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Palliative care practiced globally that is to improve quality of life for patients and their families whom facing life-threatening. Adequate palliative care services have to begin from the time of diagnosis until patient die or improvement. In addition the suffering of patients can be relieved with palliative care. Palliative care is an urgent need worldwide for people living with advance of cancer (who.int, 2007).
History of palliative care;
The concept of palliative care has evolved in the origin of the hospice philosophy of meeting the gaps in the care of patients with serious illnesses and death. It is a Latin word thats means, to alleviate the symptoms without treatment .Furthermore, the first time palliative care introduce in1990 by the World health organization and now called approach Auan care that improves quality of life of patients and their families facing life threatening disease through prevention ,evaluation ,treatment of pain and other problems of physical ,psychological and spiritual problems. and mental, and spiritual (Backer, 2010).
Definition of palliative care;
World health organization has diffened palliative care as the full care that approch to imporve quality of life for patient and thier families whom facing life- theartening disese through prevent and relif thier suffering.These care concern in pain and other problems treatmen, physical, psychological , social and spiritual support(Lugton, & Mcintyre, 2005).
Objective of palliative care;
To mitigate the physical symptoms, the mitigation of diseases, to maintain independence. As well to ease of isolation, anxiety, fear, to provide dignity as possible and support victims(Lugton, & Mcintyre, 2005).
Different between palliative care and hospice;
Palliative care is focus on the management of pain and symptoms, the patient does not have to be terminal and it may be still receive an aggressive treatment. Yet the hospice is focus on the management of the pain and symptoms, diagnosis the patient has a terminal with a life expectancy less than six months, and do not seek treatment.
Both are focusing on quality of life .In addition the goal for both types are to address any settlement on the issues the end of life or disease (umm.edu, 2010).
Definition of quality of life;
It is general patient's well-being, including a mental status, level of stress, sexual function, as well as self-perceived health situation. patient will feel with high quality of life if he almost feels he is like other wellbeing person and this depend on the health team, family and relative behaviour and how they are deal and support the patient (Batiste Caja, Espinosa, Bullich, Porta-Sales, Sala, Limo´n, Trelis, Pascual, & Puente, 2010).
There is a high correlation between the quality of life and palliative care for the patient's life. Therefore palliative care improves the quality of life for patients and their families who face life-threatening illness, through the provision of pain and symptom relief, spiritual, psychological and social support, from diagnosis to the end of life and bereavement. Morover effective approaches to palliative care services available to improve the quality of life for cancer patients (who.int, 2007).
The paliative care not limited to the cancer only but it can be seen on the patient those who have chronic disease such as congestive heart faliur, chronic obstructive pulmonary disease, kidney faliure, alzheimer and HIV/AIDS (who.int, 2007).
Palliative care ensure the quality of life by alleviates pain and some other symptoms such as shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. Nevertheless it helps patients gain strength to continue in daily life. And improves their ability to afford medical treatments. In addition it helps to better understand their options for care(getpalliativecare,org, 2010 ).
There are different preception of palliative care and quality of life; regarding to the patients and teamwork, so from the old persons point of view those who reciving that care decreased the suffering from various health complaints also means dependecy on others for carrying out of daily living ,which may be more or less hard to live with. It is challange to understand the meaning of living with help form professional for most activities of daily living (Anderssona, Ingalill, & Edberga, 2007). Moreover team perceptions described that care is a supportive and therapeutic which increase the relationships with patients, and their carrying love and spiritual care. Furthermore, it is matched to education for pain and symptoms control with a focus on psychological and social aspects of palliative care and critical role of effective communication and characteristic care (Johnston, & Smith, 2006)
The palliative care is based on four components that are pain and symptoms control, communication, palliative care as support and palliative care team. all these will describe in detailes as following;
Pain and symptoms control;
The main objective of palliative care is giving proper care and management as well as focus on pain aand symptoms management with special knowledge and education. Moreover finding highlights the needs for patient care and the education in reporting the pain and using of analgesic (Docherty, Owens, Asadi, Petchey, Williams, & Carter, 2008).And according to WHO that palliative care are placed an experts in the pain and control symptoms experienced by people with advanced cancer can be controlled if they had followed the appropriate lines of clinical evidence and effective, including the opioid -type drugs and palliative care available and work to expand the scope of application of the principles of pain and control symptoms (uro.who, 2010).From my point of view that control pain and symptoms is very important which show respect the dignity of patient and care this patient as holism by giving the needs medicine in order to relief the pain even though this medicine will not cure the disease but it will remove or reduce the level of the pain.
The communication is skill and this communiction make the ability of health professional to communicate effectively with patients and families and involve them in decision making process is alwayes appears an important contributor to satisfaction with care at the end of lif.Nevrtheless the communication should be sensitive to a patient who is predict the poor and account must be taken (euro.who, 2010).
