Palliative care is specialized care provided to patients diagnosed with life-threatening diseases such as heart failure and cancer. The approach’s main goal is improving the quality of life by preventing and alleviating suffering via identifying early and managing physical, social, mental, spiritual needs of patients and their families. A team approach is usually employed in the delivery of palliative care to ensure holism; palliative care physicians, specialized nurses, nutritionists, pharmacists, social workers, and chaplains are some professionals involved in delivery of palliative care. Improving quality of life, ameliorating symptoms, lowering healthcare costs, and facilitating healthy bereavement are some crucial roles of palliative care. My research study will focus in detail on the role of palliative care in Canada. As an introduction, the following paper presents an annotated bibliography of some research articles that will be used in the development of my research study.
The authors, Connolly and colleagues, are reputable professionals working in the nursing profession and providing specialist palliative care services. These authors are investigating the responsibilities of nurses in acute settings such as hospitals in relation to specialized palliative health care services. I chose the article because, firstly, the authors are well-versed in my main topic, palliative care, and secondly, the research article is peer-reviewed and up-to-date. The use of qualitative research methods provides a detailed discussion about the roles of the nurses in palliative care. Although the study was orchestrated outside Canada, it provides a great insight and attitude towards specialized roles of nurses in delivery of palliative care healthcare facilities. The authors assert that many individuals are appreciative of the specialized roles which include supportive role, patient advocacy, guidance on management of symptoms, education, discharge planning, and continuity in care. Limitations, as the authors stipulate, include fewer than expected number of participants, and less than 61% response rate (mainly from nurses), that can be addressed by increasing response from other health professionals in future studies. Additionally, allowing patients to present their views about the specialize services can paint a clearer picture about the same. The article will be integral in my thesis about the role of palliative care in Canada and it will introduce the theme on settings of palliative care.
The authors, Moran, Baily, and Doody are probing how advancements in medicine and nursing have affected the role of nurses and maintenance of nursing values during delivery of palliative care services. Baily and Doody are nursing professionals in the Department of Nursing and Midwifery, faculty of education and health sciences, and the Health Research Institute, University of Limerick, Limerick. With their expertise, along with peer-reviewing of the article, the source can provide information to build themes for my thesis. An integrative review through seven reputable databases was conducted as Crowe Critical Appraisal Tool was used to appraise identified research articles. The literature review demonstrated how palliative nurses uphold values of compassion, care, and commitment whilst failing to maintain nursing values. End-of-life has also been highlighted as a key concept in palliative care. One limitation is exclusion of articles because of stipulated timeframe and dearth of research articles. However, it would be important for future studies to carefully incorporate and utilize older research studies. The article will form the basis for my thesis because it builds on different approaches used to improve the quality of life of individuals diagnosed with terminal or life-threatening diseases.
Carvajal and colleagues review barriers and facilitators the perceived enhancers and barriers that nurses encounter while provide end-of-life care. Data from a scoping review, reviewed and analyzed by the authors, was used to uncover factors which facilitate or impede provision of patient-centered end-of-life care. Knowledge of end-of-life care, communication skills, coping strategies, and teamwork were identified as barriers to quality end-of-life car. Three primary facilitators were identified: Knowing the person in a holistic way, nurses’ self-knowledge, and the development of a good nurse-person relationship. The article provides good themes for my research paper; that is, barriers and facilitators of end-of-life care, which is a portion of palliative care. Roles of palliative care cannot be understood without information about factors that enhance or derail its delivery. Being a scoping, the article gives a broad, international view of barriers and facilitators of generalist nurses when caring for patients during the terminal life stages. This was identified as the core limitation, but supplementing the findings with more studies on different sub-themes can address this limitation. The article will build my thesis and add important themes such as improving person-centeredness of palliative care.
The articles sought to illuminate the lived experiences of the elderly and those living with advanced cancers in rural areas. The authors are professors and a doctoral student at Mid-Norway, Steinkjer, Norway; Department of Nursing Mid-Sweden University, Sundsvall, Sweden. The article is recent and peer-reviewed and can be relied upon to inform my research study on palliative care. Qualitative research method, narrative interview, was completed on nine elderly patients to provide data to inform the aims of the study, and phenomenological hermeneutic approach was employed to give interpretations. The author’s primary focus was to discuss the actual experiences of patients in relation to palliative care within rural setting. Devik et al.’s research article is useful to my thesis as it unveils an important setting, rural areas, where palliative care is often under-provided with many patients preferring to receive such care from their homes in the rural area. The core limitation of the study was small sample size, and the authors note that future studies should consider using more participants within different areas to make it possible for generalization. I will use the research article to discuss different settings where palliative care can be provided to maximize outcomes, especially for the elderly patients.
Danielsen, Sand, Rosland, and Førland conducted a study to scrutinize home-based palliative care under two domains; experiences and hurdles encountered by health professionals while providing home-based care for the elderly and the terminally sick. The source is up-to-date and the authors are reputable individuals working at the Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, and the Department of Clinical Medicine, University of Bergen, Bergen, Norway Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital Bergen, Bergen, Norway. Data gained through four focus groups using semi-structured interview (qualitative research design) was used to identify factors which hamper or promote efficient and effective home-based palliative care. The authors’ article provides good information about an important setting, home-based environment, and factors that can increase life expectancy and reduce deaths of patients with terminal illnesses while being cared for at home. I will use information on factors that increase provision of quality palliative care at home such as collaboration between healthcare professionals, patients, and family members to inform my thesis. Insights from both nurses and other healthcare providers provided a diversified view; an important strength for the study. However, the main limitation of the study was not focusing on professionals from hospital setting but only from primary healthcare setting. Such a limitation can be addressed by expanding focus to doctors and nurses from hospitals who discharge patients home for further palliative care. I will apply the source to discuss home-based palliative care and how to increase positive outcomes for patients and families with terminal illnesses.
Mittman and colleagues probe the impact of early palliative identification in improving its utilization in the healthcare system. The authors are considered expertise in their respective field and worked together to bring together the research article. Utilizing quantitative research design, the authors implemented the Integrating Early Palliative Care into Routine Practice for Patients with Cancer (INTEGRATE). Four different cancer centers were used during the study. Propensity score-matched study was used to compared uptake of palliative modalities by patients in centers using INTEGRATE against those patients in centers that did not use the same. The main limitation for the study was lack of randomization when selecting participants which could have resulted in selection bias. Therefore, future studies should randomly choose participants from different settings to avoid bias and allow generalization. The article is an excellent source that I will use to inform my thesis because it was conducted in Canada and provides the role of early palliative care under two important themes; ameliorate the quality of life and heighten life expectancy.
In the article, the authors through a systematic review of reviews investigate factors which impede the provision of palliative care. The authors being faculties in the School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, have expertise to conduct research in palliative care. Recent research articles and reputable databases have been used, making the source integral in my thesis. Abu-Odah and colleagues aim to provide personal, organizational, policy, and system barriers and facilitators in the verge of providing palliative care to cancer patients. Use of different databases makes the systematic review strong whereas the main limitation was the few number of original studies. However, the authors suggest the importance of future systematic review using original qualitative and quantitative studies to conduct original studies on palliative care. I will utilize the article as a basis for my research article because it provides background information about palliative care and challenges and facilitators encountered whilst providing the same. The authors borrow ideas from different peer-reviewed sources to inform their arguments, further inclining my choice for the article. Finally, I will integrate some concepts, including policy and organizational factors that influence palliative medicine, as themes for my research study.
The study conducted by the researchers is focused on analyzing the experiences palliative patients go through while dealing with breakthrough pain. There are multiple ways to minimize it, including psychological support and medications. The aspects that participants of the research found dissatisfying are the lack of visits from the doctors, ineffective treatment, and no compassion from the healthcare providers.
Critique of the Qualitative Research Study
The paper is well-organized and presented in an accessible manner. The title summarizes the main point, although it is too long and might confuse the readers.
However, the abstract offsets an ambiguous summarization of the research paper. It describes the sampling methodology, which consists of 21 interviews.
Analyzing the data gave the researchers an understanding that the psychological aspect helps diminish pain.
