• Subject Name : Nursing

Principles of Palliative Care

Palliative Care Standards

As per the World Health Organization Palliative care Australia defines the purpose of palliative care to provide support and clinical services in managing the care of the patient in their difficult times (National Palliative Care Standards, 2018). Palliative care model can be defined from the point of view of patient care center approach or family-care center approach model. The care for palliative phase can be provided in the following phase:

  1. Active phase
  2. Progressive phase
  3. Advanced phase

Palliative care aims at lending a helping hand at providing a cure prospect to the patients that might not be having any ray of hope as far as treatment is concerned (Hudson, 2018). Palliative care model Australia is formulated aiming at designing and dispersing a holistic approach, covering all major aspects of the care model.

Basic Aims of Palliative Care

Palliative care should also aim at keeping a close consideration for patient’s individualised needs, preferences and their own cultural values. The care can only be provided in a successful manner, when there is a strong and robust communication channel established between the patient and the healthcare providers (Kobel, 2019). The process should also be able to ensure smooth facilitation of autonomy of the patient and their families in the process and thus, enhancing the decision-making process by multiple folds.

Death is inevitable for each individual. Palliative care can be useful in assisting smooth transition of life for the patient, especially in their end days of lives (Rosenberg, 2018). The death of the patient is certain to happen but the methods and inculcation of palliative care approach can ease the misery of the patient and helping them with limiting the negative impact of their illness on them as well as their family members. In few cases scenarios palliative care can also delay the process of death of the patient.

The National Palliative Care Standards enunciates and advertises the vision for compassion for the patient and enabling specialist care as per the medical needs of the patient. Utter importance is given to the method of person-care centred delivery and in accordance to the age of the patient. the standards also help in recognizing and segregating patients as per the stratification of the degree of risk they are vulnerable to.

Helping Aboriginal and Torres Strait Islander Community

There is a population sect that might require special attention when it comes to palliative care. These population include Aboriginal and Torres Strait Islanders community (Welch, 2020). These individuals abide by their ethnic and cultural values with highest respect for the same. Aboriginal and Torres Strait Islanders community have experienced significant torture and trauma in their past. There has also been a reluctancy in these communities to acknowledge the healthcare services as the remedy for palliative care. These people are dealing with multiple health-related and personal issues as follow:

  • Intellectual disabilities.
  • People suffering from mental health-related issues of conditions like dementia.
  • People having special needs.
  • Paediatric population suffering from health-related issues and conditions (Woods, 2020).

These culturally and linguistically diverse communities lack the basic knowledge of the health concept and thus, suffer from multiple social as well as economic disadvantages.

These standards for palliative care have been developed to approach the patient with providing a sense of care, that enables them a better life in their end of days. These services are also formulated keeping a close consideration for targeting each component of health (Sullivan, 20019). These components comprise of the following elements:

  • Social care delivery systems
  • Acute care delivery systems
  • Aged care delivery systems
  • Overall health promotion delivery systems

Agencies Working Behind the Scenes

These standards ensure that the service model is followed as per the set strict guidelines and with due adherence to the protocol. These are certain agencies that have been helpful in enhancing the productivity of this care delivery model. The names of some of these agencies are enumerated as beneath:

  • Australian Commission on Safety and Quality in Health Services (ACSQHC)
  • ACSQHC- National Consensus Statement (Delaney, 2018).
  • ACSQHC- Essential Elements for Safe and High- Quality Paediatric End-of-Life Care.
  • Quality of Care Principles 2014 administered by Australian Aged Care Quality Agency (Zaghini, 2020).
  • Palliative Care for all Australians, drafted in 2005.

These agencies have been constantly engaged in ensuring continuity of palliative care provision for the patient while delivering them, regulated as per the relevant standards of care.

Core Values of Palltive Care Standards

the standards are driven by few foundational core values included as follow:

  • Ensuring and maintaining the dignity of the person receiving the care.
  • Maintaining the dignity of the family of the patient receiving care.
  • Establishing the strengths and limitations of the patient while providing the care to the them.
  • Ensuring the compassion towards the patient and their families.
  • Making sure that the resources are allocated with equity.
  • Advocating for the rights and wishes of the patients and the families involved in the process.
  • Accountability of the family as well as the community as well.
  • Making sure that the services are delivered with high-quality, through person-centred approach and on the basis of evidence-based services (Meier, 2017).
  • Making sure that the palliative care services are delivered as per the standards and quality accepted, as far as healthcare outcomes are considered.
  • Adhering to the professional code and conduct and as per the organizational standards.
  • Engaging the healthcare providers in clinical practices that also help with the continuity of professional and organizational progress. This will be helpful in enhancing the palliative care delivery services in a profound manner (Nevin, 2020).
  • Making sure that the healthcare professionals engaged in the process, get a chance of learning as well as develop their individual skills, attitude and clinical knowledge in the field of palliative care.

End-Of-Life Care Delivery in Palliative Care

Providing palliative care to the patient might not be as easy as it seems. There are multiple challenges that are faced by the healthcare providers while treating the patients in their end days of life (Shepherd, 2020).

The person who is dying has to be considered from a holistic point of view. These aspects should include these following imperative pointers:

  • Promoting physical well-being
  • Promoting psychological well-being
  • Pain management to reduce the suffering of the patient.
  • Promoting guidance and counselling for the patients and their family members.

More typical cases involve managing end-of-life care for elderlies. These patients might fear loneliness and might not have someone to provide the emotional and physical support. These older individuals can be staying retirement homes, without having any next to kin in family to offer them solace.