Communication is essential aspects to the role of team epically the nurses. Hence to control the symptoms effectively is impossible without effective communication. Furthermore the nurses should perform the skill of effective communication. Effective communication must be included active listening and providing appropriate non verbal communication counseling skill, such as sympathy, supportiveness and self awareness (Lugton, & Mcintyre, 2005).
From my experience the effective behavior, attitude in communicating with the patient and family is very important.Moreover effective and efficent communication is prviding better response.Communicating with other professional group such social worker, physiotherapists to ensure that the patient holistic needs are met .
Support the patients and their families.
Collaborting is approach involves the patient and family by asking the family . Reviewing the the progress with family under the effective communicatin wich can reduced powelessness and build the family confidence in the care and feeling security (Lugton, & Mcintyre, 2005).
From my experince i observed that supporting the patient and family enhance the quality and couping with their situation. Providing effective communicaton and good listening that will contribute to a positive out come. As well as empower the confideance.
extendin family support is an important factor in determining whether a terminally ill patient dies
at home. Understanding caregivers' needs, their varied experiences and the complex interactions between caregivers, health care professionals and patients is important if effective end of life care is to be provided
Palliative care team;
Consist of doctors, nurses and social workers, chaplains, massage therapists, pharmacists, nutritionists and others team.They are preforming these tasks. Closed and clear communication, an expert management of pain and other symptoms, movement assistance in the health care system. In addition direction with difficult treatment options and complicated, emotionally and spiritually support for the patient and family(getpalliativecare,org, 2010).
Team work is central to effective palliative care. In the same time this team are require a high level of professional skill ,the primary goal of team are to offers the best possible quality of life for the patient and family and to provide support .Moreover the effective team work depends on good communication, effective leader ship and coordination. These teams consist of hospice (director), nurse, doctors, professions allied to medicine (social worker, pharmacist), other professionals (research nurse practitioner), clergy, support staff, kitchen and domestic staff, maintenance, voluntary staff (Lugton, & Mcintyre, 2005).
From my experience I notice that team whom working together with patient and their families are providing a holistic management. So the team work is very useful and helpful to have knowledgeable team whom are providing a holistic management care to the patient and supporting family that will give a better out come. In addition this team should work hand to hand; otherwise they will be on conflict. Furthermore communicating with other team such as social worker, physiotherapists will ensure that the patient holistic needs are met (Lugton, & Mcintyre, 2005).
The palliative care must put in their consderation the ethical issues that will enhance the quality of patient life and make the team work proparly.
Respect for the individual; the team has very important duty to respect the rihgt ,autonomy and dignity for the patient as well as in promoting the wellbeing ,truth and honest. Respect and carying are vital components role for nurse when practising withen the palliative care setting.In addition respicting confidentiality and privecy for the patient are esential.
Repect autonomy; it is the rihgt and ability for patient to diced individualy his or her own value ,beliefs and slife long.Respect for autonomy implies truth telling and exchange of accurate information about status, goal of care ,option and expectation. Moreover the skills of communication listening and maintaining confidentiality are paramount in respecting autonomy.
Beneficence; it is the most commonly used principle in application of care ,it is requires that physician ,nurse to prevent or remove harm.Delivering effctive and beneficial treatment for pain or other symptoms, providing support and assisting patient and family as possible.
Non- maleficene; providing the necessary information and review the understanding is a good way to support decision making and autonomy of the patient with out causing harm.
Justic and unity; Justic it is equal respect for a person rights for fair and equal access to tretment. And the right not to be discriminated . In addtion the care given based on evidence and best practice.
Utility; it is providing the greatest good for the greatest number (Lugton, & Mcintyre, 2005).
I think all these factors will giving patient and thier family a hope, so hope is essential to life , that may giving direct coping in their life. hope is relevant in palliative and end of life care.
Professionals in the field of health care is able to promote and maintain of hope to the patients through their attitudes, behaviors and ways of communication(Mok, Lau, Lam, Chan, Ng, and Chan, 2010).
Affected tens millions of people all over the world from life- threatening disease such as HIV/AIDS and cancer, that cause them much suffering and their families as well as economic hardship. Furthermore the majority of cases occur in developing world, where often there is easy to remember of diseases. Development and addition of palliative care through effective approaches and low cost is usually the only possible to respond the urgent needs of patients and improve the quality of their life. Furthermore evidence based standards of palliative care services are focusing on improving clinical and organizational knowledge and practice are needed in all setting. In addition palliative care is concerned not only with all aspects of patients needs but also with needs of the family and of the health care provider (Sepúlveda, Marlin, Yoshida, & Ullrich, 2002).