NURS6711 Palliative Care Practice

Question:

It is important to support and respect the beliefs, rituals and practices during palliation as death is the most sacred and significant societal event. As they are towards the end of life, they want empathy, sensitivity and compassion from the caregivers in providing the optimal care. Enrolled nurses should also consider the spiritually that is integrated within the culture and important in the person’s last journey of life.

Answer:

Palliative nurse have the responsibility to take into consideration the wishes and lifestyle choices of the palliative patients while planning end-of-life care. Cultural, spiritual and nutritional considerations are important for the palliative care patients. It is important to support and respect the beliefs, rituals and practices during palliation as death is the most sacred and significant societal event. As they are towards the end of life, they want empathy, sensitivity and compassion from the caregivers in providing the optimal care. Enrolled nurses should also consider the spiritually that is integrated within the culture and important in the person’s last journey of life. Nutritional considerations are also important as it not only affects the physical well-being, but, also psychological aspects. So, patient centered-care is the prime consideration in palliative care considering the cultural, spiritual and nutritional aspects. According to the Nursing and Midwifery Board of Australia (NMBA), under the Conduct Statement 4, enrolled nurses should respect the culture, beliefs, dignity of the people under their provision of care and also with their colleagues (Quill and Abernethy 2013).

During the palliative care, there are some instances where there are emerging issues and needs that cannot be addressed and beyond the responsibility and skills of the nurses. In such situations, they provide referral services for the patients under palliation. Referral needs are provided that helps to ensure more in line care and in meeting the wishes of the patients. It also helps to improve the quality of end-of-life care and exceed the resource, knowledge facilities and capacity. Moreover, the patient’s family should also be informed about the referral in the palliation (McCabe and Coyle 2014).

Advanced care directive, also called a living will or medical directive is a legal document where a person specifies the actions that has to be taken in terms of health. It is used in such situations where a person is no longer able to make decisions of their own because of incapacity or illness. It is also a type of health care proxy or power of attorney where a person authorizes a trustworthy person on one’s behalf to make the decisions regarding their care. Patients during palliation makes advance healthcare directive when they are unable to make decisions due to their incapacity (Brinkman-Stoppelenburg, Rietjens and van der Heide 2014).

One of the main features of the palliative care is pain management. Chronic pain put immense stress on the patient’s families and requires support when there is no treatment for the disease. There are more than 80% of the cases where the palliative patients suffer from pain and distress, so it is important for the nurses to reduce the pain (Puntillo et al. 2014). Firstly, there is assessment of pain by the nurses. In this case, patients are the ones who express their pain and are the prime assessors of their suffering pain. They would provide information to the patients about pain where they would agree on the goals of treatment and encourage them to take an active part in the pain management. According to the World Health Organization, analgesic ladder is used to manage pain in palliative care. Non-pharmacological methods like sleep; relief of symptoms, listening, diversification, relaxation and social inclusion and by finding meaning in their lives can help them to manage patients in acute pain or distress. A wide range of strategies that improve the morale, mood, general health and provide them resilience power to lead the rest days of their life in relief. In addition, the multi-faceted interventions that helps them to overcome the impairment in performing the daily activities and sense of independence (Raffa and Pergolizzi 2014).

When a loved one is undergoing serious illness, there are emotional experiences that akin to grieving. The emotions like sorrow, anxiety, anger, acceptance and depression and denial multitude when a person is on the last stage of one’s life. For the care plan, nurses would assess the level of the patient’s anxiety and try to establish rapport with the patient. It is also important to acknowledge the difficulty of the patient that would be helpful in meeting the emotional needs of the patient. The behavioral and emotional responses are also important aspects of assessment which is resulted from the dependency and weakness. There are many legal and ethical issues related to advanced care directives in the palliative care. Competency or legal capacity in which the ability and right to manage one’s affairs is an important legal issue. Legal and clinical incapacity are also some of the legal issues faced in the implementation of advanced care directives. Power of attorney in the health care is also a matter of legal and ethical issue where the person is unable to make decisions on their own and appoint person to make legal decisions on their behalf (Dobrina, Tenze and Palese 2014).

The difference between the palliative and normal patient is that the people under palliation are in the last stage of their life and are suffering from terminal illness. They suffer from illness that cannot be cured and require end-of-life care. In normal ward patients, they are not on the last stage and can recover from the illness.