The concluded recommendations involve creating more interactions between doctors and patients, providing better care, and having a more compassionate approach towards the patients (Pathmawathi et al., 2015). This is beneficial for the patient’s disposition.
The purpose of the study is clearly stated, and it is to meet the needs of palliative patients and manage the pain more effectively. Moreover, the literature review has been undertaken and divided into main topics that meet the research’s philosophical basis, which allowed for the objectives to be fulfilled. Furthermore, the theoretical framework highlights the truthfulness of the idea that pain management needs improvement, and the collected data reinforces this proposition. After identifying the theoretical framework, it has been concluded that there is a relationship between poor pain management and lack of communication with doctors. Another significant factor points to the connection between physical pain and mental health. While a strong mind can ease the uncomfortable feeling, pain can be destructive to one’s psychological well-being, leading the individual into depression and constant frustration (Pathmawathi et al., 2015). These conclusions are proof of an adequate framework that points out the critical connections and crucial ideas in an appropriate manner.
The sampling method is described as purposive and heterogeneous. The design is described which allowed for a more in-depth and philosophical approach from the participants. While it was subjective rather than objective, it made it more suitable for the individuals who were giving the interviews to relax and be honest. The patients were chosen wisely to be suitable for the research. They were free to express their genuine feelings and deep-rooted thoughts instead of focusing on numbers, dates, and facts.
Data collection strategies were described. Information was taken from a sample of 21 palliative patients ranging from 23 to 75 years old.
To ensure all the participants are suitable for the research, the researchers analyzed their medical notes.
There were about six months of interviewing and collecting raw data that was later examined. The amount of time and recordings gathered in the six months makes the data appropriate for studying the subject.
The statistical analysis method is described as being comparative. The researchers followed the right steps by categorizing the information and comparing it.
The type of data, which achieved saturation during the interviews, was enough to support outcomes. It was appropriate for receiving a clear understanding of the subject since each session lasted around 40 minutes, which gave the patients enough time to explain themselves.
The ethical component is present and ambiguous.
Hospital’s ethics committee approved the research, and all the participants were notified about the study’s purpose and goals, including in written form. The confidential data was stored on a computer, and only the researchers could access it. While the researcher does not mention the level of trustworthiness, the rigor shows that the hospital management was aware of the research and the patients gave their consent. The researchers have mentioned credibility, dependability, and goodness. However, there is no mention of transferability.
The findings that the researchers discovered include a lack of time and compassion from the physicians’ side, the effectiveness of physiological solutions to ease the pain, and overall dissatisfaction of patients.
These discoveries were significant in terms of finding better ways to deal with pain, which was the original aim that was addressed in the paper alongside the known phenomenon of lack of effective palliative care.
The conclusion is connected to the findings that were identified and examined. The research shows that healthcare providers should focus on combining medications and psychological approaches to the strategy as well as pay more attention to the patient’s health concerns. Pain management is an important medical field, and it should be researched and improved. More training, information, and expertise are crucial when it comes to providing patients with better care.
Conclusion
After reviewing the research, it is clear that the findings correlate to improve pain suppression in palliative care. Based on the paper, it is highlighted that medications are not the only options.
There is also a psychological aspect that doctors fail to use. However, it is efficient among the majority of the interviewed patients. While this is successful research, it would have a more precise answer if there were more than 21 people interviewed. The small amount of patients is a disadvantage, but long and in-depth interviews would not be possible to conduct with such a big group. The aim was to learn about managing pain more efficiently, and the study achieved this goal.
References
Pathmawathi, Subramanian, et al. “Satisfaction with and Perception of Pain Management among Palliative Patients with Breakthrough Pain: A Qualitative Study.” Pain Management Nursing, vol. 16, no. 4, 2015, pp. 552–560., doi:10.1016/j.pmn.2014.10.002.
To create an explicit and detailed healthcare policy in writing, which prioritizes concrete palliative care (PC) aspects to restructure the service delivery system within one month.
S – Specific: This goal aims to achieve a single result of having an explicit written policy that suggests several improvements to the current PC delivery system.
M – Measurable: The guidelines created to achieve this goal should address rules of staff conduct regarding integrity, interpersonal communication, and non-discriminant patient treatment regardless of race, gender, age, religion, disease, or current health status.
A – Achievable: This policy proposal’s author(s) will be responsible for drafting, writing up the final version, and monitoring the policy.
R – Relevant: The written policy will embrace three priorities of restructuring the PC delivery system, such as integrated care, personalized care, and carer support. Each of the suggested staff conduct rules is suggested according to the secondary literature review on the topic. The resulting policy will be presented in class to ensure accountability and feedback.
T – Time-Bound: The timeframe for achieving this goal is one month from the date of the project’s start.
Medium-Range Goal
To conduct an informative campaign that articulates the value of the proposed palliative care policy development to gain wider political support for its implementation within three months.
S – Specific: The single goal is to create an informative campaign promoting the implementation of the policy proposed in the short-term goal.
M – Measurable: At the end of the campaign, the author(s) would have engaged with potential sponsors and policymakers to secure the campaign’s support. Moreover, the engagement with major stakeholders such as healthcare providers (HCPs) and patients would have received their input on the suggested policy.
A – Achievable: The author(s) of this policy proposal will be responsible for creating campaign materials, selecting target locations and audiences, and presenting the campaign to them.
R – Relevant: This goal was set due to scholarly research pointing out the need to attain wider political support for PC. The campaign will be organized in local healthcare facilities, public speaking venues, and online via social media platforms to ensure accountability and receive feedback from stakeholders.
T – Time-Bound: The timeframe for achieving this goal is three months from the date of the proposal’s acceptance.
Long-Term Goal
To develop the appropriate nursing staff support, training, and reporting system to enforce the proposed guidelines in nursing facilities within a year.
S – Specific: The single goal is to develop an effective HCPs support, education, and enforcement network in local nursing facilities and elderly homes.
M – Measurable: This goal’s achievement can be evaluated using several metrics. First, all staff members in the local facilities would have been thoroughly educated on the policy’s requirements. Second, when sufficient resources and staffing to reduce burnout of HCPs would have been ensured in every local nursing facility. Third, a reporting system to detect, report, and prevent neglect due to negligence would have been developed.
A – Achievable: The author(s) of the policy will be responsible for developing the system and testing it in several selected locations. In order to ensure mutual agreement, the feedback received from stakeholders will be accounted for in designing the network.
R – Relevant: The objectives for this goal were created due to the necessity of minimizing instances of patient neglect in care facilities. Secondary literature identified that having clear rules and expectations, minimizing instances of neglect due to technical reasons, and holding staff responsible for detected neglect were the major ways to reform the PC delivery system.
T – Time-Bound: The timeframe for achieving this goal is six months from the date of policy implementation.
The vague language of the current Intermountain Healthcare (IH) description of PC results in insufficient elaboration of specific nursing responsibilities such as quality of patient life, caregiver support, and non-discriminant patient treatment. A comprehensive PC policy has not been adopted in the IH facilities, leaving care teams to devise an individual approach to each terminal patient, which may be inefficient and result in subpar service. Across the country, many HCPs lack knowledge and skills in pain and symptom management, communication, and care coordination, while the public has only a vague understanding of the benefits of PC and how to access them (Meier et al., 2017). Given a wide range of responsibilities in providing palliative care (PC) and lack of specific instructions, IH healthcare providers (HCPs) filling only primary orders such as medical prescriptions may coincidentally neglect some care aspects. Therefore, an instructive PC policy is needed to facilitate successful administration and ensure equitable access to care services in the IH facilities.
Current Policy
Due to the lack of an established PC policy, most details were obtained from annual reports and public website sections. Palliative care in IH facilities pursues several goals: quality of patient life, symptom relief, family and caregiver support, and a team approach to care and care aligned with patients’ aspirations (Intermountain Healthcare, 2018). However, the current key goal is for HCPs to focus on managing pain and other symptoms like nausea or sleep problems (Intermountain Healthcare, 2020b). None of the listed elements are thoroughly elaborated, including the key goal. Intermountain Healthcare (2022) nursing services for end-of-life care include symptom assessment, “skilled services and treatments,” and situational management. In addition to nursing care, patients and their families can expect the care team to cover counseling, emotional and spiritual support, medication and supplies, domestic helper services, and home care in acute need (Intermountain Healthcare, 2022). The nuances are to be addressed in a plan of care (POC), jointly created by the care team and the patient based on the diagnosis, symptoms, and other needs (Intermountain Healthcare, 2022). However, it is unclear what ‘skilled services’ constitute or how detailed POCs are.
