Principles of Nursing: A Palliative Approach

Table of Contents

Definition of dementia and Palliative care.

Importance of palliative care to people with dementia.

Barriers in providing End of Life care (palliative care)

Involvement – who are involved in planning.

Considerations to palliative care – what to establish religion, culture.

Critically apply nursing ethical and legal requirements when providing EOLC..

Role of palliative nurse.

Comfort measures – oral care, pain relief, pressure area care, skin integrity

Establish the link between intellectual disabilities and the National Palliative Care Standards.

References.

1. Definition of Dementia and Palliative Care

Dementia

Dementia is considered as the loss in context to cognitive functioning, reasoning with other behaviours to an extend that it interferes with a person's daily life and activities. These elements comprise of memory loss, loss in context to language skills, perception in visual terms, problem-solving skills, self-management, and non ability to concentrate. Some people with dementia cannot control their emotions and their personality may change. Dementia starts from mild to severe, affecting one’s performance at a critical stage, where the person has to be completely dependent on others for the initial activities of life. Symptoms and signs of dementia occur when healthy neurons (nerve cells) in the brain stop working at once, lose contact with other brain cells, and die. Although dementia is more common with age, it is not a normal part of aging. The causes of dementia can vary depending on the changes that could occur in the brain. The most frequent cause is Alzheimer's disease, a mixture of two or more types of dementia (Livingston et al. 2017).

Palliative care

A specialized form of medical care for patients with serious illness and are highly focused on the aspect of providing relief. These care processes address the symptoms as well as helps the patient to deals with the stress of the illness. Palliative Care goals are catered through maintaining comfort at home, control symptoms, and limit or prevent hospitalization. Role of palliative care can be performed by any one, by nurse or by psychologist or by care taker. A care process focused on providing relief from the symptoms and stress by improving the life’s quality for both patient’s as well as the family (Matzo & Sherman, 2018). This in turn helps the patient to recover faster. Patients diagnosed with a long-lasting or terminal illness are advised for palliative care to make their life and that of those around them much easier (Becker, 2016).

2. Importance of Palliative Care to People with Dementia

Improving the quality associated with life, maintaining effectiveness, as well as maximizing comfort are the goals associated with treatment in context to different stages associated with dementia. The emphasis is on specific goals that change over time. In the early stages associated with relapse, management usually slows the onset as well as progression associated with symptoms, helping a person stay active as well as a comfortable future treatment. Interventions often become ineffective; the focus associated with treatment is on managing the behavioral as well as psychological symptoms associated with dementia (BPSD) as well as maintaining patient safety. The more caring, the more focus on comfort which can be an expensive life. In addition in the direction associated with severe memory loss (Palliative Care Australia, 2020). Patients with improved memory may experience pain (for various underlying reasons), significant difficulty eating as well as swallowing, limited or no speech or motility at this stage, as well as BPSD5. Treatment is required 24 hours per day. The definition associated with this treatment varies - some people will be treated at home, some in care (such as a rest home, long-term hospital, memory unit or psychiatric unit), and others in specialist palliative care. Poor communication makes it difficult in context to physicians in the direction associated with determining, diagnose, as well as monitoring the treatment effects associated with patients with advanced dementia (Faull & Blankley, 2015).

3. Barriers in Providing End of Life Care (Palliative Care)

Barriers considered by health professionals as well as beneficiaries are influenced by changes in the healthcare system. Some associated with the symptoms with advanced dementia, in context to example; difficulty swallowing, urinary incontinence as well as stagnation make people very susceptible in the direction associated with other problems such as infections as well as malnutrition. Over the past few decades, healthcare systems in developed countries have changed to meet the requirements for improving efficiency as well as quality. The barrier to providing life care is the lack associated with continuity in the benefits associated with nursing care by health professionals which is a major threat to the care. It is helpful in the case of asthma in people with severe dementia. The stress associated with time as well as the growing demand for skills especially affect vulnerable residents with dementia. Health professionals often feel that he has guilty conscience of spending little time with each resident in conflict with the pressure to come as well as help everyone. Beyond the taboo of discussing managing chronic conditions and end of life care, When it comes to getting sick, the generic attitude is "cure or nothing" and this in something as simple (and misguided) as all the people demanding antibiotics for their colds and flu. Lack associated with resources is a big hurdle because days associated with dementia were over (Ferrell, Coyle & Paice, 2014).