The strategies that meet the needs of the palliative care patient are that they should encourage high quality of palliative care with cultural and emotional needs that provides patient satisfaction. Another strategy is to consider the cultural, spiritual and emotional needs of the patients so that they are able to provide the long-term palliative care (Keall, Clayton and Butow 2014).

The ethical issues in palliative care are beneficence, autonomy, justice and non-maleficence. The right of the patient to choose the treatment is autonomy. Beneficence means where the nurses should work in fulfilling the interests of the patients. Non-maleficence means where one should not harm the patient under their provision of care. Dignity, honesty and truthfulness are also important in the palliative care. According to Code of Ethics for Nurses in Australia, under the Value Statement 4, enrolled nurses have the responsibility to perform their practice in an ethical manner (Gysels et al. 2013).

Life-limiting illnesses are considered to be illnesses that would eventually result in death and is a direct consequence of the life-limiting illness. These illnesses have no hope or reason to live or cure where there is progressive deterioration and is on palliative care treatment. Moreover, in such illnesses there are no curative treatment and consider the stage to be inevitable. There is an irreversible condition that leads to susceptibility to health problems and approaching death. It has severe impact on the emotional, spiritual, physical and social implications on the patient and their family members. It also affects their ability to perform their daily activities, social life and have distress on their part and families (Beernaert et al. 2016).

There are many equipments that are required to assist the client’s needs in palliative care like occupational and physical needs, spiritual needs, nutritional needs, hygiene needs and respiratory needs. Health and safety equipments are also required for the palliative care patients. Walkers, wheelchairs, hospital beds, bedside commodes, bath chairs are some of the equipments that provide physical assistance. Respiratory equipments are also required that helps to provide oxygen supply when required during emergency (Skene, Loveland and Solomon 2015).

Loss of life is an inevitable part of life and grief is the way to heal the process. It has impact on one’s family where there is anxiety, depression, distress and social isolation among the family members who have suffered loss. Moreover, the caregiver also has feelings of grief for the people they cared for. Family members also suffer from grief and depression due to loss of life and have distressing thoughts, although, in palliative care the death is planned and have time to prepare for the loss.

There are legal issues in the palliative care approach. The ethical and legal decision-making is a part of palliative care. Enrolled nurses have the responsibility to understand the medical ethics in nursing so that they are able to provide the best quality of care to the palliative patients. The legality and confidence of the enrolled nurses to take ethical decisions that work for the best interests of their clients and do not harm them like non-malifecence and beneficence respectively. Moreover, they should have dignity for the patients under their provision and provide them freedom to take decisions independently (Coyle and Ferrell 2016).

Pain is one of the goals of palliative care treatment as the patients in palliation suffer from pain and distress. Enrolled nurses have the responsibility to manage pain in the patients so that they are able to get relief from the acute pain. However, pain assessment starts from the patients as they have to prompt the degree of pain. The pain is assessed by the nurses by pain ladder to manage pain in palliative care. Pain ladder is a way to manage pain developed by World Health Organization to use drugs for the pain management. The pain ladder has three steps. Step one indicates mild pain where non-opoid and optional adjuvant is administered. If there is persistence of pain, the pain assessment proceeds to step two. In the second step, there is determination of moderate pain. Again non-opoid, optional adjuvant along with weak opoid is given to the patient. If there is pain persistence, strong opoid along with non opoid and optional adjuvant is given indicating severe pain and finally after the administration, there is relief from pain (Puntillo et al. 2014).

After the loss of life, there is bereavement in the life of the loved ones. They require support services to cope up with the loss of life and grief that prevails after death. The support services are bereavement advice center, grief counseling and emotional support services that provide additional support to help the people in coping up with depression and grief after loss of life. The Australian Centre for Grief and Bereavement (ACGB) through education, research and consultancy provide support to the bereaved people on overcoming the grief they face after he death of their loved ones (Counselling 2013).

Care of body after death is important as it is an important ritual in societal life. After death, the nursing care starts with the caring of the body that is physical care like washing, dressing and positioning of the dead body are important concerns after death. It is an important nursing function so that there is respectful and dignified care of the patient’s body after death.

Enrolled nurses practice under the delegation and direction of a registered nurse in delivering their nursing care in palliation in the clinical, residential or community setting. Firstly, the patient should be assessed for the additional help so that there are coordinated efforts to meet the needs of the palliative care patient. Then, the activities have to be performed at a slow rate so that they have long periods of rest. The motion exercises, sitting and standing are some of the ways to enhance gradual progression of daily activities. They have to balance the assistance so that there is independence and gradual progress (Berry and Griffie 2015).

