Principles of Nursing: A Palliative Approach 

Introduction to The Importance of Palliative Care

End of life care is an approach in which the care is provided to the patients suffering from the illness of an incurable health problem and is on the verge of their death or very close to it (Head et al., 2018). The National Palliative Care Standards are 9 in number: standard 1 – assessment of need, standard 2 – developing the care plan, standard 3 - caring for carers, standard 4 – providing care, standard 5 - transition within and between the services, standard 6 – grief support, standard 7 – service culture, standard 8 – quality improvement, standard 9 – staff qualification and pieces of training (International association of hospice and palliative care, 2020). 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.

Principles of Palliative Care

According to Montgomery et al. (2018), palliative care is not just a process but it included complete care of the patient and care the care that is received by his/her family members as well. The principles include: supporting the family members of the patient so that they can cope up, ensuring a support system for the patient so that the patient receives complete care until his/her death, integrate the spiritual psychological and aspects of care, and providing relief from pain and other unexpected symptoms. 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. 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.

Communication in Palliative Care

The demonstration of respect and care for the patients, carers, and his/her family members is the core values/themes of the National Palliative Care Standards. Effective communication with patients and health professionals ensures the delivery of quality palliative care. The patient’s needs should be fulfilled to ensure her/his satisfaction and ambient/private environment in a palliative care result in improved outcomes. The lack of mutual communication and collaboration failed the consultants and the nurses led to a critical situation that resulted in a patient’s death in a more adverse state (Palliative care Australia, 2020). According to Cronin & Finn (2018), the ability to talk to family members and friends about everyday topics and treatments play a major role in improving the situation of the patient. Effective communication with health caregivers or family members or friends about the pain and suffering during the end stage of life makes the patient feel that he/she is not alone. For making the availability of friends or family members to the patient, hospital staffs prepare a room for their stay and manage the visiting hours accordingly. Moreover, the involvement of the patient and his family members in decision making gives insights about the patient’s beliefs, values and needs that in improved treatment of the patient. During palliative care, other factors like creating and maintain an environment of care contribute to enhancing safety or comfort and optimizing the patient’s experience. Culturally, if the patient is from an educated and open-minded background, then she/he will actively get involved in her/his decision-making and family involvement decision-making as well (Smith et al., 2018).

Faulkner, A. (2018). ABC of palliative care: Communication with patients, families, and other professionals. The BMJ, 316. https://doi.org/10.1136/bmj.316.7125.130

This results in effective feedback and a strong relationship between the patient-nurses but if the nurses do not take advantage of such points then the health of the patient might not improve at a good pace. The RN should always meet the needs and demands of the patient. The patient’s feedback through effective and brief communication should always be taken under serious consideration ensuring that safe and quality palliative care is provided. The health professionals should have strong communication among associated care providers about the details of the patient’s progress/deterioration of health so that an effective plan can be made and implemented as soon as possible.

According toFerrell et al. (2019), there is a need to build effective end of life care or palliative care is felt in such a world where most of the population at least once get hospitalized in their old ages with health issues, like diabetes, cancer, and many others. Sometimes the lack of experience in delivering the care impacts the effectiveness of end of life care. 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. 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.

Principles of Communication in Palliative Care

According to Frey et al. (2019), few principles of palliative care communication, from a relational communication perspective:

  • Involvement of health care multidisciplinary team
  • Involvement of the family of the patient id decision-making
  • Effective communication within health staff and with the patient(clinical narrative practice)

As per the relationship-centered care model, the main focus is on the relationships that are enacted across all healthcare providers.

  • The mixture of task-related interactions and social interactions (to enjoy and have fun, but be productive)
  • Variety of mental models ( managing with the diversity within the context of care)
  • Use of effective communication (being open to new ideas, relationships awareness, awareness of self, and others.)
  • Maintaining and ensuring the respect of health care professionals and patients with his/her family members.

Moreover, ethical communication is a form of care, subject to ethical norms:

  • Respect for personhood
  • Minimize harm
  • Maximize benefit

Frey, R., Balmer, D., Boyd, M., Robinson, J., & Gott, M. (2019). Palliative care nurse specialists’ reflections on a palliative care educational intervention in long-term care: An inductive content analysis. BMC Palliative Care18(1), 103. https://doi.org/10.1186/s12904-019-0488-4

According to Faulkner (2018), communication in nursing has the following points to consider:

  • Participates in patient assessment and collaborative care planning with the team
    • Nurses rated by the public as the most trusted healthcare team member
  • Uses symptom assessment instruments to evaluate pain, take pain history.
  • Uses verbal or symbolic means appropriate for patients to assess coping.
  • Facilitates communication within the circle of care
  • Patient, family, healthcare team, other providers
  • Assessment and attention to spiritual issues and concerns for patient and family
  • Elicits cultural identification, strengths, concerns, needs
  • Determines cultural background as a source of resilience and strength for patients and families.

Using communication as a palliative care includes many other factors like:

Diagnosis

  • Tailoring the information to individual and family needs
  • Addressing Psychosocial concerns

Plan of Care

  • Organizing and interpreting patient and family data

Advance Care Planning

  • Supporting patient autonomy, self-determination
  • Include caregivers

Pain and Symptom Management

  • Educating patient and family about medication, side effects
  • Teaching complementary and alternative techniques

Practical support

  • Discussing home care needs, insurance, financial needs

Assess patient distress

  • Providing supportive counseling
  • Reinforcing strengths and coping mechanisms

Conclusion on The Importance of Palliative Care

At the end of life care or palliative care, it should be ensured that the care services that are provided to the patient are effective, safe, and ensure quality care. 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 shred decision-making. If effective communication is maintained then the patients can freely and comfortably express his/her feelings and give brief feedback. The use of communication among health professionals also ensures that an effective plan is prepared and implemented for the quality of palliative care services to the patients. Thus, communication is palliative care is very important as it ensures that the patient does not feel alone, safe and quality care is delivered to him/her and his/her right and values are respected.

References for The Importance of Palliative Care

Cronin, J. A., & Finn, S. (2017). Implementing and evaluating the COMFORT Communication in palliative care curriculum for oncology nurses. Journal of Hospice & Palliative Nursing19(2), 140-146. https://doi.org/10.1097/NJH.0000000000000320

Faulkner, A. (2018). ABC of palliative care: Communication with patients, families, and other professionals. The BMJ, 316. https://doi.org/10.1136/bmj.316.7125.130

Ferrell, B., Buller, H., Paice, J., Anderson, W., & Donesky, D. (2019). End-of-life nursing and education consortium communication curriculum for interdisciplinary palliative care teams. Journal of Palliative Medicine22(9), 1082-1091. https://doi.org/10.1089/jpm.2018.0645 

Frey, R., Balmer, D., Boyd, M., Robinson, J., & Gott, M. (2019). Palliative care nurse specialists’ reflections on a palliative care educational intervention in long-term care: An inductive content analysis. BMC Palliative Care18(1), 103. https://doi.org/10.1186/s12904-019-0488-4

Head, B. A., Song, M. K., Wiencek, C., Nevidjon, B., Fraser, D., & Mazanec, P. (2018). Palliative nursing summit: Nurses leading change and transforming care the nurse’s role in communication and advance care planning. Journal of Hospice & Palliative Nursing20(1), 23-29. https://doi.org/10.1097/NJH.0000000000000406

International association of hospice and palliative care. (2020). 6 principles of palliative care. Retrieved from: https://hospicecare.com/what-we-do/publications/getting-started/6-principles-of-palliative-care

Montgomery, K. E., Sawin, K. J., & Hendricks-Ferguson, V. (2017). Communication during palliative care and end of life: Perceptions of experienced pediatric oncology nurses. Cancer Nursing40(2), E47-E57. https://doi.org/10.1097/NCC.0000000000000363 

Palliative care Australia. (2020). National palliative care standards. Retrieved from: https://palliativecare.org.au/standards

Smith, M. B., Macieira, T. G., Bumbach, M. D., Garbutt, S. J., Citty, S. W., Stephen, A., & Keenan, G. (2018). The use of simulation to teach nursing students and clinicians palliative care and end-of-life communication: A systematic review. Journal of Hospice and Palliative Medicine35(8), 1140-1154. https://doi.org/10.1177%2F1049909118761386

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