The Importance of Palliative Care for the Dying Patient Essay

Q1: Complete the following table, describing the needs you would have to consider when planning the different aspects of end of life care for an individual

The World Health Organisation (2010) defines palliative care as: An approach that improves the quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. It is also our duty to support John and his wife`s in their decision for John to die at home, Department of health (2008) patients should have a choice over the care they receive and where.

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

The beginning of life is celebrated. Books and resources are shared among friends and family in preparation for becoming a new parent. So, what happens as one approaches the end of life? Unfortunately, the same care and sharing rarely occurs in those circumstances and many face the prospect of dying unprepared. Though most people state they would prefer to die at home, this is often not where death occurs. Many Americans spend their last days attached to medical apparatus that keeps the body alive, but it does not allow for communication with family and often requires heavy sedation. Additionally, this level of treatment comes at a high price. As a society, we must become as comfortable in addressing the end of life process as we

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

For many people, the process of dying is a prolonged, painful, and emotionally devastating experience. Dying often leaves an individual filled with fear, confusion, and feelings of loneliness and isolation. Fortunately, there are palliative care options that seek to mitigate not only the physical pains and symptoms of death, but also actively work to address the emotional turmoil countless people experience as they begin to descend towards death. On the other hand, far too many Americans still die in intensive-care-units and emergency rooms, where doctors aggressively work to save the lives of all patients, without regarding the actual status or well-being of the person’s life before them. Dying in a hospital room is not peaceful; it is often

they can offer a wealth of information and can help to make them feel useful.

In recent years, Hospice care have risen to popularity and is being widely used among many terminally – ill patients and their families. This is evident in a report from the National Hospice and Palliative Care Organization, “In 2014, an estimated 1.6million – 1.7 million patients received services from Hospice” (NHPCO, 2015). It is seen that many people uses Hospice care which means that many deaths are also under the care of a Hospice program, therefore, patients and families satisfaction is a crucial factor in assessing the quality of Hospice care and how to make improvement for future services. Thus, I decided to conduct a research on patient and/or caregivers satisfaction that received care from hospice programs.

In almost every case of a terminal disease, pain is intolerable and seeing someone in such agony is heartbreaking. For example, Brittany Maynard, a 29 year old brain cancer patient who had to move to Oregon so she can avail of the Death with Dignity act. “Maynard knew that her form of brain cancer would be excruciating. She would endure swelling of the brain that would very likely cause seizures, painful headaches and the gradual loss of bodily function. Doctors know that for about 5 percent of the population, no amount of morphine can block the agonizing pain the terminally ill endure” (EDITORIAL: Dying with dignity). Palliative care can often be provided for the dying patients and alleviating pain to provide comfort for the dying has always been the priority. “Palliative care focuses on relieving the symptoms, particularly the pain, of incurable illness.” (Palliative Care) But, in relieving pain through the prescribed medications there are also side effects that are caused by the prescribed pain suppressors and two examples will be lethargy and it compromises breathing. In most cases the effectivity of the pain medication may no longer alleviate the pain. If a patient will be in such agony for the remaining days or weeks the quality of life is no longer present. The agony of pain prevents a patient from performing even just the bodily functions.

Having a dignified approach and respecting elderly patients in a palliative care unit is important because it is enabling them to have control over their care and treatment. This is going to help the patient to feel valued and throughout their last days of life, as they have a choice. (Social care institute for excellence, 2010). By making the patient feel as comfortable and as pain-free as possible, it will help encourage family members to respond in a positive way. This is because they are seeing that their relative is in a comfortable state.

This is recognized to be an issue, and throughout the article the authors provided an understanding of how palliative care and end-of-life care are provided too late for a patient and should be provided at an earlier time in order to bring more comfort to the patients. The authors suggest that when and how end-of-life care is provided should be altered, with nursing ethics in mind, so that patients and nurses may feel better about the care they receive. This source will help my research by providing information on how changing the policies of end-of-life care and palliative care can result in the patient feeling a relief from their suffering and ultimately feeling more comfortable. This will also help my argument in how altering the current policies and focusing on providing better end-of-life care can lead to the diminishment of physician-assisted

In my nursing practice, I frequently care for dying patients. Instead of simply providing medication to ease pain during the dying process, I wanted to learn about ways to enhance the comfort of the dying patients and possibly assist their family during a difficult time. This desire led me to examine the conceptual model of comfort. Through my research of the concept of comfort care at end of life, I discovered Katherine Kolcaba’s theory of comfort. I found her theory to be useful in describing the concept of comfort care and decided to further analyze it for a more thorough understanding of its usefulness and applicability to nursing practice. Nurses are the ones in direct contact with their patients, providing relief from certain discomforts, continuously assessing, monitoring and providing care that will ensure the patient is at ease. According to Kolcaba, “Comfort is the desirable state that nurses would want for their patients.” (Kolcaba, 2003). With its fundamental emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, the Theory of Comfort care will contribute to a proactive and multifaceted approach to care. This paper aims to describe the origin of Comfort Theory, its primary concepts and relational statements, review of the literature, critique describing its strength and limitation as a middle range theory

In 2003, the American Nurses’ Association published a position statement regarding “Pain Management and Control of Distressing Symptoms in Dying Patients.” The organization states:

The case study based on the palliative patient Mrs. Mavis looks at issues both the family and the patient are dealing with in regards to the end of life treatment Mrs. Mavis is receiving. Mrs. Mavis is a palliative patient, currently unconscious, who is dying and only wants comfort measures within her nursing care. This was made clear through her advanced care directive, which was made weeks before beginning to receive her end of life care. Mrs. Mavis’ comfort measures include pain relief, hygiene and keeping her comfortable. Mrs. Mavis’ family want her to have fluids and medications to help improve her health. They also want oxygen and pain relief to help with her breathing. Issues such as educating and supporting the family, pain management, the effectiveness of having an advanced care directive and pain assessment will be evaluated to determine the best effective interventions for Mrs. Mavis and her families care. Interventions that will be discussed through-out this essay include the use of analgesia medication, the use of subcutaneous injections and syringe drivers, emotional support for the family, effective communication, educating the family on Mrs. Mavis’ wishes and the importance of having an advanced care directive. These interventions will be evaluated to ensure they are the best practice for Mrs. Mavis’ care.

* 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.