When the patient has serious illness like cancer and came to the hospital and complaining from pain, anorexia and fatigue at this time what can he is suppose to do? The answer of this question is in the definition of palliative care.
What is palliative care?
Palliative care according to (World Health Organization [WHO], 2010) it is a medical profession stand up to helps the patients and families to come over the pain and other problems like physical, psychosocial and spiritual with life-threatening illness. This can be done by the prevention and relief of suffering and early assessment and treatment of pain.
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Palliative care according to (Get palliativecare.org, 2010) “is provided by a team of professionals working together with your primary doctor. It is appropriate at any point in a serious illness and can be provided at the same time as treatment that is meant to cure”. Moreover, patient in the end of life can face and experience a host of distressing symptoms such as pain, dyspnea, and delirium are reported to be among the most feared and burdensome. Also, pain can be influenced by many factors, including the patient’s prior experience with pain, meaning given to pain, emotional stresses, family, and culture influences (Mcphee & papadakis, 2009).
(Mcphee& papadakis ,2009,p.70) stated that” the common problem for patients at the end of life up to 75% of patients dying of cancer is the pain and it is what people say they fear most about dying”. Therefore, nurses must be aware about the barriers to good care ,which including the lack of knowledge about the proper selection and dosing of analgesic medication ,limited training and clinical experience with pain management, addiction which can occurs if the patient and caregivers misused the medicines (Mcphee& papadakis, 2009).
In addition, there are 20 reasons can make the palliative care difficult to the nurses (Becker, 2010). I am going to mention some reasons;
Shortage of staff.
Shortage of nursing staff is one of the reasons which can make the palliative care difficult. In my experience in the hospital where I was working the staff nurses are in limited numbers , especially in the word the staff nurse can handle 9-12 patients some of these patients are having cancers and some time one staff nurse for 6 rooms each room has 5-7 patients!. Cancers patients cannot bear the pain and the staff nurse wants to do other work like inserting intravenous fluid for diabetic patient with hypoglycemia, so how the nurse can concentrate in doing that?
Here the staff has to prioritize her work, some staff nurses finding difficulty to do that. Therefore the hospital’s administration has to find and create a policy change in response to the nursing shortage as supported by Twigg , Duffield , Thompson & Rapley (2010). In addition to that, as Abrahm(2010) stated that due to shortage of staff palliative care in oncologists, intensivists, advanced cardiac, pulmonary, renal, and hepatic diseases needs to be improved.
Lack of knowledge of some medications and symptoms control.
There were 146 surveys distributed to care providers from multiple settings. Out 135 0f 146 reported that there are several problems can make the palliative care difficult like poor pain and symptoms control, lack of education for care providers as stated by Sellick , Charles , Dagsvik , & Kelley (1996)
The availability of clear polices in dealing with death issues.
In my experience only in some hospitals we can find clear polices in dealing with death issues especially brain death , this matter can involve many elements like; patient himself if he/she recommended before death if his/her brain died the caregiver can remove the supporting equipments, family according to the religion. So the staff nurse must be a wear about many religions. In understanding of the reasons and finding solutions to make the difficulties easier to the nurses can make too much improvement in quality of life.
Quality of life can be affected by the level of education in heart failure patients. Patients with high education level often can improve more than low education level which usually reported to care givers in bad physical and functional condition as supported by Barbareschi, Sanderman, Leegte, van Veldhuisen & Jaarsma (2011).
In addition, there are two factors are related to quality of life in heart failure patients, demographic and clinical. Also physical excises one of the main elements of disease management program. (Jaarsma, Johansson, Agren , & Strömberg ,2010)
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I want to stress in one point from my experience I did not see patient with heart failure has been cured totally from the disease, so I think the palliative care can play role to help this patient to enhance his quality of life.
For example, one of the patients I was taking care of him he told me I am useless now!
So for this type of patients I have to help him to move this idea from his mind, and let him to understand that the life did not end yet and we are finding developments in medical field, and give him task and encourage him to do it, after of compilation I have to enhance the feeling which he can feel it and let him to understand that he is worthfull and useful.
Since I chose the heart failure I want to mention how the staff nurse can manage the pain in this case, which include:
Pharmacologic treatment: like angiotensin-converting enzyme inhibitors, Î²-blockers, diuretics, and possibly aldosterone antagonists and angiotensin receptor blockers (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2007).
Diet and body weight: the recommended diet for these patients is low sodium diet to reduce body edema; recording upon admission body weight can detect the body weight if increased or no (Lewis et al., 2007).
Behavioral and lifestyle management: exercise/physical activity: as stated by Benetti, Araujo, & Santos (2010) exercises can improve the quality of life for heart failure.
Therefore, the nurses must promote home and community-based care by taking the responsibility and contribute in education of patient and involve him to implement the therapeutic procedure to improve the quality of life. “Teaching the patients and family how the progression of the disease is influenced by compliance with the treatment plan” (Johnson, 2008, p.428).
One of the most important points in improving quality of life as human being in my point of view is being opened to others .By this way the person can share other’s experience which can teach him/her something can change or improve the quality of life. In addition to that some patients need spiritual support which can make the life of some patients running in smooth way as supported by Hegarty , Abernethy , Olver & Currow (2011). Also, the quality of life can enhanced by the disable patients rehabilitation. As will as, mixing patients with disabilities in right and balance way can improve the quality life as supported by (Fadyl, McPherson & Kayes, 2011).
So how the caregivers can measure the quality of life?
The relationship among patients and families with caregivers can detect the quality of life as Hasson-Ohayon, Roe, Kravetz, Levy-Frank & Meir (2011) stated in their article. And, in my opinion quality of life is not easy to measure it because different criteria. The quality of life can make the measurement is so complicated, but generally speaking the improvement of individual health can indicate in quality of life.
The palliative care profession is can plays important role in professional health’s fields by helping the patients and families to understand the serious illness and how to manage and improve the quality of life .By educating the nursing staff and they must be in university level in both arts and sciences (McEwen & wills’s, 2007). As deeply supported by Henderson theory which stressing on the important of education for the nurses. In addition to that the caregiver should try their best to improve the quality of life which can lead to improve the palliative care, by understanding each individual is unique in many aspects and trying to deal differently accordingly. The hospital’s managers should understand the teamwork’s conflict and create polices to solve the shortage of nursing staff can enhance the palliative care to reach to optimal quality of patient’s life.
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