4. Involvement – Who Are Involved in Planning

Planning is considered to be important for life-limiting conditions for persons with dementia, to try having these conversations making decisions for them. End of life care with a dementia patient involves different working of the professionals taken all together. It is instrumental in including GP, along with the community nurses as well as the social workers working in the forms of a care home staff. In case of a need an experienced Palliative care professional might be able to give specialist suggestions at a local hospice based hospitals. This professional team should keep the updates of the patients’ conditional changes as well as must get involved in any decision making process. This experienced nursing person should be standing stout with an effective care plan. This up to date care plan includes end of life wishes as well as planning’s. Going further it is further shared with those who are involved in the process associated with the person’s care. A number of areas do possess especially skilled staffs that are instrumental in co-coordinating with the dementia patient going through an end of life care for people.

5. Considerations to Palliative Care – What to Establish Religion, Culture

In simple terms, “ palliative” care consideration approves those which is placed at the opposite of “curative” care. Some of the considerations are (Holland et al., 2019):

  • Their main consideration is to focus on comfort aspect of the patient because curing whatever illness isn't the only option.
  • Again, palliative care is for both people with chronic illnesses/ailments as well as people who have a terminal illness but aren't yet ready for hospice (meaning they won't use curative treatments), or they don't qualify for hospice or even don't want hospice care.
  • Palliative care must consider the best options for the patient prioritizing their belief over the conventional methods of curative treatments emphasize on getting utmost pain reliefs.
  • Palliative care is about making the life’s meaning change in case of patients suffering from terminal illness, or is dying.
  • It considers the psychology of the patients and helps the patient comfortably make critical decisions even death.
  • There is a unique element of humanism, communication skills, and empathy which at times considers the economic strata of the person, and the family support network since the formal palliative care (or hospice) is only provided at few large hospital chains.
  • Considering the aspect of pain management, they use a variety of techniques in reducing other unpleasant symptoms and looking after them because they tend to be bedridden.
  • It aims to relieve suffering by identifying, assessing, and treating pain and other physical, psychosocial, and spiritual problems (Australian Government Department of Health, 2020).

6. Critically Apply Nursing Ethical and Legal Requirements when Providing EOLC

A registered nursing personnel may be asked to do what many providers have difficulty doing due to time constraints, personal conflict, ethical conflicts, discomfort with talking about death and dying, barriers to getting family organized and agreeing, getting patients to clarify goals of care (Johnson & Chang, 2018). The conversations are characteristically hard, heavy, sad, and emotional. Some of the ethical as well as legal requirements while practicing as ER/IM/FP are:

  • Need be in touch with the providers and know what that feeling is like to receive help depending on the aspect of getting relief.
  • It's an acknowledgment that they are looking at management rather than treatment and trying to establish the highest quality of life possible.
  • This type of an EOLC decision can be needed to consider and differentiate between misconceptions of death and dying and caring for people who are ill with the courage to have the hard conversations about end of life care (Advanced Care Planning Australia, 2020).
  • The nurse aim is to consider the goal and manage symptoms by doing regular checks and tune ups for lungs so that the process can be executed easily.
  • With no attempt to slow or stop the progression of the disease there must be an easy demise process that can be kept handy with a better attitude.

7. Role of Palliative Nurse

In accordance to Kissane et al. (2017), it includes:

  • Performing of a range of tasks toward ensuring a long-term patient’s well-beings.
  • Timely monitoring the patients symptoms as well as assist them with personal care needs
  • Timely evaluation of patient’s health to ensure that the proper care is given each day.
  • Helping the patients stick toward their medication that includes certain schedules as well as protocols
  • They maintain communication line in between the patient and the doctors ensuring a safe and comfortable treatment plan.,
  • The allied health professionals assist patients in the physical activities to accomplish everyday tasks

8. Comfort Measures – Oral Care, Pain Relief, Pressure Area Care, Skin Integrity

Oral care

  • In early Dementia stages, dental care is the primary focus on prevention.
  • Regular cleaning, check-ups as well as flossing of teeth, prevents the extensive procedural need the person with dementia
  • Helps in increasing the tolerance level of the patient (Larkin, 2015).

Pain relief

  • Pain difficult to assess in an elderly patient due to cognitive as well as their physical impairments.
  • Traditional approaches used in treating pain are modified to conduct an elusive diagnosis.
  • Altering of patient's physiology is required at times making the way for side effects.
  • Monitoring carefully can balance risks as well as treatment's benefits (Levett-Jones, 2018).

Pressure area care

  • A pressure ulcer is highly painful developing a requirement of an apt pain relief plan.
  • The nurse helps the patient using pressure-relieving pads, specialized cushions, overlaying mattress (Macauley, 2018).
  • Teaching the ways to use them and provide aid to get rid of them.

