Palliative care free essay sample

To set up your essay, you may use headings such as â€Å"introduction†, â€Å"Communication strategies† â€Å"Conclusion† etc. If you want. Or you can set it up so that each paragraphs are structured and there is good flow. You may use direct quotes – but you need to reference these correctly including with page numbers, which i have done Ensure your referencing is correct – intext and at the end of the essay a reference list is attached i think your uni guidelines said â€Å"Harvard system† Other nice ways to get extra marks = include a diagram or table that provides good summary of what you discussed – in this case, maybe something for your communication strategy or approach? If you can think of something nice, it would be good. I’m happy to go over your final draft and edit if needed (charges may apply if it takes more than 10mins) Introduction The World Health Organization (2003)[1] defines palliative care as: â€Å"An approach that improves the quality of life of individuals 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†. We will write a custom essay sample on Palliative care or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page WHO (2003) further states that palliative care: †¢ provides relief from pain and other distressing symptoms; †¢ affirms life and regards dying as a normal process; †¢ intends neither to hasten nor 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 patient’s illness and in their own bereavement; †¢ uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; †¢ will enhance quality of life and may also  positively influence the course of illness; and †¢ 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 complications. This recent definition and description of palliative care asserts that, contrary to earlier definitions, individuals with diseases other than cancer that have a terminal phase and are progressive in nature would benefit from the philosophical underpinning of the palliative approach. These include chronic obstructive pulmonary disease (COPD), Alzheimer’s disease,and acute massive cerebrovascular accident, to name a few. Palliative Care is a team effort THREE FORMS OF PALLIATIVE CARE (i) A palliative approach A palliative approach aims to improve the quality of life for individuals with a life-limiting illness and their families, by reducing their suffering through early identification, assessment and treatment of pain, physical, cultural, psychological, social, and spiritual needs. Underlying the philosophy of a palliative approach is a positive and open attitude towards death and dying. The promotion of a more open approach to discussions of death and dying between the care team, residents and their families facilitates identification of their wishes regarding end-of-life care. A palliative approach is not confined to the end stages of an illness. Instead, a palliative approach provides a focus on active comfort care and a positive approach to reducing an individual’s symptoms and distress, which facilitates residents’ and their families’ understanding that they are being actively supported through this process. When should a palliative approach be implemented? * Methods used to identify survival time, such as physicians’ clinical predictions, have limitations in accuracy and precision resulting in overestimating survival. Therefore, relying only on these methods to determine when to start a palliative approach is not recommended. Care team members need to be aware of this tendency to overestimate survival, to reduce residents’ and families’ potential distress. * 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. Where can a palliative approach be provided? A palliative approach can be provided in the resident’s familiar surrounding if adequately skilled care is available, which reduces the need for transfer to an acute care setting; thereby, avoiding potential distress to the resident and his/her family. Who can provide a palliative approach? A palliative approach is best provided by an effective multidisciplinary team. A palliative approach Is proactive approach  Multidisciplinary approach, team based individuals and their families have complex needs Seeks to maximise quality of life for individuals and their families facing life threatening illnesses. Important to accept and include death and dying as a ‘normal’ part of life Key importance of the palliative care approach in nursing is for it to be responsive, rather than directive, in order to meet the needs of individuals and their family and friends (ii)Specialised palliative care and (iii) end of life care when providing nursing care Consider influences of social, cultural, psychological and spiritual factors – all these influence the experiences of disease, symptoms, and dying. Nursing approach needs to ensure that the focus on death is non-medical. Palliative care became a recognised and distinct specialty over the past 20 years in Australia. Specialist palliative care nurses are equipped with special skills and qualities that facilitate them to meet the needs of individuals and their families. In particular, allowing for enhanced care and support that people facing end of life need and as well extending out to the family and communities that support them. Furthermore, their skills include knowledge on end of life issues, management of pain, and complex symptoms that are part of the advanced terminal illness. Skills and competencies developed and strengthened over a  number of years through interdisciplinary clinical practice and continuing education Training is founded based on philosophies of palliative care and end-of-life care provision as well as strong foundation in ethics. Nursing role – specialised, leadership, autonomous, and collaborative approaches Also provide mentoring and education to other nurses and health care professionals. Role of advocacy is important as well – important for policy at the national and organisational levels. Importance of collaborative work – and research to improve and advance the knowledge base about end