Literature Review
Scholars in medical and legal research encourage the development of detailed palliative care policies. Supporting this initiative, IH developed a hospital-based electronic palliative care algorithm to improve the identification of patients benefitting from PC services and calculate PC penetration rates (Gruhler et al., 2018). The algorithm then indicated that the need for receiving PC might be as high as 26.4% of the total IH inpatient population (Gruhler et al., 2018). It will be progressively more challenging for HCPs to devise individualized care plans for IH patients with as high and potentially increasing numbers. Therefore, an approach with great universal applicability is needed to meet this demand.
Furthermore, the policy focus should be on restructuring service delivery as a whole. Palmryd et al. (2021) found that nurses caring for intensive care unit patients did not prioritize integrity, arguing that more explicit guidelines are required to ameliorate the issue. This issue may apply to the IH facilities, given that extant IH guidance on PC does not identify the expectations and responsibilities of each party. Thus, the research mandates a policy change to guide productive communication between providers and patients.
Additionally, the lack of a universal, comprehensive PC opens a leeway for bias. A striking finding was that patients’ quality of end-of-life care might depend on the disease the patient suffers (Martinsson et al., 2018). At the same time, Spraker-Perlman et al. (2019) found that IH patients without known critical conditions (CC) benefit significantly from PC support before their death just as much as patients without CC. Therefore, the research necessitates ensuring that the non-discriminant approach to PC provision is specified in the policy.
Lastly, blaming IH nurses for negligence is impractical, given their inability to assist sometimes. The outbreak of the COVID-19 pandemic has demonstrated that the lack of resources and nursing burnout contribute to the increased negligence in PC (Human Rights Watch, 2021). In its Annual Report (2020a), IH recognized that its caregivers focused on creating personal protective equipment (PPE) assembly lines, with their regular duties seeing a significant decrease in hours because of the pandemic. This situation mandates ensuring that nurses can meet the care requirements. Hence, the policy to improve patient care should involve reconsidering the carer support system, as nurses’ workload can interfere with the quality and quantity of services provided.
Discussion Outline
A detailed assessment of contributing factors, strategic goals, and budget plan will be required to create and implement the policy successfully. The policy should ensure even responsibility distribution and uphold an appropriate accountability standard for non-compliance. It should provide an appropriate level of detail in each aspect and implement enforcement mechanisms to avoid regular duties suffering due to negligence. Moreover, sufficient staffing in every establishment is mandatory to avoid situations where IH staff is overwhelmed with double duty. Overall, the proposed approach should create concrete and explicit guidelines regulating nursing staff responsibilities in end-of-life care, a comprehensive support network for HCPs and patients, and specific instances of accountability.
Demographics
The COVID-19 pandemic highlighted that curative care is currently at the core of provider-patient interaction over any PC aspect. During an acute crisis, hundreds of IH staff members were sent to help in New York hospitals (Intermountain Healthcare, 2020a). The crisis may have passed, but the question of which duties take priority remains, which may be overwhelming for the IH facilities staff. Therefore, the major demographic that policy changes can affect will be nursing staff needing explicit guidance on responsibilities and expectations. Further, the inpatient population of the IH facilities will be experiencing the consequences of the changed PC routine.
Morbidity and Mortality Rates
Not addressing the issue of inadequate PC may impact mortality rates significantly. Gruhler et al. (2018) estimate 90 million Americans currently living with serious, life-threatening illnesses and expect the number to double within 25 years. There is strong evidence of PC reducing acute unplanned hospitalizations and specialized PC services associated with improved short- and long-term care outcomes (Sleeman et al., 2021). Therefore, improving the policy approach to specialist palliative care would improve patient outcomes.
Disparities Resulting from the Current Policy
The poorly recognized role of end-of-life care in current policy contributes to unequal access to care. Although PC is increasingly recognized as a human right, the lack of guidelines’ support and research prevents many from utilizing it (Sleeman et al., 2021). Specifically, there are two downsides resulting from IH policy reliance on the individual POCs in the facilitation of end-of-life and palliative care. First, individualized POCs mean no universal standard of conduct is established; coupled with a potentially limited level of patient understanding of the services they may require, this could result in underperformance. Second, Intermountain Healthcare’s (2022) policy states that the hospice program and the patient’s physician must approve any proposed POC tests, procedures, and services, adding that “generally, treatments necessary for symptom or pain management” are approved. Therefore, services beyond the necessary symptom management may not be approved.
Cultural Issues
The proposed change in policy would provide an all-encompassing transformation of the extant system. If any of the PC aspects in IH are currently dependent on creating individualized POCs, these aspects will be thoroughly regulated in the future system. For the IH care teams that are used to working closely with each patient, such a system may initially seem overly prescriptive. Additionally, the cultural background may influence patients’ decision-making regarding pain and PC, making it vital to consider the patient’s beliefs regarding care and death before forming an all-encompassing instructive guidance of staff conduct.
Readiness for Change and Stakeholders
America has seen tremendous growth in palliative care in the 21st century, indicating the national readiness for policy change and implementation. The IH facilities are receptive to innovative missions and have supported designing other healthcare policies, such as Primary Promise – IH’s plan to build children’s national model health system (Intermountain Healthcare, 2020a). Providers and policymakers have begun recognizing the potential benefits of PC for patients with severe illness at any stage (May et al., 2021). The major stakeholders are HCPs and terminally ill patients in IH facilities, both groups being receptive to potential policy changes.
Costs
The costs of implementing a PC health policy have been scarcely investigated in recent years. Increasingly, though still limited, evidence supports the efficacy and cost-effectiveness of specialized PC (Sleeman et al., 2021; May et al., 2021). Patients who receive early specialized PC show improvements in a range of outcomes, including physical symptom control, survival, and quality of life, and caregivers report increased satisfaction and decreased depression (Sleeman et al., 2021). Moreover, appropriate and timely provision of PC likely lowers overall healthcare expenses (May et al., 2021). Therefore, the costs of keeping current HCPs and effectively helping patients in IH facilities may be reduced by implementing a new policy.
Meier, D. E., Back, A. L., Berman, A., Block, S. D., Corrigan, J. M., & Morrison, R. S. (2017). A national strategy for palliative care.Health Affairs, 36(7), 1265–1273. Web.
Palliative care (Fact sheet for patients and families No. FS239-04/20). (2020b). Intermountain Healthcare. Web.
The post provides an insightful combination of personal experience with key databases and facts about the current shifts in cancer screening, cancer survivor issues, and policies in regard to hospice and palliative care. It is important to point out how critical the given fields are to human health and wellbeing. Studies suggest that “lack of access to palliative care is a major problem worldwide. Every year, 40 million people need palliative care, 20 million at the end of life, yet only about three million are able to access the care they need” (Connor & Gwyther, 2018, p. 112). In addition, “as a consequence, 18 million people die with avoidable pain and suffering” (Connor & Gwyther, 2018, p. 112). In other words, one can see not only the essential nature of the preventative aspect of healthcare but also the minimization of pain and suffering. Therefore, developments and changes should move in supporting both directions since every human being deserves his or her right to dignity.
By offering healthcare services independently and as members of health providers that include doctors of nursing practice and nurses, healthcare professionals contribute to American healthcare. The burden of giving diagnoses, prescriptions, treatments, consultations, and other services might be shared by doctors and advanced registered nurse practitioners (ARNPs) by increasing their scope of practice (Ortiz, 2018). In regions with significant physician shortages, such as country places, where scarcity has persisted and is likely to continue for the foreseeable future, ARNPs operating at the level at which they are trained might aid in reducing inequities in healthcare access.