Skin integrity

  • Problems arise due to a lack of nutritional factors.
  • Forgetting to eat with a drop of weight along with nutrients that are essential in maintaining skin
  • Inadequate nutrition leads to higher accidental falls
  • The presence of blood sugar can open the skin leading to infection
  • Proper nutritional foods intake plan are to be incorporated by the nurse (Larkin, 2015)

9. Establish the Link Between Intellectual Disabilities and The National Palliative Care Standards.

Intellectual disabilities in dementia patients are characterized by intellectual activity and can be significantly adjusted. There has been a growing recognition in recent years. The emphasis on caring has significantly increased. Even the life expectancy of people with these intellectual disabilities (dementia) in the last fifty years has increased. While long-term treatment may be required, patients are more likely to die from age-related diseases (Tuffrey-Wijne, 2019). The incidence of memory loss is higher among people with disabilities. In particular, people with Down syndrome are at higher risk of Alzheimer's disease and its prevalence starts from 40-60 years. The treatment process must include service culture, quality improvement, as well as team coaching skills. It is important to promote national standards related to palliative care as an expert vision. Relief care services are clearly identifiable and qualified in terms of the value of intensive care and the importance of individual age. The standards of National Palliative Care are very important to be subjected to ensure patient safety. The standards include of assessment of needs, developing the care plan, caring for care providers, providing care, transitions within and between services, grief support, service culture, quality improvement, and staff qualifications and tanning. These are important to cater as The National Palliative Care Standards without a doubt promote and articulate a vision for appropriate and compassionate specialist palliative care. The Standards subject the significance of care that is age-appropriate and person-centred (National Palliative Care Standards Australia, 2018).

References for Palliative Care for Patient with Dementia

Advanced Care Planning Australia. (2020). Advanced Care Planning in your state or territory. Retrieved from: https://www.advancecareplanning.org.au/resources/advance-care-planningfor-your-state-territory

Australian Government Department of Health. (2020). Advance Care Directive. Retrieved from: https://www.health.gov.au/health-topics/palliative-care/planning-your-palliativecare/advance-care-directive\

 Becker, R. (2016). Fundamental aspects of palliative care nursing: An evidence-based handbook for student nurses (2nd ed.). London, U.K.: Mark Allen Group.

Faull, C., & Blankley, K. (2015). Palliative care. Oxford University Press, USA. Retrieved from: https://ebookcentral.proquest.com/lib/acu/detail.action?docID=1978014#

Ferrell, B. R., Coyle, N., & Paice, J. (Eds.). (2014). Oxford textbook of palliative nursing. Oxford University Press.

 Holland, K., Jenkins, J., Solomon, J., &Whittam, S. (Eds.). (2019). Dying. In D. Roberts, Applying the Roper-Logan-Tierney Model in practice (2nd ed.). (Ch.14., pp.453-476). Churchill Livingstone Elsevier

Johnson, A., & Chang, E. (Eds.). (2018). A palliative approach. In A. Johnson, & E. Chang (Eds.), Caring for older people in Australia: Principles for nursing practice (Ch.12., pp.215-229). John Wiley & Sons Australia, Ltd.

Kissane, D.W., Bultz, B.D., Butow, P. N. Byland, C.L., Noble, S. & Wilkinson, S. (2017). Oxford Textbook of Communication in Oncology and Palliative Care (2nd ed). Retrieved from: https://oxfordmedicine.com/view/10.1093/med/9780198736134.001.0001/med9780198736134

Larkin, P. (2015). Compassion: The essence of palliative and end-of-life care. Oxford, England: Oxford University Press.

Levett-Jones, T. (2018) Clinical reasoning: Learning to think like a nurse, Melbourne. Pearson.

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet390(10113), 2673-2734.

Macauley, R.C. (2018). Ethics in Palliative Care: A Complete Guide. Retrieved from: https://oxfordmedicine.com/view/10.1093/med/9780199313945.001.0001/med9780199313945

Matzo, M., & Sherman, D. W. (Eds.). (2018). Palliative care nursing: Quality care to the end of life, fifth edition. Retrieved from: https://ebookcentral.proquest.comWittenberg, E. (2016). Textbook of palliative care communication. Oxford, NY: Oxford University Press.

National Palliative Care Standards Australia (2018), National Palliative Care Standards, Retrieved from: https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/11/PalliativeCare-National-Standards-2018_Nov-web.pdf

Palliative Care Australia. (2020). Understanding Palliative Care. Retrieved from: https://palliativecare.org.au/ 

Tuffrey-Wijne I. (2019) Palliative Care and Intellectual Disability. In: MacLeod R., Van den Block L. (eds) Textbook of Palliative Care. Springer, Cham. doi: https://doi.org/10.1007/978-3-319-77740-5_69

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