The approach to death is evident from the signs and symptoms and needs to be reported to the family members by the nurses. They have to communicate with compassion and have empathetic listening towards the family members. To avoid this, they plan the end-of-life care in advance to avoid the blaming and emotional outbreak on the sudden death. In addition, enrolled nurses have to react to the psychological responses empathetically and patiently so that the loved ones are able to cope up with the loss o life.

Support from family members is important during palliative care as their support is the core in palliation. Through effective communication and compassion with the family members, the meetings can be effective in discussing the goals and advanced plans for the end-of-life care. The family interviews conducted by the nurses to discuss the plan of care are an effective way to strengthen family meetings. During the last stage of life, they need their loved ones support and care.

Palliative care is a way to provide the best quality of health care to the people who suffer from terminal illness and there is no treatment except for end-of-life care. It mainly focuses on improving the quality of care during the last stage of life. It is provided by the collaborative team comprising of palliative care physicians, nurses and specialists required for providing the extra emotional, cultural and spiritual support required during the end life care (Brinkman-Stoppelenburg, Rietjens and van der Heide 2014).

Curative care is provided to the patients where the disease or illness is curable through medicines in medical conditions achievable through curative medicine. This type of treatment is given with an intention to eliminate or improve the symptoms of the illness and gives a cure to the overall medical problems. It is only used in cases where the prolonging of life or cure is attainable (Van Baal 2014).

References:

Beernaert, K., Deliens, L., De Vleminck, A., Devroey, D., Pardon, K., Block, L.V.D. and Cohen, J., 2016. Is there a need for early palliative care in patients with life-limiting illnesses? Interview study with patients about experienced care needs from diagnosis onward. American Journal of Hospice and Palliative Medicine®, 33(5), pp.489-497.

Berry, P. and Griffie, J., 2015. Planning for the actual death. Social Aspects of Care, 6.

Brinkman-Stoppelenburg, A., Rietjens, J.A. and van der Heide, A., 2014. The effects of advance care planning on end-of-life care: a systematic review. Palliative medicine, 28(8), pp.1000-1025.

Counselling, B., 2013. Programs and services. Grief Matters, p.26.

Coyle, N. and Ferrell, B.R., 2016. Legal and Ethical Aspects of Care (Vol. 8). Oxford University Press.

Dobrina, R., Tenze, M. and Palese, A., 2014. An overview of hospice and palliative care nursing models and theories. International journal of palliative nursing, 20(2).

Gysels, M., Evans, C.J., Lewis, P., Speck, P., Benalia, H., Preston, N.J., Grande, G.E., Short, V., Owen-Jones, E., Todd, C.J. and Higginson, I.J., 2013. MORECare research methods guidance development: recommendations for ethical issues in palliative and end-of-life care research. Palliative medicine, 27(10), pp.908-917.

Keall, R., Clayton, J.M. and Butow, P., 2014. How do Australian palliative care nurses address existential and spiritual concerns? Facilitators, barriers and strategies. Journal of clinical nursing, 23(21-22), pp.3197-3205.

McCabe, M.S. and Coyle, N., 2014, November. Ethical and legal issues in palliative care. In Seminars in oncology nursing (Vol. 30, No. 4, pp. 287-295). WB Saunders.

Puntillo, K., Nelson, J.E., Weissman, D., Curtis, R., Weiss, S., Frontera, J., Gabriel, M., Hays, R., Lustbader, D., Mosenthal, A. and Mulkerin, C., 2014. Palliative care in the ICU: relief of pain, dyspnea, and thirst—a report from the IPAL-ICU Advisory Board. Intensive care medicine, 40(2), pp.235-248.

Quill, T.E. and Abernethy, A.P., 2013. Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), pp.1173-1175.

Raffa, R.B. and Pergolizzi, J.V., 2014. A modern analgesics pain ‘pyramid’. Journal of clinical pharmacy and therapeutics, 39(1), pp.4-6.

Skene, R., Loveland, J. and Solomon, S., 2015. Well Equipped For Palliative Care. The Aids And Equipment Utilised In A Specialist Palliative Care Service. Australian Occupational Therapy Journal, 62, p.98.

Van Baal, P., 2014. Less need for prevention through better care? Towards an effective deployment of preventive and curative care. Nederlands tijdschrift voor geneeskunde, 159, pp.A8680-A8680.

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NURS6711 Palliative Care Practice

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