Discussion
Increasing the practice scope does not affect the quality of health outcomes. Highly qualified and effective ARNPs may positively impact access to and use of primary healthcare services in rural regions. Especially in rural and disadvantaged locations, the improved availability and decreased costs can justifiably merit enhanced nurse practitioner autonomy. Expanding the scope of practice for ARNPs might increase the availability of primary healthcare services in rural regions. It is conceivable to conclude that an extended range of services can improve provider supply, access to health care and use, and quality of treatment after carefully examining how it affects the utilization of healthcare services.
One of the most effective solutions is the use of telehealth. Over the past 20 years, telehealth has been utilized more to provide healthcare access (Watts, 2021). This was not the case with palliative care (PC), as the delicate nature of the interactions made telemedicine unorthodox and unworkable (Watts, 2021). Medical PC telehealth approaches have been evolving due to the restricted PC availability to underserved and rural populations and encouraging PC telehealth investigations.
Conclusion
In conclusion, the COVID-19 epidemic has dramatically expedited the usage and use of telemedicine in the medical field, particularly in PC (Watts, 2021). Clinicians, managers, and others concur that telehealth will stay and will probably continue to be widely used and improved outside of rural regions.
References
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), p. 65.
Watts, A., K., Malone, E., Dionne‐Odom, J. N., McCammon, S., Currie, E., Hicks, J.,… & Bakitas, M. (2021). Can you hear me now?: improving palliative care access through telehealth. Research in Nursing & Health, 44(1), 226-237.
The public health policy for palliative care was created by the World Health Organization, which has a critical role in the United Nations system as the governing and coordinating body for international health. Its broad mandate includes providing leadership on increasingly complex global health issues (Gruhler et al., 2018). Moreover, the organization is responsible for creating health guidance, norms, and standards, monitoring and evaluating health trends, and formulating research programs in the health sector.
There are significant risks in the course of organizing palliative care; therefore, it is imperative to conduct a thorough review before implementing a policy in an institution. The process should commence with an assessment of service needs in the population of the area served by the IH (Gruhler et al., 2018). Subsequently, a person in charge should be identified and have necessary conversations with all staff members. Moreover, IH ought to acquire a universal, comprehensive PC to stop bias. In this regard, training is of great matter in the development of palliative care, especially the movement of all health care workers on issues relating to anesthetic maintenance. It is also necessary to review the support system for caregivers because nurses’ workload may interfere with the quality and quantity of services provided.
It is crucial to organize educational events and public relations to promote and publicize the policy. Periodic advertising, including media and newsletters simultaneously, will be helpful in promoting the quality of services, which can influence consciousness and education (Gruhler et al., 2018). Moreover, community outreach, weekly information sessions, videos, and surveys of families of former patients are essential. Ultimately, the Internet should be the primary source for promoting services and educating consumers about the benefits of hospice care.
In order to maintain trusting relationships and be effective in providing quality palliative care, it is necessary to understand the specifics and characteristics of the target group. When working with relatives and families in general, the multidisciplinary nature of respect and the specialist’s personal willingness to be in contact must be considered (Gruhler et al., 2018). Frequently, specialists consider one of the aspects – either psychological or physiological. However, quality palliative care regards a comprehensive team approach to meeting the needs of terminally ill children and their families. In order to communicate the new workplace policy to employees, it is vital to hold a meeting and share the updates. The policy is extensive, and additional training with confidential feedback from employees should be provided.
Implementation
The first step in the implementation process is to create a sense of urgency for changes. To achieve a sustainable transformation, everyone involved must feel the transition speed and believe that the new policy is required. If workers do not support the initiative, it will be challenging to maintain momentum, and therefore any modifications may not last for an extended period (Gruhler et al., 2018). The goal of the first step is to prepare employees for future changes and encourage their participation. In order to accomplish this aim, it is crucial to identify the existing challenges and opportunities of the IH using a SWOT analysis. Therefore, a thorough dialogue with the staff will be provided to explain the necessity for changes.
Furthermore, building a team with the necessary skills, qualifications, reputation, relationships, and credibility is crucial to leading change initiatives and influencing stakeholders. The team will have a leader responsible for the transformation initiative. His responsibility will be to provide executive-level assistance and sufficient resources to implement the policy. The fourth step is to utilize all available communication channels to ensure that the medical staff comprehends the need for the approach and its benefits to both the institution and the patients. There will frequently be obstacles to implementing organizational shifts, and it is essential to focus on removing them.
The process of implementation is endurable; therefore, the early phase will focus on short-term goals. It will be accomplished primarily to measure and evaluate the effectiveness of care to improve the strategies. The next step is to maintain policy by ensuring that teams work hard to achieve the vision of change by tracking their progress (Gruhler et al., 2018). People must be advised to refrain from celebrating notable victories after a few completed goals. In order to preserve the momentum of policy proceedings, a determination will be completed. There is a need to maximize the benefits of swift goals, and then the work on large-scale changes can start.
The goal of transformation leaders is to create a new culture in which policy can be sustained. It includes adjusting organizational norms and values, procedures, reward systems, and other infrastructure components. Everything must be aligned with the new strategy in this step. Therefore, the discussion of the importance of the latest changes, emphasizing the benefits they provide, will be conducted. Identifying and adopting norms and values that promote modifications are necessary. Leaders should consider unique models and weights when identifying and hiring new talents or promoting employees. It is also vital to create further training and development programs to help employees acquire the skills and competencies needed to adapt to recent changes (Gruhler et al., 2018). One should improve or eliminate organizational procedures that do not accommodate the new culture.
Policy Evaluation Considerations
Disproportion is one of the setbacks in the availability of a full range of medical interventions in favor of predominantly medical and social care. Furthermore, the tendency for hospices to be located far from urban hospitals causes complexities, which guides to a lack of awareness. Students and residents have infrequent opportunities to practice palliative care. The lack of teaching and residency programs causes hardships in comprehending the need for policy implementation.
The sustainability of palliative care policies can be performed through planning and funding. Efforts should ensure continuity of resources and be reliable guarantors of the implementation and reality of the strategy. Moreover, the policy can be implemented in other institutions. Its features allow the methodology to be applied at homes, outpatient clinics, nursing departments, and general hospitals. Standardized clinical methods should be utilized to routinely measure patients’ suffering symptoms and functional capacity.
The implementation of the policy should lead to the gradual expansion and integration of palliative care into the healthcare system. Access to medications must be improved, and human resources strengthened. It is also expected that every patient will be able to receive four-pronged urgent care. Palliative care is an essential component of service delivery, and its significant implication is to improve outcomes for patients and their relatives and reduce health care costs.
Senior management must agree that palliative care is part of the role of all health care workers. There is a need to review the approach and consider it a routine rather than a specialized medical activity. It is also essential to re-evaluate capacity, drug control, and training approaches. Policies allow services to be provided at the proper time in a suitable place, supported by individuals with the relevant skills and appropriate resources to provide care. The focus should be shifted from tools and high-tech equipment to coherence.
Additional
The public health policy for palliative care is one of the most comprehensive and multidisciplinary approaches developed to improve patients’ lives. This policy aims to prevent and relieve suffering through early detection, proper assessment, and treatment of pain and other concerns. The approach promotes dignity, quality of life, and adjustment to progressive disease by employing the most satisfactory possible evidence. It represents comprehensive physical, psychological, and spiritual care for the patient and support for the family. The policy includes a few significant steps to guarantee the result. It starts from the point the disease is diagnosed and continues regardless of whether or not the patient receives treatment for the disease itself.
The basis for palliative care strategy is the speed and necessity of getting rid of pain and other suffering symptoms. Furthermore, it is not limited by these aims and includes measures to improve the quality of life and even thoroughly influence the course of the disease. A vital policy condition is that all people, regardless of income, type of illness, or age, should access a nationally established set of essential health services, including palliative care. Medications must be available to all who need them. Such lists include opioid and non-opioid pain medications and medicines used to manage the most common symptoms in palliative care.
The leading methods of the policy are divided into four categories: physical care, psychological, emotional, spiritual maintenance, care planning, coordination, and communication. It operates brief screening methods tested in rich and developing countries. Moreover, the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Indicators (POS) are essential policy elements. Treatment should focus on symptoms that reduce patients’ quality of life. Otherwise, the side effects of the intervention may cause harm rather than the pathological condition itself. A multidisciplinary team qualified in palliative care, including physicians, nurses, community health workers, and volunteers, must be involved to implement the policy.
Reference
Gruhler, H., Krutka, A., Luetke-Stahlman, H., & Gardner, E. (2018). Determining palliative care penetration rates in the acute care setting. Journal of Pain and Symptom Management, 55(2), 226–235.
Nurses play a major role in the context of pain management. However, they must learn to acquire new skills when it comes to terminally ill patients and clients with fatal conditions (Macintyre & Schug, 2007). A dying patient needs more than a typical pain management program. In the case of elderly patients suffering from fatal conditions – pain management must be enhanced using palliative care. Barriers exist and challenges abound with regards to effective deliver of palliative care, the best way to deal with it is to increase the capability of nurses and they must learn to acquire new skills and new mind-sets in order to improve their efficiency with regards to delivery of palliative care.
The Role of Nurses in Palliative Care
Pain management comes in several stages. The first stage is all about the assessment of pain. The second stage is the understanding what the different reactions to pain. Patients have different pain thresholds. The third stage deals with the patient’s perception of the type of pain they are suffering (Bijur et al., 2008, p.1). The fourth and final stage, which is known as pain behaviour, focuses on the various behavioural expressions that people with painful conditions exhibit (MacLellan, 2006, p.3). In most cases, nurses are able to deal with pain successfully with the effective use of pain relievers if needed. In many cases, patients recover as expected (Fosnocht & Swanson, 2007, p.791-792; Hager & Brockopp, 2007, p.9). However, terminally ill patients have different needs.
Nurses must be trained to understand that pain treatment strategies that can result in negative outcomes such as anxiety, depression, hypochondriasis as well as somatisation (Todd, Ducharme, & Choiniere, 2007). Problems in pain management must encourage nurses to improve their assessment methodologies. They need to acquire the ability to determine patients’ emotional status before they embark on treating these painful conditions. This is usually considered in a case wherein a patient appears to be extremely depressed, demands high level of opioids, ignores examination procedures or is totally non-compliant (Price, Fogh & Glynn, 2007, p.12).
This kind of behavioural characteristic is common in patients with acute painful conditions and such conditions point to the onset of a bio-psychosocial pain disorder, which is multidimensional and requires a level of expertise to achieve correct diagnosis (Fosnocht & Swanson, 2007, p.791-792).
The Importance of Education, Training, and Experience
Nurses must be able to deal with different types of pain but when it comes to terminally ill patients, a different skill-set is needed. Ill-equipped nurses can contribute to barriers in effective pain management and it can be broken down into three major parts:
insufficient knowledge;
lack of skills when it comes to basic palliative care techniques; and
lack of skills when it comes to standard assessments (Deandrea et al., 2008, p.1986).
Insufficient knowledge with regards to effective and efficient pain management strategies would result in underutilization because the focus is usually on the use of aggressive interferences that does not guarantee ability to prolong life but simply add more pain and suffering to the lives of patients and their families (Deandrea et al., 2008, p.1986). They have to understand that palliative care is “medical care focused on relief of suffering and support for the best possible quality of life for patients facing serious, life-threatening illness and their families” (Hong et al., 2010, p.854).
Nurses must learn to master the requirements needed to deliver the following:
availability of palliative care services;
timely identification of the need for palliative care; and
family concordance around the illness prognosis (Ahluwali, 2007, p.38).
The common denominator is awareness and expertise; these can be acquired through education, training, and experience.
The following are some areas that nurses must look into when it comes to a continuous learning process:
describing pain;
identifying aggravating and relieving factors;
determining the meaning of pain;
determining its cause;
determining individual’s definition of optimal pain relief;
deriving nursing diagnoses;
assisting in selecting interventions; and
evaluating efficacy of interventions” (Yarbro, Frogge & Goodman, 2005, p.650).
Nurses must also how to evaluate the impact of the analgesic regimen on the patient and the family’s quality of life (Yarbro, Frogge & Goodman, 2005, p.650). This requires constant assessment of the effectiveness of the analgesic applied and the amount of relief obtained as well as constant communication with members of the family.
By carefully following several guidelines nurses are able to effectively gauge the reaction of the patients towards a particular analgesic; however, someone must model to them how to do it. Nurses must learn to collaborate with other health workers.
The training and education of nurses must not be limited to reading books and case studies. There is a wealth of information that they can access by learning in a collaborative environment wherein there is horizontal and vertical interactions with other nurses, hospital staff and other key players in the palliative care department of the hospital or hospice.
Nurses must be aware of a standardized approach to determine if a patient is suffering from pain. At the same time they must has access to an evaluation strategy to enable to know if a patient has experienced optimal pain relief. They must also know how to assess if a certain analgesic is causing addiction or overdose. Thus, an effective use of assessment tools would enable nurses to eliminate the fear of addiction and overdose when it comes to their patients (Yarbro, Frogge & Goodman, 2005, p.650).
The standardized approach could be enhanced by adding the concept of whole patient assessment because it involves “a complete assessment of a patient’s medical, psychological, spiritual and social history” (Hong et al, 2010, p.854). Nurses must learn to augment standard assessment strategies that includes “assessment of chief complaint; history of the present illness; past medical and surgical history” and then moves towards exploring patient’s “social and community support, impact of the cancer diagnosis and treatment on patient’s quality of life, spiritual and social well-being” (Hong et al., 2010, p.854). Aside from increasing a nurse’s knowledge regarding the individual needs of the patients the whole person assessment approach also enhances the communication between nurse and patient.
The managers of a hospital or hospice must invest in a training program that not only increases the knowledge of nurses when it comes to palliative care but also their ability to communicate to the patients. It is imperative to learn how to communicate to a dying patient and nurses must be able to see beyond the pain and discomfort. Terminally ill patients may be depressed or angry. Nurses must learn to deal with these issues as well as the capability to make observations and pass it along to physicians and fellow nurses who are working with them.
In addition, nurses can help enhance the delivery of palliative care if they are trained to detect caregiver strain among the members of the family that are providing support and help solve that problem. Their ability to detect strain helps to mitigate the impact of a burnout. They could help intervene and tell physicians and others to immediately provide counselling and other helpful strategies to alleviate the suffering not only of the patient but also the caregivers and family members assigned to take care of loved ones.
It must be made clear however, that nurse must be trained to communicate effectively. Nurses must communicate well to gather information with regards to what the patients are feeling with regards to the pain and the analgesic given to them. Effective communication is necessary to understand all the pertinent information regarding past history especially when it comes to dealing with pain and other medical needs. Effective communication also enables nurses to work closely with the family in order to satisfy all the requirements. Therefore, insufficiency in knowledge regarding effective assessment, standardized approaches in pain management and effective communication must be identified as one of the primary barriers to effective pain management and palliative care.
Conclusion
End of life-care requires expert help from nurses and physicians. Nurses play a major role in palliative care. Nurses must be trained about the different aspects of palliative care including delivery, and effective assessment of patient as well as caregivers. Nurse must be trained to see beyond the negative behaviour of the patient and family members so that they can provide observations and assessment that could help other health workers to provide the necessary assistance or treatment. Nurses must learn new skills that would enable them to deal with the barriers to effective pain management. Lack of knowledge can be defeated through deliberate training and collaboration with other health workers within a hospital or hospice.
References
Ahluwalia, S. 2007. Professionalism among physicians: factors associated with outpatient palliative care referral in a managed care organization. MI: ProQuest LLC.
Bijur, P., Bérard, A., Esses, D., Calderon, Y., & Gallagher, E.J. 2008. Race, ethnicity, and management of pain from long-bone fractures: A prospective study of two academic urban emergency departments. Academic Emergency Medical journal, 15, p.589-597.
Deandrea, S. et al. 2008. Prevalence of under treatment in cancer pain. A review of published literature. Ann Oncology, 19(12), p.1985-1991.
