Palliative And End-Of Life Care

Palliative services are offered professionally so as to achieve a certain health care provision that is standard for an end of life patient. As such it should be administered to certain standards that require individual proficiency. Palliative care majorly deals in psychological aspects, physical needs, spirituality and social balance of a person nearing mortality as well as their immediate family and friends. Such services are not developed to bring about the death of a person more promptly nor does it intend to prolong the eventuality. It serves the purpose of managing the best health outcome for the affected parties through the challenging period. The palliative care service is broader than the end of life care though it is commonly used to refer to the concept. It is a very dynamic field that puts ones system of belief to the test and in some cases some patient’s way of life could go against the values one upholds. This should be anticipated by the health care providers and also work to possess the necessary skills to be able to deliver quality services without losing their work ethic or personal values in the process.

The motivation behind offering palliative care is to provide closure and a sense of relief to the affected persons. It is in no way aimed for curative purposes. To offer such services social cues as well as empathy have to come into play. This is largely by making concessions as well as adjustments that create a favorable environment for the patients to express their fears and insecurities which would lead to closure which is necessary for those around the patient and the patient in person (Singer, 1999). In catering for their physicality one should apply the pain relieving remedies prescribed to the patient that caters to the aging complications, poor health or the resultant effect of being immobile. The main aim here is providing optimal comfort to the patient. This may prompt you to make special considerations of moving the patient to their home or the hospital based on their preference. The physical appeal and general hygiene of the person should always be in check so as to foster self-dignity. For any given health provider their core purpose is performing their professional duty in administering health care services to the betterment of society without discrimination (Meyer, 2006). A health care provider will have to take care of the physical needs of the patient and in so doing should view the patient in terms of their human faculties. Personal and social orientation should not affect service delivery and in order to do so a health care provider needs to manage and have a control of the relation they build to the affected. They should be impartial and act as a professional support system to guide them through the period. If the situation is not properly managed the health implications could be extenuating.

In catering for the psychological needs of the patient one should master the management of resultant emotions as well as realistic thought processes. These should be steered in a containable fashion that does not lead to people denying their reality by suppressing such emotions which may cause psychological harm to loved ones or suffering to the patient. Every patient fears death even those pretending to be balanced. They need to be reassured and guided through accepting and letting go as it is in the reality of life (Prendergast, 1998). They need to make concessions and amends as well as being reassured by their immediate relations so as not to feel dejected in the period. Patients nay show signs of emotional outbursts as well as psychological disorientation. Some may reach out to their spiritual beliefs which may go against yours. You need to exclude your personal life from intruding in your professional output and this may entail going out of your way sometimes to make last moments of your victim’s life have some resolution and human dignity.
End-Of-Life Care

End-of –life care encompasses all nursing procedures including pain and symptoms management, cultural practices, ethical decision making and all practices that assist the patient and the family to go through the dying process. Advocacy is highlighted as the most essential attribute to posses for nurses in this profession. Unfortunately the skill is hard to master due to a variety of factors ranging from limitation of death and the dying process in the nursing curricular, to variations of the end-of-life legal language, to different practices and policies in the healthcare system (Hanson, 1997). That said, Patricia Benner’s conceptual model of advocacy provides the framework for building professional nurses focused on providing effective patient care. Effective communication skills alongside active listening skills enhance the nurse-patient relationship and create a healing environment.

With advancements in technology in recent years, care of the dying patient has shifted from loved ones to community centers under the watchful eyes of health professionals. During the time, nurses have also sought to develop new ways to improve the quality of care for dying patients, their families and the community at large through advocacy. At this point at this point, it is important to note that advocacy is divided into two parts: information and support. The nurse sees the patient’s experiences as their own and by so doing is able to intervene on their behalf. When in need of advocacy the patients may depict the following traits: helplessness, powerlessness, inability to speak, vulnerability loss of self-control and dependency. Trigger situations such as hospitalization, change in diagnosis, and illness require immediate attention and decision making thus prompting the advocacy process.

Doctors remain the sole gatekeepers of sensitive information and are usually the ones mandated to break bad news to the patients, such as the need to diagnose a terminal disorder. Due to their bulk workload, the physicians may be hurried to break bad news to patients insensitively without caring for the needs of both patient and family. In such a scenario, the physician engages technically instead of personally and thus necessitates the presence of a nurse to act as an advocate for the patient. At this point, their main duty is to act as translators and communicators of emotions and information. They help the patients understand more about their conditions by explaining what the doctors say while in consultation. Unlike the physicians, nurses explain the situation in a different way so that patients are able to identify with their conditions in a brave manner. However, both doctors and nurses have the duty of consulting with other disciplines involved in the patient’s care so that they are able to create a holistic environment of compassion and openness (McDonagh, 2004). The accountability role of translation by nurses in care delivery is in contrast to doctor’s accountability role for passing true information to the patient and family members so that they best understand the condition. For example, when a nurse is working with a terminally sick individual, the end game is to work with the patient so that they are accorded the best medical care.

From the precedent, it is clear that end-of-life care is a form of palliative care that looks to ensure that patients are given legal support and receive proper care for as long as possible so that they die with dignity. From the arguments above, end-of-life care relies on a personal attachment by the nurse to understand the situation and effect of the disease on the patient. Good relationship between nurse and patients leads to a good death.
References

Hanson, L. C., Danis, M., & Garrett, J. (1997). What is wrong with end‐of‐life care? Opinions of bereaved family members. Journal of the American Geriatrics Society, 45(11), 1339-1344.

Meyer, E. C., Ritholz, M. D., Burns, J. P., & Truog, R. D. (2006). Improving the quality of end-of-life care in the pediatric intensive care unit: parents’ priorities and recommendations. Pediatrics, 117(3), 649-657.

McDonagh, J. R., Elliott, T. B., Engelberg, R. A., Treece, P. D., Shannon, S. E., Rubenfeld, G. D., … & Curtis, J. R. (2004). Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Critical care medicine, 32(7), 1484-1488.

Prendergast, T. J., Claessens, M. T., & Luce, J. M. (1998). A national survey of end-of-life care for critically ill patients. American journal of respiratory and critical care medicine, 158(4), 1163-1167.

Singer, P. A., Martin, D. K., & Kelner, M. (1999). Quality end-of-life care: patients’ perspectives. Jama, 281(2), 163-168.

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