NRSG374 Issue within Palliative Care Assignment Sample

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• Subject Code : NRSG374
• University : Australian Cathloic University My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Principles of Nursing: Palliative Approach

Introduction to Issue within Palliative Care

Palliative care is an approach that helps in improving the quality of life of the patients and their family members also who has been dealing with the issues that are related with life-threatening illness. This is done by preventing and providing relief from the suffering by detecting the pain and other issues be it physical, psychosocial or spiritual at early stage and doing impeccable assessment followed by the provision of treatment of pain and the other issues (Al-Mahrezi & Al-Mandhari, 2016). The main objective of palliative care is to mitigate the affliction of the patients along with their families by the inclusive evaluation and treatment of the physical, spiritual, and psychosocial symptoms that have been experienced by the patients. As the fatality approaches to a patient, its symptoms may entail more hostile palliation. The Palliative therapy is corresponded to the active care provided to the patients the nature of whose illness is such that it does not respond to the curative treatment. It is provided for the mitigation of the misery of the patient and to not affect the cure along with helping the individuals to address the people with their physical, social, spiritual, psychological, and practical issues along with preparing them for managing their life closure as well as their dying process. It also helps the patient’s family in coping with the loss and the grief at the time of illness and mourning (Hospice & Alliance, 2014).

Target Audience and Rationale for Resource

This booklet will help the third year undergraduate students and the new graduate nurses as well in assisting them to understand the concepts of palliative care for end-of-life stage people. The booklet will help the care providers in developing the understanding for the challenges that may occur and the strategies that could be implemented in the provision of palliative care in end-of-life stage of the people.

Learning Objectives

1. Palliative care and hospice care

2.  Principles of Palliative care for the individuals who are end stage of their life

3. Goals

4. Challenges or barriers faced in providing end-of-life palliative care

5. Potential Interventions

6. Core values of National Palliative Care Standards in end-of-life palliative care

Palliative Care and Hospice Care

Palliative care is an approach that helps in improving the quality of life of the patients who has been dealing with the issues that are related with life-threatening illness. The provision of palliative care is done by a team that includes nurses, clinical physicians, and other consultants who work in collaboration with the patient's other physicians for providing an extra stratum of support (Al-Mahrezi & Al-Mandhari, 2016). It is provided at any age of life and at any stage of any serious illness, and its provision can be done along with the curative treatment. While, Hospice is a program structured for providing the palliative care to the patients who have life expectancy of about six months or even less that and are at their residents. It has been covered by some medicare, Medicaid, private insurance plans that have enhanced home care benefits (Oechsle, 2019).

Principles of Palliative Care for The Individuals Who Are End Stage of Their Life

• Respecting the likes and the dislikes of the patient
• Integrating the psychological aspects with the spiritual ones while providing patient care
• Offering a support system that will help the patient in living his life as actively as possible until his demise
• During the end-of-life, the palliative care should be more of patient-centered instead of disease focused (Karen, 2017)
• Care should be focused on healing in spite of curing
• Building ways that helps in providing exceptional care during the end of the life. This could be done by the means of suitable health policies and funding from government and insurers.
• Providing care that helps them to get relief from pain as well as other distressing symptoms
• Keeping “adding life to the days and not days to the life” in mind
• Collaborating with patient and his care providers
• Supporting the family members and their preferences in order to gain accessibility to the required health care providers & suitable care settings. This will also help them in coping up with the patients’ illness and their own grief (Getty, 2018).

Palliative Care Plan

Palliative care plan entails:

• Care objectives
• Advance care planning
• Symptom management
• Family support
• Financial planning
• Spiritual care
• Rehabilitation
• Functional status support
• Management of comorbid disease

(Bergenholtz et al., 2019)

Goals Associated with The Palliative Care and Improving Quality at Life’s End

The ultimate goal of palliative care at the end of life is to improve the quality of life during the last few months. for individuals who are suffering from severe diseases. This could be done by providing a miscellaneous array of support and care delivery to the patient (Davis & Hui, 2017). Apart from improving the quality of life some other goals are:

• Helping the patients in identifying, expressing, and achieving their aspirations. This is done by summoning family symposium, and bearing in mind the hospice and palliative care.
• Discussing the goals of Care such as medical, emotional, social, and spiritual in the perspective of the prognosis.
• Better symptom control, Improvement of function, escaping any unnecessary, undesired, and potentially oppressive interventions
• Telling the truth as it has been considered as a crucial aspect at life’s end because honestly permits the patient and his family in understanding the severity of the situation. This will also help in addressing the essential issues that could get neglected by the patient and his family otherwise.

