom management and prognostic awareness (Strand, Kamdar, & Carey, 2013). The goal is to have a plan in place and set realistic expectations before the disease progresses. For example, patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) may have years before the disease takes its toll on their body; however palliative care discussions should start with diagnosis as it allows for a candid, open discussion between the patient, their loved ones, and the palliative care team.

The elderly patient normally shows some reluctant to report painful stimuli due to fear of side effects and also the fear of addiction. Some clinicians are not treating pain to the optimal level due to their unfamiliarity with assessment and treatment because of lack of formal education. As a nurse practitioner, been able to balance the appropriate medication, and the dosage used to reduce pain in these elderly patients while maintaining safe practices in the older adult suffering from pain is a

Pain management also involves the use of prescribed analgesics. Older people experience of pain varies with some because of increased tolerance to some medications as well as interactions of analgesics to medications taken for chronic conditions. Considering the fact, it highlights the need for all older patients to have their pain assessed and managed on an individual basis. (McClean et al 2007).

Palliative care is a service provided by trained medical professionals to provide comfort to the patient that is suffering from a serious illness. Many people do not have a clear understanding of what palliative care is and how it provides relief for the patient, as well as the patient’s family. There is a definite need for education on this topic as well as many other topics concerning patient education and safety. The Joint Commission (2016) launched a Speak Up™ campaign in 2002 and one of the main topics the campaign focuses on is palliative care. The brochure offered is titled What You Need to Know About Your Serious Illness and Palliative Care (The Joint Commission, 2016) and is available for the public to download or print at no cost. The brochure provides useful information on what services are provided and where you can receive those services. It includes other information that is not only beneficial to a patient, but a patient’s family member, or anybody who knows someone that may benefit from palliative care.

Pain management also involves the use of prescribed analgesics. Older people experience of pain varies with some because of increased tolerance to some medications as well as interactions of analgesics to medications taken for chronic conditions. Considering the fact, it highlights the need for all older patients to have their pain assessed and managed on an individual basis. (McClean et al,

Manual of Hospice Care and Palliative Care International Association for Hospice & Palliative Care Promoting Hospice & Palliative Care Worldwide The IAHPC Manual of Palliative Care 2nd Edition Published by IAHPC Press ISBN 0-9758525-1-5 Derek Doyle OBE, DSc, MD, FRCSE, FRCP (Lond & Edin)