The final care provided to the people who needs the palliative assistance
INTRODUCTION
Palliative care (pronounced pal-lee-uh-tiv) is the medical specialty focused on relief of the pain and other symptoms of serious illness. The goal is to prevent and ease suffering and to offer patients and their families the best possible quality of life.(Get Palliative care.org, 2008).
It is also defined as “Palliative care is an approach that improves the quality of life of patients and their families facing the problem 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” (W H O,2008).
The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. Well-rounded palliative care programs also address mental health and spiritual needs. The focus is not on death, but on compassionate specialized care for the living. Palliative care is well-suited to an interdisciplinary team model that provides support for the whole person and those who are sharing the person's journey in love (Growth house.org, 2007). The term "palliative care" is increasingly used with regard to diseases other than
cancer such as chronic, progressive pulmonary disorders,
renal disease,
chronic heart failure, and progressive
neurological conditions. In addition, the rapidly-growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. Although the concept of palliative care is not new most physicians have traditionally concentrated on trying to cure patients. Treatments for alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects. The focus on a patient's quality of life has increased greatly over the past twenty years. In the United States today 55% of hospitals with over 100 beds offer a palliative care program and nearly one-fifth of community hospitals have palliative care programs. A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment, called a palliative care team (Wikipedia, 2008).
Characteristics of Palliative Care
The main characteristics of Palliative care by the World Health Organization are as follows,
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical
(WHO, www.WHO.int, 2008)
According to the Ontario Palliative care Association the main objectives for the palliative care are as follows,
providing education development opportunities to facilitate communication
being a central resource for information
being a link between local, regional, provincial and national palliative care
advocating the importance of palliative care through influencing government policy and funding
promoting standards in palliative care
participating in the evolution and implementation of standards
enhancing the work of OPCA
maintaining financial stability
(Ontario palliative care Association, 2007)
According to the European Association of Palliative care the main objectives for the Palliative care are as follows,
Increase the awareness and promote the development and dissemination of palliative care at scientific, clinical and social levels
Promote the implementation of existing knowledge, train those who at any level are involved with the care of patients with incurable and advanced disease and promote study and research
Support and give patronage to scientific and educational events promoting the dissemination and development of palliative care
Promote and sponsor publications or periodicals concerning palliative care
Bring together those who study and practice the disciplines involved in the care of patients with advanced disease (doctors, nurses, social workers, psychologists, volunteers and others)
Unify national palliative care organizations and establish an international network for the exchange of information and expertise
Address the ethical problems associated with the care of terminally
(European Association of Palliative Care, 2002)
According to the Asia- Pacific Hospice Palliative care Network the main objectives for the Palliative nursing care are,
To facilitate the development of hospice and palliative care programs (both service providers and umbrella bodies) and other relevant initiatives
To promote professional and public education in palliative care
To enhance communication and dissemination of information
To foster research and collaborative activities
To encourage co-operation with local, regional and international professional and public organizations.
(Asia Pacific Palliative Care Network, 2008)
Pain Management during Palliative Nursing
Pain management is a vital component of nursing care that presents ever evolving challenges. Nurses must keep up to date with emerging trends in order to ensure use of good pain management techniques, compliance with regulations governing handling and use of controlled substances, and be able to effectively assess, monitor and document pain management strategies and outcome (Medi- smart,
www.medi-smart.com, 2005). Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care (PUBMED,
www.pubmed.gov, 2001). We can classify the most widely used techniques in terms of the degree of intervention they involve:
Noninvasive non-drug pain managementNon-invasive pharmacologic pain managementInvasive pain managementNon invasive non-drug pain management
1. Exercise—physical exertion with the aim of training or improvement. Includes the McKenzie method, water therapy, flexion exercises, aerobic routines, and many others. May involve active, passive, and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition, and musculoskeletal health.
2. Manual techniques—manipulation of affected areas by means of chiropractic adjustments, osteopathy, massage therapy and other techniques. Some evidence for the effectiveness of certain techniques is available.
3. Behavioral modification—use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for symptomatic improvement.
4. Cutaneous stimulation —superficial heating or cooling of skin. These pain management methods include cold packs and hot packs, and should be used in conjunction with exercise.
5. Electrotherapy —the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain.
Noninvasive pharmacologic pain management
Analgesics—include acetaminophen. Long-term use involves risk of renal damage.
Nonsteroidal anti-inflammatory agents (NSAIDs)—include aspirin, ibuprofen, naproxen, and the new COX-2 inhibitors.