of life care. Important role in being able to promote optimal well-being at the end of life regardless of patient’s location and financial position. Major communicatio n strategies required by nurses when providing palliative care to clients include Empathy, meet the needs of patients and families. Importance of non-verbal communication – careful listening!! Non-verbal cues answer questions   djust expectations, set achievable goals, help control symptoms, help patients deal with inevitable death, address emotional issues and deal with responses = open questions, empathy, listen communicate and discuss with other health professionals any issues, wishes, treatment options. Good communication will facilitate addressing problems dealth with end of life care such as physical symptoms, psychological distress, social distress and spiritual and existential distress ( 2-5% fear death). Two cultural groups with differing issues in relation to death and dying and provides significant information on the issues Cultural attitudes and traditions create a tricky path, requiring a delicate tread. Being informed that the words Death, Dying and Cancer are taboo for many cultures creates immediate difficulties in discussing palliative care. Each cultural group is by no  means homogeneous; some community leaders are well integrated in to Australian society and seek an open ‘one size fits all’ dialogue, but most are cautious, unwilling to upset the strongly traditional members of their community. importance of social and cultural differences in attitudes towards end of life, death and dying. Two cultural groups in Australia – Indigenous/Aboriginal and Torres strait islander – require different approach, respect cultural differences and also migrant populations – Asians, south east asian, African etc. Be aware of taboos, beliefs around death and dying, spirituality etc Death dying – attitudes towards it, coping mechanisms and strategies may be different, as may be ways of coping with grief. Some cultures prefer to die at home, vs. Dying in hospital Important to emphasis palliative care to be provided to all irrespective of social/cultural background and financial status. An older woman from Pakistan was admitted to a hospital with malignant bowel obstruction. The family, who had limited English, had indicated they did not want more cancer treatment and surgery was not an option. While her symptoms were well controlled she was deteriorating and it was likely that she was going to die in a few days; this was explained to the family. Some members of the aged care team became upset when they saw a family member trying to force-feed a mixture of rice and broth to their mother. An explanation of why their mother could not be given food was given and the family was shown how to give good mouth care. The family yet again was seen force-feeding their unresponsive mother. This time when staff talked to the family they asked them why they were continuing to feed their mother. They explained that they were disturbed by the cold water and ice chips being given and were afraid that they were weakening her further. To counteract the cold fluids they wanted to give her something warm. Together, staff and family agreed that the mother would be given warm water for mouth care, supplemented by occasional use of the clear broth. All parties were satisfied and there were no more conflicts between the family and aged care team. Pain management and various pain assessment tools available to nursing staff Pain is under-treated in many clinical settings. Pain management requires a systemic and holistic approach to treatment that is tailored to the individual’s physical, psychological and spiritual needs. As Dickinson stated, â€Å"Pain is a subjective sensation and therefore pain is what the individual says it is and not what others think it should be†.[10] The experience of pain is one of the body’s natural defense mechanisms. However, pain can be debilitating for the patient and treating the experience of pain can be challenging for nurses. Below is a list of proposed strategies that clinicians can rely upon to assist in effective pain management for their patients: A detailed history and physical This is the initial step whereby the patient and the nurse can explore the history of the pain, the nature of the pain, and the history of already used treatments. They can also use a pain score. This also allows the nurse to have the chance to listen to and understand how the pain has impacted the patient’s life (Pain Management: Nursing Role Core Competency). Any appropriate testing that can facilitate diagnosis After gaining a subjective report, further objective data is often necessary. An X-ray or MRI might be ordered to fully understand the cause of the pain. Establishment of realistic and desired goals of further treatment This would be a point where effective evaluation and treatment start to take a unique path. It is critical for the nurse clinician to understand what the patient is looking for in terms of successful treatment, regardless of the painful condition. In some situations, the diagnostic answers might be clear, as in headaches, but the impact on the patient’s life, quality of life, ability to perform activities of daily living must be identified, documented, and constantly revisited along the continuum of care (American Society for Pain Management Nursing, 2010). Formulation of a treatment plan The patient and the clinician would then work together to develop a treatment plan that would include diagnostic testing and follow-up visits. The plan might require other interventions, if the patient develops tolerance. Referral to a pain specialist If the nurse clinician can no longer provide effective therapy, referral to a pain specialist might be warranted. These are only several strategies that nurses can use to assist in pain management. Often, effective treatment requires creativity and diligence on behalf of the care team. But, the overall, result is improved patient outcomes and quality of  life. Assessment tools: