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  • Subject Code : NRSG374
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  • Subject Name : Nursing

Principles of Nursing A Palliative Approach

Introduction to Principles of Nursing A Palliative Approach

According to the World Health Organization (2020), palliative care is defined as care in which health care services are provided to a patient who is on the verge of death or suffering from a life-threatening illness. This care is provided by treating the signs, symptoms, and other problems. The palliative care: enhance the quality of life, address the needs of patients and their families, uses a team approach, supports the patient and his/her family, and provides relief from pain. The core values of palliative care are – dignity, integrity, vision, support, responsiveness, empowerment, collaborate, and organize. The themes of palliative care are –private healthcare, access to equipment, enhancing communication, developing competence, and information transfer between services. Effective communication is very important in palliative care. This effective communication is not only between the patient and the associated health care providers but it is also among the associated health care professionals and with family members as well (Harasym et al., 2020).

Standards and Principles of Palliative Care

According to Palliative Care Australia (2018), the standard 1 – assessment of patient’s needs, standard 2 – an effective and proper care plan is developed for the patient, standard 3 – needs of the carers and patient’s family are assessed, standard 4 – quality care is delivered to the patient as per his/her care plan, standard 5 – multidisciplinary care services are ensured, standard 6 – family is supported in loss and grief situations, standard 7 –the environment, value, and culture of the services provide patient-centered palliative care, standard 8 - research is conducted to improve service development and provision, and standard 9 - skilled and qualified staff is used for professional medical palliative care of the patient. The principles of palliative care include – the care is the carer, patient and his/her family-centered, care is equitable, care is coordinated and integrated, care is culturally and clinically effective and safe, care is evidence-based, and many others (Gonella et al., 2019). The attitude and principles required for successful palliative care are - good communication with patients and his/her family, choice of the site of care, consent of the patient is very important with shared decision-making, cultural considerations, consideration of individuality, and a caring attitude. Effective communication should seek to:

  • Discern and incorporate the values and preferences of patients and family members, thereby respecting their autonomy
  • Minimize the risk of avoidable harm, thereby respecting non-maleficence
  • Maximize the benefit to patients and families by engaging processes and producing outcomes that are consistent with how they would define “good,” thereby honoring beneficence.

Gonella, S., Campagna, S., Basso, I., De Marinis, M. G., & Di Giulio, P. (2019). Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review. Patient Education and Counseling102(12), 2134-2144. https://doi.org/10.1016/j.pec.2019.06.018

Communication in Palliative Care

The use of effective communication in palliative care is very important as it enables the patient and care provider to develop a strong relationship where the patient will give feedback and care providers will provide patient-centered care meeting patient’s needs person (Gainza-Miranda et al., 2019). The palliative care builds diverse ways to provide excellent care at the end of life, helps gain access to needed health care providers, supports the needs of the family members, looks after the emotional, social, mental and psychological needs of the patients, and respects the goals, likes, and choices of the dying person (Gainza-Miranda et al., 2019). Good communication allows the nurses and other health care provides to understand the wishes, priorities, and needs of the patient, support them in shred decision-making discussions, and connect to the patient. If the communication is not effective then the patient will not give proper feedback, the nurse will not realize the needs or feelings of the patient and if the health care professionals did not communicate among themselves then quality care will not be ensured to the patient who is suffering from a life-threatening disease or is dying with the disease.

Gainza-Miranda, D., Sanz-Peces, E. M., Alonso-Babarro, A., Varela-Cerdeira, M., Prados-Sánchez, C., Vega-Aleman, G., &Polentinos-Castro, E. (2019). Breaking barriers: Prospective study of a cohort of advanced chronic obstructive pulmonary disease patients to describe their survival and end-of-life palliative care requirements. Journal of Palliative Medicine22(3), 290-296.https://doi.org/10.1089/jpm.2018.0363

According to Estacio et al. (2017), palliative care communication included both non-verbal and verbal messages of patients and health care professionals. With the help of effective communication in palliative care, the patient’s counseling sessions will be helpful with improved results, ensures appropriate setting, skillful titration of the information about the patient, improved multidisciplinary care services, and many others. Few core communication principles are maintained while using effective communication in palliative care -eye contact, verbal acknowledgment, sit and listen, asking for more brief and elaborated feedback from the patient, and allow for pause/silence points. The social, cultural, and behavioral aspects of the patient and their family members create barriers in the execution and planning of delivery of care and treatments to the patient (Gradwohl et al., 2019). It is important to meet the general ideology of code value related themes so that the patient can live the rest of their lives happily and meaningfully. Effective communication ensures that the associated different health professionals will make an effective care plan, the patient will express his/her viewpoints, and the environment will be established with a strong relationship between the patients and the health care providers (Gradwohl et al., 2019). Communication in palliative care is very important as it ensures following points: involvement of the patient’s family in shred decision-making, respect for carers, patients and family members of the patient, tailoring the information to individual and family needs, properly explaining and transferring the information from health professionals to patient and their families and vice-versa, and many others.

Principles of Practice in Palliative Care

The principles of communication are – documenting the patient’s progress, encouraging him/her to speak and question, using a realistic approach, acknowledging the patient's concerns, providing clear information to the patient and his/her family (Gradwohl et al., 2019). The use of language and speech therapies can be used in palliative care patients who are facing difficulty in communicating. According to Ferrell et al. (2018), various communication aids are also available for those patients who find it difficult in communicating with others in their palliative care like high-tech electronic aids, image boards with pictures, and many others. For patients who are deaf, there are many ways for communication like reading written information, fingerspelling, lipreading, and others. When the patient is in the last stage of his/her disease, he/she often feels alone, depressed, and distressed. In this case, if the patient is provided with effective communication by his/her family members and health care providers then it can result in a feeling of happiness in the patient. The needs and demands of the patients should be respected and it should be ensured that there is informed consent with the involvement of patients in the discussions of his/her treatment (Etkind&Koffman, 2016). Moreover, the patient’s progress and other tract reports should be documented with proper information transfer to the patient about his/her reports. The carer and families should ensure that they are actively engaged or willingly involved in conversations with the patient. The care providers should never be harsh in replying to the patient, the patient should be explained about the uncertainties, limitations, and other information related to the patient’s palliative care. According to Gonella et al. (2019), in clinical practice other roles of communication are:

Four key roles:

  • Assess and target treatment services for patients
  • Provide education and supportive services to families and caregivers
  • Participate in educational and support activities that assist the palliative care team

Sometimes, few barriers act as roadblocks in palliative care like

Patient factors

  • Emotional overwhelm, language barriers, cultural barriers may create mistrust of physicians; patients may have limited health literacy, over-estimate cure

Physician factors

  • Lack of proper communication skills or training in managing emotions; fear of causing pain or taking away hope

Healthcare factors

  • No incentives for patient-centered communication, multiple transitions of care, multiple subspecialists

Conclusion on Principles of Nursing A Palliative Approach

Palliative care is provided to patients who are dying with serious diseases or disorders. If effective palliative care will be provided to such patients then their feelings and wishes will get fulfilled and they will not feel alone at this stage of their life. Communication is very important in palliative care as it establishes a healthy environment where the patient trusts/respects the nurse and health care professionals’ decisions. The patient’s and his/her family member’s needs and demands should be met and respect and dignity of the patient should be maintained. It should be ensured that with effective communication with patients, associated health professionals and the family members of the patents ensure complete care and shared decision-making. If effective communication is maintained then the patients can freely and comfortably express his/her feelings and give brief feedback. With the use of effective communication, the outcomes of palliative care can be improved and enhanced.

References for Principles of Nursing A Palliative Approach

Estacio, C. F., Butow, P. N., Lovell, M. R., Dong, S. T., & Clayton, J. M. (2017). What is symptom meaning? A framework analysis of communication in palliative care consultations. Patient Education and Counseling100(11), 2088-2094.https://doi.org/10.1016/j.pec.2017.05.006

Etkind, S. N., &Koffman, J. (2016). Approaches to managing uncertainty in people with life-limiting conditions: Role of communication and palliative care. Postgraduate Medical Journal92(1089), 412-417. http://dx.doi.org/10.1136/postgradmedj-2015-133371

Ferrell, B. R., Buller, H., Anderson, W., Paice, J. A., &Donesky, D. (2018). Interdisciplinary palliative care communication for quality palliative care: Outcomes of a statewide train-the-trainer course.BMJ Open. https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.34_suppl.83

Gainza-Miranda, D., Sanz-Peces, E. M., Alonso-Babarro, A., Varela-Cerdeira, M., Prados-Sánchez, C., Vega-Aleman, G., &Polentinos-Castro, E. (2019). Breaking barriers: Prospective study of a cohort of advanced chronic obstructive pulmonary disease patients to describe their survival and end-of-life palliative care requirements. Journal of Palliative Medicine22(3), 290-296.https://doi.org/10.1089/jpm.2018.0363

Gonella, S., Campagna, S., Basso, I., De Marinis, M. G., & Di Giulio, P. (2019). Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review. Patient Education and Counseling102(12), 2134-2144. https://doi.org/10.1016/j.pec.2019.06.018

Gradwohl, K., Wood, G. J., Clepp, R. K., Rivnay, L., &Szmuilowicz, E. (2019). Preventing readmissions through effective partnerships—Communication and palliative care (PREP-CPC): A multisite intervention for encouraging goals of care conversations for hospitalized patients facing serious illness. American Journal of Hospice and Palliative Medicine, 1049909119891996.https://doi.org/10.1177%2F1049909119891996

Harasym, P., Brisbin, S., Afzaal, M., Sinnarajah, A., Venturato, L., Quail, P.,& Holroyd-Leduc, J. (2020). Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: A qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives. BMJ Open10(8), e037466.http://dx.doi.org/10.1136/bmjopen-2020-037466

Martin, A. S. H., Costello, J., & Griffiths, J. (2017). Communication in palliative care: The applicability of the SAGE and THYME model. International Journal of Palliative Nursing23(6), 288-295. https://doi.org/10.12968/ijpn.2017.23.6.288

Palliative care Australia. (2018). National palliative care standards. Retrieved from: https://www.health.qld.gov.au/__data/assets/pdf_file/0032/697046/PCare-National-Standards-2018a.pdf

World Health Organization. (2020). Definition of palliative care. Retrieved from: https://www.who.int/cancer/palliative/definition/en/

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