Palliative care is considered as a type of health care which focused on reducing the severity of disease symptoms and to relieve pain. In addition according to Florence Nightingale to use the word nursing as is very essentials of but unknown (McEwen & Wills, 2007). Palliative care is very important aspect for the patients and their families especially who suffer from pain, which can leads them enjoy the life easily without suffering until they died (Becker, 2010).
The World Health Organization recently describes palliative care as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."(WHO, 2010).
Palliative care goals are much more than comfort in dying and focusing on relief from physical and psychological suffering, provide psychological and spiritual care and support family by rehabilitate the individual's (Lugton, 2009).
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Teamwork in palliative care is very important, and the team consists including of doctors, nurses, social worker, physiotherapist, pharmacist, dietitian and the patient is an essential of the team as well their family. The priority of this team is to provide as much as possible quality of life for the patient. Each member need to contribute in the decision making, as well as teamwork based on three effects; good communication, leadership and coordination (Lugton, 2009).
Symptoms management is an essential corner of palliative care regardless of other symptoms such as physical, psychological, social or spiritual. The role of symptoms management is centered on patients and their families to provide a good quality of life through teamwork and communication with patients and their families. Specifically the role of the nurse must have a broad knowledge in medicine and nursing in order to be ready to provide care for patients and their families in palliative care, however, should be to show kindness and compassion and patience (Becker, 2010).
The role of nurse in palliative care
The relationship between Nurse and patient the is the therapeutic relationship in order to be successful the relationship must be a presence the partnership, familiarity and mutuality come together in curative encounter between nurse and patient (Lugton, 2009). The role of nursing in palliative care plays an important role in the teamwork as it is in the individual and group which patient and family. To offer an important role in Supportive care which can helps the patient and family to cope with their condition and treatment process from pre-diagnosis, passing through diagnosis and treatment, to the cure, continuing illness and death. Which helps the patient to get the most benefits of treatment and to live with the effects of the illness (NCPC, 2009). The nursing role includes relief physical and psychological suffering, treatment of pain, and treatment of associated symptoms, relief psychological pain and social isolation and rehabilitation to achieve a good quality of life to and die in comfortable situation (Lugton, 2009).
Quality of life (QOL)
Quality of life is defined as: "The product of the interplay among social, health, economic and environmental conditions which affect human and social development" (Sirgy, Rahtz & Lee, 2004). Also the quality of life (QOL) can be defined in several ways, since the illness and its treatment affect the psychological, social and economic wellbeing, as well as the individual's biological integrity, so any definition should allow the individual components to be delineated. The impact of QOL will determined by allow of different disease states and interventions on overall or specific aspects. Moreover the approaches of quality of life within the health care field usually focus on illness and disability, with an inadequate attention to environmental factors of health and welfare. This considered as the components and determinants according to the quality of life profile (Dunderdale, Thompson, Miles, Beer, & Furze, 2005).
There are two types of quality of life:
1- Health-related quality of life (HRQOL)
Related to health directly affected by changes in health. HRQOL aspect are improve when the physician dealing with patient in a successful manner, by providing necessary health care and follow-up daily, and alter the medication or treatment. HRQOL include symptom states (e.g. allergy, pain), mental health or emotional wellbeing (e.g. depressive symptoms), social engagement and functional status.
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2- Non health or environment-based quality of life (Non-health-related QOL).
Non-health-related QOL are including: the personal resources (e.g. the capacity to form friendships) and the natural and the created environment (e.g. economic resources, water and housing).
Although the non-health-related QOL can affect to HRQOL with that non-health-related QOL is not related to health, but HOW? That is because the components of non-health related QOL for example (environment resources or personal resources) could be affect on results of HRQOL, such as (functional status, mental health or emotional wellbeing) (Medicine Encyclopedia, 2010).
Quality of life Measurement as a general Quality of End-of-Life Care Questionnaire (QEOC)
To assess the skills of the physician whose dealing with special group of patients with life limiting illnesses such as cancer, chronic obstructive pulmonary disease (COPD) and acquired immune deficiency syndrome, at end of- life care using and the family members who had lost a loved one, nurses and physicians with expertise in end of life care based on conceptual model. Which identifies five domains of physician skills; communication, symptom, affective, patient centered values, and patient centered systems. And to using this model, the QEOLC was developed. (Engelberg et al, 2010).
The palliative care can be used to relief from suffering in many cases (e.g. cancer, COPD and HIV) and let the patient to die in comfortable condition. For Example: the patients with end stage chronic obstructive pulmonary disease COPD. Certainly he has difficulty in breathing, fatigue, frustrated and suffering from pain, and the pain has a major effect on the psychological state such as depression, anxiety, fears. So, we can provide the palliative care by:
The most important element of palliative care which is the physical support where include providing personal hygiene, control the pain and relieve the difficulty of breathing, healthy nutrition and elimination.
Depression, anxiety, fears and psychological problems suffering by the patient because of his condition which its need to psychological support.
Promote spiritual support through discussion on his religion, faith and belief. Also encourage and support the patient to live of daily life in comfortably and let him look to the future with optimism. And provide full assistance for the practice of his rituals and spiritual beliefs.
Family support by showing compassion and sympathy and provide the advice to them and urged them to lift the morale of the patient through the presence near of him and beside him also encourage them to coexistence with situation of the patient. In addition the family support has a major impact on the psyche of the patient.
Helping the patient die with dignity.
So, the palliative care is an effective role and is very important in this case to provide the best possible quality of life. In order to measure the quality of life of COPD patients are needs to complete the St George's Respiratory Questionnaire (SGRQ). But when the failure to evaluate the psychological distress of the patient, sometimes will lead to serious consequences such as hopeless and depression with reduced cognitive function. Moreover according to (Spathis & Booth, 2008) "Chest physicians and respiratory nurse specialists have a vital role in ensuring that the care of patients dying from COPD improves to the level of the best".
From my point of view the palliative care is very important for the patients with acute illnesses and their families to provide the best as much as possible to improve quality of life and to provide quality of end of life care much more than comfort in dying. Life is a matter of living better with quality rather than to live long without quality. In addition consider to maintaining the privacy and confidentiality of patients and honestly and compassionately with patients and treating them with kindness, dignity and respect their beliefs and culture, to establish and maintain supportive relationships. Through from my research to make this essay, I found the palliative care in originally is created for the quality of life which I was thought quality of life is a part from palliative care.