There are multiple challenges identified in such given case scenarios as follow:

  • Under-reporting or false reporting of pain by the patients.
  • A disbelief in effectiveness of palliative care, due to cultural and ethical believes (Ding, 2018).
  • Clinicians that are responsible for managing care of these patients might not be well-equipped to make sound clinical decisions, leading to faulty care management.
  • Certain patients might be more sensitive to drug-drug interactions leading to complicated situations while managing care for them.

Facing the Challenge with Methodical Approach

Death is a complex matter in itself and to deal with the same a strategic and schematic approach should be opted for.

Clinicians should be engaged constantly with patient and their families to help them with complex and emotionally challenging situations.

The challenges can be experienced by the healthcare professionals in other forms as well. These can be reflected as follow:

  • Patient suffering from depression- Many studies have shown that almost 70% of the patients suffering from caner are also suffering from various psychological distress. The depression in terminally ill patients can sometimes lead to patient having a tendency for suicide as well. This clinical depression observed in these patients is also found to have a negative impact on the progression of the disease in few cases as well. Depression can also be observed to be correlated with patients having anxiety. This anxiety can also be due to the lack of information and knowledge about their clinical condition (Mitchell, 2018). Prolonged treatment methods such as chemotherapy regimens can also lead to severe weight loss, fatigue, sleeplessness and so on, all of the factors leading to depressive state of mind of the patient. Treatment of these patients should be aimed at including coping strategies and enhancing their compliance with the treatment interventions.
  • Promoting coping strategies-

Coping with an advanced disease can be very challenging for the patient, especially to deal with on daily basis. Care provider have a duty to ensure that optimism should be promoted in these patients. This is also crucial from the point if promoting psychological well-being of the patient and thus, helping in enhancing overall health status of the patient.

  • Promoting dignity of the patient-

Promoting dignity in these patients makes sure that they have the desired honour and respect even in their last days of life. Loss of dignity is found to be closely associated with multiple distress, such as depreciating physical appearance, emotional state of mind and physical state of mind (Brodtkorb, 2017).

References for National Standards of Palliative Care

Brodtkorb, K., Skisland, A. V. S., Slettebø, Å., & Skaar, R. (2017). Preserving dignity in end-of-life nursing home care: Some ethical challenges. Nordic Journal of Nursing Research37(2), 78-84. https://doi.org/10.1177%2F2057158516674836

Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in Australia. Collegian25(1), 119-123. https://doi.org/10.1016/j.colegn.2017.02.005

Ding, J., Johnson, C. E., & Cook, A. (2018). How we should assess the delivery of end-of-life Care in General Practice: a systematic review. Journal of Palliative Medicine21(12), 1790-1805. https://doi.org/10.1089/jpm.2018.0194

Hudson, P., Hall, C., Boughey, A., & Roulston, A. (2018). Bereavement support standards and bereavement care pathway for quality palliative care. Palliative & Supportive Care16(4), 375-387. https://doi.org/10.1017/S1478951517000451

Kobel, C., Morris, D., Thompson, C., & Williams, K. E. (2019). Bereavement support in palliative care: a national survey of Australian services. Journal of Palliative Medicine22(8), 933-938. https://doi.org/10.1089/jpm.2018.0502

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 Affairs36(7), 1265-1273. https://doi.org/10.1377/hlthaff.2017.0164

Mitchell, G. K., Senior, H. E., Johnson, C. E., Fallon-Ferguson, J., Williams, B., Monterosso, L., ... & Nwachukwu, H. T. (2018). Systematic review of general practice end-of-life symptom control. BMJ Supportive & Palliative care8(4), 411-420. http://dx.doi.org/10.1136/bmjspcare-2017-001374

National palliative care standards, 2018. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0032/697046/PCare-National-Standards-2018a.pdf

Nevin, M., Hynes, G., & Smith, V. (2020). Healthcare providers’ views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis. Palliative Medicine34(5), 605-618. https://doi.org/10.1177%2F0269216319899335

Rosenberg, J. P., O’Connor, M., & Huang, X. (2018). A qualitative evaluation of Australian palliative care services’ participation in National Palliative Care Standards self-assessment. Progress in Palliative Care26(2), 81-87. https://doi.org/10.1080/09699260.2018.1454093

Shepherd, J., Waller, A., Sanson-Fisher, R., Clark, K., & Ball, J. (2020). Where would acute care nurses prefer to receive end-of-life care? A cross-sectional survey. International Journal of Nursing Studies, 103-183. https://doi.org/10.1016/j.ijnurstu.2020.103683

Sullivan, R., Ugalde, A., Sinclair, C., & Breen, L. J. (2019). Developing a research agenda for adult palliative care: A modified Delphi study. Journal of Palliative Medicine22(5), 480-488. https://doi.org/10.1089/jpm.2018.0462

Welch, S., McMillan, F., & Moles, R. (2020). Hospital pharmacy services supporting Aboriginal or Torres Strait Islander peoples in Australia: a systematic review. Journal of Pharmacy Practice and Research50(3), 191-204. https://doi.org/10.1002/jppr.1666

Woods, J. A., Johnson, C. E., Ngo, H. T., Katzenellenbogen, J. M., Murray, K., & Thompson, S. C. (2020). Symptom-related distress among indigenous Australians in specialist end-of-life care: Findings from the multi-jurisdictional palliative care outcomes collaboration data. International Journal of Environmental Research and Public Health17(9), 31-33. https://doi.org/10.3390/ijerph17093131

Zaghini, F., Fiorini, J., Piredda, M., Fida, R., & Sili, A. (2020). The relationship between nurse managers' leadership style and patients' perception of the quality of the care provided by nurses: Cross sectional survey. International Journal of Nursing Studies101, 103-114. https://doi.org/10.1016/j.ijnurstu.2019.103446

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