Fosnocht, D.E., & Swanson, E.R. 2007. Use of a triage pain protocol in the Emergency Department. American Emergency Medical journal, 25, p.791-793.
Hager, K.K., & Brockopp, D. 2007. Pilot project: the chronic pain diary – assessing chronic pain in the nursing home population. Journal Gerontology Nursing, 22, p.14-19.
Hong, W. et al. 2010. Cancer Medicine. 8th ed. CT: People’s Medical Publishing House.
Macintyre, P. & S. Schug. 2007. Acute Pain Management. New York: Elservier.
MacLellan, K. 2006. Expanding nursing and healthcare practice – Management of pain: A practical approach for healthcare professionals. Cheltenham: Nelson Thornes.
Price, P., Fogh, K., & Glynn, C. 2007. Managing painful chronic wounds: the Wound Pain Management Model. Internal Wound Journal, 4, p.4-15.
Todd, K.H., Ducharme, J., & Choiniere, M. PEMI Study Group: Pain in the emergency department, Results of the pain and emergency medicine initiative (PEMI) multicenter study, 8, p.460-466.
Yarbro, C., M. Frogge, & M. Goodman. Cancer Nursing: Principles and Practice. MA: Jones and Bartlett Publishers.
Description of the Clinical Issue, the Setting, and Population of Interest
The clinical problem for my project is concerned with palliative care for cancer patients. The population of interest is adult patients. The environment described in the proposal is the hospital setting. The purpose of my project is to investigate the possible advantages of palliative care over conventional care. As a result of the project, it is expected to obtain solid data concerning the benefits of palliative care over conventional care for patients suffering from cancer.
Clinical Question
The clinical question in the current study is, “In adult patients with cancer pain (p), what is the significance of receiving palliative care from the palliative care team (i) when compared to conventional care practice (c) in terms of pain intensity reduction and improved pain management (o) during their course of care (t)?”:
P: Patients with cancer pains.
I: Palliative management and consultations.
C: Conventional care practice (no palliative care whatsoever).
O: Reduced pain strength and enhanced pain management.
T: The duration of care.
Proposed Intervention
The suggested intervention for the project is a developed practitioner-led intervention (Matzo & Sherman, 2014). As a result of this intervention, I plan to answer the question of whether palliative care gives better outcomes than conventional care in the treatment of adult patients with cancer. To organize this intervention, it will be necessary to identify patients who have cancer and allocate them into two groups: those receiving palliative care and the ones receiving conventional care. Researchers note the significance of palliative care (Howie & Peppercorn, 2013; Satija et al., 2014; Wilkie & Ezenwa, 2012). However, there is no substantial evidence of such practice to be the most effective one. Therefore, I want to check this theory with the help of my intervention.
The study conducted will be experimental. The rationale for such a choice is that it is necessary to compare the impact of two different types of care on patients with cancer. Thus, the groups will be randomly selected depending on the necessity to find the necessary number of patients in various hospitals.
Type of Study
As it was mentioned earlier, the type of study chosen for the intervention is experimental. Such a choice is delineated by the clinical study of the project. Since I need to compare the impact of two various types of care on the same population group, it is possible to assign people to the experimental and control groups randomly. Patients belonging to the experimental group will receive palliative care, and patients in the control group will take conventional treatment. As a result of this intervention, it will be possible to evaluate the advantages of palliative care over conventional care. It is expected that patients in the experimental group will experience reduced pain strength and enhanced pain management.
Theoretical Framework and Rationale
The theoretical framework for the project is based on Jean Watson’s theory of caring science (Revels, Goldberg, & Watson, 2016). With the help of this theory, it is possible to evaluate the quality of care provided for cancer patients. Watson’s theory focuses on the practice of caring as a core requirement in nursing (Revels et al., 2016). The rationale for choosing this theory is that it is the most closely connected to the clinical question of my project. Utilizing the theory of caring science will make it possible to find and evaluate the differences between the two kinds of care suggested for cancer patients.
References
Howie, L., & Peppercorn, J. (2013). Early palliative care in cancer treatment: Rationale, evidence and clinical implications. Therapeutic Advances in Medical Oncology, 5(6), 318-323. Web.
Matzo, M., & Sherman, D. (2014). Palliative care nursing: Quality care to the end of life (4th ed.). New York, NY: Springer. Web.
Revels, A., Goldberg, L., & Watson, J. (2016). Caring science: A theoretical framework for palliative care in the emergency department. International Journal for Human Caring, 20(4), 206-212. Web.
Satija, A., Ahmed, S. M., Gupta, R., Ahmed, A., Rana, S. P. S., …Bhatnagar, S. (2014). Breast cancer pain management – A review of current & novel therapies. The Indian Journal of Medical Research, 139(2), 216–225. Web.
Wilkie, D. J., & Ezenwa, M. O. (2012). Pain and symptom management in palliative care and at end of life. Nursing Outlook, 60(6), 357-357. Web.
Palliative care is any form of treatment by medical care that is meant to reduce the seriousness of the symptoms causing a certain disease, in place of curing the disease. The main motivation for this system of care is to reduce the suffering and to improve the lives of people who are facing complex and serious illnesses. (Davis, 2001) The symptoms may include pain, constipation, loss of appetite, lack of sleep, and vomiting. Palliative care helps patients to understand and to choose how they can be cared for. The comfort of the patient is always given priority so as that of their families.
Definition of palliative care
Palliative care can also be defined as an approach that is employed to improve the quality of life for sick people and their families who have been affected by life-threatening diseases. This is done through relieving and prevention of suffering by identifying the symptoms early and also through critical assessment of those signs to treat the pain and other problems such as physical, spiritual, and psychological.
Palliative care, therefore, is very important in that:
It relieves the patients from pain and reduces stress inflicted by the various disease-causing symptoms.
It ensures that life is very critical for every human being and everyone has a right to live a decent life. Death is also viewed as a normal process in which everyone has to undergo it.
Doesn’t intend to increase the lifespan of the patient nor do they want to hasten it.
Ensure that the patient’s morale is boosted by motivating them spiritually and also psychologically.
It ensures that the patients remain active throughout their lifetime. They do this by providing the patients with a support system.
The families of the affected patients are also provided with support systems to enable them to overcome the hardship during the patient’s life and also after the patient’s death.
Provides assistance and support to the patients and also to their families whenever they are in need. This involves providing them with a counseling team when the hardships are difficult to overcome and also during the time of mourning.
Constantly advise the patients on the positive and the quality of life to improve the angle in which the sick view about life.
It provides care early in the patient’s life. This is achieved by incorporating with other therapies whose main motives are to prolong the life of patients e.g. chemotherapy. Investigations are done in the ways of reducing and managing the distressing symptoms. (Gormley,1999).
Who defines palliative care for children using the following principles
Palliative care for children is the absolute care that is provided to the child’s body, mind, spirit and also supporting the child’s family.
It usually starts after the diagnosis of the illness and goes on despite the child being given the treatment for the disease or not.
Providers of the care must first of all study child’s psychological physical and social conditions and try to assist the child come through all these.
Successful implementation of palliative care requires support from the child’s family and also from the rest of the community in terms of resource allocation. Palliative care can still be successful even if the resources are scarce.
Palliative care can also be provided in health centers, children’s homes, and also other tertiary facilities that provide care to the children. (Tannisio, 1999).
Providers of palliative care
Palliative care is mostly provided by two different health and social professions.
Some provide these services on a day-to-day basis to patients who are at home and also to those who are at the hospital.
There are those specialists who have specialized in palliative care and therefore provides these services at their hospitals.
Those who are providing this care on day – to –day basis are required to carefully study and access the needs of their patients and also their parents. These studies should be based on the physical, mental, and spiritual state of the patient. They should also be able to meet all the requirements that are required for anyone to conduct this service. They should also seek any assistance from professionals who are trained to provide these services whenever they are in need. ( Jennings, 2004).
Specialists in palliative care also providers this kind of care to the affected patients and their families. They accomplish these by assessing and providing advice to the affected patients and the families who are either at the hospital or in their homes. Specialists provide this care to all the patients who are in hospitals by providing them with the required care and support. They are also supposed to provide coordination to the services provided to the patients who have wished to stay at home due to complex needs. This may involve ensuring that the patient is given his doctor who will be assisted by the district nurse. Also, this team of specialists can team up together to provide nursing and medical services and also support the patients at their own homes. Their responsibilities also lie in the provision of assessment facilities to the patient’s needs in terms of provision for physical and social needs. They also provide support to all those people who are involved in caring for the patient. This involves assisting them after the patient’s death and also supporting them when they are bereaving. The areas are also involved in training and educating the patients and also their family members. The specialist team usually includes medical consultants and a care nurse specialist. Physiotherapists and also occupational therapists should be included.
Hospice vs Home Palliacitce Care
Home palliative care is characterized by the varied nature of its interventions. Home palliative care includes individual nurses who do not have clear training, personal doctors, and varied professional teams. The teams mostly come from hospitals or hospices. Some studies indicated that the professionals came from palliative care and most of them were not where they came from.
The outcome of the various studies indicates that patients were satisfied with the home palliative care because most of the services were quality. This was because these services were offered by professional teams and most of the staff were trained to some extent. The studies have also indicated that there was a lower cost for the home palliative care and most of their staff have to work in multi-professional teams and obtain some training on palliative care to improve the outcome.
In Hospital palliative care, most of the studies conducted showed that the care was a grade2. The study indicates that those in the hospital usually spent less time in the hospital and the quality of life reduced significantly as time passed by. The staff mostly includes a nurse and a surgical doctor.
There is a common similarity between hospice care and palliative care when it comes to the issue of sick people. That is care: Hospice usually provides palliative care services. This palliative care provided by the hospice differs slightly from the usual palliative care this is because hospice palliative care involves administering comfort, care through an administered system and is usually offered by the hospitals. Both hospice and home care usually require patients to receive most of the services in a single approach where medications, equipment, counseling, day–to–day services, and treatment of the symptoms are done using a single program. Though hospice and home palliative care have similarities in the way they deliver their services, they also differ so much in terms of care location, payment, timing, and ability to deliver services. (Lumby, 2001).
Place
Hospice
The hospital provides so many programs as compared to those of Home palliative care. After enrolling through the permission obtained from the care physically, and after the patients in the hospice program being endorsed by professionals from the hospice team, care is allowed to be conducted and carried out at home. Hospice care program usually relies on the patients family as well as the visiting nurses from hospice. Though hospice usually provides care on 24 hours basis, mostly in hospitals and sometimes in specially equipped hospice facilities, sometimes their services can be provided at the patient’s home.
Home palliative care
Home palliative care team are usually made up of professional medical teams which include doctors, and nurses. These professionals are usually located at the place where the patient will receive the treatment i.e., usually at the patients home. These professionals will be respectable for ensuring that the patient receives the required comfort – care and also to supervise all the services offered. Though home palliative care usually takes place at home. Sometimes palliative care team provides this service at the hospital.
Timing
Hospice
For one to be considered in most hospice programs and also to receive insurance, benefits one must be within six months of death.
Home palliative care
Home palliative care has no restrictions in terms of time. These services can be provided to patients at any time and whatever stage of illness. It should not really be terminal or not.
Payment
Hospice
Hospices usually have policies regarding payment units. Hospice programs usually cover almost all the expenses because all their services have been paid for. These payments are usually done in form of insurance policies.
The in-services policies coverage for hospice care usually varies. Other hospice programs usually assist those who are economically capable or to those who were not covered by their insurance policies. Most of the hospice programs are usually covered by Medicare.
Home palliative care
In-home palliative care every item and service they provide will be paid separately. These payments are usually made to the doctors and care nurses during their regular visits. The prescriptions made for the outpatient palliative care patients are usually paid differently and are done according to the regular insurance coverage.
Treatment
Hospice
Hospice programs usually provide more comfortable services rather than concentrating their services on reducing pain inflicted by various diseases to the patients. This is because the hospice program decided to forego those treatments which extend the life of an individual, by making the patients have the maximum comfort out of the little time they are left with. They decided to forego life-prolonging treatment because they did not want their patients to suffer much from the side effects which are a result of using life-prolonging drugs. Most hospice care services involve preparing the patient both emotionally and practically to achieve the level of comfort that can make him/her die conformably. ( Allen,& Brock, 2003).
Home palliative care
This palliative care does not have a time limit for an individual to be provided with this care unlike hospice, this system of care can provide their patients with comfort and care at any stage. Therefore patients undergoing this system of care can receive the care at any time of their illness period. Also in-home palliative care, life-prolonging drugs are mainly used. These drugs are mainly meant to extend the life of the patient as he is being cared for. The side effects of the life-prolonging drugs are treated while the individual is being provided with care. (Hanson, & Callanhan,1999).
Treatment issues form Ethical perspective
Beneficence
The principle of beneficence mainly is to act in mind others’ interests. That is every individual has a moral obligation to act to benefit others. This principle seems obvious to many who want to offer help to other people. Though it looks obvious there are so many risks associated with it. At times we offer so much help to our patients as it reaches a time that we believe that everything which is best for them is known to us. Sometimes we hold a belief that the patient should follow each and everything we say because we know what is best for them regarding their conditions. This kind of behavior in which a person knows and declares the preference of others is usually called paternalism when we force some ideas on patients because we pretend that we know more than them, even if they do not want them, we risk crossing the boundary to paternalism. When this happens, the patient’s independence is not given the respect they deserve. Example of paternalism includes. Depriving information to patients to support you in making some decisions, giving the patient the treatment they do not require. (Cricton, Robertsom, Gordon, & Farrant 1997).
Non – maleficence
The principle of non-maleficence states that no harm is to be inflicted intentionally. This principle is mostly seen to be applied in the hospital environment where the health care employees, only want to help people by providing the necessary services and not harming them. Usually, the issue of non-maleficence comes in place when the patient is nearing to die. Here the decision about the importance of the treatment to the patient takes center stage. Physical therapists are not usually involved in deciding about the end–of–life action to a certain patient but they are usually involved in discussing options with either patients, family members, or any patient’s relatives. These options might include whether or not to withdraw from the life-supporting system. Patients should also be given a chance about their desire to prolong their lives using life-supporting machines. Though other patients might decide to be left to die without using the supporting machines, physicians, nurses, and the patient’s family members should be conducted so that their wishes can be known. Other treatments on physical therapy might not be very comfortable to patients. In such cases, a continuation of the treatments to patients who might not last long requires an ethical decision. This is because the patients might not gain or benefit from the treatment instead the treatment might be inflicting so much pain to the patient. In such a case the patient’s wishes and his/her life should be considered and not necessarily believing in the physical therapist. ( Jennings, Ryndes, D’onotro & Baily,2003).
Justice
Justice is usually defined as a form of fairness in health care. Air stokes also once said, “giving to each that which is his due.” This means that when distributing anything we’ve to look and decide on who deserves it. This principle also applies in the way of distributing resources. Due to the current scarcity of various resources, a fair means should be developed in the way these resources are distributed. It is generally believed that equal people are qualified to receive equal treatment.
This is usually applied by Medicare and is already available to persons over the age of 65 years. The people in this group have been categorized by use of their age. There are various factors today which are being used to categorize people for them to get fair justice. These factors include:
Each person should receive an equal share.
Each person is rewarded according to the need.
Each person is recommended according to the effort.
Each person is recognized according to the contribution.
Each person is grouped according to the merit.
Each person is rewarded according to free-market exchanges.
The general society has to obtain a fair playing group by assisting in any disadvantaged situation in terms of resources provided. One of the fundamental issues facing health care today is the question of who has the right to health care? That is the society should be fair to all citizens regardless of their economic status so that every citizen have access to quality health care.
Autonomy
The principle of autonomy states that the patient should be treated according to the patient’s desires and all health professionals must implement this. Health professionals are also required to provide the treatment according to the customer’s preferences without crossing the boundaries. The patient’s confidentiality should also be protected by avoiding disclosing any confidential issues. The doctor is required to provide meaningful treatments to the patients. This involves considering the needs the patient requires, the patient’s ability, and protecting the patient’s privacy. (Leathard,2003).