Muscle relaxants—used to treat muscle spasms due to pain and protective mechanisms.
Narcotic medications—most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions.
Antidepressants and anticonvulsants—used to treat neuropathic (“nerve”) pain.
Invasive pain management techniques
Injections—direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, “trigger point” and other locations are also known as “blocks”. These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.
Prolotherapy—injection of solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.
Surgically implanted electrotherapy devices—implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. Clinical data offers inconclusive findings on the effectiveness of SCS.
Implantable opioid infusion pumps—surgically implanted pumps that deliver opioid agents directly to affected nerve. The appropriateness and effectiveness of these devices for treating chronic back pain is controversial.
Radiofrequency radioablation—deadening of painful nerve via heat produced by a specialized device. The efficacy of this treatment is mixed.
( Spine- health,
www.spine health.com, 2001)
Nursing Processes
By applying the nursing process in the palliative care the nurse is able to cope with the strategies of the people in need of the hospice care. And also the nurse is able to collaborate with the patients and meet the basic needs of the care.
But according to a supportive care model, there is a special way of approach for providing the palliative assistance they are
Each dimension represents a standard:
1. The hospice palliative care nurse believes in the intrinsic worth of others, the value of life and that death is a natural process.
II. The hospice palliative care nurse establishes a therapeutic connection (relationship) with the person and family through making, sustaining and closing the relationship. III. The hospice palliative care nurse provides care in a manner that is empowering for the person and family. IV. The hospice palliative care nurse provides care based on best practice and/or evidence-based practice in the following areas: pain and symptom management, coordination of care, and advocacy. V. The hospice palliative care nurse assists the person and family to fi nd meaning in their lives and their experience of illness. VI. The hospice palliative care nurse preserves the integrity of self, person and family.
Nursing standards not only guide nursing practice but can be applied in the following ways:
• by developing new models of nursing care delivery, through staff orientation and continuing education programs, when evaluating performance with career planning and professional development
• by determining appropriate referrals for nursing consultation within a specialty area
• by ensuring quality of nursing care through increasing public awareness about the nursing roles of a specialty area
• by creating an environment for excellence in nursing practice .
Nursing standards are designed as benchmarks to measure a nurse’s performance but are also used as the foundation for the development of nursing competencies and guidelines for practice. Therefore, nursing standards are useful tools for nurses in determining what knowledge and skills are required to provide quality care.
(Perspectives on Hospice Palliative care, 2002)
Personal Experience
During my clinical placement in one of the clinic in Cyprus I had the experience of dealing with a Cancer Terminal stage patient from France. He had the terminal prostate cancer. But he is a special case that I had ever seen during my placement. He knows very well about the conditions that he have and he was well prepared for his last day. The other fact is that he never likes other people to feel pitty on him and to tell him the lies about his health condition. He was a retired Engineer. Also he knows very well to adjust the I-MED machine and all and he doesn’t want other nurses or others to comment on it. And since he have the terrible pain, on his request the doctor prescribed to give the morphine 120 mg. At first he was not that much co-operative with me,but later own he become my friend. He started to talk on his life and everything. And also he likes others to talk to him according to his present situation . he don’t want anybody to act and pretends to be happy on his condition. Every day the urine bottle is with blood (heamaturia). Also he wants the things done to him according to his wishes. Most probably the nurses and the doctors performed according to his wish and he felt comfort.
Conclusion
Palliative nursing is one of the major field of nursing which requires special training and special skills. It is actually one of the field dealing with the emotional , physical and spiritual well being of the patients. And also for this the profession the nurses and the professionals to be more motivated and patient. And also it requires a good mentality of human considerations. And also ability to collaborate with the people in the hospice period.
References
1. Perspectives on Hospice Palliative Care,
http://palliative.info/resource_material/NursingMonographLR.pdf, USA,2002.
World Health Organization,
http://www.who.int/en/, Switzerland, 2008.
Get palliative care.org,
http://www.getpalliativecare.org/whatis/2,2008.
Growth house,
http://www.growthhouse.org/, 2007.
Wikipedia,
http://en.wikipedia.org/wiki/Palliative_care,2006.
Ontario palliative care Association,
http://www.ontariopalliativecare.org/,Ontario, 2007.
European Association of Palliative Care,
http://www.eapcnet.org/About/about.html,Italy, 2002.
Asia Pacific Palliative Care Network,
http://www.aphn.org/,Singapore, 2008.
PUBMED,
www.pubmed.gov, 2001.
Spine- health,
www.spine health.com, 2001.
Own Experience.