Challenges or Barriers Faced in Providing End-Of-Life Palliative Care

• Insufficient training and teaching of the health care providers in symptom management as well as in other end-of-life abilities
• Lack of accountability while providing care to the dying patients (Hawley, 2017)
• Inadequate standards of care
• Lack of suitable information as well as resources
• Lack of speculation in pertaining the researches regarding end of life care
• Some other identified potential barriers are poverty, work force development, geographic distances, population density, opioid availability, and restricted national palliative care policy (Koshnazar et al., 2016).

To overcome them, educating with various concepts and training the nurses with respect to the end of life palliative care would help in this. However, Physical barriers such as distance, poverty etc could be overcome by the implementation of government programs and providing cost effective care.

Potential Interventions

Given below are the potential interventions that are taken in case of any of the below issue faced during the care (Henson et al., 2020).

Pain	-Limiting the unnecessary painful procedures -Administering anticipatory analgesia prior to the course of action -Acupuncture/acupressure -Heat/cold treatment -massage -yoga -Transcutaneous electric nerve stimulation if required -distraction
Dyspnoea	-Comfortable loose clothing -Fan to provide cool air -Limiting the volume of IV fluids -Behavioural strategies, this include breathing exercises, relaxation, guided imagery, music
Fatigue	-Gentle exercise -Proper sleep
Nausea/Vomiting	-Dietary modification -Aroma therapy
Oral Lesions	-Oral hygiene -Appropriate treatment for infection
Anorexia	-Managing the treatable lesions
Pruritus	-Moisturizing the skin -Applying cold packs -Anti-itch lotions
Depression & Anxiety	Psychotherapy and behavioral techiques

How National Palliative Care Standards Help in The End-Of-Life Care

The National Palliative Care Standards helps in evidently eloquent and endorsing the vision for the compassionate and proper specialist palliative care. The Standards will also helps in distinguishing the significance of person-centered and age-appropriate care. This helps to manage the end-of-life care to the patient efficiently. In scrupulous, the standards point to the choices and the need for the attention towards the needs of the people that is at risk (Dalal & Bruera, 2017).

The core values of the National Palliative Care Standards entails:

• Endeavoring for maintaining the dignity of the health care, patient, family members, and caregiver
• Working according to the patient preference and providing the care with empathy and compassion towards the patient
• Assessing the potency and limits of the healthcare system, patient, and his family members for empowering them and working according to that only
• Taking care of respecting the patient irrespective of the other factors
• Advocating as per the expressed wishes of the patient and his family
• Providing commitment to the patient regarding the provision of brilliance in the care
• Considering the equity with respect to the expediency of services along with the allotment of the resources
• Being accountable and responsible towards the patents and his family

References for Issue within Palliative Care

Al-Mahrezi, A., & Al-Mandhari, Z. (2016). Palliative care: Time for action. Oman Medical Journal, 31(3), 161–163. https://doi.org/10.5001/omj.2016.32

Dalal, S., & Bruera, E. (2017). End-of-life care matters: Palliative cancer care results in better care and lower costs. The Oncologist, 22(4), 361–368. https://doi.org/10.1634/theoncologist.2016-0277

Davis, M. P., & Hui, D. (2017). Quality of life in palliative care. Expert Review of Quality of Life in Cancer Care, 2(6), 293–302. https://doi.org/10.1080/23809000.2017.1400911

Getty, J. (2018). Principles of palliative care. InnovAiT, 11(12), 676–679. https://doi.org/10.1177/1755738018793921

Hawley P. (2017). Barriers to access to palliative Care. Palliative Care, 10, 1178224216688887. https://doi.org/10.1177/1178224216688887

Henson, L. A., Maddocks, M., Evans, C., Davidson, M., Hicks, S., & Higginson, I. J. (2020). palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 38(9), 905–914. https://doi.org/10.1200/JCO.19.00470

Hospice, W., Alliance, P. C. (2014). Global Atlas on palliative care at the end of life. London: World Hospice and Palliative Care Alliance.

Karen, R. (2016). Palliative care improves quality of life, reduces symptoms, AJN: American Journal of Nursing, 117(4), 66. doi: 10.1097/01.NAJ.0000515237.74666.c3

Khoshnazar, T. A., Rassouli, M., Akbari, M. E., Lotfi-Kashani, F., Momenzadeh, S., Haghighat, S., & Sajjadi, M. (2016). Structural challenges of providing palliative care for patients with breast cancer. Indian Journal of Palliative Care, 22(4), 459–466. https://doi.org/10.4103/0973-1075.191828

Oechsle K. (2019). Current advances in palliative & hospice care: problems and needs of relatives and family caregivers during palliative and hospice care-An overview of current literature. Medical Sciences (Basel, Switzerland), 7(3), 43. https://doi.org/10.3390/medsci7030043

Schroeder, K., & Lorenz, K. (2018). nursing and the future of palliative care. Asia-Pacific Journal of Oncology Nursing, 5(1), 4–8. https://doi.org/10.4103/apjon.apjon_43_17

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