Freedom
These principles state that patients should be given the freedom to choose what they think is right for them. Health care professionals should not force patients to undergo certain treatments which they do not wish to go through. They should also be given the freedom to have access to all the information regarding their performance on the treatment they are going through. This will help them so much especially in deciding their future ways of treatments. Decisions on whether to continue using the life support machines or not should also be left to be decided by the patient himself/herself. (Murray, 2002).
Concepts of Good Health
To have good health the following principles help in ensuring that these health concepts are achieved in the community in which we live and care for others.
Equity
This principle states that all human beings have equal health rights, despite their economical status, race, country, or areas with which they come from. The rich should help the poor whenever he/she is sick and cannot afford the health services. Every country should ensure that hospitals are built close to the people and no areas should be deprived of this important facility. The cheap and affordable hospital should be constructed in rural areas to help those who cannot be able to pay for the services to have access to it. Human rights groups or other groups of people who are held in high esteem in society should help those disadvantaged groups of people to acquire treatment services in their time of need. (Cassell, 2003).
Community participation
All the communities leaving in every country should be informed about their rights to access health facilities. The poor communities mostly living in rural areas should be taught about the availability of free medical services in public hospitals. Other services which are also free and readily available at their disposal should be made known to them. All the communities should be well motivated to participate in various stages of decision-making concerning their health. This involves participating in helping the needy by providing the health care personnel with the required resources that are used to uplift those most disadvantaged in society. They should also assist in planning the ways of improving the health conditions in their surrounding communities. This has to be done in conjunction with their area’s health care personnel. The community should also assist in the implementation of every issue that has been set to improve the health conditions not just for themselves but also for their immediate neighbors. (Macnamara, 2001).
Inter – sectoral collaboration
The co-operation of voluntary groups, organizations, and the community is also a very important issue in ensuring that good health is being provided to the people. The co-operation of citizens at the local level will help in identifying those people who need health services and cannot be able to achieve it. Such information if given to the various organizations and voluntary groups will assist much because he will be able to receive free medical services. This collaboration also will assist very much in identifying areas which require urgent medical requirement. E.g. hospital. This hospital might get free financers who will be ready and willing to build the structures. The governmental and nongovernmental organizations should ensure that health-related issues should be on the agenda of public institutions dealing with policymaking. (Langton, 2000).
A good death
Definition of good death
A good death can be defined as an acceptable way of dying. But this definition has led to contradiction because what is acceptable in one society might not be accepted in another Weisman (1978, P.193) proposed various factors on the ways of maintaining patients’ physical, psychological, and social way of life to enable him/her have a peaceful death. A person who is to die on appropriate death should have all the symptoms causing diseases reduced to be relived from pain. All the care should be given to the patient and also he/she should be encouraged to live and perform everything to the scope of his/her capability. Necessary attention should be focused on the sick person to help him/her come out of the miseries by providing the person with whatever requirement he needs. The patient therefore according to Weisman should be allowed to explore numerous choices that can enable him/her to live and have whatever he/she requires
In trying to define a good death, Steinhauser gathers various definitions from seventy-five doctors nurses, patients and social workers. He then identified six components of a good death:
Pain and symptom management. Almost everybody fears a peaceful death. The fear of the pain which is inflicted by the disease-causing symptoms can cause a lot of stress and worry to the patient and its family members. But on many occasions these worries can be reduced whenever there is clear strategies on the ways of making decisions
Clear Decision Making. Patients feel great when they are included in the decision-making process. These decisions include the way of planning treatment options for the patient. The patient will feel great if he/she is involved in this process. In order to successfully reduce the pain on the disease affecting the patient, good communication between the patient, family members, and the physician is required.
Preparation for death. Patients have to know what is expected of them during the period of their illness. This will help them in planning for the events that will come after their death. These involve the writing of the will, the preparation of their funeral, and also contributing to the writing of the obituary patients who are involved in the preparation of their deaths feel very much satisfied because they feel they have met all the requirements which are expected of them before they die. Family members can prepare for the patient’s death by getting ready mentally and physically to fill into the shoes of the patient after his death. They can also get prepared not to waste so much money in the last-minute rushes of the patients to the hospital due to them panicking. They can therefore allow the patient to die peacefully at home
Completion. The patient can have time to review what he/she has accomplished in life, settled any pending matters and also having time to part with their family members and friends. The issue of the spiritual faith of an individual can also be reviewed.
Contribution to others. Many patients usually have a feeling to share whatever they have. They recognize the importance of the human-to-human relationship. They can therefore give out gifts, money, or their possessions which then can be useful to others after the patient’s death.
Affirmation of the whole person. The caretakers should ensure that they are dealing with and caring for an individual who is a normal human being. The value of the life of an individual should be given priority before anything else. The sick person should therefore not be viewed in terms of the disease they have but should be viewed like any other complete human being.
Sources of Stress and Burnouts
The strain of providing care is mainly seen to impact those who are providing the care and also to the patients. The stress mainly results from two factors:
Sources of stress.
The stress mediators.
The major sources of stress are the situational characteristics of the patient and the caretaker. The stress mediators involve the resources of the patient and also the caretaker. The resources might include the social support and the style of the patient and care provider coping and reduction in the provision of care. These might impact negatively on the health of the patient and the caretaker.
Sources of care giving stress
Factors related to illness
Serious diseases and a threat to the lives of the patients reduce the quality of life for the patient. This may negatively have a serious impact on the mental health of the patient thus increasing stress to the care provider. An example of such illnesses is heart-related diseases which usually cause mental disturbance to the sick thus increasing stress.
Caregiving situation
The situation of giving particular care can increase the influence and the amount of stress experienced. These might involve the environmental resident of the patient, the economic situations, the degree and the amount of care which are provided to the patient, and also the number of people providing the care.
Environmental context of the home
The environment might affect the patient in terms of the patient’s adaptation and the patient’s needs. The inability of the patient to respond to the various demands related to the environment might affect the patient negatively. This then leads to overdependence of the patient on the caretaker.
Economic Burden
The medical conditions of the patient lead to overdependence on care providers and life-supporting medical treatment which may reduce the amount of the patient’s money and that of the family. This may then cause stress because the family members will have less money to sustain them.
Single Vs Shared care giving
The sharing of caregiving duties is likely to reduce the stress of the caretaker. The workload in the provision of necessary assistance demanded by the patient is reduced because the demands can be handled by two or more people. A single caretaker is likely to get stress resulting from too much work done in responding to the demands.
Stress and burnouts on Palliative nurses
Most staff nurses who are providing palliative care face so much stress in that:
The nurses are generally stigmatized for working with people who are not going to live.
Some of the patients for which the nurses work are suffering from diseases that do not have a cure e.g. HIV AIDS.
Nurses might fear to come in contact with some of the patients which can expose them to getting infected with the disease.
The association of palliative patients makes them always come in contact with the death and dying.
Therefore the stresses and burnout that can face the palliative nurses and the health worker are categorized as:
Fears on the staff.
Associations issues
Role and professional issues
Stigma and discrimination.
Fears on the side of staff
Palliative staff fears being contaminated and infected with the same kind of disease as that of the patient. Some patients even have been denied access to palliative care because their illnesses are feared to be contagious and can be transmitted to the staff. Most of the staff is known to avoid such kind of patient because they fear the same kind of disease can be transmitted to them.
Issues of Association
Palliative care staff is required to associate with patients who are from the same age group. The association of their grieving family members can course stress to the staff. Issues of stigmatization because of associating with the sick can also arise.
Role and Professional issues
The work definition to the staff sometimes causes them to work under conditions they are not comfortable with. Some staff is forced to associate with patients whom they are not comfortable with but because they are guided by certain rules and regulations and therefore they have to do it. E.g. a survey conducted by Ross and Seeger (1988) concluded that 33 percent and 43 percent of 108 staff workers had stress working with patients who were sick from Aids-related illness.
Stigma and Discrimination
The association of the palliative care staff with the sick and the threat of them being infected by some contagious diseases results in this stigmatization. The stigmatization also comes in terms of their association with the already marginalized groups of people.
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